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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    had no connection with the thyroid body or trachea, and had prob- ably existed for some time, perhaps years, if we may judge from the presence of the calcareous plates upon the inner surface of its walls. The exact pathology of the cyst it is very difficult to determine. There were no signs of interference in the function of either trachea or oesophagus during life, so that its rate of growth is unknown. In view of the constitutional syphilis, its origin had been probably a gummy deposit in the subcutaneous tissue of the neck, just below the isthmus of the thyroid and in front of the trachea, which had sub- sequently undergone retrograde metamorphosis. Its contents found at the autopsy were regarded as disintegrated clots, but the presence of the blood may be accounted for by the marked hemorrhagic dia- thesis. The wall of the cyst varied in thickness from three to five lines, its inner surface was smooth, as if covered by a membrane, except where the calcareous plates were situated, and the outer sur- face rough, owing to adhesions to the surrounding tissues. Micro- scopic sections showed that there was no distinct lining membrane, nor any trace of epithelium, and the smooth appearance of the inner surface was probably the result of pressure of the contents. The wall was composed of a large number of layers of fibro-areolar tissue, with some cells, fusiform and round, with nucleus and granular con- tents. These layers of fibres were packed very closely together, forming a dense, strong wall, which had probably originated in the following way. A gummy deposit had occurred in the subcutaneous areolar tissue, which by its presence had set up a localized inflam- mation, lymph was poured out around the gumma, became organized, and thus the growth went on. At some subsequent period the con- tents of the tumor began to break down, disintegrated and perhaps suppurated, and at this stage the hemorrhage may have occurred and mingled with the contents. As the process of absorption went on, these bloody extravasations probably recurred again and again, and thus the cyst-wall had no opportunity of collapsing, and hence no obliteration of the cavity occurred. The accompanying eruption was another interesting feature in the case. Its ill-defined, nondescript character was at first unsatisfac- tory. The spots were as often pustules as vesicles ; and even when more truly vesicular, the surrounding areola was different from that usually seen in this variety of eruption. Only in a few of the spots was the areola at all well marked, and the vesicles were not large enough to speak of them as bullae until towards the close of life. The ill-defined character of the eruption was no doubt the sign of de-