Numerous observations have been made on the pathology of pro gressive paralysis (Alzheimer, Hirsch], Meyer). The brain is atrophic, the convolutions are narrowed, the pia greatly thiekened, cloudy and adherent to the cortex; the basal ganglia often exhibit marked atrophy. Microscopically we find pronounced leptomeningitis, syphilitic endart eritis, increase of connective tissue in the meninges and in the brain, and considerable atrophy of nerve fibres, particularly in the deeper layers of the cortex; the radiation of fibres in the medulla is diminished. In the spinal cord sclerotic changes are sometimes seen in some of the columns.
Treatment is absolutely powerless in progressive paralysis.
G. Other Di.eases of the Spinal Cord due to Hereditary Nyphilie.—In addition to the affections in which spinal symptoms are associated with disturbances of the cerebral function (Siemerling, BOttger, Lamy, Sachs, etc.), and in addition to tabes dorsalis, which we have been dis cussing, children affected with hereditary syphilis exhibit certain condi tions which by their clinical course as well as by their pathology, point to some lesion of the spinal cord alone.
From the pathologic investigations of Gasne and Gangitano already referred to, it appears that, newborn syphilitic. children often exhibit extensive pathologic changes in the spinal eord of the nature of a diffuse or a circumscribed meningomyelitis, which is usually associated with other organic diseases and destroys the child's life. According to Gilles de la Tourette, spastic paralysis may result front this condition if the child survives and may simulate the clinical picture of universal rigicl ity (spastic paraplegia).
More important than the above are those cases of spinal syphilis in which clinical symptoms develop late. Gilles de la Tourette recognized two groups, depending on whether the disease begins in earliest child hood_ or at a later period of life. The symptomatology of these condi tions consists in paraplegia of sudden or gradual onset, pain, sensory disturbances, flaccid atrophic palsies and disturbances of urination and defecation. The grouping of the symptoms may be such as to suggest, in some cases, circumscribed myelitis or gumma of the spinal cord; in other cases, a diffuse inflammation extending over the entire cross section of the cord. Cerebral symptoms usually make their appear ance at the same time.
Among special forms of spinal syphilis the following should be phasized: Fournier described what appeared to be a spondylitis, followed by paresis of the legs which yielded to treatment with the iodides. Hoffman reported a case of simple spastic spinal paralysis ling the spastic spinal paralysis observed in the syphilis of adults, and described by Erb (cases of VC11 -Mendel, Luzenberger, achs, Nonne, etc.). Friedmann knows of cases with repeated attacks of spastic sis in the legs, with weakness of the bladder, lasting several months, followed by temporary recovery. Ee regards the condition as a liar relapsing form of spastic spinal paralysis depending upon hereditary The prognosis in these cases of simple spinal syphilis is not so unfavorable as that of tabes. Vigorous treatment with the iodides and bichloride of mercury is often followed by arrest or complete cure of the disease. The cases in which the disturbances are congenital or develop in earliest childhood are more unfavorable.
II. Peripheral Palsies.— Multiple reuritis due to hereditary syphilis is unknown. One case reported by Nonne, although quite characteristic, lacks the proof of a syphilitic basis. Palsies of individual ocular muscles of temporary character (Zappert), pupillary rigidity, and diseases of the fundus have been observed as isolated symptoms, but probably represent only separate stages in the course. of brain syphilis. Deafness of rapid onset and due to central origin labyrinthina deafness) is a well known late symptom of hereditary syphilis.
For syphilitic pseudoparalysis see the chapter on hereditary syphilis. There is no doubt that this temporary paralysis of the arms in infants in the majority of cases is due to syphilitic osteochrondritis: but the peculiar type of this reflex paralysis and the occasional occurrence of cases without any demonstrable bone lesion are worthy of note. Since, however, palsies of this kind are associated with contractures (Doucas, Detnetriades, Reuter), with ptosis (Sandoz, Soltniann), with (Julio pupillary symptoms (? Peters), and in view of the absence of bone lesions as shown at the autopsies of otherwise typical cases tScherer), it is a question adenoch, Roamer, Reuter and Pollack) whether diseases of the bone can be properly regarded as the cause in all these cases pre senting the picture of a pseudoparalysis.