As to the syphilitic nature of this affection, there had been at eighteen (22 years before) a colorless small induration of the penis, lasting about three weeks. There was now evident a small oval pigmented scar. The patient had married at 20 and has had three healthy children.
The lumbar puncture fluid yielded pleocytosis (120 per cmm.). Mercurial treatment was instituted.
The treatment has not reduced the pains. Long thinks it was undertaken too long (six months) after onset. The warning for early diagnosis is manifest. There was somehow a delay under the medical conditions of the army.
Can the “lighting up” of NEUROSYPHILIS IN CIVIL LIFE be induced by the domestic stress of war? A possible example from Dr. R. Percy Smith, London.
Case L. A German Jew in London passed into the Paretic form of Neurosyphilis shortly after the outbreak of war under conditions suggesting that the stress of emotions directly or indirectly lighted up the neural process.
The man was a bank-officer, 52 years old, and married. He had lived many years in England and was in fact a naturalized citizen. He had been under treatment for syphilis by Sir Jonathan Hutchinson, 29 years before, namely, at the age of 23. Subsequently, Sir John had given him permission to marry.
It proved that for years the man had had fixed pupils, absent knee-jerks, and a perforated ulcer of the foot. However, there had been no other mental or nervous symptoms preventing bank-officer’s work.
At the outbreak of war the man was discharged from the bank. He grew worried and sleepless. He began to charge himself with sex irregularity. He went down to the city and burned trust documents belonging to others.
From worry and self-accusation he passed into depression and agitation. He developed a belief that not only he but also his German wife were to be executed. He thought he was a criminal and was to be hanged.
The depression then altered to a condition of hilarity and loquacity.