A system of practical medicine. By American authors. Vol. 5

by Unknown

The relation of inherited syphilis to various nervous affections not distinctly specific cannot yet be determined. Arrested development, and the consequent epilepsy, idiocy,²¹ early brain sclerosis, are probably sometimes due to the inheritance; and the cases collected by E. Mendel²² show that chronic hydrocephalus is frequently of specific origin.²³

²¹ See Brain, vol. vii. 409.

²² Archiv f. Psychiatrie, Bd. i. 309.

²³ See, also, Virchow's Archiv, Bd. xxxviii. p. 129.

Another very important question connected with the etiology of these disorders is as to the time of their development. Nervous diseases following acquired syphilitic infection certainly belong to the advanced stages of the disorder. Huebner reports²⁴ a case in which thirty years elapsed between the contraction of the chancre and the nervous explosion. I have seen a similar period of thirty years. Fournier reports intervals of twenty-five years, and thinks from the third to the tenth year is the period of maximum frequency of nervous accidents.

²⁴ Ziemssen's Encyclopædia, xii. 298, New York ed.

The fact that nervous syphilis may occur many years after the cessation of all apparent evidences of the diathesis is of great practical importance, especially as the nervous system is more prone to be attacked when the secondaries have been very light than when the earlier manifestations have been severe. I have repeatedly seen nervous syphilis in persons whose secondaries have been so slight as to have been entirely overlooked or forgotten, and who honestly asserted that they never had had syphilis, although they acknowledged to gonorrhœa or to repeated exposure, and confessed that their asserted exemption was due to good fortune rather than to chastity.

The following citations prove that this experience is not peculiar. Dowse²⁵ says: “Often have I had patients totally ignorant of having at any time acquired or experienced the signs or symptoms of syphilis in its primary and secondary stages, yet the sequelæ have been made manifest in many ways, particularly in many of the obscure diseases of the nervous system.” Buzzard²⁶ reports a case of nervous syphilis where the patient was unconscious of the previous existence of a chancre or of any secondaries. Rinecker also calls attention²⁷ to the frequency of nervous syphilis in persons who afford no distinct history of secondary symptoms.

²⁵ The Brain and its Diseases, London, 1879, vol. i. p. 7.