Case 86. Frank Johnson was 21 years of age when he was taken up by the police for threatening his sister with a revolver. The police thought he deserved an examination at the Psychopathic Hospital. The patient protested that he had threatened his sister only to frighten her because, he said, she nagged him and made him nervous. In fact, they had always had trouble as she had always nagged him and they had always fought together. Moreover, their mother always took the sister’s part. They had been troubling him for days, and at last Frank could stand it no longer. His sister had complained of the way he treated her dog. Moreover, Frank said he had not been feeling well; there had been some trouble with his stomach; and after one of the nagging attacks, he had taken out an old empty pistol to scare his mother and sister.
In these cases, it is good practice to consult the sister also. She said that Frank had always been very difficult to manage, unwilling to work, preferring to loaf about, spending every obtainable cent; he was once in a reformatory for several years, but not reformed thereby; recently given to drinking; at times acting somewhat peculiarly (sitting at the window with his hat on, refusing to move).
Further mental examination of Frank showed that he was properly oriented and in possession of a good memory, although he was quite obviously a liar. He lay about in bed at the hospital, saying that he was too weak to be up. He was a bit dull, at times not readily grasping ordinary questions.
Physically, Johnson was rather thin; the teeth were somewhat peg-shaped although far from typically Hutchinsonian. The pupils were unequal and irregular, and failed to react to light or even to accommodation when tested. The deep reflexes of arms and legs could not be obtained, though the superficial reflexes were present. For the rest systematic examination proved negative. Serum W. R. negative.
The first thought in such a case would be that the criminological diagnosis of delinquency would be sufficient. However, the pupillary disorder and the areflexia are suggestive despite the negative serum W. R. Resort was naturally had to lumbar puncture, whereupon a positive W. R. was found, a characteristically “paretic” gold sol reaction, globulin, excess albumin, and 134 cells per cmm. In short, it would appear that we must consider a diagnosis of Juvenile Paresis, and, in point of fact, the patient deteriorated rapidly from this time, becoming demented at the end of a few months.
1. How far are the early difficulties of management (leading to a reformatory) due to syphilis? We should not dogmatically say that there is a relation between the early delinquency and syphilis. Still, it is not unusual to find emotional disorder and instability as well as delinquency in congenital syphilitics.
2. What suggestion, if any, should be made to the patient’s intelligent and seemingly normal sister, two years older? We prevailed upon Miss Johnson to submit to the W. R. of the serum, which was found, as in the case of Frank, to be negative. Frank’s sister should undoubtedly submit to a lumbar puncture; but in the present phase of mental hygiene, she would be difficult to persuade.
3. How is it possible to find such a marked evidence of congenital syphilis in a younger sibling with no evidence of syphilis in the elder? In the first place, there may be a history of entrance of syphilis into the lives of the parents between the pregnancies. However, in other instances, there is no evidence of such intercurrent syphilis, and contrary to the prevailing opinion it is not so infrequent to find congenital syphilis in the younger brother or sister of a normal person.
4. What can be said of treatment in such cases? In the first place it is clear that delinquent cases should be tested far earlier for the possibility of syphilis. Had this case been examined by a neurologist or alienist many years earlier, it is probable that the same pupillary signs and the peg-shaped teeth would have been found, and that the hypothesis of syphilis might have been raised. There is no good evidence as yet that these cases can be markedly benefited by treatment.
Neurosyphilis in a “defective delinquent.”