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FAMILIAL NEURO-SYPHILIS WITH APPARENTLY HEALTHY PARENTS.
179 limit of cardiac dullness was normal. On the right the limits of dullness were normal over the first two spaces, but below them the cardiac dullness was continuous with that produced by the rounded tumour. There was, therefore, continuous Heart sounds : double dullness from nipple to nipple. aortic murmurs, conducted in the usual directions, and audible over the rounded swelling. At the apex there was a long systolic bruit, conducted to the axilla, followed by a long rumbling bruit occupying the whole of diastole. No thrill was felt. Pulse 72, regular, of well-marked Corrigan type. Blood pressure 210/80. There was no pain or dyspnoea, and he could sleep well in any position. This condition remained the same, except that the oozing of blood from the hole slowly increased until June 16th, 1925. On this date there was a sudden severe haemorrhage from the hole, which was eventually stopped by pressure. On the following day the aneurysm burst through the hole, causing death in about two minutes. Post-mortem Examination.-All the organs were normal, except the heart and great vessels. The pericardium was very large, and was firmly adherent in front to the sternum and to the costal cartilages of the third, fourth, and fifth ribs on the right side. The pericardial cavity was completely obliterated, the two serous layers of the pericardium being united by dense fibrous adhesions. The right auricle and right ventricle and their valves were normal. There was well-marked hypertrophy of the left ventricle, but there were no vegetations or signs of old endocarditis on the mitral valve. The aortic valves showed profuse changes of syphilitic character, being fused at their base, shortened, and the edges thickened into a nodular roll. The sinus of Valsalva by the anterior cusp was expanded out to form a saccular aneurysm of circular shape, the entrance to the aneurysm having a sharp edge surrounded by great hardening of the aorta. The aneurysm, which was entirely intrapericardial, had passed anteriorly to the right auricle, becoming firmly adherent to it, and had then pushed its way through the pericardium, lying beneath the sternum, finally perforating the latter through a hole half an inch in diameter. The chief mass of the aneurysm had spread to the right, causing the large rounded swelling seen clinically, under which, at the post-mortem, the pericardium was firmly adherent to the chest wall. Beyond the aneurysm the aorta showed patches of syphilitic aortitis, but was otherwise normal.
The obliteration of the pericardial cavity, presumably as a result of his attack of rheumatic fever in 1914, had evidently prevented an intrapericardial rupture, as is common in this class of aneurysm. The aneurysm had pushed the anterior half of the pericardium against the chest wall, caused the two to adhere, and had then perforated externally through the pericardium lying beneath the sternum, and finally through the sternum itself.
FAMILIAL NEURO-SYPHILIS WITH APPARENTLY HEALTHY PARENTS. BY A. G. DUNCAN, M.D.LOND.
illustratesI
THE following personal and family record several interesting points which bear on congenital
syphilis.
D. X., the mother ; no symptoms ; physical examination negative ; W.R. negative in blood and C.-S. F. normal on
two occasions. She had seven pregnancies :1. A., male, born 1894. Died in a mental hospital of dementia paralytica at age 26. 2. E., male, born 1896. No symptoms ; physical examination negative ; W.R. negative in blood ; C.-S. F. normal. 3. D., female, born 1899. The patient described above. 4. F., male, born 1900. No symptoms ; physical examination negative ; W.R. negative in blood ; C.-S. F. normal. 5. S., male, born 1902. Occasional headaches since receiving a blow on the head when 16 years old. Physical examination negative ; W.R. positive in blood. C.-S. F. 12 cells (small lymphocytes) per c.mm., protein not in excess, W.R. negative, colloidal gold curve 001110000. 6. Miscarriage at sixth week in 1904. No symptoms ; physical 7. H., female, born 1906. examination negative ; W.R. negative in blood ; C.-S. F.
normal. S. was given mercury and potassium iodide by mouth and courses of intravenous injections of novarsenobillon. C.-S. F. was completely normal when next examined, three months later, and has remained so. Positive W.R. in the blood persisted for 16 months, after which it remained negative. D., the patient who first came under observation, died in May, 1923. .
