The syphilitic affections of the nervous system / by J. Hughlings Jackson.

  • Jackson, John Hughlings, 1834-1911.
Date:
[1875]
Catalogue details

Licence: Public Domain Mark

Credit: The syphilitic affections of the nervous system / by J. Hughlings Jackson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    often a misunderstanding about the influence of reme'dies in such cases. For instance, it may be replied “ however indirect the pathological process may be, anti-syphilitic treatment does cure a patient of syphilitic hemiplegia.” It is really. no answer. In the first place, by the statement that iodide of potassium does no good for the kind ol syphilitic hemiplegia we are considering, I do not mean to say that the patient may not get rid of his paralysis whilst he. is taking that drug. Next, I deny that there is any evidence that the patient is cured by it. It is not sufficiently known that if the damage to the motor tract which causes hemiplegia be limited, the patient will get well without drugs, and this is so, whatever the nature of the damage may be—clot, or softening however caused. The statement one occasionally hears (1) that a patient cannot recover from paralysis when part of a motor centre is permanently wanting, and (2) the statement that prompt and complete recovery shews that there “ could not be” a destructive lesion, are simply not true. From not knowing that recovery is spontaneous in many cases of hemiplegia from local damage, erroneous conclusions are come to on therapeutics; the patient may get well of this variety of syphilitic hemiplegia, but our drugs do not cure him. Third variety of Syphilitic Hemiplegia (Hemiplegia after a Convulsion).—There is hemiplegia, almost invariably transi- tory, after a convulsion. This form of hemiplegia (the epileptic hemiplegia of Dr. Todd) is so very indirectly owing to syphilis that the convenience, even for utilitarian pur- poses, of the expression “Syphilitic Hemiplegia” is very dubious indeed. Syphilis is one of the commonest causes of this variety of hemiplegia. The causation is, however, we shall see, very indirect. We find post mortem in such cases a gumma in the mem- branes growing into the convolutions. What happened, I suppose, was that the gumma was first formed. Secondly (as explained under the head of Convulsion), the gumma, as a “ foreign body,” causes localised instability of grey matter —causes a “ discharging lesion.” The gumma is syphilitic, but the “ discharging lesion” is not, for a similar one is pro- ducible by a glioma. Thirdly, the convulsion is a result of a strong discharge of the locally unstable grey matter. Now for the fourth step, which brings us to the symptom spoken of. In some cases the patient is paralysed after the convulsion, that is, when the cerebral discharge is over. According to