Volume 2

The student's book of cutaneous medicine and diseases of the skin / by Erasmus Wilson.

Date:
1864-1865
Catalogue details

Licence: Public Domain Mark

Credit: The student's book of cutaneous medicine and diseases of the skin / by Erasmus Wilson. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    mencement the tubercle is covered with a thin brown crust; from time to time a little discharge takes place at the edge of this crust, but the crust remains undetached, and is closely adherent for the greater part of its circumference. In this smouldering state the disease may continue for several weeks or months; at last the ulceration extends beyond the limits of the crust, and then the nature of the disease becomes apparent. If the crust be raised, the ulcer will be found to be deep, with vertical edges and uneven granular surface, sometimes secreting a dense white pus and sometimes a sanious fluid. From time to time, and without apparent cause, the ulcer becomes inflamed, and the tissues at its base congested and hard; and in a short time the hard and congested tissues are destroyed by the ulcera¬ tion. This is the course of the disease : the primary tu¬ bercle distended by congestion and infiltration, ulcerates for relief; the congestion and infiltration are repeated from time to time, each time followed by ulceration, and so by degrees, sometimes slow and sometimes rapid (lupus vorax), tissue after tissue is destroyed, until the entire nose may be removed; or the nose and adjacent skin of the face, including the upper lip and deeper parts. In a case lately brought before us, the interior of the face was converted into one large cavern, communicating with the exterior by means of a single vertical hole which extended from the teeth of the lower jaw to the forehead ; and through this large hole could be seen the lateral walls of the nares and the pharynx, the palate and the roof of the mouth being entirely destroyed. Lupus non exedens is less destructive and therefore more lasting than lupus exedens; it is unattended with ulceration, and its situation is somewhat different, beginning on the cheek, on the upper lip, or on the lobe of the ear, and occasionally on the ala nasi, and spreading, not in depth, like the former variety, but along the surface. It originates as a small tubercle of a reddish yellow, or pale amber-colour,