Neurosyphilis : $b Modern systematic diagnosis and treatment presented in one hundred and thirty-seven case historiesSouthard, Elmer Ernest
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Neurosyphilis : $b Modern systematic diagnosis and treatment presented in one hundred and thirty-seven case histories
Southard, Elmer Ernest
Neurosyphilis
It appears, according to Collins, that he had obtained some work the
night before, and had quit work about 6.30, whereupon he stepped into a
barroom, took one drink of whiskey, left the barroom, walked down the
street, and suddenly lost track of the world, coming to consciousness in
a carriage with two policemen, but remaining, as he said, “dopy,”
inattentive, and confused. After a meal, however, the patient began to
feel better and soon felt quite all right.
The =physical examination= was quite negative except that
=neurologically= there was lingual and manual tremor, a speech defect,
apparent only with test phrases, unsteadiness of handwriting, left
knee-jerk greater than right, a left-sided Babinski reflex, and a
difficulty in executing rapid successive movements (dysdiadochokinesis).
This degree of neurological disorder in our experience warrants lumbar
puncture as well as a serum test. The lumbar puncture shortly disclosed
a positive globulin and excess albumin, and the returns from the W. R.’s
were positive for both spinal fluid and blood serum. The data of the
gold sol reaction were not available on account of technical
difficulties. However, it appears that the diagnosis of neurosyphilis
could hardly be avoided in this case.
David Collins differs from Francis Murphy, then, in showing a positive
blood and spinal fluid reaction for syphilis as well as a positive
globulin and excess albumin. As above remarked, it is probable that the
positive globulin and excess albumin would not warrant more than a
suspicion of neurosyphilis taken by themselves.
Unfortunately, we were unable to persuade the patient to submit to
treatment, and from the patient’s point of view possibly his decision,
not to submit to treatment, was a good one since he has had no symptoms
of any sort for a period of 18 months since his episode. However, as
abundantly elsewhere demonstrated, we feel that the patient is wrong,
and that the physicians are right in urging treatment.
Public-domain text, read in full here on John Shaqi.
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