File:A treatise on the nervous diseases of children, for physicians and students (1905) (14598008068).jpg

Identifier: treatiseonner00sach (find matches)
Title: A treatise on the nervous diseases of children, for physicians and students
Year: 1905 (1900s)
Authors: Sachs, Bernard, 1858-1944
Subjects: Nervous system Children
Publisher: New York, W. Wood and company
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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developed on a specific basis. Morbid Anatomy. — The anatomical changes in thespinal cord, due to syphilis, may be quite as varied in thechild as in the adult. It is well known that syphilis is aptto cause disease of the blood-vessels. Obliterative endoar-teritis, with subsequent softening of the area supplied bythe diseased vessel, is perhaps the best known anatomicalprocess directly attributable to syphilis; but a general ar- * Figs. 69-71 are reproduced by the courtesy of the editor of the New York Medi-cal Journal. SYPHILIS OF THE SPINAL CORD. 299 teritis is quite as frequent as an inflammation of the endo-thelium alone. Bruce has directed attention to changes inthe adventitia (nodose periarteritis); moreover, veins aresubject to syphilitic changes quite as often as the arteriesare (phlebitis obliterans, GreifT). All these vascular changesare much more pronounced in the pial covering than in thesubstance of the spinal cord. The investigations of other authors, as well as my own,
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Fig. 70.—Section from Ventral Surface of Medulla Oblongata (high power), show-ing Infiltration of Pia and Substance of Medulla (a) and Typical Syphilitic Arteritis ;Marked Thickening of, and cellular proliferation in Intima (i) ; Narrowing of theLumen ; Cellular Infiltration of Adventitia (£). have shown that syphilis of the spinal cord is more oftenassociated with a subacute or chronic meningitis, or me-ningo-myelitis, than with any other process. The diseasestarts, as a rule, in the pia, and subsequently invades thespinal cord. There can be little doubt, however, that thechanges may in some instances be developed in the reverseorder. In the gross specimen we find the pia thickened and 3oo THE NERVOUS DISEASES OF CHILDREN. often covered by a thick gelatinous substance. On micro-scopical examination this thickening is seen to be due to aproliferation of all the tissues. The cells are multiplied innumber, the nuclei have increased, and the blood-vesselsshow the characteristic change

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