Precocious gummata / by R.W. Taylor.

  • Taylor, Robert W. (Robert William), 1842-1908.
Date:
1887
Catalogue details

Licence: Public Domain Mark

Credit: Precocious gummata / by R.W. Taylor. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    tistics show that the greater number of my patients were between twenty and thirty-five and after fifty years. My opinion is in accord with most syphilographers that syphilis in persons beyond fifty years of age is fre- quently severe; that its lesions are often precocious, grave, and extensive; and that the diathesis has a tendency to modify, to engraft itself upon and often to intensify previous morbid processes or affections, local or general. I have repeatedly seen instances of this malignant action, and I have very frequently seen the form of precocious syphilide now under consideration in old subjects. Malaria very frequently acts as a formidable complication of syphilis, and some of the most rebellions cases that I have treated were in per- sons whose systems, prior to syphilitic infection, had been debilitated by its virus. In such cases I think that we more frequently see precocious cerebral and nervous symptoms, and not infrequently early hepatic disturbances, of greater or less severity. In these cases of mixed diatheses, however, the syphilides often run an active and severe course, and precocious gummata not infrequently attack them. The clinical history of this form of precocious syphilide then is as follows: As early as the eighth week of infection, rarely earlier, the patient notices either small circumscribed swellings under the skin, generally unattended with pain and only perceptible to the touch, or this stage of the eruption may escape him and his attention is at first arrested by a number of bright red spots. Quite frequently the patient comes with the statement that blind boils are breaking out all over him. Examined early in their history these gummata are found to be round tumors of the size of a bean, deeply set in the skin, having a bright red color which, at the first, is dissipated by pressure, but becoming deeper, more sombre and permanent in color later on. They increase periphe- rally quite rapidly, so that within a week or ten days they may attain an area of an inch, or an inch and a half. Then again their growth may be slower. In general a goodly number of tumors appear scattered symmetrically over the whole body. As they grow they are followed by new ones which come along with greater or less rapidity, in propor- tion as internal medication is pushed. If a correct diagnosis is at once made and appropriate treatment instituted, the first crop may be the only one and that may be promptly dissipated. Unaffected by medi- cine, their evolution continues and in a fortnight the arms, forearms, perhaps the scapular region, not infrequently, but not as a rule, the back and anterior surface of the trunk, the gluteal regions, thighs, and legs are invaded by these tumors. The course of these gummata is, in general, quite regular and not subject to great variation. When developed they present a quite firm sensation and this may be termed the period of condensation. As they grow older the red color becomes rather coppery, and while the periphery