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TABLE OF CONTENTS

Page
Section I. The Nature and Forms of Syphilis of the Nervous System (Neurosyphilis). Cases 1 To 8[17]
Case
1.Paradigm: protean symptoms, nervous and mental. Autopsy, with meningeal, parenchymatous, and vascular lesions.[17]
2.Tabes dorsalis (tabetic neurosyphilis). Autopsy[31]
3.General paresis (paretic neurosyphilis). Autopsy[37]
4.Cerebral thrombosis (vascular neurosyphilis). Autopsy[42]
5.Juvenile paresis (juvenile paretic neurosyphilis). Autopsy[45]
6.Extraocular palsy (focal meningeal neurosyphilis). Autopsy[50]
7.Gumma of brain (gummatous neurosyphilis). Autopsy[53]
8.Meningitis hypertrophica cervicalis (gummatous neurosyphilis). Autopsy[56]
Section II. The Systematic Diagnosis of the Forms of Neurosyphilis Cases 9 To 38[63]
Case
9.Neurasthenia versus neurosyphilis[63]
10.Paretic neurosyphilis versus manic-depressive psychosis[68]
11.Neurosyphilis versus manic-depressive psychosis[71]
12.Dementia praecox versus neurosyphilis. Autopsy[74]
13.Neurosyphilis: negative Wassermann reaction (W. R.) of serum[77]
14.Diffuse neurosyphilis: six tests apt to run mild[80]
15.Paretic neurosyphilis: six tests strong[85]
16.Taboparesis (tabetic neurosyphilis): tests like those of paresis[92]
17.Paretic versus diffuse neurosyphilis: confusion re tests[97]
18.Vascular neurosyphilis: positive serum, negative fluid W. R.[101]
19.Seizures in diffuse neurosyphilis[103]
20.Seizures in paretic neurosyphilis[106]
21.Aphasia in paretic neurosyphilis[111]
22.Aphasia in paretic neurosyphilis[115]
23.Remission in paretic neurosyphilis[117]
24.Remission in diffuse neurosyphilis[122]
25.Paresis sine paresi[126]
26.Paretic neurosyphilis. Autopsy[131]
27.Gummatous neurosyphilis. Operation[137]
28.Extraocular palsy (cranial neurosyphilis)[140]
29.Tabes dorsalis (tabetic neurosyphilis): six tests apt to run mild[141]
30.Tabetic neurosyphilis, clinically atypical[143]
31.Cervical tabes[146]
32.Erb’s syphilitic spastic paraplegia[147]
33.Syphilitic muscular atrophy[149]
34.Neurosyphilis of the secondary period[151]
35.Juvenile paretic neurosyphilis: optic atrophy[154]
36.Juvenile paretic neurosyphilis[157]
37.Simple feeblemindedness, syphilitic[159]
38.Juvenile tabes[161]
Section III. Puzzles and Errors in the Diagnosis of Neurosyphilis (Including Non-syphilitic Cases). Cases 39–82[165]
Case
39.Paretic versus diffuse neurosyphilis. Autopsy[165]
40.Paretic versus vascular neurosyphilis, cerebellar. Autopsy[169]
41.Paretic versus vascular neurosyphilis, cerebellar. Autopsy[172]
42.Tabetic combined with vascular neurosyphilis. Autopsy.[175]
43.Tabetic neurosyphilis: mental symptoms, non-paretic. Autopsy[177]
44.Cerebral gliosis. Autopsy[180]
45.Neurasthenia versus neurosyphilis[183]
46.Hysteria. Neurosyphilis of the secondary period[185]
47.Manic-depressive psychosis versus paretic neurosyphilis[187]
48.Cerebral tumor[190]
49.Early post-infective paretic neurosyphilis[192]
50.Atypical paretic neurosyphilis, hemitremor. Autopsy[197]
51.Paretic neurosyphilis. Autopsy[199]
52.Manic-depressive psychosis versus paretic neurosyphilis[202]
53.Syphilitic(?) exophthalmic goitre. Autopsy[205]
54.Argyll-Robertson pupils[209]
55.Argyll-Robertson pupils: pineal tumor. Autopsy[212]
56.Neurosyphilis(?) with negative spinal fluid[216]
57.Disseminated syphilitic encephalitis, seven months post-infective. Autopsy[218]
58.“Pseudoparesis”[222]
59.Syphilitic paranoia?[225]
60.Paretic neurosyphilis versus alcoholic pseudoparesis[227]
61.Alcoholic pseudoparesis versus paretic neurosyphilis[231]
62.Alcoholic neuritis and paretic neurosyphilis[234]
63.Chronic alcoholism versus paretic neurosyphilis[236]
64.Neurosyphilis, diabetic pseudoparesis, or brain tumor[238]
65.Neurosyphilis and diabetes[240]
66.Neurosyphilis: hemianopsia[242]
67.Paretic neurosyphilis versus syphilis and cerebral malaria[245]
68.Paretic neurosyphilis: gold sol test “syphilitic.” Autopsy[247]
69.Lues maligna[250]
70.Neurosyphilis versus multiple sclerosis[253]
71.Atypical neurosyphilis[256]
72.Huntington’s chorea versus neurosyphilis[258]
