Neurosyphilis

Section I. the Nature and Forms of Syphilis of the Nervous System

(NEUROSYPHILIS). CASES 1 TO 8 17

CASE

1. Paradigm: protean symptoms, nervous and mental. Autopsy, with meningeal, parenchymatous, and vascular lesions. 17

2. Tabes dorsalis (tabetic neurosyphilis). Autopsy 31

3. General paresis (paretic neurosyphilis). Autopsy 37

4. Cerebral thrombosis (vascular neurosyphilis). Autopsy 42

5. Juvenile paresis (juvenile paretic neurosyphilis). Autopsy 45

6. Extraocular palsy (focal meningeal neurosyphilis). Autopsy 50

7. Gumma of brain (gummatous neurosyphilis). Autopsy 53

8. Meningitis hypertrophica cervicalis (gummatous neurosyphilis). Autopsy 56

Section Ii. the Systematic Diagnosis of the Forms of Neurosyphilis

CASES 9 TO 38 63

CASE

9. Neurasthenia versus neurosyphilis 63

10. Paretic neurosyphilis versus manic-depressive psychosis 68

11. Neurosyphilis versus manic-depressive psychosis 71

12. Dementia praecox versus neurosyphilis. Autopsy 74

13. Neurosyphilis: negative Wassermann reaction (W. R.) of serum 77

14. Diffuse neurosyphilis: six tests apt to run mild 80

15. Paretic neurosyphilis: six tests strong 85

16. Taboparesis (tabetic neurosyphilis): tests like those of paresis 92

17. Paretic versus diffuse neurosyphilis: confusion re tests 97

18. Vascular neurosyphilis: positive serum, negative fluid W. R. 101

19. Seizures in diffuse neurosyphilis 103

20. Seizures in paretic neurosyphilis 106

21. Aphasia in paretic neurosyphilis 111

22. Aphasia in paretic neurosyphilis 115

23. Remission in paretic neurosyphilis 117

24. Remission in diffuse neurosyphilis 122

25. Paresis sine paresi 126

26. Paretic neurosyphilis. Autopsy 131

27. Gummatous neurosyphilis. Operation 137

28. Extraocular palsy (cranial neurosyphilis) 140

29. Tabes dorsalis (tabetic neurosyphilis): six tests apt to run mild 141

30. Tabetic neurosyphilis, clinically atypical 143

31. Cervical tabes 146

32. Erb’s syphilitic spastic paraplegia 147

33. Syphilitic muscular atrophy 149

34. Neurosyphilis of the secondary period 151

35. Juvenile paretic neurosyphilis: optic atrophy 154

36. Juvenile paretic neurosyphilis 157

37. Simple feeblemindedness, syphilitic 159

38. Juvenile tabes 161

Section Iii. Puzzles and Errors in the Diagnosis of Neurosyphilis

(INCLUDING NON-SYPHILITIC CASES). CASES 39–82 165

CASE

39. Paretic versus diffuse neurosyphilis. Autopsy 165

40. Paretic versus vascular neurosyphilis, cerebellar. Autopsy 169

41. Paretic versus vascular neurosyphilis, cerebellar. Autopsy 172

42. Tabetic combined with vascular neurosyphilis. Autopsy. 175

43. Tabetic neurosyphilis: mental symptoms, non-paretic. Autopsy 177

44. Cerebral gliosis. Autopsy 180

45. Neurasthenia versus neurosyphilis 183

46. Hysteria. Neurosyphilis of the secondary period 185

47. Manic-depressive psychosis versus paretic neurosyphilis 187

48. Cerebral tumor 190

49. Early post-infective paretic neurosyphilis 192

50. Atypical paretic neurosyphilis, hemitremor. Autopsy 197

51. Paretic neurosyphilis. Autopsy 199

52. Manic-depressive psychosis versus paretic neurosyphilis 202

53. Syphilitic(?) exophthalmic goitre. Autopsy 205

54. Argyll-Robertson pupils 209

55. Argyll-Robertson pupils: pineal tumor. Autopsy 212

56. Neurosyphilis(?) with negative spinal fluid 216

57. Disseminated syphilitic encephalitis, seven months post-infective. Autopsy 218

58. “Pseudoparesis” 222

59. Syphilitic paranoia? 225

60. Paretic neurosyphilis versus alcoholic pseudoparesis 227

61. Alcoholic pseudoparesis versus paretic neurosyphilis 231

62. Alcoholic neuritis and paretic neurosyphilis 234

