Although there is some doubt what ethical relation a state institution shall maintain with physicians in private practice, we took occasion to call the attention of our patient’s new counsellor to the fact of the patient’s neurosyphilis. We noted that the man’s serum had been constantly positive (Massachusetts State Board of Health findings) in a score or more of observations. We called attention to the fact that lumbar puncture had shown positive signs of neurosyphilis, including a positive W. R., globulin, excess albumin, pleocytosis, and positive gold sol. These facts, according to a letter received from the private practitioner in question, have not altered his opinion in the slightest to the effect that our patient is completely normal and entirely suitable for marriage. It is clear that he regards the patient as not a victim of General Paresis.
5. What is the significance o the negative observation eventually obtained in Jacobs’ serum? One’s first thought is to impugn the accuracy of the laboratory work, but against this suspicion is the excellent reputation of the laboratory in question, and the agreement in the majority of its findings with those of the State Board of Health. It is more likely, as we assured the private practitioner at whose request the observation was made, that this negative test was an exceptional and isolated observation such as is not infrequent in long series of observations, particularly those made under therapeutic conditions. In so important a matter, we are inclined to feel that the physician in question should have resorted to two more observations at intervals before running counter to the position taken by the hospital.
——many a hard assay
Of dangers, and adversities, and pains.
Paradise Regained, Book IV, lines 478–479.
V. SOME RESULTS OF TREATMENT
Cases 99–103 show the Variety of Structural Lesions that Treatment has to face.
SPASTIC HEMIPLEGIA in PARETIC NEUROSYPHILIS (“general paresis”), showing marked degenerative changes, a condition in which therapy could be theoretically of very little avail. Autopsy.
Case 99. James McDevitt arrived at the Danvers Hospital, July 20, 1906 (saying that he came to be “thawed out”), and died less than six months later: January 12, 1907. He was 34 years of age. He had been a shoe-worker after leaving school, had worked eight years with the General Electric Co., and had then become a bartender. He had, however, stopped work in September, 1905, and we may safely say that mental symptoms had begun insidiously at about that time. His symptoms, if there were any, had been masked by a heavy alcoholism, but an obvious change had appeared in November, 1905. The patient lost ambition, smoked and loafed about his room, and developed speech disorder. He denied venereal disease, nor was there any superficial evidence of such.
Physically, the patient showed little or no disorder except acne of the trunk, patches of eczema on the left lower chest, and numerous brownish scars along both tibiae.