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
However, in the hospital Mrs. Silverman could hardly be got to answer
questions, continually saying, “You know what it is; I don’t have to
tell you.” She claimed so marked a degree of confusion as not to know
where she was and what she was doing. She would beg despondently that
something be done for her, and iterate and re-iterate these claims.
There appeared to be a marked degree of amnesia. Some one, she felt, had
controlled her thoughts and made her do things she did not want to do
and say things she did not want to say, things she did not know she was
about to say. She said, “I feel like jumping around. I couldn’t believe
myself as if I am me. Some one is making me jump around. I used to hear
him talking. I don’t know who it is. I used to keep my eyes open and I
couldn’t move. I feel only I would like to talk, and talk, and talk, and
talk all the time. It seems to me that some one talks in me. I couldn’t
sleep for five minutes. My God, I wish I could sleep! I used to feel
something in my heart. I used to faint. It seems to me I used to see a
funny thing. What it was I can’t tell. It used to talk to me, make me
get out of bed, throw me about, make me do things. O, I don’t know what
it was.”
These not entirely characteristic mental symptoms, together with the
suggestive physical signs and the laboratory examination, caused
treatment to be instituted; under which treatment (intravenous
injections of salvarsan) she improved rapidly. Mental symptoms
disappeared under the administration of 12 injections of salvarsan
within two months. Moreover, the spinal fluid became entirely negative.
Two and a half years have now elapsed since her discharge and she has
shown no return of symptoms. The serum W. R. has always remained
negative although there has been no treatment since leaving the
hospital. There has, however, been no change in the reflexes, which
remain as on admission. The 7–months baby has continued to be perfectly
healthy. Its W. R. is negative, as are the W. R.’s of the husband and
the other three children. It must seem surprising that a healthy child
could have been born from a mother with generalized syphilis as in this
case. However, perhaps there are more instances than we imagine like the
case of baby Silverman.
1. May a patient be considered permanently cured although there has
been no recurrence of symptoms for 2½ years and although the
Wassermann has remained negative? One would hesitate to give a
definite statement that the patient was cured until more time had
elapsed. It is quite possible that spirochetes may be lurking in
some portion of the body without causing the production of
symptoms or Wassermann bodies and yet ready to break out at any
time. This hypothesis has added weight from the recent work of
Warthin already quoted. We advise examination of this patient at
intervals of not longer than six months for a good many years.
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