Cases illustrating two rare diseases of the eyelids ; Syphilitic gummata of the conjunctiva / by Charles Stedman Bull.

  • Bull, Charles Stedman, 1844-1912.
Date:
1878
Catalogue details

Licence: Public Domain Mark

Credit: Cases illustrating two rare diseases of the eyelids ; Syphilitic gummata of the conjunctiva / by Charles Stedman Bull. 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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    lowed, whether solids or liquids, he felt a severe pain in the ej?es, and this was immediately followed by marked blepharospasm. Nothing particular about the man’s general appearance, except a dull yellow complexion and a look of hopeless wretchedness. An ex- amination of the abdomen and back showed the marks of an extensive old eruption, consisting of small white cicatrices, with deep brown pigmented margins, which have existed for twenty years. Upon the hands and face there was a peculiar eruption, composed of elevated spots with flat tops, some round, others oval, yellowish red in color, with a narrow dark red areola. They were neither painful nor ten- der to the touch, and presented a mid state between vesiculation and pustulation. On opening these a thin, watery pus mixed with blood could be pressed out. These vesicles or pustules were scarcely large enough to be called bulks, and yet there was conveyed to the mind a general idea of pemphigus. One of the largest pustules was on the left upper lid, and there were two smaller ones along the cil- iary margin. There were several on the face, and the remains of a large one on the bridge and right side of the nose. On the hands the eruption was almost entirely on the dorsal surface, and was grouped around the knuckles and between the fingers. Some vesi- cles on being opened gave exit only to blood. The eyes were almost identical in appearance. Surrounding the cornete there was a growth, most marked on the outer and lower sides, varying in height from one and a half to two lines, seated in and beneath the ocular conjunctiva. This growth extended away from the cornea on all sides about one-third of an inch, was pale yellow in color, moderately hard to the touch, with an irregular, knobby surface, and apparently destitute of vessels. The conjunc- tiva was firmly adherent to this growth, and the cornea was embedded in this wall like a watch-crystal in its frame. On being incised it cut like brawn, and the hemorrhage was very slight. Upon the sclera of each eye, between the tendons of the superior rectus and external rectus muscles, and partially covering the latter, was an extensive and extremely well-marked gummy infiltration of the sclera, very vascular, very tender to the touch, and especially painful when the eyes were turned outward. This infiltration extended backward symmetrically in the two eyes, but was somewhat more extensive in the right eye. The media were clear, and an ophthalmoscopic examination revealed nothing abnormal. The patient’s breath was fetid, the buccal mucous membrane very pale, and bore the marks of the teeth along the cheek. Tongue moist and thinly coated ; appe-