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THE SYPHILITIC AND PARASYPHILITIC AFFECTIONS OF THE NERVOUS SYSTEM.
909 to the widely prevalent practice of allowing children from the earliest ages to make a playground of the streets of London. No district of London is free from these irresponsible little danger-seekers, although in the crowded small streets of Whitechapel they do not run so much risk as among the more rapidly-moving carriage The child, of course, is not to traffic of the West-end. He has been sent blame for incurring unnecessary peril. to play in the street and it is the mothers who should If there be brought to see the danger of their advice. could only admire a were no open spaces available we determination to let the children have fresh air at all As it is we ought to insist that such a practice, costs. in itself admirable, should be carried out under the safe and most suitable conditions that are so freely available to the London poor in the public parks and open spaces. District visitors, among whom we believe a suitable topic of conversation at once edifying -and capable of sensational treatment is often welcome and sought in vain, may do good service by a crusade against the use of the streets as a playground. We recommend the subject their and are certain that medical to consideration cordially men in London, some of whom perhaps have had the unpleasant experience of treating a child whom their coachman has run over, will thankfully endorse the efforts of the district visitor.
surgeon, stated that a patient under his observation withtabetic symptoms which appeared seven or eight years after syphilitic infection had been put under the mixed treatment " with mercury and iodides with the result that all tabetic symptoms had disappeared and recovery could be: now regarded as complete. On the other hand, he had. seen similar treatment fail entirelv in a number of cases of tabes. Professor A. Fournier stated that his personal experience of syphilitic and parasyphilitic diseases included 1300 cases of tabes collected from his case-books and that 1000 of these patients had had undoubted syphilis, 200 weredoubtful, and 100 were quite free from syphilis. There were undoubtedly cases of tabes which improved with anti-syphilitic treatment but were not cured and he had only seen one case which could be regarded as completely cured by thetreatment mentioned. Tabes in women had a tendency to: remain benign for a very long time, the clinical symptoms consisting of slight darting pains in the limbs, myosis and inequality of the pupils, Argyll-Robertson reflex, and slight bladder troubles. Some of these cases might easily be mistaken as instances of recoveries when the pains in the limbs and the bladder troubles improved under treatment, whereas the disease nevertheless progressed slowly. Parasyphilitic nervous affections were, in the vast majority of cases, incurable, whereas true syphilitic affections (commencing gummatous lesions and connective tissue hyperplasias in the nervous system, as well as mucous plaques) AFFEC- were in most cases amenable to anti-syphilitic treatment.
largely due
THE
SYPHILITIC AND PARASYPHILITIC TIONS OF THE NERVOUS SYSTEM.
AN important discussion syphilitic affections of the
on
the
nervous
Leredde, Professor Fournier, and
syphilitic and parasystem by Professor
others is recorded in Médical of Feb. 12th and March 12th last. Professor Leredde stated that under the designation of parasyphiliticnervous affections there were included two groups of ailments-viz., first, hysteria, neurasthenia, and other rare nervous troubles which might occur in syphilitic subjects, as in patients suffering from other infections or toxæmias ; and secondly, tabes dorsalis, general paralysis of the insane, and leukoplakia lingualis, which constituted parasyphilitic diseases in the proper sense. It was his experience that a certain proportion of patients in the latter group were beneficially affected by anti-syphilitic treatment carried out with perseverance and regularity. A case in support of this statement was quoted of a man, aged 43 years, who had contracted syphilis, and who had after an interval of five years rapidly developed grave nervous symptoms like those of tabes dorsalisdiplopia, visual troubles of accommodation, tachycardia, For this he muscular atrophy, and bladder troubles. was treated with mercurial injections for 12 months and with calomel for 18 months, the latter drug being alternately given for six weeks and stopped for an equal interval. Under the above treatment the symptoms were improved and the progress of the disease was arrested. M. Hallopeau, in his contribution to the discussion, stated that the degenerative lesions of tabes dorsalis were initiated by syphilitic hyperplasias and neoplasms affecting the posterior root ganglia of the spinal cord and hence followed the want of success in the anti-syphilitic treatment of tabes dorsalis of long standing when the degenerations of nerve-tissue were advanced, whereas treatment was often successful at the onset of the disease when the nerve cells and fibres had not as yet been degenerated or destroyed. M. Jaquet pointed out that tabes sometimes underwent sudden arrest in its development and even improved or retrogressed without anti-syphilitic treatment and that when optic neuritis developed in the course of tabes the other symptoms of the disease were often arrested, as was pointed out long ago by Professor Benedikt of Vienna. Dr. Moty, an army
Progres
ATAXY AND TETANY AFTER
DIPHTHERIA.
