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
1. Was the conclusion “aggravated by service” sound? On humanitarian
grounds the victim is naturally conceded the benefit of the doubt.
But it is questionable how scientifically sound the conclusion
really was.
2. Could the condition come only from syphilitic infection of at
least three years’ standing? Hardly any single symptom in this
case need be of so long a standing; yet the combination of
symptoms seems by very weight of numbers to justify the conclusion
of the medical board.
=Can PARETIC NEUROSYPHILIS (“general paresis”) be lighted up by the
stress of military service without injury or disease? A possible
example from P. Marie, Chatelin and Patrikios of Paris.=
=Case G.= In apparently good health a French soldier repaired to the
colors, in August, 1914, being then 23 years old.
Two years later, August, 1916, symptoms appeared: speech disorder with
stammering, change of character (had become easily excitable), stumbling
gait. He became more and more preoccupied with his own affairs, grew
worse, and was sent to hospital in October, 1916.
He was then foolish and overhappy, especially when interviewed. There
was marked rapid tremor of face and tongue. Speech hesitant, monotonous,
and stammering to the point of unintelligibility. His memory, at first
preserved, became impaired so that half of a test phrase was forgotten.
Simple addition was impossible and fantastic sums would be given instead
of right answers; handwriting tremulous, letters often missed, others
irregular, unequal, and misshapen.
Excitable from onset, the patient now became at times suddenly violent,
striking his wife without provocation. After visit at home, he would
forget to return to hospital. Often he would leave hospital without
permission (of course the more surprising in a disciplined soldier).
No delusions were found.
The serum and fluid W. R. were positive, albumin in fluid,
lymphocytosis.
=Neurological examination.= Unequal pupils, slight right-side mydriasis,
pupils stiff to light, weakly responsive in accommodation, reflexes
lively, fingers tremulous on extension of arms.
The patient had, December 5, 1916, an epileptiform attack with head
rotation, limb-contractions and clonic movements.
1. Should this soldier recover for disability obtained in service?
Marie was inclined to think military service in part responsible
for the development of the paresis. Laignel-Lavastine thought so
also, but that the amount assigned should be 5%–10% of the maximum
assignable.
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