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ALPHA DRAGON’S FORBIDDEN
MATE
(RUNAWAY DRAGON MATES)
SERENA MEADOWS
Copyright ©2021 by Serena Meadows - All rights reserved.

In no way is it legal to reproduce, duplicate, or transmit any part of this document

in either electronic means or in printed format. Recording of this publication is
strictly prohibited and any storage of this document is not allowed unless with
written permission from the publisher. All rights reserved.
Respective authors own all copyrights not held by the publisher.
 C O NT E NT S

Chapter 1
Chapter 2
Chapter 3
Chapter 4
Chapter 5
Chapter 6
Chapter 7
Chapter 8
Chapter 9
Chapter 10
Chapter 11
Chapter 12
Chapter 13
Chapter 14
Chapter 15
Chapter 16
Chapter 17
Chapter 18
Chapter 19
Chapter 20
Epilogue

Also By Serena Meadows

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CHAPTER 1
 * * * C A S S ID Y * * *

P redictably, Ben took my news with hurt, dismay, and no

little anger. “Why?” he asked, his voice high, containing
the trace of a whine.
Both exasperation with him and guilt for what I planned riding
the tide of my emotions, I gazed at the television without really
seeing it. “You know why,” I replied, keeping my voice even. “I want
a career. What you want for our relationship doesn’t include that.”
“You wanted the same things I did,” he snapped, forcing me to
look at him when he paced into my line of sight. “Marriage, kids, I
work while you stay at home. That was what you wanted.”
“No,” I told him with heat in my tone, “you dreamed of that
scenario, Ben. I’ve tried and tried telling you that if an opportunity
to get into a school with a broadcasting program popped up, I’d
take it. Now it has.”
“So school means more to you than I do?”
Ben’s hurt and pain, evident on his not-quite-handsome face, in
his deep-set brown eyes, churned my guilt in my stomach like bad
food. I loved him, or I thought I did. Ben was a sweet, kind, easy-
to-be-with sort of guy. Still, his major flaw, one that forced me to
break up with him, was his inability to comprehend the ambitions
and desires of others. Even his best friend warned me of that aspect
not long after Ben and I became a couple.
“Ben,” I said, fighting my guilty feelings, “if you agree to support
me in my choice of a career, I’ll go through with the wedding.”
 He set his hands on his narrow hips, staring at me with derision.
That expression decided it. If he truly loved me, he wouldn’t look at
me as though I was a cockroach. Nor did I love him enough to put
up with being looked at as though I was a cockroach.
“This is what we agreed on, Cassidy,” he complained. “You
staying home to raise our kids.”
“No. You told me this was how it was to be,” I retorted. “You
can’t be bothered to listen to what I want.”
“That’s not true.”
“You never listened to anything I say,” I said, swiping angrily at
my black hair, “or want. I told you when we first met, I wanted to
be a reporter. You blew it off.”
“No, you gave up on that idea,” he grumbled. “You continued
with our relationship knowing what I wanted from the beginning—a
wife, family. If you didn’t want that, why did you say you’d marry
me? We planned this months ago.”
“Because I love you.”
That startled him enough that he dropped the contemptuous
sneer from his mouth. Ben looked away.
“I wanted a life with you and a career,” I told him. “Now I realize
I can’t have both.”
“So now I’m kicked to the curb.” The sneer resumed, twisting the
mouth I used to love to kiss into an ugly mess.
“Your attitude is certainly making it easier to do exactly that,” I
replied dryly.
“Yeah, you’re making me the bad guy,” he said, stabbing his
finger toward me, “when it’s your fault. This is on you; you own it,
not me.”
“And your subjective deafness had nothing at all to do with
anything.” I stood up. “Anything I said that you didn’t want to hear
went straight through without connecting. Whatever, Ben. You’re
making me realize what married life with you would be like, so
thanks. This’ll save us the trouble of a divorce down the line.”
“That’s not fair,” he retorted. “I listened to you. You’re just
making all this up to get out of marrying me. You just don’t love
me.”
 I stared at him, unable to fully believe how easily he twisted the
situation to suit himself. To make it about him.
“Get out. I’m done with this conversation and you.”
“You can’t just tell me to leave.” His disbelief was almost
comical.
“You’re standing in my apartment,” I answered. “I can, and I will.
Get out.”
Striding to the front door, I opened it, then gazed at him as he
stood with his jaw loose. As though he hadn’t heard anything I’d
just said, and that I opened the door for kicks.
“I think we should discuss this,” he said, his tone conciliatory.
I wasn’t in the mood to reconcile. “Out.”
Ben continued to stand like an idiot, his mouth opening and
closing without saying a word. At last, he unhooked his feet from
my carpet and paced slowly toward me. With each step, he got
angrier and angrier. By the time he reached me, he glared in fury.
As he was taller than I, he scowled downward into my face.
“You can be the one to tell our friends and family the wedding is
off,” he almost shouted. “Since this is your fault.”
“Nice to see how much you love me,” I replied as he strode past.
On the threshold, Ben paused as though he wanted to say
something else. I shut the door in his face. For good measure, I
locked it. Listening, I heard his slow steps move away from my
apartment, my chest tight. Not one to cry very often, I still felt tears
burn my throat and sting my eyes.
“Good riddance,” I muttered, then recrossed my living room to
sit on the couch.
I did love the guy. Ben and I had been together for about eight
months. I’d truly believed I’d found my soul mate, a man who,
despite his lack of personal relationship skills, was a good and kind
