Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects.

Mansell-Moullin, C. W. (Charles William), 1851-1940

Date:: 1893

Credit: Surgery, a practical treatise with special reference to treatment / by C.W. Mansell Moullin ; assisted by various writers on special subjects. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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$described by Hutchinson, is characteristic; it very rarely, if ever, occurs under any other circumstances, and it is caused by and is i)roi)ortionate to the stomatitis of infancy. If this is severe at the time the dental papillae are developing, they are so much reduced in size and so alteretl in shape that it is almost im[jossible to recognize them as teeth at all. Mercurial teeth, in which the enamel is defective transversely and marked by horizontal darkened grooves and pits, are totally different, but it is not uncommon to find the two associated. In excep- tional cases, in which the stomatitis has been late or prolonged, a similar change is visible in the lateral ones as well ; but it is only the median of the upper jaw that are definite and characteristic. At puberty there is often a fresh outbreak, some of tlie lesions being distinct- ive, others resembling those of the tertiary period. Of the former the most important are interstitial keratitis ^x\<X ostitis. A sym- metrical form of deafness, quite incurable, is also met with, but more rarely. The keratitis always attacks both eyes, although one is usually in advance of the other, lasts a variable number of months, and then clears up again, leaving, unless it has been very severe, little permanent defect. The ostitis is more intractable. It always attacks the shafts of the tibiae, one or both, although it may appear in other bones as well. The shin grows out first and becomes tender ; the leg seems to bow forward ; then the whole shaft enlarges, and in a few months, or two or three years, the bone stands out, misshapen, massive, enormously thickened, and often increased in length. .In the milder cases the exudation is diffiise and becomes organized; in the more severe ones gummata are present as well, especially on the periosteal surface, and cause superficial sequestrse, w^hich separate with the most extreme slowness. Possibly this is due to the sclerosis, which may also account for the fact that iodide of potash is almost without influence; it relieves the pain for the moment and causes the gummata to diminish in size, but it does little or nothing more. In the worst of all the inflammation spreads to the ends of the bones, synovitis sets in, and at length, after lasting many years, with constant attacks of pain, the limb is reduced to a condition resembling an old, gnarled tree-trunk, covered all over with cicatrices. In the tibios this condition is very common and is absolutely distinctive ; in other bones it is more rare, peri- osteal and myelitic gummata, resembHng those of acquired syphilis, occurring instead. Very often the effect is rendered still more striking by the peculiar undeveloped condition of the skeleton. Congenital syphilis in this respect closely resembles rickets; not only do the bones of the extremities and face fail to grow, but they do not undergo the proportionate development of adult life; the type remains that of the child. There is no lesion in acquired syphilis that is not also met with sometimes in the hereditary form. The skull may be almost destroyed by necrosis ; iritis, choroiditis, and optic neuritis may occur; ulceration of the soft palate and per- foration of the hard one, with necrosis of the septum and turbinate bones, are not infrequent, causing the most fearful ozsena. Gummata—visceral, subcutaneous, and muscular—are of common occurrence. Skin diseases, however, with the exception of a rapidly-spreading form of lupus, are rare, and the same may be said of degenerative lesions of the nervous system. I have met with ophthalmo- plegia (complete) in a girl sixteen years of age, in whom the only evidence of disease, past or present, was the presence of a few cicatrices at the angles of the mouth; but probably many of the cases of epilepsy, idiocy, and other diseases of the nervous system are merely coincidences ; at least, there is no direct evi- dence to connect them with the hereditary taint. Treatment.—Excision. There is some evidence in favor of the view that early excision can prevent the further development of the disease; but it must be done within forty-eight hours, or three days at the utmost, and cases in which this is possible are altogether exceptional. By the time the chancre has developed it is certainly too late, and in this respect the analogy with such diseases as malig- nant inistule fails com])letely.$