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On Syphilitic Affections of the Nervous System

  • J. Hughlings Jackson (a1)

I wish here to give as briefly as possible an account of the pathology of the nervous symptoms which result from syphilis. Of necessity there is considerable recapitulation from former papers I have written. For syphilis produces very different affections of the nervous system, and I have therefore had to speak of syphilis when considering Amaurosis, Epileptiform seizures, Hemiplegia, &c. It is, however, justifiable to bring together the conclusions one has arrived at about syphilitic nervous affections from the study of nervous affections in general.

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Of syphilitic disease of the spinal cord, however, I do not wish to say anything, because I have not yet seen a single case as proved post mortem. There are very few cases of this kind with post mortem examinations on record; there ought, therefore, to be more hesitation than there is in ascribing paraplegia to syphilis.

It is for this reason that I have urged that we should make a distinction betwixt the physiology (abnormal, of course) and the pathology of a case of nervous disease. There are the two (abnormal) physiological conditions of nervous tissue (loss of function and over function). The pathological processes begin, ning in non-nervous tissues of nervous organs, by which the loss of Function or the over-Function result, require separate investigation.

I know nothing of eyphilitic meningitis. Need I say that I except cases of meningitis from bone disease, the result of syphilis.

I may here remark that I only know of one kind of change in the optic nerves from intracranial tumour, syphilitic or other, and this I call optic neuritis. There are all degrees of this change, from a climax of great swelling with haemorrhages to white atrophy. I do not recognise a swollen or choked disc, from raised intracranial pressure. There is a swelling of the disc in some cases of tubercular meningitis and pyaemia. The swelling is, I believe, from venous thrombosis; but I have had no demonstration of it.

It is not due to diplopia, as is commonly supposed, but to erroneous estimation of position of objects by the one eye which is lamed.

From facts of this kind I have long been driven to the conclusion that the units of the cerebral hemisphere represent, not only the large muscles of the body, but the heart, viscera, &c. It seems to me, that this is a conclusion one must reach d priori, if we take careful note of emotional manifestations.

I used to say (Study of Convulsions, St. Andrew's Transactions, 1870) “ of the nerve fibres which pass from the part discharged to the muscles convulsed.”

Really this cannot possibly be the explanation, because there will occur after convulsion absolute, and yet transitory, paralysis of a part, of the arm for example, when there has been no trace of affection of consciousness, and not the least embarrassment of respiration in any part of the convulsion. Moreover, the convulsion has affected most the parts paralysed, a “ coincidence” not explainable on the theory here disputed.

As to peculiarities of insanity, in such cases as those called Phthisical Insanity, I must say that I see no other explanation than that these peculiarities arise, not from the particular morbid process, but from the inherited or acquired temperament of the patients who become insane.

I have stated that such a classification is not intended for direct utilitarian purposes; for these we must have empirical arrangements.

I would here urge again that the absolute distinction of epilepsies into cases in which consciousness is lost, and cases in which it is not lost, is not a distinction of either anatomical or physiological parentage. It is probably due to the common metaphysical habit of mind, which considers consciousness to be an entity. The distinction, even empirically, is into cases in which consciousness is lost, first of all, early or late, in the paroxysms.

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The British Journal of Psychiatry
  • ISSN: -
  • EISSN: 2514-9946
  • URL: /core/journals/the-british-journal-of-psychiatry
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On Syphilitic Affections of the Nervous System

  • J. Hughlings Jackson (a1)
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