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
3. Bearing in mind that Sullivan was a waiter, what shall be said
about the infectivity of these cases? It is counted as a rule as
negative, since there are no open spirochete-bearing lesions. The
longer the period since infection the less, as a rule, is the
chance of contagion in syphilis; and as tabes and paresis occur
fairly late in the disease, the infectiousness at this stage is
practically negligible.
4. Of what differential value is the insight shown by Sullivan into
the nature of his symptoms? Kraepelin remarks that a genuine
insight into the nature of the disease does not as a rule occur in
paresis. At the beginning of the disease, there may sometimes be a
correct understanding of the nature of the disease and of its
probable outcome; but the presence or absence of insight into the
fact of mental disease is by no means a differential sign of
practical value.
5. What is to be said of the occurrence of depression and excited
states in paretic neurosyphilis? A variety of classifications of
sub-forms of paretic neurosyphilis have been propounded.
Kraepelin, for example, deals with four: the demented, depressive,
expansive, and agitated forms, but remarks that the division is
merely convenient for exposition. The institutional intake does
not accurately represent the distribution of cases. Under
psychopathic hospital conditions with the relatively easy resort
to such institutions, the number of quiet cases increases; under
the less advanced conditions in Heidelberg, Kraepelin took in 53%
demented paretics as against 56% at Munich (73% women) under the
easier conditions of admission. The admissions of demented
paretics varied from 37 to 56%. The variations depend much upon
the facility with which the cases can be brought to institutions.
Where admission is beset with various legal restrictions, the
quiet and demented cases are more apt to be treated for long
periods at home. The depressive type of paretic neurosyphilis
forms a much smaller group, according to Kraepelin, as only about
12% of his Heidelberg admissions were of this type, and still
fewer of his Munich admissions. Other authors give percentages as
high as 16 and 19. The so-called expansive group is larger,
Kraepelin finding 30% of his Heidelberg cases to be of this group,
and 21 to 22% of his Munich cases. The rarest sub-form of paretic
neurosyphilis is the agitated form: 6% of Kraepelin’s Heidelberg
admissions; 14% among males and 5% among females in his Munich
admissions, where the diagnosis of agitated paresis was entered on
somewhat broader lines. French authors (Sérieux and Ducaste) have
enlarged the number of sub-forms of paretic neurosyphilis as
follows: Expansive 27%; sensory 24%; demented 24%; persecutory 3%;
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