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.

  • Keen, William W. (William Williams), 1837-1932.
Date:
1899
Catalogue details

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.

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    2. The region occupied by a chancre may cause errors or difficulties in diagnosis. (rt) In the cephalic region chancres of the //'///•// acalp^ of the supi-aoriutal prominences, and of the chin and cheeks are the most deceptive. They always assume an ecthyniatous form, and are so concealetl by the hair that it is impossible to judge of the character of their surface. In all such cases the hair must be carefully shaved, and if we then find that we are dealing Avith an ulceration lacking the ordinary characteristics of ecthyma, and glazed, flat, or even elevated, our suspicious should be aroused, and after eight or ten days will usually be confirmed, if the sore is syphilitic, by the development of induration and of neighboring lymphatic enlargement. Razor-cuts on the chin, cheeks, or lips which, after having healed, reopen and become covei'ed with a crust, should on a p)riori grounds be suspected. This is equally true of pseudo-furuncles, acneiform pustules, cracks around the circumference of the nostrils, etc., which persist without giving rise to pain, and become bloody, encrusted, and surrounded by an area of subinflammatory, oedematous swelling. We should then carefully examine the preauricular, parotidean, and submaxillary lymphatic glands. A stiie which behaves in an unaccustomed manner or is accompanied by hyperplasia of the lid, or a conjunctivitis which becomes localized and causes an isolated swelling, should be attentively watched. In the neighborhood of the mouth errors of diagnosis should be less frequent than in other portions of the cephalic region, because it has been shown so often that the lips, tongue, and fauces are frequently brought into contact with syphilitic discharges and constitute one of the principal channels of infection. Here, however, as elsewhere, the chancre assumes at the very outset the appearance of ordinary lesions. Thus, upon the lips the chap, crack, or fissure often found in the median line, the little aphthous erosions, herpetic ulcerations, and cigar or cigarette burns, simulate very closely the characters of the initial lesion, and, as the latter will almost invariably be attributed by patients to some such ordinary cause, ma}'' give rise to serious error. At the end of the first week, however, the specific characters of labial chancre are usually so distinct as to render diagnosis easy. In several instances these chancres have been mistaken for epithelioma, and have been excised. The diagnostic differences may be indicated as follows: Labial Chancre. Epithelioma. No marked difference between the sexes. Twenty times more common in males than in females. The ulcer may involve either lip. Almost invariably situated upon the lower lip. Occurs at any a^i^e. Rarely occurs before middle life. Patient often strong and robust. Patient usually in impaired health. Is insensitive. Often sharp, burnin<r, lancinatinfr pains. Regular in outline, smooth surface, elevated. Irre^rular in outline, ragged, tilled with fungous granulations, bleeding easily. Indurated and sharply circumscribed base. Induration less cartilaginous, unequal, not clearly circumscribed, and more extensive. Evolution of sore usually occupies a few Sore may lie months in developing after its weeks at the most. first appearance. Glandular involvement follows closely on Glands are not implicated for three or four appearance of sore. months, often not until later. No marked odor from secretion of sore. Odor often extremely offensive. History of exposure to syphilitic inoculation Frequently no such history. often obtainable. Heals rapidly or disappears under mercurial Not affected or rendered worse by such treatment. treatment.