IN the twenty-eighth volume of St. Thomas’s Hospital Reports Dr. Charles R. Box has called attention to the: occurrence of two rare sequels of diphtheria-transient,, ataxy and tetany-and has recorded a remarkable case in which both were present. A house physician contracted nasal and pharyngeal diphtheria. On the third day thebacilli were found and 7000 units of antitoxin were injected. On the fourth day the dose was repeated. The temperature became normal and the throat rapidly assumed a healthy appearance. On the fourteenth day there were a feeling of oppression in the chest and prceoordial pain. The latter increased and radiated into the arms. Tingling of the fingers and dyspnoea followed and the pain extended to the legs. The hands were clenched, the wrists wereflexed, and the forearms were strongly pronated. The legs were extended and the feet were in a position of extreme plantar flexion with flexion of the toes. The back was slightly arched, but the jaws were not affected. The patient spoke with difficulty and complained of pain in, the wrists, the ankles, and the chest. The spasm gradually disappeared but next night it recurred in less degree. During convalescence slight spasms occurred in the armsfor many weeks. About the end of the third week nasal regurgitation and intonation and tingling of the tongue The regurgitation lasted; and finger-tips were present. for a month. The patient was allowed to sit in a chair but he betook himself to bed again on the sixty-first day. The legs were weak and hyperassthetic. Tenderness was sogreat that he could not sit with the legs crossed. The external popliteal nerves were tender. The knee-jerks were easily obtained. The fingers were hypothetic and the arms were paretic. Ataxic symptoms were definitely noticed on the seventy-third day. The patient could not stand and in attempting to walk he reeled in all directions ; the movements of the arms were incoordinate and almost choreic. In trying to feed himself he nearly injured his eyeball with the fork. He never knew where his arms and legs were. The fingers and hands were hypæsthetic, the arms and feet were parsesthetic, and the soles were hyper2estlietic. The kneejerks were obtained with difficulty. Muscular weakness was
surgeon, stated that a patient under his observation withtabetic symptoms which appeared seven or eight years after syphilitic infection had been put under the mixed treatment " with mercury and iodides with the result that all tabetic symptoms had disappeared and recovery could be: now regarded as complete. On the other hand, he had. seen similar treatment fail entirelv in a number of cases of tabes. Professor A. Fournier stated that his personal experience of syphilitic and parasyphilitic diseases included 1300 cases of tabes collected from his case-books and that 1000 of these patients had had undoubted syphilis, 200 weredoubtful, and 100 were quite free from syphilis. There were undoubtedly cases of tabes which improved with anti-syphilitic treatment but were not cured and he had only seen one case which could be regarded as completely cured by thetreatment mentioned. Tabes in women had a tendency to: remain benign for a very long time, the clinical symptoms consisting of slight darting pains in the limbs, myosis and inequality of the pupils, Argyll-Robertson reflex, and slight bladder troubles. Some of these cases might easily be mistaken as instances of recoveries when the pains in the limbs and the bladder troubles improved under treatment, whereas the disease nevertheless progressed slowly. Parasyphilitic nervous affections were, in the vast majority of cases, incurable, whereas true syphilitic affections (commencing gummatous lesions and connective tissue hyperplasias in the nervous system, as well as mucous plaques) AFFEC- were in most cases amenable to anti-syphilitic treatment.
largely due
THE
SYPHILITIC AND PARASYPHILITIC TIONS OF THE NERVOUS SYSTEM.
