The pathology of syphilis of the nervous system in the light of modern research : Morison Lectures, 1909 / by F.W. Mott.

  • Mott, F. W. (Frederick Walker), 1853-1926
Date:
[1948?]
Catalogue details

Licence: In copyright

Credit: The pathology of syphilis of the nervous system in the light of modern research : Morison Lectures, 1909 / by F.W. Mott. Source: Wellcome Collection.

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    to the right on one occasion, but she was able to look to the left when told to do so while the fit was proceeding. The spasm of the orbicularis pal- pebrarum spread to the opposite left eye and the eyeballs rolled upwards; it did not spread to the opposite lower face, nor did it spread to the arm. She has never complained of headache, but there was a tender spot on pressure just above the attachment of the left ear to the skull. There was no optic neuritis and no vomiting. The diagnosis I made was gum- matous pachymeningitis over the region of the left ascending frontal and parietal convolutions at their lower extremity, involving especially the tongue area, also probably the pars basilaris of the third frontal. Subsequent Notes by Dr. Daniel. May 17th, 1908.—The notes state that the fits continue on an average about 50 a day. One fit lasted about 30 minutes (probably it was a series fused together), but it is interesting to observe that she remained for 1^ hours unable to speak at all. May 20th, 1908.—She has had 50 fits in the night, and they are occurring every few minutes in the morning. Yesterday she complained of numbness and pains down the right arm. To-day there is distinct devia- tion of the eyes to the right during the tonic stage of the convulsion, and the fits are occasionally attended by loss of consciousness. She is now being treated by mercurial inunction twice a day. May 26th.—The notes state that the fits now extend to the right arm, and various sedatives were given, including hyoscyin l-50th grain, which, it is stated, has had a marked effect; she has had fewer fits and is markedly drowsy this morning; the pulse is feeble and rapid. May 30th.—A difficulty in swallowing has been observed, and there seems to be an actual paresis. Fits continue practically uncontrollable. June 1st.—The fits ceased, but patient died June 2nd at 4.35 p.m. On June 3rd I made the post-mortem examination. On removal of the calvarium, a pachymeningitis about the size of a florin was observed in the region of the tender spot noticed during life just three-quarters of an inch above the attachment of the left ear. On opening the dura mater the thickening was very definite. It was about five times as thick as the normal dura mater. This thickening was uni- form, except at the circumference, where it gradually sloped off. It was red and inflamed both externally, in contact with the bone, and inter- nally, in contact with the pia arachnoid. The bone in contact with the inflamed dura was roughened, and there was a slight degree of osteitis ; the middle meningeal artery passed through the middle of the patch. Internally the pia arachnoid was red and inflamed, but there was'no symphysis with the dura mater in this situation. One inch and a quarter