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 fact that Morovitz had no apparent symptoms for several years led to
rather desultory treatment chiefly in the form of mercury by mouth.
Previous to the time when the W. R. and lumbar puncture were available,
the physician had no exact means of determining cure except the
non-appearance of symptoms. But a period of years of quiescence before
the outbreak of symptoms referable to the involvement of the nervous
system is characteristic of syphilis. With this knowledge in mind it is
evident that today the care of a syphilitic patient must be guided, in
part at least, by examinations of the spinal fluid and W. R.
=Salvarsan treatment may even occasionally be of value in simple
FEEBLEMINDEDNESS due to congenital syphilis.=
=Case 123.= The somewhat unattractive Robert Matthews was brought, at 5
years of age, to the hospital for backwardness of mind. It appears that
the patient was born at term, with instruments, that he began to talk at
a year, and to walk at 13 months, but that in point of fact, he had not
talked intelligibly to date. Robert had never played with other children
and is regarded by his parents as backward. In fact, Robert’s sister—a
year his junior—is much brighter. Robert had had scarlet fever but
without sequelae.
Examination by the Binet scale showed that, although he is actually 5½
years, he graded by the Binet scale at 4 and was regarded as
feebleminded.
The =physical examination= showed a general adenopathy and prominent
frontal bosses. In the study of the family history in the search for an
etiology for the evident feeblemindedness, little or none could be
found. There were no miscarriages or stillbirths; the parents were
living and well. There was only the one sister above-mentioned, who is
brighter than Robert.
The advantage of a routine W. R. is here well shown, for the W. R. in
the serum was positive.
1. What is the prognosis of cases of syphilitic feeblemindedness? It
would appear that every case is an individual problem.
2. What is the effect of treatment? Robert Matthews was given
mercury protoiodid ⅛ gr., three times a day, by mouth, for three
months. The protoiodid was followed by ten injections of
salvarsan, average: 0.15 gram, during six months. At the end of
this period, the W. R. in the blood had become negative. A
re-examination by the Binet scale, when Robert was 6–5⁄12 years of
age, showed him to grade at 5⅖, so that one might conclude that
Robert had shown more mental progress in a year than he had
previously.
Public-domain text, read in full here on John Shaqi.
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