The surgical diseases of the genito-urinary organs including syphilis / by E.L. Keyes ; a revision of Van Buren and Keyes's text-book upon the same subjects.

  • Keyes, E. L. (Edward Lawrence), 1843-1924.
Date:
1889, ©1888
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Licence: Public Domain Mark

Credit: The surgical diseases of the genito-urinary organs including syphilis / by E.L. Keyes ; a revision of Van Buren and Keyes's text-book upon the same subjects. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    (Bristowc*). and consoquent cutting off of the t^ni)ply of blood from a part, acting in the same way as an embolus ; but, as a rule, as Lan- cereaux observes, softening of the braiji due to syphilitic encephalitis may be distinguished from softening dependent on arterial oblitera- tion by the absence in the latter of any product of new formation. The softening in 83'])hilitic encephalitis is due to the fatty metamor- phosis of the newly-formed tissue. {b) Gummy Tumor.—Gummy tumors of the brain-substance are rare. It has been even doubted (Wilks, Ileubner) whether they ever occur except in connection with a gummatous process arising in the pia mater or in connection with a surface tumor. They occur in the cerebrum and cerebellum, chiefly toward the periphery of the cere- brum, in the anterior and posterior lobes. They are found of varying sizes, single or grouped, nearly always surrounded, whether single or multiple, by a dense fibrous envelope. They arc white or yellow in color, of consistence either firm, cartilaginous, or fibrous, or soft, lique- fied, or cheesy, dejjending upon their age and greater or less degree of fatty degeneration. Little masses of proliferated connective tissue are sometimes found along the course of the vessels. Gummy tumors are subject to the same retrogressive metamorphosis in the brain as else- where. They soften, and may become totally absorbed, leaving dense fibrous cicatrices behind ; they may calcify, or finally, as shown by Lancereaux, the tumor may be absorbed, leaving the fibrous envelope permanently patulous as a cyst, containing a serous fluid, the whole surrounded or not by softening. Such cysts are distinguishable from cysts the result of apoplectic effusion, in that the walls of the latter are impregnated with the coloring-matter of the blood in an amorphous or crystalline state, and from the result of infarction by the condition of the arteries. The lesions of the substance of the cord, far less fre- quent than those of the brain, are yet anatomically identical with them : sclerosis, softening, gummy tumor. It must not be forgotten, in connection with the brain-lesions due to syphilis, that local effusions of blood from previously-diseased ves- sels, aneurismal or otherwise, in the brain or in the cord, are often the immediate cause of the startling symptoms appearing suddenly during the course of the disease. The plugging up of an artery from syphilitic disease of its coat often also occasions the sudden appear- ance of symptoms. 4. Lesioxs of the Ceeebral Artekies.—Ileubner's investiga- tions in this field have thrown new light upon the pathology of those forms of cerebral syphilis in which, after death, the older observers found no lesion, and tlierefore called the disease cerebral syphilis sine materia. A modern pathologist would probably have found the materia in syphilitic thickening of the arterial coats, a change not * Lancet, June 15, 18'72.