Case 89. Margaret Tennyson was a small girl of six years, described as having been normal until run down by a double-runner sled about 13 months before her arrival at the hospital. The change was stated to be remarkable. “She was as unlike her own self as darkness and daylight.” Once fat and sunny, talkative and demonstrative with her toys, now Margaret had become silent, sullen, worried, and of a violent temper, stubborn and unmanageable. It does not appear that the patient was seriously injured by the double-runner, as she was able to walk a short distance home. Shortly, however, she began to have trouble with her feet (diagnosed at the time as flat-foot), and thereafter her whole character and disposition changed. Upon arrival at the hospital, the patient walked with a typical scissors gait of spastic paraplegia.
Physical examination was very difficult through lack of coöperation and a screaming and kicking resistance upon every attempt. There was a suggestion of hydrocephalus in the protrusion of the forehead. The pupils reacted readily to light and accommodation. The knee-jerks were active, but there was otherwise no disorder of reflexes. The patient had great difficulty in getting up from the floor, and for the most part insisted upon lying in ventral decubitus on the floor, crying when attempt was made to raise her. An attempt was made to test her by the Binet scale, by which she was found to rate at 2⅘ years although a portion of this low-rating was thought to be due to a failure of coöperation.
The family history threw little or no light upon the case. The parents were living and well; a brother of 16 years was at work in the market district; two of the other siblings are in the first and second grades at school and regarded as exceptionally bright by their teachers. The fourth was the patient, Margaret; a fifth had died at 9 weeks of heart trouble; the sixth, seventh, and eighth, of 3, 1½ years and 3 months respectively, appeared entirely well. There were no miscarriages or stillbirths.
Juvenile paresis—spastic paraplegia. 5 years.
The scissors gait and spasticity seem to point undoubtedly to organic disease of the nervous system, along with which the mental deterioration seemed to suggest an active progressive involvement of the cerebrum. The history seemed to be convincing that the child was not an instance of congenital feeblemindedness.
A neurologist’s clinical diagnosis would naturally be syphilis. In point of fact, this diagnosis was borne out by the laboratory tests, which showed a positive W. R. in the serum and spinal fluid, positive globulin, a slight excess of albumin, and a syphilitic gold sol reaction.
1. What is the significance of the trauma in the case of Margaret Tennyson? The trauma seemed to the family the precipitating cause. We find cases of general paresis in adults very definitely following trauma, yet neurosyphilis, both in adults and in younger patients, mainly occurs without trauma. On the whole, in this case, it is perhaps safer to regard the trauma as mere coincidence. A sister older than Margaret was found upon examination to have a positive W. R. The other children could not be examined.
Traumatic form of PARETIC NEUROSYPHILIS (“general paresis”).
Case 90. The point about Joseph O’Hearn was his entire mental soundness up to the time of an injury at work, when he was blown through a double window in an explosion, badly bruising his head. Shortly after the accident, although not immediately, the patient began to show signs of mental disorder, doing very foolish things, losing his memory, and becoming unable to work.