A case of Taboparetic Neurosyphilis in which the heavy exudate characteristic of paresis became a soil for a growth of the typhoid bacillus is presented with autopsy.[[108]] This fatality with Typhoid Meningitis is merely a concrete example of the many complications which syphilitics and especially neurosyphilitics have to sustain.
The case series then goes on to illustrate, though quite inadequately, a variety of MEDICOLEGAL AND SOCIAL complications of neurosyphilis. It is well known that many social complications with grave moral, economic and even political difficulties occur.
Our series starts with a “public character”[[109]] whose eloquence and reformatory efforts led to a considerable notoriety. The autopsy in this case showed singularly few lesions despite the fact that the case was microscopically one of wholly characteristic Paretic Neurosyphilis. The question might arise how far we are entitled to correlate the reformatory efforts of this always eccentric character with syphilis. The man himself a physician, was aware of the doubt which his Argyll-Robertson pupils threw upon his medical situation. He explained them on the basis of an old smallpox! We are inclined to think that the whole of this man’s life, from his giving up of medical practice to live as a kind of literary and political hack, was due to subtle changes of neurosyphilitic origin. The fact that there was a certain delinquent streak in the man is not inconsistent with this idea. Interestingly enough, a fall on the ice in the man’s 61st year actually started up the fatal process, a condition of affairs amply illustrated in cases of neurosyphilis, brought out by trauma that come to the attention of the Industrial Accident Board in connection with claims for compensation.
A case of sudden grandiosity[[110]] illustrates an episode of Neurosyphilitic origin. Such a person might well be regarded by the lay newspaper reader as a crank or a grafter but the neurosyphilitic possibility should always be entertained in cases of this order.
As against the social difficulties that look in the direction of the classical paretic grandeur, we present a case of apparent suicidal attempt by gas, which attempt was followed by a period of amnesia that, taking into account the laboratory findings, was probably Neurosyphilitic.[[111]]
Vistas of extraordinary interest are opened out by studies of the relation of neurosyphilis to delinquency. The case of the psychopathic reformer (Case 83) above mentioned was one in which the delinquency may possibly have been related to acquired syphilis. We present also a case of juvenile neurosyphilis, a young man of reform school type[[112]] in which Juvenile Paretic Neurosyphilis was established. This patient, in fact, deteriorated very rapidly to a condition of considerable dementia a few months after the diagnosis was established.
A striking case of so-called Defective Delinquency is presented, an alcoholic prostitute of the reformatory group.[[113]] The Neurosyphilis in this case was a complication rather than an original factor in the delinquency.
One case of Paresis Sine Paresi was that of an habitual criminal[[114]] and forger who, without showing mental or physical symptoms of neurosyphilis, yielded the laboratory signs of paretic neurosyphilis. Again, as in the case of the prostitute just mentioned, the Criminality[[115]] seems to have antedated the neurosyphilis and even to have been hereditary.
By way of introducing the next group of Industrial Accident Board cases, we present a case of Juvenile Paresis with initial Traum.
The Industrial Board group is of note in that the signs of the traumatic form[[116]] of paretic neurosyphilis do not occur immediately upon the accident. Some time elapses in which the physical, chemical or parasitological changes have time to work themselves out in the injured tissues. Many hypotheses may be raised as to the reason why a trauma lights up a syphilitic process. Of course, false claims[[117]] may be made for compensation by neurosyphilitics in whom the symptoms were already in existence before the accident and in whom they may not even be markedly exacerbated by the accident. The false claimants can probably not readily frame a story which the expert psychiatrist cannot discredit if he is allowed to perform laboratory tests and give the patient the benefit of thorough examination. However, some cases of established Paretic Neurosyphilis are perhaps truly subject to exacerbations[[118]] of the clinical process and it may well be held that such exacerbations warrant partial compensation.