disappeared together, when a syphilide appeared on the cheek. Zambaco quotes a case of Potain's where palsy was attributed to an enlarged lymphatic gland. If the paralysis of the seventh depends on intracranial disease, Duchenne supposes that the muscles will retain their excitability to electricity, but lose such irritability if the paralysis depends on disease along the course of the nerve after it has left the brain. Sense of Taste.-Zambaco relates cases where the sense of taste was lost in persons whose tongue was enlarged by a syphilitic tumour; as the mass grew less, the taste was restored. The taste is also destroyed where the patient has lost the soft and hard palates by ulceration, when the faculty of taste is generally removed with that of smell; still permanent complete loss of taste is exceedingly rare. THE EYE AND ITS APPENDAGES. The eye may be displaced forwards by a periosteal tumour in the orbit, or its motion and function may be impeded by paralysis or disease of the nerves, as described in the chapter on nervous affections, page 184. Lachrymation sometimes accompanies iritis, but is of little importance. It has been already related that the eyelid is now and then the point of introduction of the disease. In such cases the indurated surface often covers a considerable extent; it is also the seat of papular eruptions, gummy tumours, and creeping lupoid ulcers, with their shining white scars, like other parts of the face. If the papule is situated along the margin of the lid, it developes into a mucous tubercle; the lashes implicated in the tubercle sometimes fall, but new ones replace them as the affection subsides. The conjunctiva around the papule often grows dull red, and swollen, while large vessels course over its surface. A little lachrymation is usually the only Ptosis is often Catarrhal ophthal inconvenience attending this conjunctivitis. present with the motor palsy of the eye. mia is not uncommon in young children, but it has no characters distinguishing it from catarrhal ophthalmia from other causes. Fall of the lashes and tinea tarsi also occur now and then in the course of syphilitic eruptions of the skin. Of the cornea, the most important affection is interstitial keratitis, or syphilitic corneitis. This affection of the cornea occurs in children most commonly when from ten to fifteen years of age it is nearly always, if not, as Mr. Hutchinson1 thinks, always, a sequela of inherited syphilis. When the disease is commencing, opaque spots form in the cornea, dotted throughout its substance, except near the borders. The spots gradually coalesce, and produce an opacity that is general, but denser at some points than at others. When the affection is very severe, vascular loops sometimes form round the opacities in the cornea; if they are placed near the surface the vessels can be seen to be continuous with those in the sclerotic conjunctiva.2 On rare occasions, lymph is exuded on the posterior surface of the cornea, and may completely hide the iris, without, however, implicating that membrane. The symptoms observed by the patient are chiefly dimness of vision, a feeling of distension in the eye-ball, and intolerance of light. Iritis is sometimes set up by extension of the inflammation from the cornea. Both eyes are usually affected; generally one a few weeks after the other, not simultaneously. Should the patient have passed through his second dentition, the upper incisor teeth will be notched. There may be scars of old ulcerations about the mouth, 1 Ophthalmic Hospital Reports, vols. i. and ii. pp. 196 and 521. an earthy complexion, and other affections first pointed out by Mr. Hutchinson to be of syphilitic origin. Corneitis is, in the majority of cases, terminated by resolution; now and then, partial opacity is permanently left in the cornea. Iritis. In adults, iritis has two forms-an early one, coming on during the course of the papular and scaly eruptions; and a later one, with the tertiary sequelae of syphilis. This iritis is said to be most frequent in persons of feeble constitution. Its occurrence cannot be traced to any local irritation, and it may even appear while the system is under the influence of mercury. Syphilis, according to Von Graefe, is the cause of 60 per cent. of iritis from all causes : Arlt met with it 26 times in 162 cases, Hasner 34 times in 81 cases. The symptoms of this affection are almost identical with those of non-syphilitic iritis. In the exanthematous, or early variety, the progress is rapid, exciting constitutional disturbance, sometimes only in a very slight degree, sometimes to a large amount. Pain is felt radiating along the brow, and around the orbit, worse at night, and generally accompanied by intolerance of light, especially of candlelight. Misty vision, from obscurity of the anterior chamber, and deposit of specks on the posterior layer of the cornea, is a common symptom. Anatomical Characters.