oo?Mm
D. X., the patient whose illness led to an investigation of the other members of her family, came under observation in 1921, when she was 22 years old. In the previous August, on ceasing work for the summer holiday, she had complained of general malaise, occasional vomiting, and slight deterioration of memory. The first sign of any serious ill-health was a severe and prolonged epileptiform fit, after which she was somewhat confused for a few days, and was then apparently well. On admission to hospital in November, 1921, she was mentally dull, lacking in attention, and emotionally unstable. The only physical signs of disease were a slight tremor of the lips, marked sluggishness of light reaction in the left pupil, and absence of tendon reflexes. Shortly after admission she had a series of fits resembling status epilepticus, and her mental condition considerably deteriorated. A positive Wassermann reaction syphilis. in the blood, and the presence in the cerebro-spinal fluid I am indebted to Dr. George Riddoch for permission (C.-S. F.) of 165 cells per c.mm., a positive Wassermann reaction, and the paretic type of colloidal gold reaction to publish these cases, and to Dr. P. Spark for notes confirmed the diagnosis of dementia paralytica. confirming the diagnosis in the case of the patient
Her parents, brothers, and sisters were seen and examined clinically and serologically for any evidence of disease. The following notes give the record of the
whole family. Family Record.-R. X., the father ; no symptoms ; physical examination negative ; W.R. negative in blood
and
no
abnormalities in C.-S. F.
on
two occasions.
A. X. ______________
THE name of Mr. Townley Clarkson’s collaborator in the article on Gonorrhcea in the Male, which appeared in THE LANCET of Jan. 16th, p. 119, should read W. J. Dwyer, M.R.C.S. Eng., Clinical Assistant, Venereal Diseases Department, London Hospital.
The obliteration of the pericardial cavity, presumably as a result of his attack of rheumatic fever in 1914, had evidently prevented an intrapericardial rupture, as is common in this class of aneurysm. The aneurysm had pushed the anterior half of the pericardium against the chest wall, caused the two to adhere, and had then perforated externally through the pericardium lying beneath the sternum, and finally through the sternum itself.
FAMILIAL NEURO-SYPHILIS WITH APPARENTLY HEALTHY PARENTS. BY A. G. DUNCAN, M.D.LOND.
illustratesI
THE following personal and family record several interesting points which bear on congenital
syphilis.
D. X., the mother ; no symptoms ; physical examination negative ; W.R. negative in blood and C.-S. F. normal on
two occasions. She had seven pregnancies :1. A., male, born 1894. Died in a mental hospital of dementia paralytica at age 26. 2. E., male, born 1896. No symptoms ; physical examination negative ; W.R. negative in blood ; C.-S. F. normal. 3. D., female, born 1899. The patient described above. 4. F., male, born 1900. No symptoms ; physical examination negative ; W.R. negative in blood ; C.-S. F. normal. 5. S., male, born 1902. Occasional headaches since receiving a blow on the head when 16 years old. Physical examination negative ; W.R. positive in blood. C.-S. F. 12 cells (small lymphocytes) per c.mm., protein not in excess, W.R. negative, colloidal gold curve 001110000. 6. Miscarriage at sixth week in 1904. No symptoms ; physical 7. H., female, born 1906. examination negative ; W.R. negative in blood ; C.-S. F.
normal. S. was given mercury and potassium iodide by mouth and courses of intravenous injections of novarsenobillon. C.-S. F. was completely normal when next examined, three months later, and has remained so. Positive W.R. in the blood persisted for 16 months, after which it remained negative. D., the patient who first came under observation, died in May, 1923. .
oo?Mm
D. X., the patient whose illness led to an investigation of the other members of her family, came under observation in 1921, when she was 22 years old. In the previous August, on ceasing work for the summer holiday, she had complained of general malaise, occasional vomiting, and slight deterioration of memory. The first sign of any serious ill-health was a severe and prolonged epileptiform fit, after which she was somewhat confused for a few days, and was then apparently well. On admission to hospital in November, 1921, she was mentally dull, lacking in attention, and emotionally unstable. The only physical signs of disease were a slight tremor of the lips, marked sluggishness of light reaction in the left pupil, and absence of tendon reflexes. Shortly after admission she had a series of fits resembling status epilepticus, and her mental condition considerably deteriorated. A positive Wassermann reaction syphilis. in the blood, and the presence in the cerebro-spinal fluid I am indebted to Dr. George Riddoch for permission (C.-S. F.) of 165 cells per c.mm., a positive Wassermann reaction, and the paretic type of colloidal gold reaction to publish these cases, and to Dr. P. Spark for notes confirmed the diagnosis of dementia paralytica. confirming the diagnosis in the case of the patient
Her parents, brothers, and sisters were seen and examined clinically and serologically for any evidence of disease. The following notes give the record of the
whole family. Family Record.-R. X., the father ; no symptoms ; physical examination negative ; W.R. negative in blood
and
no
abnormalities in C.-S. F.
on
two occasions.
A. X. ______________
THE name of Mr. Townley Clarkson’s collaborator in the article on Gonorrhcea in the Male, which appeared in THE LANCET of Jan. 16th, p. 119, should read W. J. Dwyer, M.R.C.S. Eng., Clinical Assistant, Venereal Diseases Department, London Hospital.