Neurosyphilis : $b Modern systematic diagnosis and treatment presented in one hundred and thirty-seven case historiesSouthard, Elmer Ernest
Science
Neurosyphilis : $b Modern systematic diagnosis and treatment presented in one hundred and thirty-seven case histories
Southard, Elmer Ernest
Neurosyphilis
1. What is the relation of neuroses to syphilis? Neurasthenia,
chorea, hysteria, and epilepsy are often grouped (for example, by
Nonne) as neuroses bearing at times important relations to
neurosyphilis. (For the relations of neurasthenia, chorea, and
epilepsy, see cases of Greeley Harrison (9), Margaret Green (72),
and David Borofski (49), respectively.) As for the hysteria shown
in Caperson, Charcot enumerated syphilis among _agents
provocateurs_ of hysteria along with alcohol, lead, arsenic, and
the like. Fournier has also considered the problem. It is clearly
necessary to show that before infection there were no hysterical
symptoms, and that the hysteria developed during the operation of
the syphilitic process, and it is probably necessary to show that
the symptoms will clear up under antisyphilitic treatment, if we
are to concede the existence of a syphilitic hysteria.
2. What are the evidences of neurosyphilis in the secondary and
primary stages of syphilis? As above stated, the findings in
Caperson are typical enough. Wile and Stokes at first stated that
60 to 70% of the secondary syphilitics show changes in the spinal
fluid; in a further article they maintain that probably every case
shows such changes and that clinical symptoms of neurosyphilis of
the secondary period can probably be determined. They claim that
it is probable also that the same holds for primary syphilis
itself. The importance of these claims lodges partly in the
relation of these early signs of neurosyphilis to the whole
question of latency and to the question of _paresis sine paresi_.
For a discussion of _paresis sine paresi_ see cases Lawlor (25),
Vogel (52).
=Differential diagnosis between NEUROSYPHILIS and MANIC-DEPRESSIVE
PSYCHOSIS.[9]=
=Case 47.= As in other instances (compare Martha Bartlett (21) and Annie
Monks (85)) so also in the case of Ethel Hunter, a woman 61 years of
age, there was no initial suspicion of neurosyphilis. Mrs. Hunter was
brought to the hospital stuporous as a result of an overdose of
paraldehyd. The paraldehyd had been administered by a physician to
combat insomnia and agitation. As soon as Mrs. H. had recovered from the
drug stupor, this agitation appeared once more, and it was clear that
she was suffering from marked depression. There was tremendous worry
over the sickness of a woman with whom the patient lived. The patient
was very self-accusatory, blaming herself for many things that had
happened in the household. Besides her agitation, depression,
self-accusations, and insomnia, the patient showed a good deal of the
symptom frequently termed “retardation”—a kind of lagging of all mental
processes found, according to Kraepelin, in manic-depressive psychosis.
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