Case 88.[[17]] —— was brought to the hospital by the police. He was charged with having forged a check, and on account of the crudeness of the work his mental condition was suspected.
Family History. The paternal grandfather was considered fast, drank a great deal and was said to be a thief. The father is said to have been forced to leave the State when a young man in order to avoid the reformatory. Paternal cousin murdered a man; the sisters of this cousin said to have been wild and one brother married a prostitute. Nothing known of maternal relatives.
Past History. Medical history is unimportant. He denies syphilis. His early childhood is of little significance. He was somewhat dull in school. At about the age of twelve he began to lie and steal, and has continued this ever since. His attempts have all been very crude, it is said, and when confronted he would strenuously deny his deeds, even when the evidence was overwhelming. He forged checks, borrowed money from all his friends, and charged things at stores to the family. The family paid the bills for a time, and then later had him sent to a reform school. He was married at nineteen, but wife has left him and obtained a divorce. He has been excessively alcoholic for years, and is suspected also of taking drugs. He was discharged from the navy dishonorably. He later joined the army and was discharged therefrom on account of “rheumatism,” according to his account, but in reality deserted. He had finished a jail sentence of thirteen months for forgery a little over a year before entrance.
Physical examination shows a well developed and nourished man. The general physical examination is negative. The lungs show nothing abnormal. The heart is not enlarged, there are no murmurs or irregularities; blood pressure, 145 systolic. The alimentary system is negative. No palpable lymph glands. Neurological examination: pupils equal and react to light and accommodation. Extraocular movements well performed. Tongue projects in the median line, with no tremor. There is no evidence of facial paresis or weakness of the muscles. The biceps, triceps, knee-jerks and ankle-jerks are present and equal on the two sides. There is no Gordon, Babinski or Oppenheim; no ankle clonus. There is no tremor of the extended hands. No Romberg sign. There is a little difficulty in the finger-to-finger test. There is no sensory disturbance either subjective or objective. No tenderness over nerve trunks.
Mental examination shows nothing of a psychotic nature. Patient is well oriented; memory for remote and recent events is well preserved, school knowledge well retained, grasp on current events good; no delusions or hallucinations elicited. Patient is not feebleminded, according to the intelligence tests of Binet and Simon and Yerkes-Bridges, but shows poor attention and gives evidence of weakness in volitional spheres; is very suggestible.
To summarize the case, then, we have a man of thirty years of age who has shown criminalistic and anti-social tendencies since childhood, whose general physical and neurological examination is negative (excepting the laboratory tests), whose mental examination shows no psychotic symptoms, and who seems not feebleminded. In other words, with the exception of the serological and chemical findings in the blood and cerebrospinal fluid, there is nothing to suggest that he is more than a “criminal type.”
Wassermann reaction in blood serum positive.
Wassermann reaction in cerebrospinal fluid positive. Examination of cerebrospinal fluid: globulin ++, albumin ++, cells 55 per cubic millimeter; large lymphocytes, 9.1 per cent; small lymphocytes, 90 per cent; plasma, 90 per cent. Gold sol reaction, 3321000000.
1. Can the criminalistic tendencies be condoned in this case on the ground of neurosyphilis? As a matter of fact the delinquencies in this patient reach back to early childhood and as there is no evidence of congenital syphilis it cannot be held that syphilis had any bearing in the causation of symptoms. Even were the delinquencies only of recent date it is doubtful if the court would take cognizance of the laboratory findings in the absence of definite mental symptoms. In this connection it may be stated that the court takes cognizance only of the acts of a patient at time of examination, and not of the history or laboratory findings, in committing a person. We have had several patients who from history, physical signs and laboratory tests made the diagnosis of paretic neurosyphilis easy and yet who could not be committed because they were mentally clear at the time. Such patients may be of grave potential danger to themselves and families, and present numerous social problems. See case of Joseph Wilson (95).
JUVENILE PARETIC NEUROSYPHILIS (“juvenile paresis”) with initial trauma.