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
referred to us with a copy of an impartial report filed by the
Massachusetts General Hospital,—we concur with said impartial report
that there is now no evidence of paralysis of the arm. We do not
find that the positive Wassermann reaction, although it indicates a
history of syphilis, has affected the patient other than possibly to
have reduced his general mental capacity. Our special tests yielded
a percentage of 62% of what a patient of his age and station should
possess. There seems, however, to be no connection between this
reduction of mental capacity and the difficulty with the arm. We
cannot connect the history of alcoholism with the arm trouble.
“There is some evidence that other stone workers have at times shown
such effects.
“The patient’s fairly circumstantial account of his difficulty seems
to point to a degree of myalgia or muscular pain in the region of
the forearm when held in a certain position and a feeling of
numbness in the third and fourth fingers. Whether these phenomena
are due to local pressure upon nerves in the upper part of the
forearm due to neuritis, or whether we are dealing with a functional
neuralgic phenomenon is a question.
“We have applied some special tests for faradic sensibility to all
the fingers of both hands and have found that the fingers of the
right hand are still less sensitive than those of the left,
particularly the thumb and the little finger. This test has not yet
been applied in a sufficiently large number of cases to prove any
difficult point, nevertheless the findings are in line with the
patient’s own circumstantial account of former feelings of numbness
in the third and fourth fingers of the right hand.
“Obviously, then, our opinion is that there is still to be found
some effect of the disease, whatever it was, which caused the
patient to knock off work. If we had more experience with such cases
and more data with the new test which we have applied, we should
perhaps be inclined to admit the diagnosis of _occupation neuritis_
and to suppose structural alterations in the nerve trunks
corresponding with the location of the muscular pain and the
anesthesia of fingers and the dulling of electric sense, but in the
present stage of our experience, it is probably wiser to call the
case one of _occupation neurosis_.”
It is clear that the W. R. in this case was of peculiar value in at
least partially clearing up the findings, yet it must be remembered that
it is a principle of the modern administration of industrial accident
boards and similar organizations that it is the employer’s lookout
whether the employee has syphilis. Recovery can be made as if the injury
were due wholly to an accident. It was not possible however definitely
to prove or disprove a relation of syphilis in the form of a syphilitic
neuritis to the condition in this case.
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