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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    with hardening or spots of softening, and gummy tumor. It has not yet been distinctly made out whether or not locomotor ataxia may be directly due to syphilis. The matter is still a question of controversy, but the almost universal testimony is that a majority of the patients with ataxia and irregular ataxic symptoms have had syphilis, and another fact is not less clear, namely, that many such patients derive more improvement from a thorough antisyphilitic course of medica- tion than through any other means of treatment. There is a vast amount of literature and statistics upon this subject, but the general facts are as above stated, and the natural deduction is that it is only just to a patient with ataxic symptoms, if a history (or a suspicion) of old syphilis exists, to give him the benefit of the doubt, and to ply him vigorously with a thorough specific course of medication before resorting to the means commonly employed against ordinary locomotor ataxia. Cure can not generally be obtained, but improvement may be, and if the treatment is commenced early the disease may at least be stayed, as I have witnessed more than once. SypMUtic paraplegia is very rarely complete. The impairment of motion usually comes on gradually many years after chancre. The ex- tremes of time, as observed by the authors, are eight months and twenty- one years.* The bladder always suffers, sometimes before the general attack, always during its continuance, and general treatment has but little effect over this symptom. The sphincters are rarely, if ever, re- laxed. The expulsive power of the rectum is usually greatly dimin- ished. Sensation is not affected as a rule. In a few cases (Petrequin, Zambaco) there has been loss of sensation in the legs without loss of motion. One case of syphilitic paraplegia has been observed by the authors in inherited syphilis, the child being five years old.f There is rarely any complaint of pain in the back while the disease is coming on, but it may occur, together with numbness of the extremities. Convulsive motions are rarely present. The feeling as of a girdle around the body is quite common, but not pathognomonic. The affection rarely comes on until long after all symptoms, secondary and tertiary, have disap- peared. Zambaco J believes that the only peculiar sign by which syphilis may be distinguished as a cause of ]3araplegia is rapid amelio- ration under treatment commenced promptly. Lancereaux states that incomplete paraplegia, with pain along the nerves and contrac- tion of muscles, indicates meningeal lesion ; while complete para- plegia, no pain, and preserved reflex motion, indicate medullary lesion. The intellect is usually sound with paraplegia, but emotional irregu- larities can usually be detected on study. Paraplegia does not neces- sarily imply that the preceding syphilis has been severe, and, although •■ Loc. cit. f Case XXVII, Van Burcn and Keyes. X Op. cif., p. 927.