Case 1.—There was, in the following case, no history of syphilis, but the appearances post mortem seem to me to warrant the diagnosis. It may be asserted that the severe blow on the man's head was not merely, as I suppose, the determining cause of intra-cranial syphilis, but that it alone, without the predisposing help of syphilitic taint, led to the changes discovered post mortem. The nodules in the testis, however, were, I think, pretty conclusive evidence that all the blow did was to determine syphilis locally. The cicatrices in the liver were more than merely suggestive. Further, the disease of the cerebral arteries was quite like that seen in cases in which there is such evidence as nodes to demonstrate the existence of syphilis. The first attack of hemiplegia, if not the second, was due doubtless to local softening consequent on thrombosis of a syphilitic artery. Such an indirect mode of production of paralysis in syphilitic cases must always be carefully considered. It has been described in this country by Bristowe, Wilks, Moxon, Broadbent, Buzzard, and myself. I have recorded several cases.—“Lond. Hosp. Rep.,” Vol. 4, 1868.
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