Clinical lecture on syphilitic gummata : delivered at the Hospital de Lourcine / by M. A. Fournier ; translated from the French by Francis Cadell.

  • Fournier, Alfred, 1832-1914.
Date:
1875
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lecture on syphilitic gummata : delivered at the Hospital de Lourcine / by M. A. Fournier ; translated from the French by Francis Cadell. Source: Wellcome Collection.

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

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    gummata. The pathological plienomena arc, to sum up,—1st, Progressive softening of the tumour from the centre to tlie periph- ery, with no elevation of temperature, pain, or inflammatory phenomena. 2cl, More slowly, peripheral inflammatory phen- omena, resulting in ulceration of the integuments on the surface of the tumour, and producing an outlet. 3d Period.—Stage of Ulceration. This is the most important of all the stages which constitute the gumma; and it is of these among the least well known. At first, after tlie tumour opens, the discharge of fluid is very trifling. Often only a few drops appear, and ooze out rather than flow; sometimes no more than a small spoonful of fluid is evacuated. After opening, the tumour remains much the same size as it was before, on account of the small quantity of matter that lias come from it. The nature of the evacuated fluid is, more rarely than is generally supposed, of a viscid, gelatinous, syrupy, transparent or semi-transparent gum- like character. Much more frequently it is a sero-sanious, yellow- ish fluid, pyoide rather than purulent, containing in suspension organic detritus and grumous debris of cellular tissue, fatty granules, oil and blood globules, and leucocytes. Yet again, but more rarely, it is a distinctly purulent fluid, yellowish-green, or still oftener a reddish, unhealthy pus. The gumma once opened, its aperture tends to enlarge. The small opening on its summit enlarges more and more by ulceration of the surround- ing skin, until after some days it has the diameter of a lentil, a twenty-centime piece, or greater still. This circular oriflce occu- pies the most central and prominent position. On examining the interior of the cavity, a solid, whitish, fleshy substance presents itself, resembling the flesh of a cod. This substance has the appearance of dead tissue, is without feeling, becomes disintegrated, and fibrilliform ] portions of the size of a filament of vermicelli be- come spontaneously separated from the mass. This substance is the actual tissue ot the tumour, having passed, or passing into the condition of a slough. The largest portion of the tumour is made up of this solid mass, and it is for this reason that the evacuation of fluid is so small, and the diminution in size of the tumour so slight. The progressive elimination of the heart of the gumma proceeds thus:—From day to day, portions of greater or less size are de- tached from the mass by suppuration ; and after the total evacuation of the core, all that is seen is the loss of substance sustained by the healthy tissue. This loss of substance, more or less deep, consti- tutes a real cavity dug out of the liealthy tissues, and lias received tlie name of a caverne gommeuse. Then by progressive ulceration of the edges of this cavity an ulcer soon forms of variable dimen- tious, according to the original size of the gumma. The ulcer is characterized by being excavated; its borders are sometimes sharply defined and cut out, or prominent, and raised by