man. Great in bed, a considerate lover, and someone whom I
thought I could trust. Now I wasn’t so sure.
Now I kicked him out of my life over a communication issue. Did
I really have to do that? Remembering the look of contempt in his
expression, I knew that I did have to. If Ben loved me, he’d not
have it in him to look at me that way. And he’d have listened to my
dreams, not just his own.
Knowing I was right to not marry him didn’t make me feel much
better, though. Depressed, upset, my stomach quivering, I lay back
on the couch and stared up at the ceiling. I absently turned my
engagement ring around my finger, wondering how my life had
gotten so crazy.
Ben and I had planned to spend the day looking at florists. Being
my day off, I found little else to do with my time.
When my cell rang, I almost didn’t answer it. It’s Ben, calling to
either yell or apologize. I don’t need either. Without much curiosity,
I glanced at the readout. It wasn’t Ben calling; it was my friend,
Rachel. I clicked the answer icon.
“Hello, this is Cassidy Lynch’s phone,” I said. “She’s having a
shitty day and is no longer getting married. Please leave your name
and number at the beep, and maybe she’ll get back to you. Or
maybe she won’t.”
“Oh, Cass.” Rachel’s voice sounded truly regretful, even though I
knew she didn’t like Ben as a marital prospect for me. “I’m so sorry.”
“Don’t be.” I aimed for lightness. “I’m free, single, and twenty-six
years old. I have my whole future ahead of me.”
“Can I ask what happened?”
“You were right all along, kid. He never bothered to listen to
what I wanted, expected me to be June Cleaver, complete with
dress and apron. Feed and bathe the children, have supper ready by
the time he gets home from work, wash dishes while he reads the
paper in his armchair.”
“What a wanker.”
“You speak Brit? I never knew that.”
“He’s a bloody disgrace to the entire male gender.”
“I got accepted to the university, kiddo,” I went on, feeling
slightly cheered by the conversation. “Scholarship, ditto. Ben
refused to be happy for me, said it’s all my fault, then I booted him
in his keister.”
“Good for you,” Rachel cried, happy, excited. “On everything,
Cass. I mean it. Ben was a shit in so many ways. I hate to say so,
but he was. And now you’re on your way.”
“Am I?” I asked. “Then why do I feel like a heel?”
“Because you love the son of a bitch.”
“Oh, is that it? I thought it was because I kicked him to the
curb.”
“And you were right to do it.” Rachel sighed. “I hate to be the
bearer of crappy news, sister, but that dude didn’t love you back.”
I recalled Ben’s contempt when he looked at me. “I’m beginning
to see the light.”
“Look, you’re drop-dead gorgeous,” Rachel continued briskly. “He
didn’t just want a wife; he wanted a trophy. He wanted to show you
off as though you were a Porsche Carrera, brag to all his buddies
about the beauty he snagged. If you followed your dreams of going
to school, then that set him into second place.”
“First place was all he wanted.”
“Exactly. When the ankle biters came along, and your figure
deteriorated, then he’d find himself a twenty-something to screw.”
I sat, numb and silent, staring into space. Seeing myself as a
dowdy, middle aged woman with teenage kids and an absent
husband, I wondered if she was right. Then I knew I didn’t have to
wonder. Rachel was right.
“Cass?”
“I’m here,” I answered. “Just thinking.”
“Look, I’ll understand if you want to be alone,” Rachel said, “but
I’m here if you want me to be.”
“I do. Whoa! I said that to you and not at the altar. Go figure.”
Rachel laughed. “Why don’t I buy you lunch? We can just hang
out, talk, just us girls.”
“I’d like that,” I replied. “I don’t really want to be alone, I guess.”
“Nor should you be. I’ll pick you up in thirty.”
“Cool. I’ll be ready. See you.”
“Bye.”
I clicked off the phone, then flopped onto my back again. School
would start in three weeks. I mentally planned to either quit my job
or go down to part-time if they’d let me. As the scholarship paid for
my school’s tuition, I still needed to work to pay rent, buy groceries.
While I had saved up in the hopes of getting this offer, it wasn’t
enough to keep me in books and donuts.
Standing up, I glanced down at the clothes I’d chosen to wear.
Jeans, sneakers, and a lavender tank top. Decent enough to wear
for a girl’s day out. In the bathroom, I brushed my lengths of black
hair while thinking of Rachel’s assessment of my looks. A trophy for
Ben to brag about, I thought, then got pissed again.
“Who are you to insist on a trophy wife?” I demanded of the
absent Ben. “I’d rather be a broadcast journalist than a trophy wife.”
I turned away from the mirror on the realization that a future
news employer would consider my looks as well as my resume
when hiring me. They would want a broadcaster to be attractive as
well as intelligent and well trained in journalism. Would my sleek
hair that fell past my shoulders, my green eyes, and peaches and
cream complexion be enough?
Was I hypocritical in thinking that Ben shouldn’t marry me for my
looks when my prospective employers would hire me for that exact
same attractiveness? But in the case of the latter, I’d not just be
paid for my looks, my intelligence, and my training; I’d be following
my dreams.
Not Ben’s.
I don’t care. If I did well in my field, and continued to advance
through the years, then I’d count myself lucky. If I landed a job with
CNN, or MSNBC, then I’d consider myself blessed. Ben’s idea of the
future never included me going to college, to land my dream job of
reporting the news to the multitudes watching on television.
“Ben, you’re a good guy and all,” I murmured, watching out the
window for Rachel’s car, “but you suck big time. In a few years,
you’ll be watching me report the news with your little trophy and
wish you’d been smarter.”
CHAPTER 2
 * * * J A IME * * *