73.Senile arteriosclerotic psychosis versus neurosyphilis[262]
74.Hysterical fugue versus neurosyphilis[264]
75.Tabetic neurosyphilis versus pernicious anemia[267]
76.Congenital neurosyphilis[270]
77.Congenital versus paretic neurosyphilis[272]
78.Juvenile paretic neurosyphilis[275]
79.Epilepsy versus juvenile neurosyphilis[277]
80.Addison’s disease and juvenile paretic neurosyphilis. Autopsy[279]
81.Neurosyphilis of the secondary period[283]
82.Taboparetic neurosyphilis and typhoid meningitis. Autopsy[284]
Section IV. Neurosyphilis, Medicolegal and Social. Cases 83–98[289]
Case
83.A public character, neurosyphilitic. Autopsy[289]
84.Debts, neurosyphilitic[295]
85.Suicidal attempt by a neurosyphilitic[296]
86.Neurosyphilis and juvenile delinquency[298]
87.Neurosyphilis in a defective delinquent[300]
88.Paresis sine paresi in a forger[303]
89.Trauma: juvenile paretic neurosyphilis[306]
90.Trauma: paretic neurosyphilis[308]
91.False claim for trauma: neurosyphilis[309]
92.Traumatic exacerbation? in neurosyphilis[310]
93.Trauma: cranial gumma at the site of injury[311]
94.Occupation-neurosis versus syphilitic neuritis[312]
95.Character change: neurosyphilis[314]
96.A neurosyphilitic family[316]
97.A neurosyphilitic’s normal-looking family[318]
98.The neurosyphilitic’s marriage[319]
Section V. The Treatment of Neurosyphilis. Cases 99–123.
(Cases 99–103 show the Variety of Structural Lesions that Treatment has to Face)[323]
Case
99.An incurable spastic paresis in paretic neurosyphilis. Autopsy[323]
100.A theoretically curable case. Autopsy[328]
101.A highly meningitic case, theoretically amenable to treatment. Autopsy[332]
102.A highly atrophic case, theoretically not amenable to treatment. Autopsy[335]
103.Paretic neurosyphilis with markedly focal lesions. Autopsy[338]
(Cases 104 to 123 are Examples of Treatment Including Successes and Failures.)
104.Diffuse neurosyphilis: treatment successful after nine months[342]
105.Atypical neurosyphilis: treatment successful[346]
106.Argyll-Robertson pupil not necessarily of bad prognosis: treated case an insurance risk[350]
107.Spinal fluid cleared: symptoms persistent[355]
108.Arteriosclerosis does not contraindicate treatment[359]
109.Symptoms of intracranial pressure relieved by treatment[362]
110.Therapeutic improvement in tabetic neurosyphilis[366]
111.W. R. rendered negative in tabetic neurosyphilis[367]
112.Example of successful treatment of paretic neurosyphilis[370]
113.Another example[372]
114.Clinical recovery but tests persistently positive in treated paretic neurosyphilis[375]
115.Improvement delayed in treated paretic neurosyphilis[377]
116.Non-neural syphilis in treated paretic neurosyphilis[380]
117.Partial recovery in treated paretic neurosyphilis[382]
118.Laboratory signs improved: clinical situation stationary: treated paretic neurosyphilis[384]
119.Another example[386]
120.Failure of treatment[388]
121.Treatment, at first mild, later intensive[390]
122.Intensive treatment[392]
123.Syphilitic feeblemindedness improved by treatment[395]
Section VI. Neurosyphilis and the War.
Cases A To N from British, French, and German Writers (1914–1916)[399]
Case
A.Tabes “shell-shocked” into paresis? (Donath)[401]
B.Latent syphilis “shell-shocked” into tabes? (Duco and Blum)[403]
C.Aggravation of neurosyphilis by service? (Weygandt)[404]
D.Aggravation of neurosyphilis by service? (Todd)[406]
E.Aggravation of neurosyphilis on service? (Todd)[409]
F.Duration of neurosyphilitic process important. (Farrar)[411]
G.Latent syphilis lighted up to paresis by war stress without shell-shock. (Marie)[412]
H.Paresis lighted up by “gassing”? (de Massary)[414]
I.Epilepsy in a neuropath lighted up by syphilis acquired at war. (Bonhoeffer)[415]
J.Syphilitic—after Dixmude epileptic. (Bonhoeffer)[417]
K.Syphilitic root-sciatica in a fireworks man. (Dejerine, Long)[418]
L.Paresis lighted up in civilian by domestic stress of the war. (Percy Smith)[420]
M.Shell-shock pseudoparesis. (Pitres and Marchand)[421]
N.Shell-shock pseudotabes. (Pitres and Marchand)[424]
Section VII. Summary and Key[427]
Appendices:
A.The six tests[471]
B.Common methods of treatment[486]

