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
=Mental Examination.= On entrance to hospital patient seemed slightly
depressed and a bit irritable. This condition lasted two days, after
which he was agreeable and apparently entirely over his depression. Even
during his mild depression, however, he talked freely. There was no
evidence of retardation. He told his story readily. Orientation was
intact. Memory excellent. Educational knowledge well retained. There was
no evidence of any hallucinations or delusions.
1. Was Richard Lawlor insane?
There was, then, on the mental and physical examination nothing to
make a definite suggestion of a psychosis, and the most one could
think of was a psychoneurosis or a cyclothymia of at least ten
years’ duration. The findings in the cerebrospinal fluid and the
Wassermann reactions, however, give us material for thought.
Certainly one cannot call the man insane; all who saw him agreed
on this point.
2. If Richard Lawlor should some day develop mental symptoms, what
would be the genesis of the new psychosis? Though writers such
as Fildes and McIntosh, and Swift, have suggested an
anaphylactic or hyperallergic explanation for the development of
symptoms after a normal interval; such a hypothesis could hardly
obtain in the present case. The hyperallergic hypothesis for the
development of tertiary neurosyphilis would run to the effect
that in the secondary stages there had been a definite disease
of the nervous system, which, however, absolutely cleared up,
leaving no inflammatory vascular or parenchymatous relics of its
existence. Nothing would on this hypothesis remain except a
hypersensitisation of the tissues. In some later period of the
now clinically normal person, one or more spirochetes from a
lesion outside the nervous system are carried into the nerve
tissues and there set up an anaphylactic or hyperallergic
reaction. It is obviously difficult to prove the correctness or
incorrectness of the hyperallergic theory without numerous
examinations of the spinal fluid, in clinically normal persons
after the secondaries have passed. The present case, so far from
demonstrating a normal fluid, demonstrates a highly pathological
fluid, even though there are absolutely no clinical symptoms
which could be regarded as of nervous origin. The burden of
proof at the present time would seem to lie with those who claim
hyperallergy in neurosyphilis. We prefer on present evidence to
think that at the conclusion of the secondaries a disease
process often remains in the nerve tissues despite clinical
quiescence.
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