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
=Case 5.= John Lawrence was an under-sized negro, who came under
hospital observation when he was 23 years of age. There was some
evidence that the patient’s father was a neurosyphilitic although
accurate data were out of the question. At all events, John had
Hutchinsonian teeth, a forward bowing of the tibiae, and
Argyll-Robertson pupils. These findings together with a history of
backwardness at school seem to stamp the diagnosis. It seems that there
had been a change for the worse from the age of 18, though the boy had
been able to sell newspapers and black shoes up to within a year of his
arrival at the hospital. During the last months of his life, he showed a
general incoördination, with false movements suggesting those of a
drunken person. There were numerous tremors, the glance was shifting,
and there was a tendency to nystagmus. Some of these phenomena (taking
into account that the Hutchinsonian teeth were not entirely typical and
there was even at times some doubt as to whether the pupils were
actually stiff) led to a question of the diagnosis multiple sclerosis.
There was, however, little doubt that the case was one of juvenile
paresis. Among the symptoms found at various times in this case are the
following: disorientation for time, place and persons, confusion, with
coarsely irrelevant replies to questions, ill-defined and transitory
delusions of persecution, auditory, tactile, and visual hallucinations,
and defective memory.
Early in life, the patient had had a habit of falling asleep in school
hours, and had experienced a number of falls at various times. During an
attack of measles he had had a number of spasms, each of which lasted
ten minutes or more.
The =autopsy= showed death to be due to an early bronchial pneumonia.
The thymus was persistent, measuring 3 × 2 × .5 cm. The marrow of the
femur was red.
There was a moderate degree of =sclerosis of the aorta= confined to a
few plaques in the arch (not a characteristic syphilitic scarring of the
aorta). The spleen was small and had a thickened capsule.
The majority of the lesions, however, were in the =nervous system=, and
the following description is taken from the routine hospital records to
exemplify the findings in a fairly characteristic case of JUVENILE
PARESIS.
Public-domain text, read in full here on John Shaqi.
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