INTRODUCTION

It is a privilege to be allowed to write a word of introduction to a textbook which so richly fulfils its function as does this volume on the manifold disorders classified under Neurosyphilis, a subject of which the importance for the welfare of society is found to loom the larger the more deeply its mysteries are probed.

The case histories with which its pages are so amply stocked are carefully analyzed in accordance with a broadly chosen plan, and the generalizations that precede and follow them are obviously based on a wide and varied personal experience such as alone could render a familiarity with the literature of the subjects treated adequate to its best usefulness. Both writers were indeed well adapted for this task. Dr. Southard, as everyone is aware, has long been a highly conscientious, ardent and productive worker in the department of pathological anatomy, and of late years a careful student of clinical diagnosis and methods, both at the Danvers State Hospital and still more, at the Psychopathic Hospital which he worked so hard to found; while Dr. Solomon’s researches, in the special field of neurosyphilis, have been of the highest order.

Undoubted as are the merits of the case-system of instruction that has been so much in vogue in recent years, and excellent as is the modern supplementation of this method by the use of published records, the danger is still real that the student will have presented to him a picture of nature in disease that is too diagrammatic, too concise, with the result that while the task of memory is lightened through simplified formulation, the training of the doubting and inquiring instincts is often given too little stimulus and scope. In this book this danger is deliberately met through the casting of emphasis rather on the pluralistic aspects of the processes at stake than (primarily) on their unitary aspects.

The student who utilizes this volume cannot but emerge from his study a more thoughtful person than he was at the period of his entry. He will have seen that clinical rules of thumb cannot be followed to advantage, and that, on the contrary, surprises are to be expected and prepared for. Let the recognition of this fact, if it seems to increase the difficulties in the way of diagnosis, not lead to pessimism in that respect, or to hopelessness in therapeutics. On the contrary the writers’ bias is towards the worth-whileness of clinical efforts and an increased respect for accuracy and thoroughness in the utilization of modern methods of research. The chance is indeed held open that even the gaunt spectre of “General Paresis” may prove to be less terrible than it seems, and for this hope good grounds are given.

It is in this way made clear, on the strength of anatomical evidence of much interest, that even if in the treatment of a given patient, the time arrives when a fatal or unfavorable result seems manifestly foreshadowed, it may be still worth while to renew the treatment with fresh zeal, for the sake of combatting some symptom or exacerbation, for which a locally fresh process furnishes the cause.