I always enjoyed the first day of classes every fall. Young

faces, sometimes older students returning to school, but
almost always they were eager to learn and interested in
the topic I taught. While anthropology wasn’t on the list of classes
incoming freshmen were required to take, the students who signed
up for my class wanted to study human evolution.
“Good morning,” I said as I strode into my classroom. “I’m
Professor Hawkins.”
Setting my briefcase down on my desk next to my lectern, I
gazed around at the eighteen students who looked back at me with
expressions ranging from boredom to happy anticipation. They were
the usual mix of men and women, a few guys with long hair and
beards as well as young ladies who eyed me with speculation.
“As you should be aware,” I continued, “unless you wandered
into the wrong class, I teach anthropology. This semester we’ll be
studying the growth of mankind from its earliest days in Africa.
Now.”
I paused to glance around. “Anyone in here who hadn’t planned
to be here?”
Naturally, the students looked at one another, expecting
someone to admit they had the wrong class. It happened now and
then. This time, however, no one stood up from their desks to
leave.
“Very good,” I said, opening my briefcase. “Then we’ll begin.”
 Being a relatively young professor in my early thirties, I certainly
wasn’t blind to the looks I received from my female students. Nor
did I fail to admire attractive women when they appeared in my
classes. Thus, one young lady caught my attention rather quickly.
She sat in the middle of the room, a backpack on the floor
beside her desk. Sleek black hair fell like a river over her shoulders,
and a fringe of it curled around her forehead and temples. Eyes of a
striking pale green hue met mine from a face with supermodel-
perfect proportions. She smiled a fraction as though she sensed my
immediate attraction.
Since I went through the list of names to match them with the
faces, I learned she was Cassidy Lynch.
“I’ll do my best to learn your names quickly,” I commented,
setting the list aside, “though it may take a week or two.”
But that girl’s name I’ll remember.
“For our first day together,” I said, forcing myself to look at each
student equally when I wanted to stare at Ms. Lynch for the entire
class’s duration, “I’ll outline what we’ll be studying this semester.
Any questions thus far?”
There were none from this bunch, though sometimes I’d get
inquiries as to my qualifications to teach anthropology. Ms. Lynch
took a notebook, a pen, a highlighter, and the textbook for the class
from her pack, preparing to take notes as I began outlining the
course structure. From my briefcase, I passed out the syllabus I’d
prepared, observing Ms. Lynch’s secretive smile as I handed hers to
her.
“Where do shifters come in during this course?” asked one of the
long-haired dudes, looking at his syllabus.
I leaned my butt against my desk and crossed my arms over my
chest. “I’m afraid I don’t cover the cultural or evolutionary
phenomenon of our shifter neighbors,” I replied easily. “Just
humans.”
“But didn’t the ancestors of shifters mate humans to their
counterparts, wolves, dragons, and such?” the guy persisted.
“If you want to study where shifters came from,” I continued,
“you should talk to one of them. There aren’t any courses on
shifters taught at this university.”
“Shifters scare me,” muttered one young woman.
As she sat next to Ms. Lynch, I observed with interest that she
didn’t nod in agreement.
“Why is there so little knowledge about them?” the dude asked.
“From what I understand,” I replied, “they don’t let themselves
be studied. And if a dragon isn’t interested in offering himself up as
a guinea pig, who’s going to argue with him?”
That brought a titter of laughter running through the room, and
even Ms. Lynch chuckled. She has a stunner of a smile. Why she
captivated me so easily when hundreds of beautiful women passed
through my classrooms over the years, I couldn’t begin to guess.
She certainly captured my interest in a big way.
“Now then,” I went on, “let’s focus on the topic at hand, shall
we?”

