A treatise on the diseases of the eye / By J. Soelberg Wells... Together with selections from the test-types of Prof. E. Jaeger and Prof. H. Snellen.

  • Wells, J. Soelberg (John Soelberg), -1879
Date:
1883
Catalogue details

Licence: Public Domain Mark

Credit: A treatise on the diseases of the eye / By J. Soelberg Wells... Together with selections from the test-types of Prof. E. Jaeger and Prof. H. Snellen. Source: Wellcome Collection.

Provider: This material has been provided by the Harvey Cushing/John Hay Whitney Medical Library at Yale University, through the Medical Heritage Library. The original may be consulted at the Harvey Cushing/John Hay Whitney Medical Library at Yale University.

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    The syphilitic character of the ulceration must, however, be suspected, if it proves very obstinate, and instead of yielding to the usual remedies, gets worse and spreads more and more. We must then carefully and searchiugly inquire into the history of the case, and ascertain whether any other symp- toms of syphilis are present, such as eruptions of the skin, ulceration of the throat, etc., or whether there has been any chance of direct contagion; for, although these ulcers are almost always secondary, a primary hard chancre of the lid may be met with. [The chancre may occur on the edge of the lid, and the induration extends upward some distance upon the tarsus. It is usually very slow in its course, and resists treatment obstinately. The in- duration occurs very rapidly in the margin of the lid. Both macroscopically and microscopically the chancre bears a close resemblance to the gummy in- filtration which has undergone ulceration.—B.] The softer variety appears, however, to be of rare occurrence. The ulceration may also extend to the eyelids from the neighboring parts, such as the nose, etc. [The condition of the glands nearest the lesion should always be ascertained. It may happen that induration of the sore is absent or but slightly marked, but it very rarely, if ever, happens that glandular induration and induration of the ulcer are both absent. Out of sixteen hundred and forty-six cases of in- durated chancre tabulated by Sturgis,^ the lesion Avas situated on the eyelid in but six.—H.] [The gumma of the lid may be circumscribed or diffuse. The former appears as a nodule near the ciliary margin. The latter may involve the whole lid, and is then known as Tai'sitis syphilitica. The cir- cumscribed gumma when isolated is a tubercular syphilide; it may be acute or chronic. Chronic infiltration of the entire lid is rare, though a number of cases have been recently reported. In these cases the skin is not involved. The isolated gumma sometimes follows hard after the initial sclerosis, though it is usually regarded as a late symptom. (See a paper on Syphilis of the Eyelids, in the N. Y. Med. Journ., March, 1878, and one on Tarsitis Syphilitica, in Trans. Amer. Ophth. Soc, 1878, by the Editor.—B.] The treatment must consist in bringing the patient as rapidily as possible under the influence of mercury, either by inunction, or mercurial baths; and the system should be kept slightly under its action for some time, otherwise a relapse may occur, or the ulcer return. The latter should be freely touched with caustic, and when it is beginning to heal, the red precipitate ointment, or the black wash should be applied, in order to accelerate the cicatrization. If the ulceration prove very obstinate, and resists the action of mercury, much advantage is often experienced from a course of Zittmann's decoction, as this is accompanied by a very free action of the skin. If this be inapplicable, warm baths should be prescribed for the same purpose. In infants, the existence of congenital syphilis generally manifests itself by the appearance of papular or pustular eruptions on the face, hands, and around the anus. The eyelids are inflamed and swollen, there is a purulent discharge, and, in very weak and feeble children, there is nuich danger of sloughing of the cornea and loss of the eye. Small doses of calomel and opium should be administered, and an astringent collyrium, or the red pre- cipitate ointment should be applied. I have already mentioned, when treating of the exanthematous affections of the conjunctiva, that the eyelids are also very prone to suffering during the exanthemata, more especially in smallpox. [This is also the case iu scarlet fever and measles, though to a less degree. Among the non-con- tagious skin diseases, lichen and pemphigus are met with not infrequently [1 Amer. Journ. Med. Sci., Jan. 1873, p. 105.]
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