MENINGITIS, Cerebral (Syphilitic).
This is a chronic ailment affecting the membranes usually at the base of the brain, and since it forms the chief feature in the clinical picture recognised as Syphilis of the Brain the term is usually accepted as a synonym for brain syphilis.
The treatment will depend upon the length of the interval which has elapsed between the primary symptoms of the original syphilis and the advent of the cerebral signs. When the latter appear towards the end of the secondary stage or soon afterwards, vigorous mercurial treatment will very probably cause complete resolution of the small-celled inflamma tory growth infiltrating the pia ma ter and extending along the arteries. Inunction should be commenced promptly. r dr. of the B.P. Ungt. Hyd. should be rubbed in daily till the effect of the metal upon the gums becomes evident, after which the inunctions should be suspended for several days, to be again renewed as soon as the signs of salivation fade. Salvarsan is clearly indicated in such cases, or Bacelli's intravenous method of intro ducing the Cyanide of Mercury into the circulation should be resorted to; 15 mins. of a r per cent. solution should be injected, and the effects kept up by inunction with mercurial ointment for a period of 8 weeks or by the intravenous administration of mercurialised serum.
As the disease shows a constant tendency to relapse, mercurial treatment must be renewed in short courses every 6 to 12 months; during the intervals Iodides in large doses should be steadily administered.
When meningeal signs and ocular paralyses, &c., manifest themselves in the tertiary stage, Mercury should also he employed, as spirochetx have been found in the brain lesions even after the lapse of several years from the primary attack. It cannot, however, be pushed as fearlessly as in the early cases, and reliance must he placed on large doses of the Iodides, which to be of use must be given boldly and for long periods.
Much advance has been made by the new method of administering Salvarsan or its substitutes and Mercurial salts by the spinal canal route. These have been enumerated under Locomotor Ataxy, where the technique of Auto-Salvarsanised Serum administration has been described. The danger of salvarsan in the presence of advanced degenerative changes in the kidney, heart or brain must not be forgotten, but when the symptoms and signs become grave even in syphilitic meningitis it should have a trial, but always in conjunction with mercury and iodides.
In a case under the writer's care, where a well-marked early attack of cerebral tumour 15 years previously yielded to inunctions of mercury, a grave seizure occurred accompanied by hemiplegic symptoms with aphasia and followed by coma of several days' duration. As the power of swallow ing was lost, 4o grs. Iodide of Sodium dissolved in 2 oz. water were admin istered by the rectum every S hours for a month, more than lb. of the salt being injected and retained. The rectal injections were continued after swallowing power returned because they gave rise to no irritation; the patient's condition steadily improved and the paralysis and aphasia gradually disappeared.
Even in the most chronic cases a short course of mercurial inunction is always clearly indicated, though the iodides must be persevered with as long as thers! is any possibility of gummatous formations being left un resolved. While gummata may remain quiescent in the periosteum of the long or flat bones and in other structures, their pressure is destructive to the delicate tissue of the brain, and treatment must be prompt, vigorous and long-continued.