ST. BARTHOLOMEW'S HOSPITAL

Holmes Coote
1847 The Lancet  
THE syphilitic poison exhibits, in most instances, an ulcerative action. Its application to the surface of the body gives rise to a vesicle, or to an excoriation, which soon becomes an nicer, the appearances and further progress of which are essentially modified by the nature of the tissues in which it is seated. If the disease be not interfered with by mercury, the poison eventually exhausts itself, the surface of the sore becomes clean, granulations spring up, and the part cicatrizes. But not
more » ... cicatrizes. But not uncommonly, and especially amongst the intemperate, the disease pursues a more violent course, and there I ensues mortification or sloughing of the part to which the poison has been applied. The various conditions under which these occurrences take place may be illustrated by the follow. ing cases:-SLOUGHING SORE OF THE GLANS PENIS; DIVISION OF THE PREPUCE. CASE 1.-William L-, aged thirty-one, iron-moulder; a healthy-looking but intemperate man, who has twice suffered from gonorrhoea, but has been well for the last four or five years; states, that ten days ago, immediately after connexion, he felt as if he had hurt himself under the foreskin. Twentyfour hours afterwards, he experienced a sharp burning pain in the part, but he continued at work, and followed his usual habits, until three days ago, when he noticed a small sore upon the upper surface of the glans, close to its junction with the prepuce. The day following, the penis was hot, swelled, and painful, and the foreskin, contracted at the orifice, could not be withdrawn. The pain, much aggravated upon pressure, soon became so severe as to deprive him of rest, and he passed the night bathing the penis with cold water, with the hope of obtaining some relief. Sept. 24th, 1846.-Admitted into Lazarus ward, under Mr. Stanley. The penis is hot, swelled, and painful; there is scarcely any discharge from under the prepuce; the pulse is accelerated, the tongue white, and the bowels are confined. Twelve leeches to the penis immediately; bread-and-water poultice; two aperient pills. 25th.—The bowels have been freely relieved, and the skin is cooler; but he passed the night without sleep. Five grains of soap-and-opium pill at bedtime; continue the poultice; broth diet as before. 27th.-The penis, still much swelled, is extremely painful when pressed over the situation of the sore; a thin and sanious, but not very abundant, discharge escapes from under the prepuce. Mr. Stanley liberated the glans by a free division of the superior part of the contracted prepuce. About two-thirds of the glans was occupied by a sore, the surface of which was covered by a black slough. Considerable haemorrhage ensued, but no artery required to be tied. Continue the soap-andopium pill; opium lotion to be applied, under the bread-andwater poultice, to the glans penis. 28th.-Early this morning, profuse haemorrhage took place from the divided prepuce. With some difficulty a large artery was tied, and the bleeding ceased. 30th.-He is quite free from pain; the slough has not extended ; the cut surfaces of the prepuce look healthy; he complains of feeling weak. Continue the 'poultice; meat diet; a pint of porter daily. · Oct. 2nd.-Nearly the whole slough has separated to-day; a deep and irregular, but healthy-looking excavation, not extending into the urethra, occupies the whole upper surface of the glans. To use a weak solution of nitric acid and opium wine as a lotion, under the poultice; meat diet and porter as before. Under this treatment, cicatrization speedily ensued, and he left the hospital well about the end of the month. SLOUGHING SORE OF THE GLANS PENIS; DIVISION OF THE PREPUCE. CASE 2.-Charles P-, aged twenty-five, sailor; a person of irregular and intemperate habits, who has occasionally suffered from slight attacks of gonorrhoea; states, that about a week ago, (the eighteenth day after connexion,) he experienced a sharp burning pain upon the upper and left side oi the glans penia, under the prepuce, which was swelled, anè hotter than natural. The day following, the swelling involved. the whole body of the penis; the prepuce could not be withdrawn from the glans, which had become the seat of pain, so severe as to deprive him of rest. He applied to a surgeon, who ordered him pills and a lotion. Sept. 28th, 1846.