On syphilitic affections of the nervous system : their diagnosis and treatment.

  • Anderson, T.M'Call.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: On syphilitic affections of the nervous system : their diagnosis and treatment. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    on the subject of causation with considerable caution, a case occurred to him recently in the Royal Infirmary of this city. The patient said he never had syphilis. There was, however, a distinct cicatrix upon the glans penis, and it was not till this was pointed out that the patient remembered that he had an attack of the disease when he was a youth. As regards the diagnosis of the seat of the lesion, when it is at the base of the brain involving certain nerves there is usually little doubt as to its position, for the functions of the parts affected are in- terfered with and corresponding symptoms are present. So also when the disease attacks the cortex of the brain in its motor region we have definite symptoms—perhaps Jacksonian epilepsy, or mono- plegia ; but should it be situated in front of or behind that region we have no such assurance, though no doubt if the upper temporo- sphenoidal convolution, or angular gyrus or occipital lobe be affected, we may have indications. But whether we have such symptoms present or not, general systematic percussion of the skull sometimes assists materially in the diagnosis of the case. As a method of examination he did not think it was sufficiently appreciated, and it was particularly useful in syphilis of the brain, which is especially a disease of the cortex, usually beginning in the membranes. By per- cussion we are able to transmit sufficient force to irritate the diseased part, which is usually hypersensitive, so that the patient, perhaps pre- viously unaware of the existence of a localized pain, by this means be- comes conscious of it. In any case in which the symptoms point to the cortex of the brain this method of examination should not be omitted. As regards treatment, he believed we are all pretty much agreed that in gross lesions mercury and iodide of potassium are the standard remedies, but he was doubtful of these medicines being of value in degenerations such as locomotor ataxy. There is even room for doubt as to a case being one of ordinary locomotor ataxy if it gets better under such treatment. He had got good results from fly-blisters, and had applied as many as ten in succession over painful parts of the head. In one case so treated, the pain, which previously had been very troublesome, disappeared, and the epileptiform convulsions also passed away almost entirely, the patient only having one in fifteen months; though previously his system had been saturated with constitutional treatment, with only comparatively slight im- provement.