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
1. What is the patient’s responsibility for these debts? Legally the
patient or his estate is responsible for debts accruing from
services rendered or goods received. As he is adjudged _non compos
mentis_ contracts entered into would not hold, and he would not be
considered liable for criminal acts.
Note: This case shows how dangerous paresis may be not only to the life
and usefulness of a patient, but further how it may ruin a family
financially. Mr. Smith’s little escapade used up all the money that he
had been able to save in his life and when he was taken to a hospital
his wife was left destitute.
=Suicidal attempt (?) by a neurosyphilitic.=
=Case 85.= At first Mrs. Annie Monks, a widowed seamstress, 50 years of
age, did not particularly suggest syphilis. Mrs. Monks was sent to us
from a general hospital. She had been found unconscious in her room,
with gas turned on, and a diagnosis of gas poisoning was made. Mrs.
Monks remained unconscious for 24 hours, and her apparent suicidal
attempt seemed to warrant her being sent to the Psychopathic Hospital.
Mrs. M., however, scoffed at the idea of any attempt at suicide, and
claimed to have had no recollection of any such affair. On the contrary,
she had gone to mass the morning of the day on which she was taken to
the hospital, remembered well enough returning to her room but nothing
of what followed until she woke up.
Mrs. Monks was not coöperative and would reveal few facts about her
history. For years, she had had edema of the feet and palpitation of the
heart (the heart was somewhat enlarged, with a double murmur in the
aortic area, systolic louder, and a blood pressure of 160 systolic and
85 diastolic; clubbed fingers; palpable liver). She had been treated in
the out-patient department of a general hospital for a number of months.
We could obtain no evidence of mental impairment, particularly none of
memory.
Aside from the heart lesions above indicated, the patient was fairly
well nourished, with a slight enlargement of superficial glands, and was
otherwise normal.
=Neurologically=, the slightly irregular pupils reacted poorly to light;
the right knee-jerk could not be obtained, whereas the left knee-jerk
was very active. Systematic examination revealed no other disorder
except that the abdominal reflexes could not be obtained.
Here we have, in a cardiac patient, a possibly or probably accidental
gas poisoning, and little to go upon for a profounder diagnosis than the
sluggish irregular pupils and unilateral absence of knee-jerk.
The routine serum W. R. came through as positive. Following custom, we
examined the spinal fluid, finding the W. R. here again to be moderately
positive (strongly positive to 1 cc., moderately to 0.7 cc., and
negative to 0.5, 0.3, and 0.1 cc.). The gold sol index was 1 2 2 1 0 0 0
0 0 0, which must be interpreted as syphilitic. There were 16 cells to
the cmm., the albumin was 1+, and the globulin stood at 2+.
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