The Treatment of So-Called Impassable Urethral Stricture
Authors: G. B. Browne
Journal: BMJ (1892)

IMPASSABLE " URETHRAL STRICTURE.[I IAL 1165genital examples.I 2 But the question arises whether con- genital syphilis is an important agent in the causation of such nervous %disorders as infantile hemiplegia, cervical opisthotonos, and the clinical conditions which are due to sclerosis of the convolutions.Hemiplegia.-Infantile hemiplegia is conveniently classified on clinical grounds into cases (a) having an acute onset, (b) having no definite onset.Many of the latter are, no doubt, due to meningeal heemorrhage occurring during labour; but this cause cannot always be invoked.In fifteen cases of this class I found evidence of congenital syphilis in the family or personal history in four or five inetances, without any his- tory of difficult labour.Hemiplegia with acute onset is particularly common under the age of 3 years, and although a certain number follow the acute specific fevers, the greater proportion arise without apparent cause.Embolism at this period of life may be practically excluded.There is reason to think that the lesion is usually either thrombosis or haemor- rhage, so the inquiry resolves itself into the causation of arterial degeneration in young children.Pathological investigations ,on the condition of the vessels in inherited syphilis are not *numerous, but sufficient evidence has accumulated to show that arterial disease is not so uncommon as was formerly supposed.3I have lately found marked arterial changes in an infant, aged 6 weeks, in whom there was advanced cirrhosis of the liver, with unmistakable evidences of congenital lsyphI 18.There is considerable divergence of opinion among purely -clinical observers as to the influence of congenital syphilis as a cause of infantile hemiplegia.Osler4 ascribed only one case out of 120 to syphilis; but it must be remembered that many of his observations were made years after the attack, when the evidences of syphilis were not readily to be made out.Abercrombie, whose investigations were made soon after the attack, ascribed 4 at least to syphilis, probably 6, out of a series of 50 cases ;-5 2 cases only out of 83 analysed by -achs and Peterson were ascribed to inherited syphilis.6Marie, Fournier, Henoch, and Hutchinson evidently consider infantile hemiplegia as being rarely syphilitic.Clinical ,observations at hospitals devoted to children's diseases appear to indicate that syphilis may have a more important .etiologicalshare than is generally allowed.Out of 25 cases of hemiplegia with acute onset, I found no history bearing on syphilis in 9; in 3 instances special inquiries were not made *on this point; in 5 there was-a suspicion of syphilis, and in 6.the evilence was stronger; in 2 cases the children were cer- tainly syphilitic.CASE i.-In a child, aged 9 years, there was ulceration of the palate and -caries of the nasal bones, as well as iritis and keratitis.The patient had been taking mercury for three months, when epileptiform attacks oc- -curred.At the end of six months, in spite of treatment by mercury, -hemiplegia supervened and the child subsequently became idiotic.CASE II.-A boy, aged 10 years; hemiplegia had occurred when he was 1 year and 9 months old.He had interstitial keratitis and extensive choroidal atrophy.CASE iii.-Syphilis was suspected in a child, aged 14 months, who had ,two distinct attacks of hemiplegia.CASE Iv. -In another case, an idiotic child, probably syphilitic, was attacked suddenly with hemiplegia.CASE V.-In another patient, hemiplegia occurred at the age of 7 years, and after the lapse of five years the limbs on the opposite side gradually became rigid, possibly from chronic meningitis or sclerosis of the con- volutions.Cerebral &lerosis.-There is good evidence that sclerosis of -the cerebral convolutions is sometimes due to inherited syphilis.In one case, in which there was slowly increasing rigidity of the arms and legs, with mental impairment, in a child aged 2 years, I found marked sclerosis of the convolu- tions.In the notes it was simply stated that the child had suffered from snuffles and a rash on the buttocks in babyhood, but I found afterwards that the father had been under the 'treatment of one of my colleagues for syphilis before the birth -of the child.2 Syphilitic (Hereditary) Disease of the Nervous System, by Dr. Barlow