Annual report of the Metropolitan Asylums Board, 1899 : (in two volumes). Vol. 2, Fourteenth report of the Statistical Committee with appendices.

  • Metropolitan Asylums Board (London, England). Statistical Committee.
Date:
1900
Catalogue details

Licence: In copyright

Credit: Annual report of the Metropolitan Asylums Board, 1899 : (in two volumes). Vol. 2, Fourteenth report of the Statistical Committee with appendices. Source: Wellcome Collection.

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    red areola. On rubbing the spots with the handle of a teaspoon it will be found that they are not at all easily removed. On the first day of their appearance, however, the red areola may be absent, and it may then be quite impossible with the closest scrutiny to feel quite confident about them, although one may have a one’s suspicions very strongly aroused : such was the case in No. 44 of my series, when it was first seen ; when once, however, the spots appear, the red areola very quickly ensues, and the spots then generally become quite typical. At first the spots may be very few in number, perhaps only one or two, or else half-a-dozen, and this is especially the case on the first and last days of their appearance. Sometimes there is only a very small number throughout the attack (in one of my cases four was the greatest number ever visible at any one time in the course of the illness), but in others they become very numerous, so that the whole of the affected areas may be covered with them. In this connection, Koplik says: “ nor do they coalesce to become plaque-like “ in form : they retain the punctate character.” Large plaques they certainly do not form, but in many cases, when the spots are abundant, one can see that some are no longer mere specks, but spots of some little size, and on examining them more closely one can see that each bigger spot is composed of three or more tiny specks more or less united together, so that they are no longer discretely punctate, but decidedly confluently punctate : others, however, remaining discrete. When they become confluent the white substance which composes the summits of the spots gets more heaped up and becomes at the same time more loosely attached to its base, so that by rubbing a teaspoon over its surface the white substance much more readily comes away. But, although this is so with the bigger spots, the smaller specks retain their white substance under this treatment, and one can then feel sure of their nature, for if it were not for the smaller spots it would be very difficult to distinguish the condition from that of aphthous stomatitis, which the bigger spots closely resemble. Whilst the white substance in these cases has been increasing in this way, the red areolae have followed suit, so that by this time the whole mucosa has become bright red in colour. When the time for its disappearance occurs the white substance comes away in a very short space of time, leaving the base of the same colour as the rest of the mucosa, so that it is then impossible to distinguish any sign of the former presence of Filatow spots, for there is no subsequent ulceration or loss of tissue. Histology.—These little spots really arise as fine papillae, and the epithelium on the summits of these papillae becomes pulpy and whitened : at the same time the papilla itself and the area immediately around it becomes injected, thereby giving rise to the red areola around each white speck. Filatow, who first described them, clearly took this view of their nature. Slawyk (.Deutsch. Med. Woch. Schr., 1898, No. 17) says they may be picked off with the forceps without pain or bleeding, and they are then seen under the microscope to consist of large masses of epithelium undergoing fatty changes. Situation.—The commonest and prevailing site for these spots is on the buccal mucosa, on which they have a partiality for certain localities. If the spots are few in number, the most likely spot is opposite to and on a level with the bases of the lower milk molars on either side: here they often form a small cluster. Another very favourite site is the corresponding situation with regard to the upper milk molars, where also they may form a cluster. Another spot