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 =autopsy= showed that death was due to bronchopneumonia with
pleurisy. There were in the body a variety of chronic lesions, such as
gastritis, colitis, epididymitis, splenitis, parietal and valvular
endocarditis, prostatitis, chronic appendicitis, and some mesenteric
lymphnoditis. The heart was somewhat hypertrophied. There was a slight
diffuse nephritis with cysts, emaciation, and decubitus. The calvarium
was thick and somewhat dense. The dura was thickened and adherent, and
the pia mater,—as above stated, the most thickened and altered pia mater
in our series,—is described as everywhere thickened, of a brownish gray
and white color, especially over the vascular lines, and as showing
small white areas of deeper thickening scattered over the surface, but
most markedly over the sulci, and not as a rule over the crowns of the
gyri. There were also yellowish brown spots with a suggestion of fibrin
over the lateral aspects of both hemispheres. The vessels at the base
were not remarkable in the gross. The brain weighed 1220 grams, and
appeared to be of darker color than usual.
=Some cases of PARETIC NEUROSYPHILIS (“general paresis”) have so
much BRAIN ATROPHY that it is not possible to expect much
improvement through antisyphilitic therapy.=
=Case 102.= Theodosia Jewett, dead at 58 years, showed the most
remarkably wasted brain in a long series of victims of paretic
neurosyphilis. We present her case to emphasize what therapy must face
in certain instances, but would recall the fact that exceedingly few
such wasted brains have come to our attention in cases dying in the
institutions of Massachusetts.
Mrs. Jewett, a housewife, whose parents died of shock, and one of whose
two brothers also died of shock, was a normal child and schoolgirl, and
worked as dressmaker until she was married, at 24, to a grocer, by whom
she had two children. At the age of 46, Mrs. Jewett began to suffer from
so-called “nervous prostration.” The attack lasted some two years, but
there were no psychotic symptoms beyond worry and insomnia. The
menopause occurred at 52, at which time the first signs of psychosis
appeared, namely, a forgetfulness concerning familiar matters, such as
sewing, cooking, and the like. At 55, this amnesia had become so marked
that Mrs. Jewett could neither write nor tell time. She, however, was a
perfectly quiet and easily manageable patient, often subject to
drowsiness in the day.
Six months before her admission to the hospital, she began to suffer
from insomnia, failed to recognize her surroundings, and had a number of
crying spells. Restlessness had begun a month before admission; auditory
hallucinations developed in the form of imaginary conversations with
dead persons. A certain loquacity set in, and for a week before
admission, Mrs. Jewett became somewhat resistive.
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