My lunchbreak came after my third class. As I usually did, I headed

for the parking lot and my car, as my office was off campus. If I
didn’t have a lunch appointment with a friend or colleague, I picked
up something on the way and ate there as I reviewed tests or
papers. But as this was the first day of classes, I had none of those.
I’d been unable to stop thinking about Ms. Lynch throughout my
morning. Thus, catching a glimpse of her with a tall, skinny young
man near an elderly blue BMW brought both pleasure and
disappointment. A girl like that would most certainly have a
boyfriend.
Still, as I drew a little closer, as my car was parked a short
distance beyond the Beemer, I recognized the antagonistic body
language the guy conveyed. Though Ms. Lynch’s personal issues
were none of my business, her defensive posture was. He had
backed her against the hood of the vehicle and leaned over her
aggressively.
 As I drew closer, I heard him say, his voice low, threatening, “I
want my ring back, bitch.”
“You’re not getting it,” Ms. Lynch snapped in reply. “So suck it up
and get out of my face.”
Neither looked my way as I approached as their attention stayed
on each other. I slowed my pace, watching, hoping the guy would
accept what she said and leave. Instead, he lifted his right hand as
though he planned to hit her. Not on my watch, dipshit.
“Ms. Lynch,” I said, my voice pleasant, instantly catching their
attention. “Is everything all right?”
“No,” she began, then the dude cut her off.
“This is none of your business, man,” he growled. “Get lost.”
“Sorry,” I replied, smiling. “No can do. You have your hand up
like you’re aiming to strike her. I can’t allow that.”
His hand lowered slowly. Ms. Lynch wriggled out from between
him and the car, then edged her way toward me. Her expression
displayed anger as well as some fear as she glanced from me to
him and back again. Now out of hitting distance, she waggled her
fingers at him.
“Sayonara, Ben,” she said lightly. “Time for you to move on.”
The fellow, Ben as she called him, scowled darkly. “Give me my
ring, dammit.”
“Sorry,” she replied, her tone still playful, “I sold it, darling. The
money will keep me in textbooks until I graduate.”
He leaned toward her, exuding menace and hate. “You’ll regret
that,” he said softly. “I swear it.”
“I doubt it,” Ms. Lynch answered, quite obviously confident in my
presence to defy him. “What would you do with it, anyway? Give it
to your next fiancée? How gauche.”
Though it no doubt only added to the fire feeding Ben’s rage, I
laughed. “If you’re not a student on this campus, sir, you’ll have to
leave.”
He sent me a murderous glare. “I’ll leave when I’m damn good
and ready.”
“Which is right now.”
 Spotting a campus cop driving slowly around the parking lot in
his cruiser, I waved. He saw me and sped up, turning around the
end of the row of parked cars before arriving at a gentle halt a few
feet away. Ben’s expression quickly altered from venomous to
nearly panicked. I briefly wondered if he had a warrant out for his
arrest to make the change so swiftly.
“Hiya, Doc,” the cop, Davidson, said agreeably, getting out of his
car and sliding his baton through its hangar. “Sup?”
“This gentleman isn’t a student at this university,” I replied,
gesturing toward Ben. “He’s hassling this young lady.”
“She’s my fiancée,” Ben protested, staring at Davidson.
“Ex-fiancée,” Ms. Lynch added.
Davidson looked Ben up and down. “Sorry, sir, but only students
and staff are permitted on campus. You’ll have to leave now.”
“But—” Ben began, then halted after a brief glance at Davidson’s
