An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White.
- William Williams Keen
- Date:
- 1899
Licence: Public Domain Mark
Credit: An American text-book of surgery : for practitioners and students / By Phineas S. Conner, M.D., Frederic S. Dennis, M.D., William W. Keen, M.D., Charles B. Nancrede, M.D., Roswell Park, M.D., Lewis S. Pilcher, M.D., Nicholas Senn, M.D., Francis J. Shepherd, M.D., Lewis A. Stimson, M.D., J. Collins Warren, M.D., and J. William White, M.D. Ed. by William W. Keen and J. William White. 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.
![vulva arc almost constant; with men, on the contrary, they are not very freciuently met with on the prepuce or glans, the most common seats being the scrotum and anus. With women the anus is also frequently the seat of mucous ])atches. The /ifstologieal structure of nmcous patches consists in a thickening of the epidermic layers and an increase in the size of the papillae of the skin by a development of the elements entering into their structure. This increase in size of the papilhx; causes a corresponding increase in the lengtli of the inter- papillary prolongations of cells of the rete mucosum. The blood-vessels of the papilljie are distended with l)lood. The tissue of the derm is found jirolifer- ating. Diagnosis of Mucous Patches.—It is almost impossible to mistake a mucous patch after a number have been seen. They are formed upon a papule—that is, an inflammatory swelling of the corium and papillae ; their surface is oozing, and the epidermis or epithelium Avhich covers them is satu- rated or desquamated. Thus, u])on the labia majora and minora there are seen whitish patches or small points which resemble moist or pulpy paper, and consist of epidermic cells or changed superficial epithelium; upon a mucous membrane, as on the lips or palate, the epithelium is whitish, opaline, resem- bling a surface which has been touched with nitrate of silver. The mucous patch, if eroded, has a surface Avhich is red and smooth after the superficial epithelium has desquamated; the shape of the patch is always circular or regularly oval, and the derm is thickened upon its surface. The patches of the vulva and k.bia majora, likewise of the anus and of the scrotum and scroto- femoral folds, even when in process of healing are very distinct; as the epider- mis forms, the derm remains a little papular and the surface dull red. The syphilitic papules, covered with thick superficial layers of corneous epidermis—that is, with scales—are termed papuio-squamous syphilides. They are generally very obstinate, since the layers of the epidermis repose upon the thickened and chronically inflamed derm. These squamous papules, covered with or deprived of their epidermic layers, when situated upon the palms of the hands and soles of the feet, are called palmar or plantar sypliilides. The papules are modified simply on account of their seat and the structure of the skin of the hands and feet. Here the corneous epidermis attains considerable thickness and resistance; it forms a layer which at times measures a millimeter in thickness and is dense and hard like parchment. Thus it offers more or less resistance to the development of the papules, especially at their beginning. Later, however, the epidermis covering the papule is raised, cracked, and partly or completely eliminated, or it forms hard and irregular stratifications. With syphilitic papules, and at the same time with secondary syphilides, there occurs a lesion allied to the lesions of the epidermis—viz. the changes of the nails. Syphilitic Onychia is a disease of the nails, the peculiarities of which result from the anatomical structure of the matrix of the nail and of the peri- and subungual papillo-epidermic tissue. There are described two varieties— the dry and the moist. The drt/ variety of onychia generally accompanies the papular and papulo- squamous eruptions situated upon the fingers and toes, the ends of which are attacked by papules, which pass around their extremities or may be seated at the roots and edges of the nails or under them. Sometimes the nail is cracked and readily broken ; it is dry and separated from the skin. Sometimes, when the papules exist at the ungual matrix, there is a swelling of the skin at this region,](https://iiif.wellcomecollection.org/image/b21217014_0196.jp2/full/800%2C/0/default.jpg)
