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
=Physically=, he was a powerfully-built man and in very good physical
condition except for an iritis and moderate thickening of the peripheral
arteries. The =neurological signs= of importance were Argyll-Robertson
pupils, and absent knee-jerks and ankle-jerks. With these findings in
mind, a tentative diagnosis of GENERAL PARESIS was made, and this was
substantiated by the laboratory tests, which gave positive W. R.’s in
blood and spinal fluid, globulin, excessive albumin, slight pleocytosis,
and a “paretic” gold sol reaction.
When the patient’s mental condition was somewhat better, he gave a
history of syphilitic infection 15 years before, for which he had had
almost continuous treatment. As a matter of fact, treatment had been
pretty strenuous because he had recurring skin lesions and iritis. It
was practically impossible to get the skin lesions to heal with mercury,
and it was not until salvarsan was introduced that a good result was
obtained in this respect. After one or two injections of this drug, the
skin lesion disappeared and has never returned. However, at least once a
year, he has had attacks of iritis, and for this reason was still being
treated for syphilis at the outbreak of his psychosis.
He was at once placed on more strenuous antisyphilitic treatment in the
form of diarsenol, semi-weekly, aided by mercury injections. After a few
months of this treatment, his mental condition improved so much that he
seemed to be entirely normal. Treatment was continued, however, without
any abatement, and it was of great interest to note at the end of five
months of such treatment that, although mentally he seemed entirely
well, he had an attack of iritis, which was considered as a sign of
active syphilis. This would appear to indicate the great difficulty of
getting results in certain cases of syphilis with any drugs at our
command at present, as in the iritis we are dealing with a condition
which as a rule reacts fairly readily to antisyphilitic remedies.
1. Are there different strains of spirochetes showing various
degrees of malignancy? This question has been discussed at length
in the literature but there is no satisfactory answer at the
present time. We must always consider the reaction of the organism
and the host; and it is true in syphilis, as in every other
disease, that in some individuals it is more difficult to get any
therapeutic results than in others.
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