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
=Case 63.= Albert Fielding, 46, was an insurance broker, who was brought
to the hospital for excessive alcoholism. Indeed, he showed all the
signs, both of chronic and acute intoxication, except that there was no
nerve trunk tenderness. Fielding was very loquacious though his speech
was rather thick. He showed tremor of hands and an alcoholic skin.
Physical and neurological examination proved entirely negative.
Fielding claimed that he had had a nervous breakdown at about 36 years
of age, after disappointment in love. He had the drinking habit and
began to drink more and more. He had now become nervous and tremulous
and had to drink in order to brace himself. After a few days, the
patient began to be much better, having recovered from acute alcoholism.
=Mental examination= now showed good memory with orientation intact.
There was a certain tendency to reminiscence and to somewhat childish
actions. He had attempted to stop drinking but had been unable to quit.
As a matter of fact, his mother and father had been excessive drinkers
and he had inherited the tendency, etc.
The =diagnosis= seemed to be plain. The routine W. R. upon the blood
serum was negative. However, the patient had remarked during the history
taking, that he had had a chancre and secondary symptoms of syphilis.
Accordingly, lumbar puncture was resorted to. The fluid showed a
slightly positive W. R.; the gold sol reaction was of the syphilitic
type; there was a considerable increase in albumin and globulin, and
there were 20 cells per cmm. The diagnosis of neurosyphilis seemed
clear.
=Course=: The patient received six months’ treatment in a sanatorium but
the symptoms remained almost as before, and the patient showed the same
childishness and inability to take care of himself. Since the symptoms
continued six months after the withdrawal of alcohol, it might well be
suspected that the condition was more than a merely alcoholic one.
However, in a number of purely alcoholic cases, such long-standing
effects are found: even as long as six months or longer after the
withdrawal of the alcohol, and one might conclude therefore that
Fielding was actually a victim of alcoholic dementia. The spinal fluid
after these six months (during which period antisyphilitic treatment was
given) showed no change, and the prognosis was offered that the case
would probably develop into one of paresis.
A year later, after six months sanatorial care and six months life in
the community, the patient returned to the Psychopathic Hospital in an
alcoholic condition. The lumbar puncture showed all signs negative
except the W. R. which was slightly positive. The W. R. of the blood was
negative.
In connection with this case, see the case of _paresis sine paresi_
(25).
Public-domain text, read in full here on John Shaqi.
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