Lettsomian Lectures on Syphilis as a Cause of Disease of the Nervous System
Authors: W. H. Broadbent
Journal: BMJ (1874)

THE fact that, in a large proportion of cases in which the nervous sys- tem is affected with disease arising out of syphilis, the secondary stage has been brief, or imperfectly represented, or absent, and that very rarely is the history of syphilis prominent, renders it very important make out, if this be possible, such a distinctive character in syphilitic affections of the nervous system, as will of itself serve to determine the diagnosis as confidently as in the case of a node or gummy tumour.We shall see later how far this is attainable; and an intermediate step to- wards the elucidation of the problem is the consideration of the pathology of syphilitic changes occurring in the nervous structures.The symptoms to which any disease of the nervous system gives rise will arise primarily from derangement of function of the parts affected; but the kind and degree of such disturbance will be greatly influenced by the nature of the morbid process and by its rate of progress.will make a great difference, for example, whether a tumour, at a given situation in the brain or cord, have its starting-point on the surface or the substance; whether it increase rapidly or slowly; whether grow at the expense of the nervous structure, causing no actual crease of volume, or add to the contents of the cavities and displace and compress the nervous matter.In considering, therefore, morbid conditions to which syphilis gives rise, we have to take account not only the morbid anatomy, but the general habits of disease.There are very large materials from which I might draw the account to be placed before you of the morbid changes produced by syphilis the nervous structures, but I shall avail myself almost exclusively of labours of Drs.Wilks and Moxon, whose contributions are at simple, clear, and comprehensive; indeed, I know nothing in pathology more admirable than their descriptions of syphilitic disease in the Guy's Hospital Reports.According to Dr. Wilks (Guy's Hospital Reports for 1863), in syphilis, there is a disposition to the effusion of a low form of lymph, or plastic material, in nearly every tissue of the body.When this tion comes to be examined after death, ithas generally had a existence in the organ in which it is found, and it presents under microscope fibro-plastic elements, small nuclei, fatty granules, and amorphous matter.As a rule, the deposits are hard and fibrous, not soft, as suggested by the term gummy or gummatous usually to them; but they may undergo secondary softening.There is specific in the individual elements, and, indeed, the notion of a structural element in any disease is now generally abandoned ; characteristic peculiarities exist, which have been more exactly by Dr. Moxon, who says :-" If one looks over a series of syphilitic changes, and compares these with any other forms of change, that the syphilitic cases have characters by which they are easily distinguished.These characters I will attempt to state."' Generally, a small part of the organ is attacked, and the is left quite free.The disease is strictly localised in the spot affects. 2.Its outer part is composed of fibrous tissue, which can be represent the natural fibrous supporting elements of the part of augmentation, while the functioning elements of the part dwindled away.It is a local sclerosis. 3. Its central part now celebrated caseous or gummatous faint yellowish matter and more elastic consistence, and less and less friability and curdiness, generally rather sharply distinguished from the fibrous outer sometimes softening down or calcifying.4.There are signs acute inflammation in the immediate neighbourhood, showing lymph, etc., or adhesions to the parts around; (3 and 4 may be Such patches,sharply contrasting with more healthy tissue about them, and (5) distributed more or less widely in organs, but especially in the testes and liver, are not a general that could be passed over as a common accident.Their characters attract attention.A syphilitic gumma in muscle or brain anything else, that, if seen for the first time by one who of the common run of pathological changes, it demands recognition of its peculiarities.In short, it is not common, but specific in the strict sense of the word.I mean, that we are not to suppose that these syphilitic changes are of a kind that are otherwise recognised as non-syphilitic, or in any sense of a 'common' kind.It is not so.They are quite peculiar, and strike the eye and the mind as peculiar.Allow that they have characters like the verbal stock descriptions of