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
=Physically=, there was a discharging sinus connected with the right
humerus, close to the elbow. The pupils, though equal and regular, were
sluggish in reaction to light. The knee-jerks and ankle-jerks were
absent. There was no Romberg sign but there was some swaying in the
Romberg position. There was a moderate ataxia in walking. Glycosuria to
a moderate degree was determined. There were no casts or albumin in the
urine. The W. R. of the blood and of the spinal fluid was negative. The
albumin of the fluid, however, was considerably increased. X-ray
examination of the skull yielded a suggestion of absorption of the
posterior clinoid processes of the sella turcica. The X-ray examination
of the arm in the region of the sinus showed a chronic osteomyelitis,
possibly syphilitic (or diabetic?).
The diagnostic problems in the case of Calvin Hall are extremely
intricate. There are clinical suggestions of general paresis, not
confirmed by the laboratory findings.
1. Are we dealing with a case of diabetic pseudoparesis? Is the pain
in the legs of like origin, and has a neuritic process led to the
absence of the knee-jerks? The Allen treatment appears to have had
no beneficial result in this case.
2. Is there a tumor of the sella region, which could account for the
mental symptoms and the glycosuria? The spinal fluid albumin might
be regarded as consistent with a variety of psychoses, including
that of brain tumor. We have to remember the definite history of
infection, the sterile marriage and the possibly syphilitic
osteomyelitis.
=DIABETES AND NEUROSYPHILIS, relations?=
=Case 65.= Donald Barrie, a man of 61, diabetic for several years, had
begun to worry about the diabetes, feeling that he was about to die, and
had gone so far as to make several threats of suicide. Hence he was
brought to the Psychopathic Hospital for observation.
Barrie was rather well developed and nourished, although he looked far
older than he was. There was a marked arcus senilis; the skin was dry
and rough; the radial and other accessible vessels were markedly
sclerosed; abdomen obese; right testicle very low with thickened and
hard epididymis.
=Neurologically= there was little abnormal to discover. The pupils were
irregular; both reacted fairly well to light. There was a slight tremor
of the extended hands, and still less of the tongue. The voice was
slightly thick and the patient stumbled somewhat on test phrases. Urine:
specific gravity, 1029; sugar; no acetone; no diacetic acid. Sugar 2 to
11 grams for 24 hours on ordinary diet. It proved impossible to get the
patient sugar-free, either by cutting down the carbohydrates or by using
the Allen method.
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