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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    one of the latest affoctions of syphilis, still the eight months'case* shows the possihility of exception. Treatment is less effective in iiaraplegia than in most other nervous affections. Still, something can always be gained, and a cure may be hoped for, if too much time has not elapsed before treatment is com- menced ; often, where the effects of disease can not be removed, its course may be stayed permanently by an intelligent course of manage- ment. The bladder requires separate care (catheter, injections, etc.). Syphilis of Special Nerves.—Among the symptoms to be as- cribed to affections of special nerves must be mentioned the facts made out by the patient investigation of Fournier, of the occasional existence (especially in women) of localized areas of analgesia, which, while they may take place on nearly all the cutaneous surfaces, have, as a point of special election, the backs of the hands, where pinching and pricking of pins are often unobserved by patients so affected. This perverted sensibility, comes on early in the secondary period of syphilis, and, if not removed by treatment, gets well s])ontancously. But there are more positive symptoms, due to lesions of special nerves, requiring attention. The lesions occasioning them are numer- ous—syphilitic diseases of the long, bony canals through which they pass, pressure from neighboring gummy tumor, disease at the origin of the nerve, thickening of the nerve-sheath, interstitial neuritis, and interstitial gummata. From some of the above causes single muscles or groups of muscles anywhere in the body may become paralyzed, but it is impossible to systematize such lesions in a text-book. Suffice it to say, irregularly distributed paralysis without a valid explanation for its irregularity should always excite the suspicion of syphilis. The nerves most commonly affected are the seventh pair, the fifth pair, the motors of the eye, and the s])inal nerves. Lancereaux believes that the sympathetic may be specially involved, and, although there is no reason to the contrary, still nothing is absolutely proved in this direc- tion. The nerves of special sense do not always escape. The sense of taste is rarely injured, except by such ravages as destroy the palates (when smell and taste are both defective), and occasionally Avhere the tongue is the seat of syphilitic tumor (Zambaco). The sense of smell suffers in all the syphilitic necroses of the bones of the nose, especially where the ethmoid is involved. AVitli pachymeningitis about the base of the anterior cerebral lobes the olfactory bulbs may be involved. In such cases sight is pretty sure to suffer as well as the sense of smell. Sight may be impaired by gummy exudation in various situations, neuritis, etc. Galezowski f believes that, where the optic nerve is in- volved previously to its entry into the globe, sight is defective in both eyes. Many of the troubles of vision due to syphilis depend upon syphilitic changes in the media themselves of the eyes (see Chapter * Case VI, Van Burcn and Keyes. f Gaz. dcs n6p., 1866, p. 106.