hardware. He pointed his finger at Ms. Lynch. “You won’t stay on
campus forever.”
Then, as though he hadn’t uttered a phrase intended as a
threat, he turned his back on the three of us to amble down the
rows of cars. Ms. Lynch and I watched him depart while Davidson
returned to his cruiser. He drove past us to follow Ben, who pulled
out of the lot in a nearly new Mustang.
I eyed Ms. Lynch sidelong. “All okay?”
As I stood considerably taller than she, Ms. Lynch gazed up with
a sweet smile. “Yes, thanks. I didn’t think he’d get violent, but I also
didn’t think he’d show up here and cause a fight.”
“Unfortunately,” I replied, “just when we think we know
someone, they show a completely different side to their
personality.”
“How true.”
She turned toward her car, the ancient Beemer, and said, “Thank
you again, Professor. By the way, I’m really going to enjoy your
class.”
“What are you majoring in?”
“Broadcasting.” Ms. Lynch opened her car’s door, then grinned at
me over the roof. “Still, we should all know where we originated.”
 Now she really had my interest. I hesitated a moment. I wanted
to ask her to lunch yet fraternizing with students went against the
university’s rules for the staff. What’s the harm? It’s just lunch.
“Would you care to come to lunch?” I asked, resting my arms on
the Beemer’s dented roof. “My treat.”
Ms. Lynch paused, her grin widening. “I should buy you lunch.”
“I asked, I pay.”
“How can I resist that?”
“You can’t, since I’m irresistible.”
Laughing, she said, “All right. I’ll follow you.”
Backing away from the car, I pointed down the row. “I drive that
black Tesla parked right there.”
“Oooh, classy.”
“That’s me.” I grinned, chuckling. “You like Italian?”
“Love it.”
“Then let’s go.”
As she closed her door and started the Beemer’s engine, I wove
my way among the rows to my car. She waited as I got in, started
the engine, and pulled out, then tagged along behind as I drove off
the campus. I whistled as I steered the Tesla down the busy city
street. Keeping an eye on Ms. Lynch in the rearview mirror, I headed
for the restaurant.
Being a regular and a heavy tipper, I and Ms. Lynch were shown
immediately to a quiet table, bypassing a lengthy waiting list. She
ordered a soda while I asked the waiter for tea, and after he left,
we stared at one another.
“Do you do this often?” she asked, glancing around the place.
“Take students to lunch?”
“Nope.” I grinned. “Don’t get me into trouble, but it’s sorta
against the rules.”
She laughed. “No one will hear it from me.”
“I thought it might be nice to, you know, get to know you.” I
waited for the inevitable question of why I picked her among all my
students to ask out. She didn’t ask it.
“I really do appreciate your timely intervention,” she said
instead. “Ben and I, well, we broke up a few weeks ago. I guess he
stayed mad about it.”
“If he’s mad,” I said slowly, “then I’m guessing you wanted the
split and he didn’t?”
Ms. Lynch rounded her shoulders, not looking me in the eye.
“Yeah,” she said quietly. “He wanted what I didn’t, and he didn’t
want what I did.”
“Better to not get married at all,” I commented, “than live a
married life in a lie.”
“That’s what I believed.” Ms. Lynch gave me a brilliant smile. “I
have wanted to be a television reporter for as long as I can
remember. Then this opportunity came along, and I had to take it.”
Our waiter brought our drinks, setting them in front of us on tiny
napkins. I grinned, lifting my glass of tea. “Here’s to the world’s
most beautiful television reporter.”
CHAPTER 3
 * * * C A S S ID Y * * *