-Injection of the ciliary vessels alters the hue of the whole of the iris, and renders it dull. Blue and grey eyes assume a greenish tint; the pupil is contracted, irregular, and less sensitive than in health; the iris shrinks back against the lens, and the anterior chamber is increased in size; the sclerotic around the iris is marked by a pinkish zone of congestion. These changes in the iris often extend to the lens, sclerotic, choroid, and other internal structures 1 Deutsche Klinik, S. 208. 1858. Zeissl, loc. cit., S. 294. of the eye, when the symptoms become mingled with others dependent on those lesions. Most commonly one eye only is attacked at first, but relapses are very frequent, and then usually both eyes are affected. The most frequent ending of iritis is resolution, even when left entirely to itself; but adhesion of the iris to the lens, or even complete closure of the pupil, sometimes remains permanently, or the lens may be irremediably injured in its refractive power, and the cornea obscured by opacities. In the late, or gummy form of Iritis, nodules or masses are produced in the substance of the iris, of similar structure to those in the liver, and elsewhere, as was shown by the microscopical examination of one that completely filled the pupil, which, as it did not subside under the influence of mercurial and other plans of treatment, was excised by Alfred Graefe. The course of gummy iritis is insidious; the pain, usually very little, is confined to distress at night, and under a strong light the sight becomes dim, objects being shrouded in a fog; the iris soon swells at one or two points, where nodules of a yellowish tint form, the size of a pin's head, or less; but they enlarge, until they even Occupy the whole anterior chamber. These nodules last a long time, but are ultimately absorbed, or in very rare instances, they liquify into pus. They may be repeated through an indefinite period, the old ones disappearing as fresh ones form in another part of the iris. Under such circumstances, adhesions of the iris to the lens or cornea frequently take place. The nodules sometimes become vascular, and the vessels may be visible on their surface. Choroiditis and retinitis often co-exist with this, as with the early form of iritis. The limited extent to which the iris is 1 Archiv für Ophthalmologie, Bd. viii., 1ster Theil, S. 288. attacked at one time is peculiar to this form of iritis; gummy nodules develop at one or two points, which are rarely accompanied by general parenchymatous inflammation, but is usually followed by atrophic change in the part affected. Iritis in Infants.-Mr. Hutchinson 1 has described a form of iritis which attacks infants with inherited syphilis, where the symptoms differ from iritis in adults in the following respects: One or both eyes are affected indifferently, but the cornea and sclerotic generally escape; the course and symptoms are insidious, and the disease is easily overlooked, though readily detected, when searched for, by the copious effusion of lymph it affords. Except in these characters, the disease is the same in infants as in adults. It is accompanied by other forms of syphilis, is not more severe or extensive in feeble than in robust patients, and it is readily controlled by mercury. Mr. Hutchinson found the commonest age in 21 cases to be five months. Mr. Hutchinson has also met with several forms of iritis in children and young adults, affected with inherited syphilis ; the corroboration of their syphilitic origin consisted mainly in the syphilitic aspect and the notched teeth of the patients. Choroiditis and Retinitis.-These affections, like the early iritis, may appear, but less frequently than that affection, along with the early cutaneous eruptions. They are sometimes, though seldom, unaccompanied by iritis. In choroiditis there is slight pain in the eye-ball, becoming sometimes intense, and likened to a fulness or bursting sensation. Misty vision, increasing, not unfrequently, even to total blindness, is a principal symptom. When the retina is also implicated, iridescent corpuscles, bright lines, flashing of light, grey spots, are complained of, and, according to 1 Med. Times and Gazette, July 14, 1860; Ophthalmic Hospital Reports, vol. i. pp. 191, 226. |