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
=Cerebellum and pons=: Weight, 145 gm. The inequality of the two
hemispheres is more marked than in the case of the cerebrum.
Greatest lateral diameter; left, 4.5 cm., right, 5.5 cm.
Anteroposterior diameter adjacent to notch: Left, 5.8 cm., right,
5.5 cm.
There is no appreciable difference in depth. The diminution in
volume appears to be chiefly at the expense of the right clivus. The
inferior surface is firmer than the superior. The laminæ adjacent to
the horizontal fissure are firmer than the remainder of the
cerebellum. The pons is small.
There was also a lateral curvature of the spinal column, as well as
characteristic adhesions between spinal dura and pia mater which are
always suggestive of syphilis. For the rest, there were few findings of
note: some adhesions of the left pleura, hypostatic congestion of the
lungs, tracheitis, and chronic gastritis. There were four lobes of the
right lung but it is doubtful whether this should be regarded as a
stigma.
1. Can we separate the symptoms of Addison’s disease from those of
paresis in this case? The extreme cardiac weakness with a
characteristic, small low-pressure pulse is in point. The asthenia
and apathy are consistent enough with Addison’s disease as well as
with paresis itself. It would also be possible to ascribe the
gastro-intestinal symptoms to either disease.
2. Of what significance is the persistent thymus? Persistent thymus
has been observed in a few cases of Addison’s disease, but that it
plays any part in the symptomatology thereof is a matter of doubt.
3. How can the obesity be explained? It is of course of note that
the thyroid gland was small, but microscopically there were no
peculiar features in this gland.
4. Was the adrenal tuberculosis actually primary? Minute search
failed to reveal evidences of tuberculosis elsewhere unless we
regard the few adhesions binding the lower half of the lung to the
chest wall as indicative of an old tuberculosis. In particular,
the mesenteric lymph nodes were normal.
=Neurosyphilis? Secondary stage of syphilis.=
=Case 81.= Florence Fitzgerald, a woman 25 years of age, applied at the
police station to be taken care of. She said she had been a prostitute
for the last few months, was now ill, and wanted to reform. She appeared
physically ill and was sent to the Psychopathic Hospital, where she
remained at first almost mute, making answers chiefly by nodding the
head. She gave the impression of daze or stupor, and in fact her
condition was at first regarded as catatonic. This reaction, after a few
days, changed and Florence became quite normal, giving a full account of
her condition.
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