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
The special tests above referred to are the electric sensory threshold
tests of E. G. Martin.
=Character change: neurosyphilis.=
=Case 95.= Joseph Wilson offered a very serious social problem. He was
the father of two children, and his wife was pregnant at the time of his
admission to the Psychopathic Hospital. He was a husky-looking man of 33
years of age, but for the past four years he had been deteriorating in
his work; he had been drinking heavily, and finally had stolen to obtain
money for liquor. It was on account of his alcoholism and delinquency,
which were taken as an indication of change of character, that he was
sent to the hospital.
Examination on his arrival disclosed at once that there was more to the
case than alcoholism, for the =neurological examination= showed that the
pupils were irregular, the right being larger than the left, both
reacting sluggishly to light, and there was an inequality in the
reaction of the two eyes, the left being better than the right. The
tendon reflexes were exaggerated, with ankle clonus on both sides, more
marked on the right. There was also a marked speech defect. Otherwise
the =physical examination= showed nothing of importance.
The W. R. of the blood and spinal fluid was strongly positive. The
globulin test was strongly positive, the albumin was markedly increased,
there were 74 cells per cmm., and a gold sol reaction of the “paretic”
type.
A formal =mental examination= did not show very much of consequence; his
memory showed no marked impairment, he was not deluded or hallucinated,
and he had a pretty good insight into his failings. However, he was
somewhat childish, and his irritability was quite marked. Were one to
rely upon the mental signs alone, it is probable that a diagnosis of
chronic alcoholism with deterioration would be made; but in the presence
of the physical findings and the laboratory tests, the diagnosis of
neurosyphilis had to be given. It is obvious that, while the patient was
suffering from a progressive brain disease, and while he did show mental
symptoms, there was not sufficient ground on which to commit him, and
therefore he had to be turned out into the community. As a matter of
fact, he was not prosecuted on account of his theft, because, although
legally responsible, it was felt that his disease was at the basis of
the character change which had led him into difficulties. Further
developments of his relations with society had to be considered,
however. It was possible to get him to discontinue the use of alcohol
altogether, and for nearly a year he has taken no alcoholic liquor and
has been self-supporting. However, his irritability has been very great,
making it very difficult for his wife to live with him, and causing his
sister to break off all relations with him.
Public-domain text, read in full here on John Shaqi.
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