The clonic spasms of cerebral syphilis may assume a distinctly choreic type, or may in their severity simulate those of hysteria, throwing the body about violently.52 It is, to my mind, misleading, and therefore improper, to call such cases syphilitic chorea, as there is no reason for believing that they have a direct relation with ordinary chorea. They are the expression of an organic irritation of the brain-cortex, and are sometimes followed by paralysis of the affected member; in other words, the disease, progressing inward from the brain-membrane, first irritates, and then so invades a cortical centre as to destroy its functional power.53
52 See Allison, Amer. Med. Journ., 1877, 74.
53 Case, Chicago Med. Journ. and Exam., xlvi. 21.
Psychical Symptoms.—As already stated, apathy, somnolence, loss of memory, and general mental failure are the most frequent and characteristic mental symptoms of meningeal syphilis; but, as will be shown in the next chapter, syphilis is able to produce almost any form of insanity, and therefore mania, melancholia, erotic mania, delirium of grandeur, etc. etc. may develop along with the ordinary manifestation of cerebral syphilis, or may come on during an attack which has hitherto produced only the usual symptoms. Without attempting any exhaustive citation of cases, the following may be alluded to.
A. Erlenmeyer reports54 a case in which an attack of violent headache and vomiting was followed by paralysis of the right arm and paresis of the left leg, with some mental depression; a little later the patient suddenly became very cheerful, and shortly afterward manifested very distinctly delirium of grandeur with failure of memory. Batty Tuke reports55 a case in which, with aphasia, muscular wasting, strabismus, and various palsies, there were delusions and hallucinations. In the same journal56 S. D. Williams reports a case in which there were paroxysmal violent attacks of frontal headache. The woman was very dirty in her habits, only ate when fed, and existed in a state of hypochondriacal melancholy. Leiderdorf details a case with headache, partial hemiplegia, great psychical disturbance, irritability, change of character, marked delirium of grandeur, epileptic attacks, and finally dementia, eventually cured by iodide of potassium.57 Several cases illustrating different forms of insanity are reported by N. Manssurow.58
54 Die luëtischen Psychosen.
55 Journ. Ment. Sci., Jan., 1874, p. 560.
56 April, 1869.
57 Medicin Jahrbucher, xx. 1864, p. 114.
58 Die Tertiäre Syphilis, Wien, 1877.