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 leading features of this mental disease were well exemplified
in our cases the past year. They formed 7.5 per cent of the total
number. They averaged forty years of age, and Ziehen says 80 per
cent of all cases are in the fourth or fifth decade of life. They
averaged ten and a half years’ service, which would indicate that
the military life was their calling. Only one had any serious
hereditary defect. Stigmata of degeneration were infrequent,
averaging only two for each case. 66 per cent had good schooling,
considering their opportunities. Physical signs were frequent in
each case. Only one showed normal light reaction. Ziehen says the
light reaction is retained in only 20 per cent of the cases.
Patellar reflex was absent in one case and normal or exaggerated
in five. The speech defect was slight in four cases. Other
physical signs were present in the usual proportions. Memory
defects existed in all the cases. In four the onset was with
excitement. One began with a character change as the most marked
feature. In only two were the transfer diagnoses correct. One,
beginning as a quiet dementia, was diagnosticated paralysis
agitans, because of a marked tremor. One was excited and euphoric
and was called a manic-depressive psychosis. One with an obscure
onset was diagnosticated as a neurasthenic. The other one was
first observed in this hospital. The physical signs should have
led to a correct diagnosis in each of these cases.”
=Duration of neurosyphilitic process important _re_ compensation.
Canadian case, courtesy of Dr. C. B. Farrar, Psychiatrist, Military
Hospitals Commission.=
=Case F.= A Canadian of 36 enlisted in 1915, served in England, and was
returned to Canada in February, 1917, clearly suffering from some form
of neurosyphilis (W. R. positive in serum and fluid, globulin,
pleocytosis 108).
There is no record of any disability or symptom of nervous or mental
disease at enlistment. The first symptoms were noted by the patient in
May, 1916, six months or more after enlistment. The case was reviewed at
a Canadian Special Hospital, October 11, 1916, by a board of examiners.
This board reported that:
“The condition could only come from syphilitic infection of three years’
standing” (a decision bearing on compensation); but the general
diagnosis remained:
“Cerebrospinal lues, =aggravated by service=.”
The picture which the medical board regarded as of at least three years’
standing was as follows:
History of incontinence, shooting pains, attacks of syncope, general
weakness, facial tremor, exaggerated knee-jerks, pupils react with small
excursion. Speech and writing disorder, perception dull, lapses of
attention, memory defect, defective insight into nature of disorder,
emotional apathy.
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