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Nervous Symptoms in Cases of Congenital Syphilis

  • J. Hughlings Jackson (a1)
Extract

Some years ago I published a pamphlet (reprinted, with slight alterations, from the “St. Andrew's Medical Graduates' Transactions,” vol. iv., 1868) on Nervous Affections in Inherited Syphilis. At that time I had had bat one post-mortem examination. The patient was a girl, the daughter of the patient Joseph Mx., whose case is the second of two related by me in this Journal for July, 1874. She had epileptic fits. She died of typhoid fever, and no lesion of a syphilitic nature was discovered post-mortem. Thus I learned nothing from this case. In the “Brit. Med. Journal,”* May 18, 1572, I have reported a case of hemiplegia, previously unpublished, in a woman aged 22, who was manifestly the subject of inherited syphilis. That patient was in good general health, and is, I hope, still living.

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* There are, unfortunately, two printer's blunders in the article in that Journal. In the 17th line from the top, for “such evidence of hemiplegia,” read “such evidence of congenital syphilis;” and in line 23 from the bottom for “his upper central” read “her upper central.'

* I do not mean that lead-poisoning may not lead indirectly to hemiplegia, for in some cases we find gout, chronic renal disease, and arterial degeneration. So, in a roundabout way, lead-poisoning may “cause” hemiplegia.

* The following extract from the pamphlet mentioned at the beginning of this article embodies some of Mr. Hutchinson's opinions:—”It is important to keep in mind the fact that this valuable test of the existence of a syphilitic taint in a family is to be found usually in but one of the children of that family. It is to be particularly observed that although Mr. Hutchinson has described many dental peculiarities in children, he relies only—for a test of congenital syphilis—on a certain malformation of the two upper central incisors of the permanent set, Normally these teeth are chisel shaped, i.e., broader at their cutting edges than at their insertions into the gum. The malformation which Mr. Hutchinson has discovered to be a sign of congenital syphilis consists (First) in a reversal of the normal shape so far as this, that the two teeth above-named are narrower at their cutting edges than at their insertions into the gum. Hence they are then, as Mr. Dixon has observed, like ‘screw-drivers.’ (Second) The teeth are often notched. Hence such teeth are often called ‘notched tceth.’ It is well to add that Mr. Hutchinson attaches no special importance to ‘bad teeth,’ to ‘irregular teeth,’ &c, but, I repeat, to a particular kind of malformation of two of the permanent teeth.”

* I remember once seeing in Mr. Hutchinson's practice a boy who had the dental malformation, and who was brought for amaurosis from optic atrophy; keratitis came on whilst he was being treated for the amaurosis.

* The words in inverted commas are his mother's statements.

* We had a patient in the London Hospital, who, fatally ill from large cerebral hæmorrhage, was seen by Dr. Sutton and Mr. Lewis Mackenzie to twirl his moustache very elaborately every now and then. Except for this the man was to all appearance deeply comatose, and died a few hours later. It would be as reasonable to say that the clot of blood “caused” this moustache twirling, as to say that syphilitic disease or cerebral atrophy “caused” such symptoms as “hiding tools.”

* “On retrouve les traces de cette persistence partielle de l'intelligence jusque dans les formes les plus avancées des dégénérescences héréditaires. Il n'est pas rare, au milieu de l'anéantissement des facultés psychiques qui caractérisent l'idiotie héréditaire, de voir survivre une faculté intellectuelle. Ces êtres dégénérés possedent pour la musique, le calcul, le dessin, la poésie, etc., une aptitude instinctive, native, qui paraît d'autant plus extraordinaire que le contrasts la fait briller d'avantage.”– La Folie Héréditaire par le Br. Legrand du Saulle.

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The British Journal of Psychiatry
  • ISSN: 0368-315X
  • EISSN: 2514-9946
  • URL: /core/journals/the-british-journal-of-psychiatry
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Nervous Symptoms in Cases of Congenital Syphilis

  • J. Hughlings Jackson (a1)
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