“H ere, here.”
I drank from my Coke as he sipped his tea, his
brilliant and incredible set of blue eyes meeting mine
over the rim. I still floated on the tide of disbelief. My anthropology
professor, the seriously sexy, incredibly good-looking hunk of
masculinity asked me to lunch.
Dr. Hawkins had thick black hair brushed neatly back from his
forehead and a tidily trimmed goatee. Two aspects I’d always found
appealing in men. So why did I fall in love with the plain-faced,
skinny, and deliriously unsexy Ben?
“So will Ben give up and go away now?” he asked, his perfect
white teeth gleaming in his smile.
“I never thought he’d show up to start with,” I replied, setting
my glass down.
“And you really sold his engagement ring?” By his expression, he
seemed to find that idea amusing.
“Not yet,” I answered. “But I plan to. He doesn’t need it. He’s
got bucks, and if he did give it to another prospective wife, well,
that’ll simply show what a dumb ass he is.”
“He gave it to you,” Dr. Hawkins went on. “You can do with it as
you like, I’d think.”
“And it really will help pay for school.”
“Good. You’re going to go far in the world, Ms. Lynch.”
“Please call me Cassidy.”
 He inclined his head as though I’d granted him a gift. “I’m Jaime
out of class and off campus.”
His choice of words made me laugh. “Then I’m guessing I might
see you off campus and out of class?”
His dark complexion turned a light shade of pink, and he glanced
away, clearing his throat. That alone endeared me to him. It made
him human, not just a college professor who taught one of my
classes. I felt drawn to him in that moment, perhaps because I’d
just peeked into his version of vulnerability and sweetness.
“I’d like that, Cassidy,” he said finally, his voice low. “If you do, of
course. But I have to inform you it’s against university policy to date
students.”
I drank from my Coke glass with a shrug. “It’s none of their
business, in my opinion. I’m an adult, and I’ll see whom I want to
see.”
“While I agree on those counts,” Jaime continued, “I also don’t
want to get fired. So, if we agree to see one another once in a
while, you’ll not broadcast the information? Pardon the pun.”
I laughed. “And ruin what might be a good thing? Never.”
“I’ll confess I’ve had liaisons with a few grad students over the
last few years,” he admitted. “Nothing permanent.”
“And you already know I’m on the rebound.”
“Excuse me for being blunt, Cassidy,” he said, leaning forward.
“Ben doesn’t seem your type.”
I nodded, shrugged. “I expect I saw something in Ben, a
vulnerability and kindness that appealed to me. But he never did
communicate well. I accepted it as part of being in a relationship,
like not putting the toilet seat down after he peed.”
Jaime chuckled. “I see your point. But communication, in my
opinion, is essential in a relationship. Not putting the toilet seat
down is a man’s bad habit.”
“The last few weeks of being single again really showed me
more of his flaws,” I said. “Especially after an hour ago.”
I looked away as the waiter brought menus, informed us of the
day’s specials, then left, absently wondering what Jaime’s flaws
might be. Thus far, I hadn’t noticed very many. You also just met
the guy. He may have a closet full of dead bodies for all you know.
“The lasagna is very good here,” Jaime said, picking up his
menu. “I recommend it highly.”
I nodded, perusing the lists of foods available, very much aware
of his very broad shoulders, his raw masculinity, the alpha look in
his eyes. While that didn’t bother me so much, I did think that
alphas tended to be control freaks. At least, those I knew were.
Still, Jaime didn’t strike me as the controlling type.
“I’ll go with that, then,” I said, closing the menu.
“You convinced me.” Jaime closed his while giving me the benefit
of those incredible eyes.
“Have you been married?” I asked.
“Naw.” He shook his head. “Still single, the perpetual bachelor,
name the excuse. Too busy, too lazy for a relationship, haven’t
found the right lady, take your pick.”
“I’m guessing you just haven’t met the right lady.”
“And why do you say that?” His eyes gleamed with humor.
“You’re neither that busy or that lazy,” I replied. “You love the
company of ladies, and for the right one, you’d walk to the ends of
the earth.”
“You’re mighty perceptive, Cassidy.”
“I try.”
Over the delicious lasagna that was everything he said it was,
we talked of relationships, philosophy, personal dreams and
ambitions, family, and friends. I had no family, and neither did
Jaime. We both had good friends, enjoyed quiet evenings with wine
and books, camping in the mountains. He liked dogs, and I liked
horses.
“One end kicks and the other end bites,” he observed, then bit
into his bread.
“Dogs bark incessantly and bite the hand that feeds.”
He grinned. “Not if trained right.”
I pointed my finger at him. “Exactly.”
He laughed. “Touché.”
 We finished our lasagna, and my next class loomed on my
horizon. “I have American History in twenty minutes,” I said, gulping
the last of my coke.
Jaime glanced at his watch. “And I have a class on the history of
the Neanderthals. If we rush, we’ll make both without being tardy.”
He paid the bill, and both of us finished our drinks while getting
up from our chairs.
“Thank you so much for the meal,” I said as we wended our way
among the diners and tables to the exit.
“I enjoyed the company,” he replied, holding the door for me.
“See you Wednesday?”
“You know it.” I grinned and held out my hand.
Jaime took it, then bent to kiss my cheek. “Thanks for coming.”
“Bye.”
Leaving him, I dashed for my car. Opening the door, I paused to
wave as he rushed to his own, then got in. As I drove back to
campus, I saw his penetrating blue eyes everywhere I looked. In
the red lights, in the rear window of the car in front, in the
pedestrians on the sidewalks. Excited, I mentally planned to call
Rachel that evening and tell her all about it.

