The non-tabetic men gave a history of chancre with symptoms following which were suspicious of syphilis in 1.5 per cent., while the tabctic4 gave such a his tory in 8.1 per cent. Of the male pa tients with tabes, 21.3 per cent., while denying the primary lesion, had suffered from such symptoms as would tend to a diagnosis of syphilis; of the patients with other nervous diseases only 4.5 per cent. had had such symptoms. In only 11 per cent. of the male cases of locomotor ataxia was there no evidence whatever of venereal infection, while 67.5 per cent. of the non-tabetics gave this negative history. The results with the women were practically the same. Of the tabes cases, 35.9 per cent. were surely syphilitics, 35.9 per cent. were suspicious, and 28.2 per cent. gave no evidence what ever of previous venereal disease. For the non-tabetic women the percentage in these three classes was 6.5, 10.5, and 80 per cent., respectively. Ernst Kuhn (Arch. f. Psych. u. Nerv., '98).
From 15 to 25 of each 1000 persons affected with syphilis develop some spe cific disease of the central nervous sys tem, exclusive of those who develop either tabes or general paresis. The greatest number of cases of cerebral syph ilis result from mild and moderately se vere forms of the disease. In 11 per cent. of cases of syphilis of the brain the cere bral symptoms have occurred within the first half-year after the initial affection, and in 24.6 per cent. of all the cases be tween 6 and 10 years after the primary sore. The brain and spinal cord are af fected much more frequently than the peripheral nerves.
Syphilis of the central nervous system is characterized, above all, by the multi plicity of the symptoms and by the tend ency to remissions and relapses. No set of symptoms is pathognomonic of syphilis of the brain or spinal cord. The presence of constitutional syphilis is more easily suspected and proved from the study of the pupils than from any other symptom that the patient may present. These pupil-changes are: (1) inequality of the pupils, one contracted and the other di lated; (2) unequal response, the one re acting to light, the other failing to re spond; (3) the complete immobility of the pupils, both to light and during ac commodation; (4) a marked departure from the circular form in cases in which there has been no preceding iritis. Chronic forms of headache in an other wise-healthy individual continuing for days, but often intermittent, possibly worse at night, dependent largely upon the position of the head, are of syphilitic origin. Vertigo is an early symptom. Single epileptoid seizures, transitory hemiplegias, and transitory motor apha sics occurring in the absence of renal dis ease are suspicious signs. Apoplectic
attacks occurring in middle life in per sons who have neither renal nor cardiac disease may be safely attributed to syph ilis.
Ocular nerve-palsies of varying kinds arc often among the earliest symptoms of tabes dorsalis, and it is questionable if some of these forms of tabes, beginning with ocular palsies, are not truly spe cific types of cerebrospinal syphilis. Often brain-symptoms are associated with those pointing to disease of the lower or lowest portions of the spinal cord. Spas tic or paralytic symptoms, which may be symmetrical, but often invade one side long before the other is diseased, are suggestive of spinal syphilis. The paral ysis may last for years before it becomes complete. Sensory symptoms, if super added, may remain slight. In pseudo tabes syphilitiea the disease often invades one leg long before it does the other. The ataxic symptoms are often very slowly developed, and it is just in these cases that the absolute immobility of the pupil, in contradistinction to the Argyll Robertson pupil, gives goad reason to be lieve that what is supposed to be tabes dorsalis is a syphilitic pseudotabes. Sachs (N. Y. Med. Jour., May 27, '09).
The prognosis of late nerve and brain syphilis is notoriously bad, but in many cases more hopeful than some authorities would have us believe.
The Syphilides.—The most prominent of the manifestations of syphilis are the eruptions of the skin. These are termed "syphilides," or "syphilodermata." The syphilides are many and various, often confusing; but their classification may be rendered quite simple; thus, if papules are the essential feature of a syphilitic eruption it may be termed a "papular syphilide." In the same way the erup tion may be designated as vesicular, pus tular, tubercular, squamous, crustaceous, or ulcerative, and such combinations as papulo-pustular, papulous-squamous, and so on, the first part of the combined term corresponding to the feature of the mixed eruption that is most prominent. Ulcera tive syphilides may be designated as su perficial, deep, scrpiginous, or perforative, as the case may be.
The principal distinctive lesions of syphilis that occur at various periods dur ing its course are papules, mu cous patches, mucous tubercles, condylo mata, vesicles, pustules, bulhe or blebs, rhagades or fissures, gummy tubercles, and diffuse gummy deposits and infiltra tions. Dependent upon some of these lesions, different forms of deep and super ficial ulceration, attended or followed by peculiarly-formed crusts and scars, may occur—syphilitic ecthyma and rupia ulcero-crustaceous syphilides. Squamre or scales in various forms and locations may develop.