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
=Mentally=, the depression with reiteration of wrong-doing and
self-accusation because of the contraction of syphilis, were the
striking features. There was, to be sure, a slight imperfection of
memory for remote events; memory for recent events and knowledge of
current events was very poor. Barrie claimed that his condition was
entirely hopeless, that his memory was exceedingly bad, and that he was
no longer capable of supporting his family.
1. What shall be said as to diagnosis in a man of 61 with
glycosuria, depression, amnesia, sluggish pupil, slight tremor,
slight speech defect, and a history of syphilis? The W. R. of the
serum proved positive, and also the W. R. of the spinal fluid. The
gold sol reaction of the fluid was of the syphilitic type. There
were 112 cells per cmm., there was an excess of albumin, and a
large amount of globulin. Accordingly, the diagnosis of PARETIC
NEUROSYPHILIS (“general paresis”), especially in view of the
laboratory findings, seems necessary.
2. What is the cause of the glycosuria? First: possibly it has no
relation with the syphilis; secondly: it may possibly be due to a
syphilitic involvement of the pancreas; thirdly: it is barely
possible that it is due to syphilitic disease of the fourth
ventricle or of the base of the brain, involving the pituitary
region. Perhaps our case is too complex for analysis. At all
events, the case brings up the possibility of a syphilitic
glycosuria.
3. Can the diabetes in the case of Barrie be explained as
syphilitic? Warthin of Ann Arbor has recently described somewhat
remarkable spirochete findings in his autopsy material. The order
of organic infection according to frequency is: aorta, heart,
testis, adrenal, pancreas, nervous system, liver, and spleen.
Warthin has called attention to the relation of pancreatitis and
spirochetosis to diabetes in a recent review[13] of findings in 41
autopsied cases from the University Hospital in Michigan. Warthin
found active luetic lesions in the pancreas in 6 cases.
=Hemianopsia in a case of neurosyphilis.=
=Case 66.= Lawrence Washington, a colored cabman, 58 years of age, began
to forget addresses given him by his fares. Moreover, he could no longer
see as well as before, especially on looking toward the right side. He
himself states that the visual trouble dated back as long ago as his
39th year, at which time he had a terrific pain in both temples, leading
back from the eyes. Washington thought that his vision had been getting
slowly but steadily worse ever since.
We got the impression that the amnesia claimed by Washington was more or
less subjective and he was found to be well informed. This association
of amnesia and impairment of vision naturally suggests syphilis. The
patient himself stated that he had had a chancre at the age of 18.
Public-domain text, read in full here on John Shaqi.
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