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
depressive 2%; circular 7%; hypochondriacal 7%; and maniacal 6%.
=DIFFUSE (meningovasculoparenchymatous) NEUROSYPHILIS may look
precisely like PARETIC NEUROSYPHILIS (“general paresis”) at certain
periods of clinical and laboratory examination.=
=Case 17.= The police found Gregorian Petrofski crouching on his knees
on a Boston sidewalk, attempting to take pickets off a fence. Petrofski
knew little English; he said that he had slept in Poland the night
before. He did not appear to be alcoholic.
When he was examined, through an interpreter, he told how he had been in
America two days, and in Boston two years; that he was at the present
time in Poland, and that his brother had brought him to the hospital and
left him there.
The =physical examination= showed Petrofski to be well developed and
nourished. His pupils were somewhat dilated and reacted somewhat slowly
to light and accommodation. =Neurologically,= there was nothing else
abnormal found upon systematic examination although, through lack of
coöperation, sensory and coördination tests proved difficult if not
impossible. There was a large ulcer on the under surface of the glans
penis, with several small smooth scars on the upper surface. There was a
purulent discharge from the external meatus. There were exostoses of
both tibiae.
The initial diagnosis had to consider uremia and diabetes, which could
be easily excluded on examination. Alcoholism was excluded through
absence of alcohol on the breath. There remained such diagnoses as
epilepsy, some post-traumatic condition, or meningitis, to say nothing
of the hypothesis of syphilis raised by the tibial exostoses and the
lesions of the penis. The hypothesis of trauma was given up, as well as
epilepsy and meningitis upon the data of the lumbar puncture. The spinal
fluid proved to be clear but with enormous amounts of globulin and
albumin, 80 cells per cmm., a “paretic” gold sol reaction, and a
positive spinal fluid W. R. (the serum W. R. was also positive).
Accordingly, it was clear that the case was one of neurosyphilis.
Treatment was instituted with injections of mercury salicylate, a grain
and a half twice a week, and potassium iodid. After some weeks,
diarrhoea and salivation with marked symptoms of mercury poisoning set
in; the treatment was suspended, but later re-instituted. In a few weeks
Petrofski was apparently quite well, the spinal fluid tests had all
become negative, as had the serum W. R.
Petrofski now began to pick up a good deal of English, and gave a
consistent narrative of his past life, although the period just prior to
and during his early stay in the hospital has remained blank. Without
further treatment Petrofski has remained well for over a year.
Public-domain text, read in full here on John Shaqi.
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