Galezowsky, a peculiar inability to appreciate compound colours-green appearing yellow, &c. The accession of amaurosis is rapid in direct proportion as the retina is implicated, inflammation of this membrane being the most common cause of syphilitic amaurosis. When vision is totally lost, the pupils are fixed and insensible. When the eye is examined by the ophthalmoscope, the posterior part of the choroid, according to von Graefe, is found dotted with white, opaque spots, or brownish areolæ. The vessels of the choroid, at first congested, are seen to be shrunken in the later stages, and the vitreous humour is turbid with grey floating flakes. When the retina is involved, it is marked by distinct venous hyperæmia; it is also less translucent than natural, and presents a bluish reflection. With the magnified direct image it is seen to be striated in appearance. Instead of many spots, a solitary patch of effusion is placed at the entry of the optic nerve, extending to the macula lutea this patch is really on the choroid, but it penetrates sometimes to the surface of the retina. Amaurosis from retinitis is the form most easily dissipated by specific remedies. If the patch has long been formed, though treatment be applied, it cannot be wholly removed, and the sight is never completely restored.

The Diagnosis of the syphilitic affections in the eye is formed mainly from the presence of syphilitic affections in other parts of the body, and from the history of the The affections of the eye are most usually, but not always, accompanied by some eruption on the skin. It is common for several parts of the eye to be invaded simul

case.

1 Gazette des Hôpitaux, No. 106, 1866.

2 Deutsche Klinik, S. 208. 1858.

3 Hutchinson Med. Times Med. Journ., Feb. 24, 1866. P. 245.

and Gazette, Sept. and Oct. 1861, and Brit. Bader: Ophthalmic Hospital Reports, vol. i.

taneously, so that more than one of the tunics is the seat of structural changes almost peculiar to syphilis, such as interstitial corneitis, choroiditis disseminata, and nodular iritis.

The prognosis in most syphilitic diseases of the eye is favourable, if treatment be applied early, before fibrous adhesions have had time to form; but unfavourable when the disease is of long standing, and in such cases, the sight is seldom perfectly restored.

SUMMARY.

Nervous affections are excited by disease of the meninges, and of the brain or nerves themselves; the former more frequently disturbs the function of the nerves. Chronic interstitial condensation of the bone, the dura and pia mater, and brain is one form of these structural changes; the other, peculiar to syphilis, is development of gummy nodules in the midst of the indurations. The first causes, in the bone, exostoses and ivory-like thickening; in the meninges, tough adhesions; and in the brain, increased consistence. of the parts where interstitial inflammation is going on, and softening of neighbouring parts, through the defective. nutrition, which comes of the impeded flow of blood in the shrunken vessels. The gummy nodules are found on the convexity and at the base of the brain, where they spring from the meninges, or in the more vascular parts of the interior, when they originate in the brain itself. Their histological structure is similar to that of gummy growth elsewhere. The diagnosis of these tumours depends more. on the presence of syphilis in other parts than on wellmarked peculiarities of their own; still, they are often very different in appearance from tubercle, or from fibrocellular tumour of the brain.

The symptoms of disease in the brain depend greatly on the locality of the lesion. If on the surface of the brain, convulsions, delirium, and dulness of the intellect are usual. General wasting paralysis is caused when the surface of the brain is greatly diseased by slow induration and adhesion of the pia and dura mater. Muscular rigidity has been noticed in the progress of a syphilitic tumour outside the brain. When the growth is at the base, hemiplegia is a prominent symptom. If the gummy mass grow inside the brain, constant headache, giddiness, and confusion come first; coma and convulsions follow later in the progress of the disease.

Of syphilitic disease of the spinal cord little is known. Paraplegia, slow in development, and, to a great extent, controllable by iodide of potash and mercury, is the leading symptom. Paralysis is sometimes well marked during life in patients suffering from syphilis, but in whom, after death, no structural alteration in the brain or spinal cord is to be found. Local palsies are met with in syphilis; they are generally consequent on disease confined to the nerves attacked. The ulnar and the sciatic nerves among the great nerves of the trunk, and all the cranial nerves are oftenest thus affected.

Of the morbid lesions of the organs of special sense little is known except of those attacking the eye. Papular and other eruptions often affect the lids, and mucous patches form on the conjunctiva. In children, after the second dentition, the cornea is the seat of interstitial keratitis, which usually subsides under treatment without permanent injury. Iritis is common within the first six months after infection during the papular eruption, and is very apt to relapse many times during the progress of the disease elsewhere. When occurring in the later periods, it is often combined with disease in the choroid and retina.

The distinguishing characters of the early iritis are, a red zone in the sclerotic round the iris, dulness of the inflamed iris, sluggishness or irregularity of the margin of the pupil when the iris contracts or expands. In the late iritis, the nodules of lymph are plainly seen at one or two points on the surface. Both varieties if untreated often cause synechia or other injury to the eye. The early one may subside without leaving permanent injury behind. Iritis is also very common in infants who inherit syphilis. Choroiditis and retinitis frequently cause amaurosis; irregular patches of an inflammatory kind form on the retina or on the choroid beneath it, and these, if they are neglected, cause permanently defective vision, but if treated in an early stage are generally capable of complete cure.

SYPHILIS.

CHAPTER IX.

GENITO-URINARY ORGANS.

Urinary Organs: Urethra-Bladder-Kidneys, Partial Cirrhosis, Nodules, and Amyloid Degenerations-Male Genitals: Corpora Cavernosa-Epididymis -Cord-Prostate-Testis, General Interstitial Inflammation, Nodules, Wasting, Symptoms - Female Genitals: Vagina, Ulcerated Gummy Deposits - Nymphæ - Uterus, Placenta - Fallopian Tubes - Ovary – Breasts-Summary.

THE URINARY ORGANS.

The Urethra is the site of chancre and erosions near its orifice, beyond this the mucous membrane is rarely attacked. Virchow1 relates an instance of ulceration of the membranous and prostatic part of the urethra, extending into the bladder, which he attributed to syphilis.

Nothing is known of the way in which syphilis affects the bladder, ureters, or pelves of the kidneys.

The Kidneys in syphilitic persons are frequently attacked in the same manner as the liver, by slow interstitial nephritis, and by gummy formations. The first form is set up commonly in one or two, sometimes in several, points at once. The stroma of the kidney thickens, contracts to some extent, and passes to fatty degeneration at these condensed areas. The glandular structure also suffers by compression, from thickening and contraction (cirrhosis) of the

1 Würtzburger Verhandlungen, iii. S. 366.