63. Chronic alcoholism versus paretic neurosyphilis 236

64. Neurosyphilis, diabetic pseudoparesis, or brain tumor 238

65. Neurosyphilis and diabetes 240

66. Neurosyphilis: hemianopsia 242

67. Paretic neurosyphilis versus syphilis and cerebral malaria 245

68. Paretic neurosyphilis: gold sol test “syphilitic.” Autopsy 247

69. Lues maligna 250

70. Neurosyphilis versus multiple sclerosis 253

71. Atypical neurosyphilis 256

72. Huntington’s chorea versus neurosyphilis 258

73. Senile arteriosclerotic psychosis versus neurosyphilis 262

74. Hysterical fugue versus neurosyphilis 264

75. Tabetic neurosyphilis versus pernicious anemia 267

76. Congenital neurosyphilis 270

77. Congenital versus paretic neurosyphilis 272

78. Juvenile paretic neurosyphilis 275

79. Epilepsy versus juvenile neurosyphilis 277

80. Addison’s disease and juvenile paretic neurosyphilis. Autopsy 279

81. Neurosyphilis of the secondary period 283

82. Taboparetic neurosyphilis and typhoid meningitis. Autopsy 284

Section Iv. Neurosyphilis, Medicolegal and Social. Cases 83–98 289

CASE

83. A public character, neurosyphilitic. Autopsy 289

84. Debts, neurosyphilitic 295

85. Suicidal attempt by a neurosyphilitic 296

86. Neurosyphilis and juvenile delinquency 298

87. Neurosyphilis in a defective delinquent 300

88. Paresis sine paresi in a forger 303

89. Trauma: juvenile paretic neurosyphilis 306

90. Trauma: paretic neurosyphilis 308

91. False claim for trauma: neurosyphilis 309

92. Traumatic exacerbation? in neurosyphilis 310

93. Trauma: cranial gumma at the site of injury 311

94. Occupation-neurosis versus syphilitic neuritis 312

95. Character change: neurosyphilis 314

96. A neurosyphilitic family 316

97. A neurosyphilitic’s normal-looking family 318

98. The neurosyphilitic’s marriage 319

Section V. the Treatment of Neurosyphilis. Cases 99–123.

(CASES 99–103 SHOW THE VARIETY OF STRUCTURAL LESIONS THAT TREATMENT HAS TO FACE) 323

CASE

99. An incurable spastic paresis in paretic neurosyphilis. Autopsy 323

100. A theoretically curable case. Autopsy 328

101. A highly meningitic case, theoretically amenable to treatment. Autopsy 332

102. A highly atrophic case, theoretically not amenable to treatment. Autopsy 335

103. Paretic neurosyphilis with markedly focal lesions. Autopsy 338

(CASES 104 TO 123 ARE EXAMPLES OF TREATMENT INCLUDING SUCCESSES AND FAILURES.)

104. Diffuse neurosyphilis: treatment successful after nine months 342

105. Atypical neurosyphilis: treatment successful 346

106. Argyll-Robertson pupil not necessarily of bad prognosis: treated case an insurance risk 350

107. Spinal fluid cleared: symptoms persistent 355

108. Arteriosclerosis does not contraindicate treatment 359

109. Symptoms of intracranial pressure relieved by treatment 362

110. Therapeutic improvement in tabetic neurosyphilis 366

111. W. R. rendered negative in tabetic neurosyphilis 367

112. Example of successful treatment of paretic neurosyphilis 370

113. Another example 372

114. Clinical recovery but tests persistently positive in treated paretic neurosyphilis 375

115. Improvement delayed in treated paretic neurosyphilis 377

116. Non-neural syphilis in treated paretic neurosyphilis 380

117. Partial recovery in treated paretic neurosyphilis 382

118. Laboratory signs improved: clinical situation stationary: treated paretic neurosyphilis 384

119. Another example 386

120. Failure of treatment 388

121. Treatment, at first mild, later intensive 390

122. Intensive treatment 392

123. Syphilitic feeblemindedness improved by treatment 395

Section Vi. Neurosyphilis and the War.

