If there be disease of the brain-cortex produced directly by syphilis, of course such disease must give rise to mental disorders; and if the lesion be so situated as to affect the psychic and avoid the motor regions of the brain, it will produce mental disorder without paralysis—i.e. an insanity; again, if such brain disease be widespread, involving the whole cortex, it will cause a progressive mental disorder, accompanied by gradual loss of power in all parts of the body, and ending in dementia with general paralysis; or, in other words, it will produce an affection more or less closely resembling the so-called general paralysis of the insane, or dementia paralytica.
As a man having syphilis may have a disease which is not directly due to the syphilis, when a syphilitic person has any disorder there is only one positive way of determining during life how far said disorder is specific—namely, by studying its amenability to antisyphilitic treatment. In approaching the question whether a lesion found after death is specific or not, of course such a therapeutic test as that just given is inapplicable. We can only study as to the coexistence of the lesion in consideration with other lesions known to be specific. Such coexistence of course does not absolutely prove the specific nature of a nutritive change, but renders such nature exceedingly probable.
What has just been said foreshadows the method in which the subject in hand is to be here examined, and the present article naturally divides itself into two sections—the first considering the coexistence of anatomical alterations occurring in the cerebral substance with syphilitic affections of the brain-membranes or blood-vessels, the second being a clinical study of syphilitic insanity.
In looking over the literature of the subject I have found the following cases in which a cerebral sclerotic affection coincided with a gummatous disease of the membrane. Gros and Lancereaux60 report a case having a clear syphilitic history in which the dura mater was adherent to the skull. The pia mater was not adherent. Beneath, upon the vault of the brain, was a gelatinous exudation. The upper cerebral substance was indurated, and pronounced by Robin after microscopic examination to be sclerosed. At the base of the brain there were atheromatous arteries and spots of marked softening.
60 Affec. Nerv. Syphilis, 1861, p. 245.
Jos. J. Brown61 reports a case in which the symptoms were melancholia, excessive irritability, violent outbursts of temper, very positive delusions, disordered gait, ending in dementia. At the autopsy, which was very exhaustive, extensive syphilitic disease of the vessels of the brain and spinal cord was found. The pia mater was not adherent to the brain. The convolutions, particularly of the frontal and parietal lobes, were atrophied, with very wide sulci filled with bloody serum. The neuroglia of these convolutions was much increased, and “appeared to be more molecular than normal, the cells were degenerated, and in many places had disappeared, their places being only occupied by some granules.” These changes were most marked in the frontal convolutions.
61 Journ. Ment. Sci., July, 1875, p. 271.
H. Schule reports62 a very carefully and meritoriously studied case. The symptoms during life exactly simulated those of dementia paralytica. The affection commenced with an entire change in the disposition of the patient; from being taciturn, quiet, and very parsimonious, he became very excited, restless, and desiring continuously to buy in the shops. Then failure of memory, marked sense of well-being, carelessness and indifference for the future, developed consentaneously with failure of the power of walking, trembling of the hands, inequality of the pupils, and hesitating speech. There was next a period of melancholy, which was in time followed by continuous failure of mental and motor powers, and very pronounced delirium of grandeur, ending in complete dementia. Death finally occurred from universal palsy, with progressive increase of the motor symptoms. At the autopsy characteristic syphilitic lesions were found in the skull, dura mater, larynx, liver, intestines, and testicles. The brain presented the macroscopic and microscopic characters of sclerosis and atrophy; the neuroglia was much increased, full of numerous nuclei, the ganglion-cells destroyed. The vessels were very much diseased, some reduced to cords; their walls were greatly thickened, and full of long spindle-shaped cells, sometimes also containing fatty granules.
62 Allgem. Zeitschrift f. Psychiatrie, xxviii. 171, 172.
C. E. Stedman and Robt. T. Edes report63 a case in which the symptoms were failure of health, ptosis, trigeminal palsy with pain (anæsthesia dolorosa), finally mental failure with gradual loss of power of motion and sensation. At the autopsy the following conditions were noted: apex of the temporal lobe adherent to dura mater and softened; exuded lymph in neighborhood of optic chiasm; sclerosis of right Gasserian ganglion, as shown in a marked increase of the neuroglia; degeneration of the basal arteries of the brain.