“Y ou ’re dating your teacher ?” she asked, incredulous. “That sounds

so very high school. And naughty.”
I laughed. “We had lunch, nimrod. That’s all.”
“Lunch is only the beginning. You’re on the rebound, girlfriend,
so watch it.”
I lay back on my couch, recalling Jaime’s powerful masculine
draw, wondering if he was thinking of me in that same moment.
“Ben showed up on campus,” I said, “wanting his ring back.”
“Don’t give it to him, babe. It’s yours.”
“I won’t. But he behaved like a damn brute, lifted his hand like
he was going to hit me. Then Jaime stepped in.”
 “Oh, the hero to the rescue,” Rachel commented dryly. “Always
attractive to the maiden fair.”
“Quit it,” I said agreeably. “If you saw this guy, Rachel, you’d go
gaga over him. Shoulders that won’t quit, a smile to die for—”
“Sounds like you’re dying for him already.”
“Not quite. I did just meet him, you know. I’m relaying his
qualities to you as I don’t yet know many of his flaws.”
“We all have them,” Rachel observed. “Still, he sounds nice.
What does he teach?”
“Anthropology.”
“So he likes old people.”
I laughed. “Yeah.”
“Old dug-up people from eons ago. Has to be good in bed for
sure.”
“Good lord,” I exclaimed, sitting up. “Where did that come
from?”
“My own horny desires that remain unfulfilled since I haven’t had
a date, or a one-night stand, in ages.”
“Gawd.” I lay back down. “Get laid, Rach. Seriously.”
“Lend me your teacher and I might.”
“Find your own anthropologist, chica,” I replied. “No trespassing
on my turf.”
“Gee, some friend you are. Won’t even let me screw your lunch
date.”
“He might like you better than me.”
“Are you going out with him again?”
“If I do, I can’t say.” I laughed. “Rules against professor/student
dating, you know.”
“Ah, forbidden love.” Rachel sighed. “Secret, clandestine
meetings, chaste kisses behind the bleachers, stolen moments in
the backseat of your shitty BMW. Chafed skin on the broken leather
—”
“Shut up,” I yelled, laughing until the tears squirted from my
eyes. “Your car isn’t any better.”
“But I ain’t looking to screw my teacher in it.”
 “Go blow it out your ass,” I yelled, still laughing. “I’m not looking
to have sex in the back of my car, jeez.”
“Didja ever do Ben back there?” she asked, her tone sly.
“No! And his car is too small, so get off your fantasies already.”
“Hey, I live vicariously through you, babe.”
“Live your own life, dummy.”
“That’s no fun. My life is infinitely boring.”
“And so is mine,” I retorted. “It was one lunch date. Come next
class, he’ll have forgotten all about me.”
“Riiight. I saw a pig flying this afternoon, did I tell you?”
“Bite me, sweetheart.”
“Eww, no thanks. I don’t swing that way. Ask your new flame to
do it. I bet he bites the instant you orgasm—”
“Oh. My. God. Rachel, you slut. I had lunch with the man, and
now you have him biting me in bed. Get your fool head out of the
gutter.”
Rachel laughed. “When he does bite you in bed, I want to hear
all about it.”
“No way. Such things are kept secret. I won’t bite and tell, and I
bet Jaime doesn’t, either.”
“Fuddy duddies.”
“Right. Now clean the slime off yourself and talk to me like
you’re my friend and not my pimp.”
“Hey, that’s an easy way to pay for school, honey. I’ll pimp you
out; we both make mucho dinero—”
A sharp rap at my apartment door had me sitting bolt upright on
the couch. “Am I expecting someone?”
“Cass? Who’s at your door?”
“I don’t know. Hang on.”
“I’m hanging.”
Keeping the phone to my ear, I got up from the couch and crept
toward the door as though the person on the other side might hear
me. Peeking through the fisheye lens, I observed Ben’s face staring
right at me. As though he knew I stood on the far side of the door
looking at him.
I lowered my voice to a whisper. “It’s Ben, Rachel.”
 “Do not let him in, Cassidy,” she ordered. “Who knows what he’s
up to. You said he acted like he was going to hit you, right?”
I backed away from the door, holding my hand over my cell’s
speaker as though that would prevent him from hearing us. “I’m not
going to. Damn it, he’s probably wanting his ring.”
Ben pounded on the door, making me jump. “Cassidy,” he yelled.
“Open up. I know you’re home.”
“Oh, shit.”
“Don’t open it, Cass,” Rachel snapped. “Don’t answer him. Stay
cool.”
“Cassidy! I swear I’ll break this door down.”
CHAPTER 4
Another random document with
no related content on Scribd:
partial unconsciousness, or even by more marked congestive
symptoms. The pain may seem to fill the whole cranium, may be
located in a cerebral region, or fixed in a very limited spot. Heubner
asserts that when this headache can be localized it is generally
made distinctly worse by pressure at certain points, but my own
experience is hardly in accord with this. Any such soreness plainly
cannot directly depend upon the cerebral lesion, but must be a reflex
phenomenon or due to a neuritis. According to my own experience,
localized soreness indicates an affection of the bone or of its
periosteum. In many cases, especially when the headache is
persistent, there are distinct nocturnal exacerbations.
39 Book Y., p. 88, 1879.