CASES A TO N FROM BRITISH, FRENCH, AND GERMAN WRITERS (1914–1916) 399

CASE

A. Tabes “shell-shocked” into paresis? (Donath) 401

B. Latent syphilis “shell-shocked” into tabes? (Duco and Blum) 403

C. Aggravation of neurosyphilis by service? (Weygandt) 404

D. Aggravation of neurosyphilis by service? (Todd) 406

E. Aggravation of neurosyphilis on service? (Todd) 409

F. Duration of neurosyphilitic process important. (Farrar) 411

G. Latent syphilis lighted up to paresis by war stress without shell-shock. (Marie) 412

H. Paresis lighted up by “gassing”? (de Massary) 414

I. Epilepsy in a neuropath lighted up by syphilis acquired at war. (Bonhoeffer) 415

J. Syphilitic—after Dixmude epileptic. (Bonhoeffer) 417

K. Syphilitic root-sciatica in a fireworks man. (Dejerine, Long) 418

L. Paresis lighted up in civilian by domestic stress of the war. (Percy Smith) 420

M. Shell-shock pseudoparesis. (Pitres and Marchand) 421

N. Shell-shock pseudotabes. (Pitres and Marchand) 424

Section Vii. Summary and Key 427

APPENDICES:

A. The six tests 471

B. Common methods of treatment 486

INTRODUCTION

It is a privilege to be allowed to write a word of introduction to a textbook which so richly fulfils its function as does this volume on the manifold disorders classified under Neurosyphilis, a subject of which the importance for the welfare of society is found to loom the larger the more deeply its mysteries are probed.

The case histories with which its pages are so amply stocked are carefully analyzed in accordance with a broadly chosen plan, and the generalizations that precede and follow them are obviously based on a wide and varied personal experience such as alone could render a familiarity with the literature of the subjects treated adequate to its best usefulness. Both writers were indeed well adapted for this task. Dr. Southard, as everyone is aware, has long been a highly conscientious, ardent and productive worker in the department of pathological anatomy, and of late years a careful student of clinical diagnosis and methods, both at the Danvers State Hospital and still more, at the Psychopathic Hospital which he worked so hard to found; while Dr. Solomon’s researches, in the special field of neurosyphilis, have been of the highest order.

Undoubted as are the merits of the case-system of instruction that has been so much in vogue in recent years, and excellent as is the modern supplementation of this method by the use of published records, the danger is still real that the student will have presented to him a picture of nature in disease that is too diagrammatic, too concise, with the result that while the task of memory is lightened through simplified formulation, the training of the doubting and inquiring instincts is often given too little stimulus and scope. In this book this danger is deliberately met through the casting of emphasis rather on the pluralistic aspects of the processes at stake than (primarily) on their unitary aspects.

The student who utilizes this volume cannot but emerge from his study a more thoughtful person than he was at the period of his entry. He will have seen that clinical rules of thumb cannot be followed to advantage, and that, on the contrary, surprises are to be expected and prepared for. Let the recognition of this fact, if it seems to increase the difficulties in the way of diagnosis, not lead to pessimism in that respect, or to hopelessness in therapeutics. On the contrary the writers’ bias is towards the worth-whileness of clinical efforts and an increased respect for accuracy and thoroughness in the utilization of modern methods of research. The chance is indeed held open that even the gaunt spectre of “General Paresis” may prove to be less terrible than it seems, and for this hope good grounds are given.

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