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.
![certain cutaneous eruptions, tlie most common of wliicli at this early date is the hirfre vesicuhn- or bullous eru])tion known as s_v])hilitic pemphi^nis. J'l'/iiphii/ioi.—With regard to the specific or non-specific character of tliis eruption tiiere has been much difterence of o))inion, and, as it is often the earliest distinctive expression of syphilis, a diajmosis of which could liardly be founded on the general appearance of the child, or even on the hoarse cry and the coryza, it becomes important to have definite ideas upon the subject. Nearly a century ago it was denied that this eruption was a manifestation of venereal disease; and this view has found sup])orters down to the present day. The progress of clinical and ])athological knowledge enables us now to assert, however, that although, as an exception, bulhc may sometimes be due to a profound cachexia not dependent on syphilis, yet in the large majority of cases they are specific in their character. If we find an infiint at or immediately after birth presenting on the soles, the palms, the fingers and toes, or on the limbs an eruption consisting of blebs more or less perfectly distended with a licjuid which may be clear, cloudy, or bloody, circular or oval in shape, sometimes irregular, seated on inflamed, red- dish skin, and surrounded by trifling areolae, we may strongly suspect the presence of syphilis in an active and most menacing form. And this suspicion becomes a certainty if, in combination with such an eruption, the general cutaneous surface is yellowish or muddy in hue, is hard and dry, without elasticity or softness—owing to the al)sence of subcutaneous fat—and, for the same reason, is furroAved and wrinkled about the face, imparting an appearance of senility; if the child has a hoarse cry, and a discharge from the nostrils; and, of course, if there are at the same time other syphilodermata. This eruption is specially important, however, because upon the recognition of its specific character in cases of stillbirth or in those in which the child survives onlv a few days—not long enough for the development of further symptoms— will depend the opinion as to the cause of death, which, whether expressed or not, will determine the future treatment of both parents during the interval between pregnancies and of the mother during the next pregnancy. Goryza is one of the most characteristic, and at the same time one of the most important, of the early symptoms of syphilis in its influence on the health of the child. It is due to the same condition of the mucous mem])rane lining the nasal fossae which manifests itself simultaneoush^ or soon afterward on the skin in the shape of erythema, roseola, or papules; in other words, it is a hyperemia with papillary infiltration. The excessive supply of blood to the parts induces a catarrhal condition which shows itself in a thin, watery dis- charge. As the child during suckling is compelled to breathe through the nose, this discharge is rapidly dried into crusts, causing the peculiar nasal, noisy respiration which has given the affection the popular name of nniifiieH. Roseola is apt to present itself about the second or third week after birth. As in the adult, it begins upon the abdomen in the form of little oval, circular, or irregular spots, dull red in color and disappearing upon pressure. Later the color becomes deeper, the eruption extends to the trunk and limbs, and, as exudation and cell-proliferation succeed to simple capillary stasis, it ceases to disappear when pressed upon. It is often moist, and sometimes excoriated, owing to the thinness of the epidermis. Occasionally it is confluent, and covers large areas with an almost unbroken sheet of deep-red color. The diagnosis in the early stage is often difficult on account of the resem- blance to the simple erythema of infancy. As the disease progresses, hoAvever, maculfe form here and there; the cell-infiltration involves the papillae, several of which coalesce, forming flat papules; the nutrition of the superficial layers](https://iiif.wellcomecollection.org/image/b21217014_0218.jp2/full/800%2C/0/default.jpg)