AN important discussion syphilitic affections of the
on
the
nervous
Leredde, Professor Fournier, and
syphilitic and parasystem by Professor
others is recorded in Médical of Feb. 12th and March 12th last. Professor Leredde stated that under the designation of parasyphiliticnervous affections there were included two groups of ailments-viz., first, hysteria, neurasthenia, and other rare nervous troubles which might occur in syphilitic subjects, as in patients suffering from other infections or toxæmias ; and secondly, tabes dorsalis, general paralysis of the insane, and leukoplakia lingualis, which constituted parasyphilitic diseases in the proper sense. It was his experience that a certain proportion of patients in the latter group were beneficially affected by anti-syphilitic treatment carried out with perseverance and regularity. A case in support of this statement was quoted of a man, aged 43 years, who had contracted syphilis, and who had after an interval of five years rapidly developed grave nervous symptoms like those of tabes dorsalisdiplopia, visual troubles of accommodation, tachycardia, For this he muscular atrophy, and bladder troubles. was treated with mercurial injections for 12 months and with calomel for 18 months, the latter drug being alternately given for six weeks and stopped for an equal interval. Under the above treatment the symptoms were improved and the progress of the disease was arrested. M. Hallopeau, in his contribution to the discussion, stated that the degenerative lesions of tabes dorsalis were initiated by syphilitic hyperplasias and neoplasms affecting the posterior root ganglia of the spinal cord and hence followed the want of success in the anti-syphilitic treatment of tabes dorsalis of long standing when the degenerations of nerve-tissue were advanced, whereas treatment was often successful at the onset of the disease when the nerve cells and fibres had not as yet been degenerated or destroyed. M. Jaquet pointed out that tabes sometimes underwent sudden arrest in its development and even improved or retrogressed without anti-syphilitic treatment and that when optic neuritis developed in the course of tabes the other symptoms of the disease were often arrested, as was pointed out long ago by Professor Benedikt of Vienna. Dr. Moty, an army
Progres
ATAXY AND TETANY AFTER
DIPHTHERIA.
IN the twenty-eighth volume of St. Thomas’s Hospital Reports Dr. Charles R. Box has called attention to the: occurrence of two rare sequels of diphtheria-transient,, ataxy and tetany-and has recorded a remarkable case in which both were present. A house physician contracted nasal and pharyngeal diphtheria. On the third day thebacilli were found and 7000 units of antitoxin were injected. On the fourth day the dose was repeated. The temperature became normal and the throat rapidly assumed a healthy appearance. On the fourteenth day there were a feeling of oppression in the chest and prceoordial pain. The latter increased and radiated into the arms. Tingling of the fingers and dyspnoea followed and the pain extended to the legs. The hands were clenched, the wrists wereflexed, and the forearms were strongly pronated. The legs were extended and the feet were in a position of extreme plantar flexion with flexion of the toes. The back was slightly arched, but the jaws were not affected. The patient spoke with difficulty and complained of pain in, the wrists, the ankles, and the chest. The spasm gradually disappeared but next night it recurred in less degree. During convalescence slight spasms occurred in the armsfor many weeks. About the end of the third week nasal regurgitation and intonation and tingling of the tongue The regurgitation lasted; and finger-tips were present. for a month. The patient was allowed to sit in a chair but he betook himself to bed again on the sixty-first day. The legs were weak and hyperassthetic. Tenderness was sogreat that he could not sit with the legs crossed. The external popliteal nerves were tender. The knee-jerks were easily obtained. The fingers were hypothetic and the arms were paretic. Ataxic symptoms were definitely noticed on the seventy-third day. The patient could not stand and in attempting to walk he reeled in all directions ; the movements of the arms were incoordinate and almost choreic. In trying to feed himself he nearly injured his eyeball with the fork. He never knew where his arms and legs were. The fingers and hands were hypæsthetic, the arms and feet were parsesthetic, and the soles were hyper2estlietic. The kneejerks were obtained with difficulty. Muscular weakness was