Surgery : its theory and practice / by William Johnson Walsham.

  • William Walsham
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Surgery : its theory and practice / by William Johnson Walsham. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    he exuded, and raise the cuticle in the form of small vesicles, or even of large blebs, conditions which are spoken of as vesicular sj'philides or eczema, and bullous syphilides or pempliigus respectively. Both, however, are rare, and the latter seldom occui'S, except in congenital sjq^hilis. Again, in situations Avhere the parts are moist, as about the mouth, anus, and scrotal folds, the papilke become succulent and the epithelium sodden, formmg condylomata and mucous tubercles. Where such occiu' between the toes, ulceration may ensue {rhagades) ;^ but this condition is not common, except as the result of tm- cleanliness. Condylomata appear as low, soft, flattened, sessile elevations of a whitish colom-, with a smooth surface, covered bv a moist secretion, and often of con- siderable size. They are intensely contagious, and when occurring where two skin surfaces are in contact, as about the anus and labia, are usually sj-mmetrically placed on either side. Still later, especially where the patient is debilitated, the vesicles may be converted into pustules {jmstular syphilide) by the escape into them of wandering leucocj-tes ; while the pustides again may dry into scabs, which fall off, leaving no scar beneath ;- Ittic ecthyma); or if the patient is cachectic, or his consti- tution broken down, ulceration may ensue beneath the scabs (ru2na). The appearance presented by rupia is peculiar. As the ulceration proceeds m depth and extent, larger and larger scabs are successively formed beneath those above, which are thus pushed forward, giving the mass the appearance of a limpet-sliell. Lach rupial spot is surrounded by a dusky-red areola, and on the separation of the scab, a foul circular ulcer is left, which, on heal- ing, leaves a permanent scar. Eupia by some is regarded as an early tertiary, rather than as a late secondary, atfoction. With the exception of rupia. the secondary eruptions resemble those duo to non-syphilitic causes. They are, howin-er, all mo.lified m sy]duhs by their coppery or raw-ham c.dour, by more or less pigmentation, bv their s^oninetrical arrangement, bv the circular or crcscoutic shape of the patches, by the absence of itching, bv the absence of the large sUvery scales scon in orcbnaiy psoriasis, by their predilection for certain situations-?.e. the chest ai'id abdomen, between the shouldei-s the back of the neck, the forehead, about the ^'^o^s of the hair, the palms and soles and the ilexor aspect of thelnnbs, and lastly by their polj-morphism-7.f., their nuxcdcharacter,
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