SYPHILITIC PARANOIA
TABETIC PSYCHOSIS
HEREDITARY
PARESIS
Kraepelin, 1910
Chart 12
TABOPARETIC NEUROSYPHILIS (“taboparesis”) is CLINICALLY a combination of the symptoms of TABES DORSALIS and those of GENERAL PARESIS. The COURSE of TABOPARESIS is likely to be from a characteristic tabes dorsalis (often of years’ standing) to a characteristic general paresis; the ultimate paretic picture is likely to retain various characteristics of tabes. The LABORATORY TESTS in the paretic phase are characteristic of ordinary (non-tabetic) general paresis. The PROGNOSIS, after the paretic phase has arrived, is apt to be that of general paresis.
Case 16. Joseph Sullivan, a waiter, 50 years of age, sought assistance at the Psychopathic Hospital voluntarily. His complaint of severe and lancinating pains in the legs, difficulty with his gait, and a feeling of constriction about the waist, was forthwith suggestive of tabes dorsalis. He was a rather poorly nourished, white-haired man, with a drooping of the left side of the face. The pupils reacted sluggishly to light, the right somewhat better than the left. A marked Romberg reaction could be demonstrated. Ataxia in walking was marked. There was some incoördination of the hands, considerable tremor, and writing was poorly performed. The ankle-jerks and knee-jerks were absent. On the whole, the diagnosis of Tabes Dorsalis was clear enough.
The most appealing situation was mental. Sullivan was exceedingly apprehensive about his condition on the ground that it was growing progressively worse; if it was to get worse, Sullivan feared he would commit suicide. From his own account, he had become irritable, quick-tempered, and often unreasonable. As usual in these cases, the question arose whether the depression was psychopathic or natural.
| TABETIC SYMPTOMS AND SIGNS IN ORDER OF THEIR FREQUENCY | ||
| ANALYSIS OF 250 CASES | ||
| PER CENT | ||
| 1. | ROMBERG SIGN | 96.4 |
| 2. | ABSENT KNEE-JERKS | 90.0 |
| 3. | LANCINATING PAINS | 88.4 |
| 4. | STAGGERING GAIT | 87.2 |
| 5. | ARGYLL-ROBERTSON PUPIL | 80.0 |
| 6. | ATAXIA IN UPPER EXTREMITIES | 68.2 |
| 7. | SPHINCTER DISTURBANCES | 67.6 |
| 8. | SENSORY DISTURBANCES | 58.2 |
| 9. | VISUAL DISTURBANCES | 43.6 |
| 10. | PARESTHESIA AND NUMBNESS OF FEET AND LOWER EXTREMITIES | 42.8 |
| 11. | GIRDLE SENSE | 31.2 |
| 12. | PTOSIS OF EYE-LIDS | 23.2 |
| 13. | PARESTHESIA OR NUMBNESS IN HANDS OR UPPER EXTREMITIES | 13.6 |
| 14. | STRABISMUS | 12.0 |
| 15. | VISCERAL CRISES | 12.0 |
| 16. | LOSS OF SEXUAL DESIRE | 11.5 |
| 17. | CHARCOT JOINTS | 9.2 |
| 18. | VERTIGO | 4.0 |
| 19. | MAL PERFORANS | 3.2 |
| 20. | PAIN IN JOINTS | 2.8 |
| 21. | RECTAL TENESMUS | 2.8 |
| 22. | MENTAL DEGENERATION (other than paresis) | 2.4 |
| 23. | HEMIPLEGIA | 2.4 |
| 24. | VESICAL TENESMUS | 2.0 |
| 25. | DIFFICULTY IN ARTICULATION | 2.0 |
| 26. | DEAFNESS | 1.2 |
| 27. | ANOSMIA | 0.8 |
| Baldwin Lucke. | ||
| Chart 13 | ||