Syphilis and local contagious disorders / by Berkeley Hill.

  • Hill, Berkeley, 1834-1892.
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Syphilis and local contagious disorders / by Berkeley Hill. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    indurates into hard contractile masses of reddish-grey colour and uneven surface. At times, before ulcerating, they produce flattened firm elevations which are divided from each other by deep furrows. These elevations may form round the anus, without implicating the perinseum and vulva (for this is particularly a disease of the female sex). More frequently, however, they are results of extension of the process which had begun at the fourchette and lower part of the vagina. In such cases, the hardened ridges often break down into obstinate sinuous ulcers which are slow to heal and often excite con- siderable suppuration of the vulvo-vaginal mucous membrane, besides abscess or fistula in the perinseum or buttock, or between the vagina and rectum. Of long continuance, this lesion causes considerable deformity, and when cicatrisation has taken place, the hard unyielding scars break down again on the smallest irritation. Strictures of the Rectum may be divided into those caused by cicatricial shrinkage and those due to infiltrating sclerosis. Cicatricial stricture from syphilis is verj^ rare, and is the result of contraction of the scars of tertiary ulceration. By these scars, a band or even a ring or valve of fibrous tissue implicating no great extent of the anus, or of the rectum contiguous to the anus, is produced. There is no authentic record of a primary syphilitic sore causing stricture; but local chancres attended by phagedsena may do so. Erskine Mason ^ states that stricture of the rectum was thus produced in five cases under his own observation. Consider- ing the phaged£enic character of these sores, it may be questioned whether they were not, in some cases at least, really tertiary syphilitic ulcers. There is no sufficient evidence that mucous patches or tubercles ever give rise to stricture. Stricture from infiltrating sclerosis is the more frequent form of rectal stenosis. The seat of the stricture is always within reach of the finger, being usually just above the internal sphincter; and, where the anus is not involved, is to be felt from an inch to two inches above the orifice. The form of the stricture is always cylindrical, and extends up the rectal walls for two or at most three inches, where it ends in a defined border usuall}^ somewhat festooned or sca,llopped. The degree of contraction varies; the little finger will sometimes pass through it, though it may not admit anj^thing larger than a No. 12 urethral bougie. Above the stricture the bowel is not simply dilated, but its mucous tissue is eroded or ulcerated. The ulceration involves a considerable surface, and may extend for some distance into the sigmoid flexure, as in a case described b}'- Paget,^ where indeed tertiary scattered ulceration ^ Erskine Mason : Amer. Joura. of the Medical Sciences. . 187-3, January, p. 22. ^ Paget: Medical Times and Gazette. March, 1865.