A system of practical medicine. By American authors. Vol. 2

by Unknown

¹⁶⁴ Trans. of Path. Soc. of London, vol. xxviii., 1877.

¹⁶⁵ Archiv für Ophthalmologie, Bd. 1, Ab. i.

¹⁶⁶ Journal of Mental Science, Jan., 1875.

¹⁶⁷ Ziemssen, vol. xii.

¹⁶⁸ Syphilis of the Brain and Spinal Cord, London, 1879, chapter on "Hered. Syph.," p. 67.

¹⁶⁹ Med. Times and Gazette (? Feb. 17, 1877).

We find, thus, that in these patients meningitis, growths, and arterial disease constitute the three clinical divisions of the disease which have thus far been distinctly differentiated, and the reported cases, with or without autopsy, fall naturally into these classes.

These cases are naturally few, and to make them absolutely reliable it is necessary to have unmistakable evidence of hereditary syphilis in some other form and the demonstration of syphilitic lesions at an autopsy. The case of Dowse, however,¹⁷⁰ includes these requirements. A child twelve years of age, of syphilitic parents, with a history of coryza, sore eyes, and a tubercular syphilide, was attacked with epilepsy, diplopia, facial paralysis, etc., and finally died. At the autopsy three gummatous growths of the surface of the brain were found, and the vessels of the base were found to have undergone the special changes described by Heubner. Their lumen was in some places nearly occluded by an accumulation of spindle-shaped cells between the tunica fenestra and the epithelial lining; and interspersed with them, but particularly in the muscular and adventitious coats, were to be seen enormous quantities of round cells which in many parts seemed actually to replace the normal structures. Dowse's other cases are not at all conclusive in their clinical histories; even the diagnosis was not established by autopsy.

¹⁷⁰ Op cit., pp. 71-75.

Barlow's two cases were both very young children, and are extremely convincing.¹⁷¹ A child four months old, with snuffles, serpiginous ulcers, etc., and with a syphilitic father, had epileptiform attacks, followed by laryngismus, carpo-pedal contraction, and changes in the choroid. She died aged about fifteen months, and the autopsy disclosed thickening of the pia mater, evidently not tubercular, and changes in the arteries, which in the gradual narrowing of the lumen of the vessel, the absence of ulceration or disintegration or calcification, and the continuity and extent of the cell-proliferation are as different as possible from ordinary atheroma, but correspond precisely with the description of Heubner's cases, which were undoubtedly the subjects of acquired syphilis.