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. Is salvarsan contraindicated in cases with involvement of the
optic or auditory nerves? Such a contraindication exists according
to prevailing opinion. In this particular case, a hemorrhagic
retinitis occurred after the injection of salvarsan, but this
retinitis disappeared along with the other symptoms. On the whole
we believe that in many cases of optic or auditory nerve
involvement salvarsan should be used. However, one should never
lose sight of the possibility of untoward results and should
advise such treatment only when other treatment seems inefficient.
=TABETIC NEUROSYPHILIS (“tabes dorsalis”) may show very marked
improvement as a result of intraspinous therapy.=
=Case 110.= Mr. McKenzie[18] was a retired merchant of 42 years whose
complaint was that he tired very easily, could not make his legs go
where he wished, was unsteady and felt a numbness in his legs. These
symptoms had been in progress for a few months only when the examination
was made. This disclosed Argyll-Robertson pupils, absent knee-jerks and
ankle-jerks, Romberg sign, unsteady gait, moderate ataxia and dysmetria.
The W. R. was negative in the blood serum but positive in the spinal
fluid with 0.2 cc., and there were 107 cells per cmm. With the symptoms
and signs it was therefore easy to make the diagnosis of TABETIC
NEUROSYPHILIS (“tabes dorsalis”).
The patient was given five intraspinous injections of mercuric chloride
in blood serum (mercurialized serum) according to the method of Byrnes.
The dose was 0.001 gm. of mercury. Two weeks after the first injection
the cell count was 58 cells per cmm., the Wassermann was positive only
with 0.4 cc. After the fourth injection there were but 18 cells and the
Wassermann reaction was negative even with 1½ cc. of spinal fluids. The
symptoms had improved to such a degree that the patient had no complaint
whatsoever and considered himself cured.
1. What are the unpleasant results of intraspinous therapy?
Frequently there is an exacerbation of symptoms and pain may be
quite severe after intraspinous injections. This, however, lasts
only a short period, that is, as a rule less than 24 hours. There
may be other symptoms of cord irritation as retention of urine or
lack of sphincter control. A rise of temperature is not unusual.
=Treatment may alter the W. R. to negative in blood and spinal fluid
in TABES DORSALIS.=
=Case 111.= Ivan Rokicki was a baker, 43 years of age, who came
complaining of exceedingly severe attacks of abdominal pain with
vomiting. He described these attacks as having occurred periodically for
a number of years, lasting sometimes as long as a week, during which
time Rokicki could not eat or get relief short of large doses of
morphine.
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