The autopsy showed few changes of the calvarium or of the dura mater, nor was the pia mater more than slightly thickened and milky over the frontal poles, along the longitudinal fissure and over the sulci. There were fairly firm adhesions of the pia mater to the dura mater along the longitudinal fissure and over the frontal poles and at the temporal tips. The hemispheres were firmly interadherent, and the cerebello-pontine tissues were covered with a firm leptomeningitis. The floors of the ventricles were smooth and the basal vessels showed little beyond a few spots of sclerosis. There was a generalized increase of consistence. The frontal gyri were rather prominent with wide sulci, but upon section no very marked atrophy of the gray matter could be shown. The rest of the brain failed to show any flaring of sulci or any special evidence of cortical atrophy. The brain weighed 1250 grams; a possible diminution of 100 grams, considering the patient’s body length. However, it must be remembered that he was at this time 63 years of age.
Microscopically, the diagnosis of General Paresis was confirmed on the basis of plasmocytosis, lymphocytosis, gliotic changes and nerve cell destruction. There was an unusual variation in the degree of the destructive process, which picked out, for example, certain regions of the right side for maximal lesion (cornu ammonis, gyrus rectus, and superior frontal gyrus).
If the patient’s own estimate of 35 years’ duration for his Argyll-Robertson pupils can be trusted (and in general his memory was extremely good), we may well conceive an unusual duration for the process in his case. There was, however, in the body at large no very marked degree of changes. There was a slight old tuberculosis. There was a slight interstitial nephritis, with cardiac hypertrophy and fibrous myocarditis. There was also a sclerosis of the mitral and aortic valves; there were chronic changes in the spleen, liver, and bladder; there was generalized arteriosclerosis of mild degree; there were two round gastric ulcers near the pylorus. The liver weighed but 800 grams, and its left lobe was somewhat rough.
This case is placed among the medicolegal and social cases because the phenomena that ushered in his last illness were mistaken by the local public for meritorious social reform measures. They were regarded as not markedly different from the variety of steps taken by the very active doctor in previous years; indeed the public eloquence that he displayed a year before his death was quite in line with previous habits, despite the suspicious over-brilliance of language. It is an important question, how far the eccentricity and literary overactivity of the latter half of the doctor’s total life can be explained on the basis of a mild syphilitic irritation of the nervous system. In this connection we are tempted to recall the suggestions of Mœbius concerning a portion of the literary products of Nietzsche. Our doctor was by no means so brilliant an exemplar of syphilitic literature as was Nietzsche, if we grant the hypothesis of Mœbius to cover our doctor’s case as well as that of Nietzsche. In the future, important studies of character change under the influence of syphilis will doubtless be made. With modern diagnostic methods, of course, the diagnosis would have been rendered almost at once in the case of Major Isaac Thompson, M.D., and much of his past life would have been brought under special review in connection with the syphilis which doubtless the blood serum or at any rate the cerebrospinal fluid would have shown.
This case illustrates but one of the many social complications arising as the result of paresis. When one recalls that the onset is often insidious and not correctly understood for a period of time, it is readily seen that many unfortunate acts may be committed by a patient. As hypersexual desire is not an infrequent early symptom and as judgment is early disturbed, loose morals may ruin the patient’s reputation. The poor judgment and expansive delusions often lead to foolish business deals wherein the patient’s family is left destitute. At other times the onset is sudden and then the danger of false commands or acts by a person in a responsible position, as a steamship captain, an engineer or chauffeur, may lead to loss of life and property.
Sudden grandiosity: debts. PARETIC NEUROSYPHILIS (“general paresis”): Question of liability.
Case 84. Lester Smith was a salesman, 31 years of age, who, while on a business trip, accompanied by his wife, suddenly developed grandiose ideas. He originated a scheme of cornering the phonograph market. His prospects seemed so certain to him, that he hired an expensive suite of rooms in a hotel at something over $35 a day. As at the first presentation of his bill it was found that he had no money to meet these charges, he was taken into custody and at once transferred to a hospital for the insane, where it was discovered that he was suffering from General Paresis.
1. What is the patient’s responsibility for these debts? Legally the patient or his estate is responsible for debts accruing from services rendered or goods received. As he is adjudged non compos mentis contracts entered into would not hold, and he would not be considered liable for criminal acts.
Note: This case shows how dangerous paresis may be not only to the life and usefulness of a patient, but further how it may ruin a family financially. Mr. Smith’s little escapade used up all the money that he had been able to save in his life and when he was taken to a hospital his wife was left destitute.
Suicidal attempt (?) by a neurosyphilitic.