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
2. Should the course under treatment cause us to change the
diagnosis? It has often been stated that a differential point
between cerebrospinal syphilis and general paresis is the reaction
to treatment, that is, that a case which recovers could not be
general paresis. Head and Fearnsides state that if six months
after beginning of treatment the spinal fluid has become negative,
the case should be considered as one of cerebrospinal syphilis and
not general paresis. We do not feel ready to concur in this view
as we know of no similar logic in medicine. We have many cases in
which a spinal fluid has remained positive for six months and
later become negative, so that where the symptoms shown are those
of paretic neurosyphilis, we are inclined to consider the case
such until such time as more definite evidence checked by post
mortem examination causes us to change this point of view.
3. Do the reflexes change under treatment? The signs of spasticity
often do disappear under treatment and also when there is no
treatment. A few instances have been reported in the literature
where Argyll-Robertson pupils are said to have altered to normal.
It has never been our good fortune to see such a change nor have
we seen an absent knee-jerk become normal, as has also been
reported, except where it is the result of pyramidal tract disease
superimposed upon the posterior column sclerosis causing a return
of reflex. This, of course, is not to be considered as a return of
the normal. (See Case 1.)
=Some RESULTS of systematic intravenous salvarsan therapy are
PARTIAL (_e.g._, clinical recovery and persistence of positive
laboratory tests).=
=Case 114.= Walter Henry was an undertaker in a small town. He was
married and the father of two healthy children. In May, 1914, he began
to lose his appetite. He felt restless and seemed to be losing his grip,
and in August he repaired to a sanatorium, where he remained for two
months. Shortly after leaving the sanatorium, he fainted one day, while
digging a grave, during a spell of great heat. Since that time there had
been numerous “weak spells,” with headaches and general debility,
insomnia, and loss of weight.
In February, 1916, Mr. Henry came to the hospital for advice, but the
trip from a distant part of the state was apparently such a strain for
him that shortly after admission he collapsed. There were no convulsive
movements in this collapse, but the patient was confused and his
breathing was rapid and stertorous. The semi-stupor lasted for about 48
hours. Upon recovery from the stupor, Henry was found entirely
disoriented, much confused, and laboring under the belief that he was
digging a grave. After a time he again fell into a stupor and his
temperature rose to 103° F.
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