Physical diagnosis : a guide to methods of clinical investigation / by G.A. Gibson and William Russell.

Date:
1893
Catalogue details

Licence: Public Domain Mark

Credit: Physical diagnosis : a guide to methods of clinical investigation / by G.A. Gibson and William Russell. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

    55/458 (page 31)
    the surface of the body, at other times arranged in circles or ellipses. These tubercles, as a rule, terminate without ulceration by subcutaneous absorption, and leave small depressed cicatrices behind. Lupus begins with the appearance of small, rounded, dull- red swellings, arranged in a patch, which enlarges by the formation of additional tubercles. These tubercles may terminate in spontaneous cicatrisation, in superficial suppura- tion, or in deep ulceration. Leprosy occurs in two forms, the tuberculated and non- tuberculated or anaesthetic. Tubercular leprosy begins by an elevated spot of ruddy tint, more darkly coloured in the centre and abruptly marked off from the surrounding skin. This fades, and is succeeded by the development of tubercles, either in the afi'ected spot or in the previously healthy skin. During the presence of the coloured eruption the areas involved are distinctly hypersesthetic, and when the tubercles appear the affected regions are as markedly anaesthetic. The tubercular eruption has a great tendency to ulcerate, and during this change there is a foul smell. Tubercular leprosy is most common on the face, mammae, genitals, and extremities. Anaesthetic leprosy makes itself known by localised attacks of pain and tenderness, especially confined to the arm and leg, and particularly along the course of the ulnar nerve, caused by a deposit of new tissue involving the nerves. After this has for some time been present, pigmented or blanched spots appear, especially on the back, shoulders, arms, nates, and thighs, attended by anaesthesia, but without any tendency to spontaneous ulceration. As the sensibility, however, is greatly impaired, bruises, cuts, and burns are frequently met with, and the wounds take on an unhealthy action, ending in ulceration and gangrene. Epithelioma assumes the most varied forms, but ulcera- tion is the most characteristic appearance which it presents. It usually begins as a small tubercle, with spreading indura- tion and subsequent ulceration, but there may be simply an