For years Garfield had been totally deaf in the right ear (following explosion of a gun?). Now, however, the left ear also showed a sensory impairment. Slight slurring of speech had been noticed first in the sixty-sixth year.
Physically there was a slightly enlarged heart with accentuated second aortic sound and irregular rhythm. Neurologically, inability to stand or walk; marked ataxia in his leg movements; upper extremities quite well controlled; the pupils were small and unequal, the left being larger than the right; although the reactions were difficult to test, the pupils seemed to react slightly to direct light stimuli; the knee-jerks were absent; tests for sensibility so far as could be determined did not show any abnormalities; there was much complaint of sharp pains in the legs.
There is no doubt that we are here dealing with a case of Tabes Dorsalis plus certain complications due to Vascular Lesions. The case went on to death from rupture of aortic aneurysm (also doubtless a syphilitic complication). The death occurred at 71, four years after admission to Danvers Hospital.
MAIN FORMS OF NEUROSYPHILIS
(CLASSIFICATION OF THIS BOOK)
DIFFUSE NEUROSYPHILIS
(non-vascular forms of “cerebral,” “spinal” and “cerebrospinal syphilis”)
VASCULAR NEUROSYPHILIS
(“cerebral arteriosclerosis,” “cerebral thrombosis”)
PARETIC NEUROSYPHILIS