LATE, OR SEQUELAR, NERVE AND BRAIN SYPIIILIS.—The nervous lesions of late syphilis are more severe, and the prognosis much graver, than in the case of the early nerve phenomena. The ac cumulation of neoplastic material in and about the delicate nerve-structures, oc curring in late syphilis, is associated with and probably dependent upon: 1. The local damage inflicted by the lesions of the active stage in the form of a low grade of inflammation with connective-tissue proliferation and vascular and lymphatic obstruction. 2. The debilitating effects of prolonged syphilization and the pro longed treatment necessitated by it. 3. Prolonged mental worry, with or without alcoholic or other excesses. 4. In some cases resistance to remedies occasioned by their prolonged use.
The main signs which, suggest the con dition are: Ileadacho and vertigo; nausea and vomiting; optic neuritis; cranial-nerve palsies or paralyses; apo pleetiform attacks or more gradual at tacks of somnolence or coma, with par tial hemiplegia; irritability and general mental failures: polyuria and polydip sia; marked remittent character to all the symptoms and their ehang,eability. A. E. lirownrigg (Boston Afed. and Surg. .lour., Jan. i2. 190:1).
It is probable that the nerve and brain lesions of the sequelar period act entirely by producing mechanical and nutritional disturbance, the syphilitic in fection proper having long since become exhausted. The manifestations of se quelar nerve-lesion are many and various.
Paralyses—such as hemiplegia, para plegia, and monoplcgias of different kinds —are apt to occur, and are due either to localized deposit of syphiloma external or internal to the structures involved, or to diffuse interstitial deposits and prolifera tion of obstructive tissue. Gummy tu mors may occur in the brain proper or its membranes or the latter may undergo a chronic thickening resembling chronic meningitis from other causes. The patho logical results and symptoms produced vary with the location and function of the structure involved. Gummy deposits
in and about the vascular walls inter fering with the cerebral circulation are prolific causes of paralysis. Vascular de generation is often the cause of those miliary aneurisms the rupture of which is at the bottom of many cases of apo plexy and hemiplegia.
The various cranial and spinal nerves are likely to become involved in sequelar syphilis. This involvement may be cen tral, involving the brain origin of the nerve, with or without a greater or less degree of coincident brain-involvement, or it may be peripheral, affecting any part or all of the distribution of the nerve. As with the brain, the nerve-lesion may consist (1) of a circumscribed or diffuse gummy deposit; (2) of sclerotic changes produced (a) by lesions of the active period or (b) by sequelar gummy deposit; (3) of destruction of normal tissue-ele In ents.
There has been something of a con troversy as to the influence of syphilis upon the spinal cord. It is well known that gummy infiltration and localized de posits with consequent paralysis occur in the cord, but the etiological relation of syphilis to locomotor ataxia has been dis puted. Erb maintains that 61 per cent. of cases of locomotor ataxia are due to syphilis. Fournier claims a syphilitic origin in the "enormous majority of cases." In regard to this question the writer can only say that, while the state ments of these authorities may be ex aggerated, clinical experience seems to prove that quite a proportion of cases are due to syphilis.
The following statistics are based on a study of 214 cases of tabes (136 men and 78 women) from the neurological service of the Charitj, in Berlin, in com parison with 600 non-tabetic patients (400 men and 200 women) from the same service: Of the tabetic men, 38.2 per cent. gave a conclusive history of syphi lis, while, of the men with other nervous affections, only 7 75 per cent. gave a like history.