-He was admitted into Lazarus ward, under Mr. Stanley. The whole penis is much swelled and inflamed ; a profuse sero-purulent and bloody discharge escapes from under the contracted prepuce, upon the upper surface of which, and towards the left side, there is a prominent part, of purplish-black colour. Mr. Stanley immediately divided the prepuce along its superior surface, and exposed a black slough of the glans, about the size of a sixpence, and having the appearance as if produced by the application of potassa fusa; considerable haemorrhage ensued. Bread-and-water poultice to the penis; milk diet. 29th.—Since the division of the prepuce, he has been quite free from pain; the slough has not extended, and he obtained some hours' rest. There occurred during the course of last evening some inconsiderable haemorrhage, which was arrested by the application of cold. Continue the same. 30th.-Sleeps badly at night, but is free from pain. Five grains of soap-and-opium pill every night. Oct. 2nd.-The slough has separated to-day. There is exposed a deep and irregular, but healthy-looking excavation, which involves about one-third of the glans penis. He sleeps well, but complains of feeling very weak. Meat diet; pint of porter daily; a weak solution of nitric acid and opium wine to be applied, under the poultice, to the sore. 6th.-The wound is cicatrizing, and he left the hospital well about the end of the month. INFLAMED SLOUGHING SORE OF THE GLANS PENIS; DIVISION OF THE PREPUCE; ANTIPHLOGISTIC TREATMENT; RECOVERY. CASE 3.-Job L-, aged twenty-one; has been leading a dissipated life for the last three or four weeks, and cannot say when he contracted the'venereal disease. About a week ago, the penis felt hot and swelled, and painful; the orifice of the prepuce became contracted, and could with difficulty be withdrawn, so as to denude the glans, the exact condition of which had not been ascertained. Admitted into Lazarus ward, Jan. llth, 1840, under Mr. Lawrence. There was acute inflammation of the prepuce, with partial phymosis, and a copious secretion of an ichorous and foetid discharge. Upon withdrawing the prepuce, there was exposed a large sloughing chancre, situated partly on the glans and partly on the prepuce ; the preputrid portion was spreading by a mixed process of sloughing and ulceration. There was an inflamed bubo in the right groin. Prepuce divided along its superior surface. About six ounces of blood flowed from the cut edges. Poppy fomentation; bread-and-water poultice to the sore ; saline mixture, with half a drachm of the solution of the potassio-, tartrate of antimony, every six hours; leeches in the evening, , should the patient complain of pain. 13th.-The penis has been quite free from pain; the slough, ; of dark livid colour and raised, seems disposed to separate at ' the edges; bubo very painful. Six leeches to the bubo; dis-I continue the mixture. 14th.-The slough has separated, leaving a healthy granulating surface. 27th.-The wounds are granulating. ' July 1st.—Discharged. The wounds were cicatrized; some ' thickening at the base of the sore was rapidly disappearing; the divided prepuce, healed and contracted, formed a very good covering or hood to the glans. . SLOUGHING SORE OF THE GLANS AND PREPUCE. CASE 4.-Thomas C-, aged twenty-six; a person of irregular habits; has frequently suffered from venereal disease. During the last five months, he has led a very intemperate life, and cannot say exactly when he contracted his present complaint. About seven days ago, he first noticed a black spot upon the penis, but as he experienced but little pain, he followed his employment, and ate and drank as usual, up to the day of his admission into the hospital. Admitted May 23rd, 1840, into Lazarus ward, under Mr. Lawrence. There is a phagedsenic sore of the prepuce, by which one-half has been destroyed: the glans penis is in great part converted into a dark-coloured slough. The pulse is feeble, the skin cool, and he sleeps at night, but complains of feeling weak. A dose of aperient medicine; bread-and-water poultice to the sore; broth diet. 24th.--The slough, which has involved three-fourths. of the-
doi:10.1016/s0140-6736(00)63621-8 fatcat:kplplv7lpbd4vclx4azqqouc6q