The neurosyphilitic’s family should not be forgotten in diagnosis and treatment.
Case 96. The Bornstein family is remarkable. Let us hang the story on Becky, the mother, an Austrian woman of 43 years, who appears to have been perfectly well up to within a year. About a year ago, Mrs. Bornstein began to suffer from severe headaches, which were treated with apparent success by an osteopath: at all events, Mrs. Bornstein recovered therefrom in about six months. However, two months later, she had a convulsion, with foaming at the mouth, blueness of face, and general muscular stiffening. The convulsion lasted for several minutes. Again, a fortnight before admission, the patient had five convulsions of an identical nature in a single night.
Moreover, since the first convulsion, Mrs. Bornstein’s mental condition has altered and become variable, so that at times she is excited, at times depressed. She would assert inaccurately that there was some one in the house, and that she had at different times committed crimes of a heinous nature. Now and then she would seem to see moving pictures. Her memory was poor and she seemed to believe that events of five or six years ago had just happened.
The pupils were sluggish, the knee-jerks and ankle-jerks were absent, there was slight ataxia, and there was speech defect. The suspicion of neurosyphilis was so strong that it seemed surprising that the W. R. of the blood serum, even after repeated tests and after the provocative injection of salvarsan, proved negative. However, the spinal fluid yielded a positive W. R., and a gold sol reaction of the “paretic” type, together with 12 cells per cmm., and a marked increase of albumin, with positive globulin. It would seem warrantable to make a diagnosis at least of syphilis of the nervous system in this case, but it is a question whether we should be warranted in making the diagnosis general paresis.
That the diagnosis is doubtful may perhaps be seen from the variety of diagnoses in the rest of the family. In the first place, Mrs. Bornstein’s husband admits syphilitic infection many years before. He states also that his wife after marriage showed signs of syphilis and received some treatment, although limited. It is stated also that the husband himself at this time has a positive W. R. and has stiff pupils and petit mal attacks. The oldest son, 22 years of age, is confined in an institution with juvenile paresis. The second son has recently died at the age of 20 years, receiving a diagnosis of rupture of the aorta. A third son, 19 years of age, has the appearance of having achondroplasia, although the proportions of his limbs do not quite correspond with those of an achondroplast. The fourth son, 17 years of age, is suffering from caries of the spine. A fifth son, 14 years old, is neurotic and has the so-called Olympic forehead. The sixth and last son died shortly after birth of unknown cause.
Neurosyphilitic’s normal-looking family proved syphilitic.
Case 97. Walter Heinmas was a draughtsman 33 years of age when he was brought to the Psychopathic Hospital suffering from mental disease. This was diagnosed as general paresis, both on account of the clinical symptomatology and on account of the laboratory findings. In fact, it was a case of the classical type with marked euphoria and grandiosity.
As is the routine procedure at the Psychopathic Hospital, in the case of all syphilitic patients, the family was sent for. This consisted of the wife and two daughters, aged 9 and 7 respectively. The patient denied any knowledge of a syphilitic infection. The wife, also, gave no history of any primary, secondary, or tertiary symptoms; there had been no abortions, miscarriages, or stillbirths; both children had been born at term and had been entirely healthy. Examination showed that the mother had no signs referable to syphilis, and that both the children were mentally well endowed, with good physique and showing no stigmata of congenital syphilis. Still the W. R. of all three (the mother and the two children) was positive in the blood serum. These tests were repeated several times on the children, with and without injections of salvarsan, and they remained consistently positive.
1. Are these children to be considered congenital syphilitics despite the absence of stigmata or symptoms? We must consider these children as congenital syphilitics and candidates for the group frequently spoken of as syphilitis hereditaria tarda.
2. What is the frequency of syphilitic involvement in the mate and children of paretics? In our series, we have found that about 15% of the marriages where one member develops paresis, result in sterility; that in 18% abortions, miscarriages and stillbirths occur; and that in 15% positive W. R. is obtained. We have adopted the motto: “The families of paretics are the families of syphilitics.”