These cases are sufficient to demonstrate that sclerosis of the brain-substance not only may coexist with a brain lesion which is certainly specific in its character, but may also present the appearance of having developed pari passu with that lesion and from the same cause.
It has already been stated in this article that cerebral meningeal syphilis may coexist with various forms of insanity, and cases have been cited in proof thereof. It is of course very probable that in some of such cases there has been that double lesion of membrane and gray brain matter which has just been demonstrated by report of autopsies; but if we find that there is a syphilitic insanity, which exists without evidences of meningeal syphilis, and is capable of being cured by antispecific treatment, such insanity must be considered as representing the disease of the gray matter of the brain. Medical literature is so gigantic that it is impossible to exhaust it, but the following list of cases is amply sufficient to prove the point at issue—namely, that there is a syphilitic insanity which exists without obvious meningeal disease, and is capable of being cured by antisyphilitic treatment:
| No. | Reporter and Journal. | Symptoms. | Results.—Remarks. |
| 1 | Luis Streisand
Die Lues als
Ursache der Dementia, Inaug. Diss., Berlin, 1878. | Epilepsy, delirium of exaltation, alteration
of speech, headache, failure of memory. | Rapid cure with mercury. |
| 2 | Ibid. | Delusions, delirium, general
mania, great muscular weakness. | Cure with mercury. |
| 3 | Müller of Leutkirch
Journ. of Mental Dis., 1873–74, 561. | Symptoms resembling general paralysis, and diagnosis of
such made until a sternal node was discovered. | Cure by iodide of potassium. |
| 4 | Esmarch and W. Jersen
Allgem. Zeitschrift f. Psychiatrie. | Sleeplessness, great excitement, restlessness,
great activity, incoherence, and violence. | Cure by mercury. |
| 5 | Leidesdorf
Medizin. Jahrbucher, xx., 1864, 1. | Complete mania; played with his
excrement, and entirely irrational. | Complete cure by iodide of potassium. |
| 6 | Beauregard
Gaz. hébdom. de Sci. méd. de Bordeaux, 1880, p. 64. | Symptoms resembling those of general paralysis. | Cure by iodide of potassium. |
| 7 | M. Rendu
Ibid. | Loss of memory, headache, irregularity of pupils, ambitious
delirium, periods of excitement, others of depression, embarrassment of
speech, access of furious delirium, ending in stupor. | Mercurial treatment, cure. |
| 8 | M. Rendu
Gaz. hébdom. de Sci. méd. de Bordeaux, 1880, p. 64. | Hypochondria, irregularity of pupils, headache,
failure of memory, melancholy, stupor. | Mercurial treatment, cure. |
| 9 | Albrecht Erlenmeyer
Die Luëtischen Psychosen, Neuwied, 1877. | Melancholia with hypochondriasis, sleeplessness,
fear of men, and belief they were all leagued against him. | Iodide of potassium, cure. |
| 10 | Ibid. | Religious melancholia, with two attempts at
suicide, ending in mania. | Iodide of potassium, cure. |
| 11 | Ibid. | At times very violent, yelling, shrieking, destroying
everything she could get hands on, at times erotomania; no distinct history
of infection, but her habits known to be bad, and had bone ozæna and other physical syphilitic signs. | Iodide of potassium, cure. |
| 12 | Ibid. | Epileptic attack followed by a long soporose condition,
ending in mental confusion, he not knowing his nearest friends, etc.; almost dementia. | Cured by mercurial inunction. |
| 13 | Ibid. | Great fear of gensd'armes, etc., mania, with hallucinations,
loud crying, yelling, etc., then convulsion, followed by great difficulty of speech. | Cured by mercurial inunctions with iodide internally;
subsequently return of convulsions, followed by hemiplegia and death. |
| 14 | Ibid. | Great unnatural vivacity and loquacity, wanted to buy everything,
bragged of enormous gains at play, etc.; some trouble of speech. | Iodide of potassium, cure. Attended to business, and
seems as well as before. Relapsed. (See Symptoms.) |
| | Ibid.
Relapse of Case 14. | Fifteen months after discharge from asylum relapse; symptoms
developing very rapidly, delirium of grandeur of the most aggravated type, with marked
progressive dementia, failure of power of speech, and finally of locomotion. | Failure of various anti-specific treatment. |
| 15 | A. Erlenmeyer
Die Luëtischen, etc. | Failure of mental powers, inequality of pupils, trembling of lip
when speaking, uncertainty of gait, almost entire loss of memory, once temporary ptosis
and strabismus. | Iodide of potassium in ascending doses failed. Recovery
under mercurial inunctions. |
| 16 | Ibid. | Failure of mental powers, pronounced delirium of grandeur,
hallucinations of hearing, failure of memory, strabismus and ptosis coming on late. | Iodide of potassium, corrosive-sublimate injections. Cure. |
| 17 | Ibid. | Failure of memory and mental powers, slight ideas of grandeur,
disturbance of sensibility and motility, aphasia coming on late. | Cure with use of iodide and mercurial inunctions. |
| 18 | Ibid. | Melancholy, great excitability, ideas of grandeur;
after a long time sudden ptosis and strabismus. | Iodide of potassium failed; mercurial course improved; joint
use cured patient. |
| 19 | Ibid. | Various cerebral nerve palsies, great relief by use of mercurial
inunctions, then development of great excitement, delirium of grandeur, failure
of memory and mental powers, and finally death from apoplexy; no autopsy. | |
| 20 | J. B. Chapin
Amer. Journ. Insanity, vol. xv. p. 249. | Melancholia with attempted suicide, epilepsy, headache, somnolent spells. | Iodide of potassium, cure. |
| 21 | Ibid. | Acute mania, noisy, very destructive; syphilitic disease of tibia. | Iodide of potassium, cure. |
| 22 | Snel | Maniacal excitement. | Cured by specific treatment. |
| 23 | Wm. Smith
Brit. Med. Journ., July, 1868, p. 30. | Apathetic melancholy, indelicate, speaking only in
monosyllables, and much of the time not at all, sullen and menacing. | Rapidly cured by conjoint use of iodide and mercurials. The
symptoms first developed 3 months after chancre. |
A study of the brief analyses of the symptoms just given shows that syphilitic disease of the brain may cause any form of mania, but that the symptoms, however various they may be at first, end almost always in dementia unless relieved.
Of all the forms of insanity, general paralysis is most closely and frequently simulated by specific brain disease. The exact relation of the diathesis to true, incurable, general paralysis it is very difficult to determine. It seems well established that amongst persons suffering from this disorder the proportion of syphilitics is not only much larger than normal, but also much larger than in other forms of insanity. Thus, E. Mendel64 found that in 146 cases of general paralysis, 109, or 75 per cent., had a distinct history of syphilis, whilst in 101 cases of various other forms of primary insanity only 18 per cent. had specific antecedents. H. Obersteiner has 1000 cases of mental disease,65 175 cases of dementia paralytica; of these, 21.6 per cent. had syphilis; moreover, of all the syphilitic patients 51.4 per cent. had dementia paralytica.
Various opinions might be cited as to the nature of this relation between the two disorders, but for want of space the curious reader is referred to the work just quoted and to the thesis of C. Chauvet66 for an epitome of the most important recorded opinions.