Meningitis, arteritis and choroiditis in a child the subject of congenital syphilis : gummata on cranial nerves; disease of cerebral arteries; cicatrices of liver and spleen in a case of congenital syphilis / by Thomas Barlow.

  • Barlow, Thomas.
Date:
[1877]
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Licence: Public Domain Mark

Credit: Meningitis, arteritis and choroiditis in a child the subject of congenital syphilis : gummata on cranial nerves; disease of cerebral arteries; cicatrices of liver and spleen in a case of congenital syphilis / by Thomas Barlow. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    In the fundus of each eye I saw sparingly distributed very small flecks of exudation of brownish colour, apparently situated in the choroid. There was scarcely any disturbance of pigment, and no atrophy. So far as I could judge there was no alteration in the optic discs. At that time I had never seen anything quite like it except once, in a young man who was the subject of acquired syphilis and who was suffering from an attack of recent hemiplegia probably the result of syphilitic thrombosis. I have since seen one case identical in appearance in a child the subject of congenital syphilis with nervous symptoms, and in whom I have traced some of the spots on to the atrophied condition with which one is familiar in choroiditis disseminata. It cannot be too strongly stated that the opthalmo- scopic appearances in E. W— were as different as possible from the milk-white, round, larger defined spots which are recognised as tubercle of the choroid. When I saw these changes in the choroid I felt the strongest suspicion that there must be also some disease of the membranes of the brain. The child died without any further nervous symptoms, apparently from exhaustion and marasmus. At the post mortem, which Mr. Nettleship and I made together, there was nothing morbid about the thoracic and abdominal viscera, but the condition of things inside the skull was very remarkable. The changes were considerable in extent of area, but not in depth or thickness. The bones were healthy. Eirst there were several spots where there was slight adhesion of the dura mater, arachnoid and pia mater. At the base near the optic commissure there was one small thin patch of greenish lymph. The Sylvian fissures were glued by thin, old exudation. In many places both on the vertex and on the under surface of the temporo-sphenoidal lobes the pia mater was extremely thickened, and fibrous in fact. On the upper surface of the left parietal lobe there was a very small thin patch of calcification. The vessels of the circle of Willis were natural. The most interesting changes were very obvious ones in some of the small vessels of the cortex. They could be traced in one or two places for some distance apparently natural, then becoming dirty white in colour, without either dila- tation or narrowing. The appearance was in fact, as Dr. G-reen- field has described it, like a white thread. Nowhere could the most careful examination detect any granulations in the pia mater.