It will be seen that there is nothing absolutely characteristic in the

headache of cerebral syphilis; but excessive persistency, apparent
causelessness, and a tendency to nocturnal exacerbation should in
any cephalalgia excite suspicion of a specific origin—a suspicion
which is always to be increased by the occurrence of slight spells of
giddiness or by delirious mental wandering accompanying the
paroxysms of pain. When an acute inflammatory attack supervenes
upon a specific meningeal disease it is usually ushered in by a
headache of intolerable severity.

When the headache in any case is habitually very constant and

severe, the disease is probably in the dura mater or periosteum; and
this probability is much increased if the pain be local and augmented
by firm, hard pressure upon the skull over the seat of the pain.

Disorders of Sleep.—There are two antagonistic disorders of sleep,

either of which may occur in cerebral syphilis, but which have only
been present in a small proportion of the cases that I have seen.
Insomnia is more apt to be troublesome in the prodromic than in the
later stages, and is only of significance when combined with other
more characteristic symptoms. A peculiar somnolence is of much
more determinate import. It is not pathognomonic of cerebral
syphilis, yet of all the single phenomena of this disease it is the most
characteristic. Its absence is of no import in the theory of an
individual case.

As I have seen it, it occurs in two forms: In the one variety the patient
sits all day long or lies in bed in a state of semi-stupor, indifferent to
everything, but capable of being aroused, answering questions
slowly, imperfectly, and without complaint, but in an instant dropping
off again into his quietude. In the other variety the sufferer may still
be able to work, but often falls asleep while at his tasks, and
especially toward evening has an irresistible desire to slumber, which
leads him to pass, it may be, half of his time in sleep. This state of
partial sleep may precede that of the more continuous stupor, or may
pass off when an attack of hemiplegia seems to divert the
symptoms. The mental phenomena in the more severe cases of
somnolency are peculiar. The patient can be aroused—indeed in
many instances he exists in a state of torpor rather than of sleep;
when stirred up he thinks with extreme slowness, and may appear to
have a form of aphasia; yet at intervals he may be endowed with a
peculiar automatic activity, especially at night. Getting out of bed;
wandering aimlessly and seemingly without knowledge of where he
is, and unable to find his own bed; passing his excretions in a corner
of the room or in other similar place, not because he is unable to
control his bladder and bowels, but because he believes that he is in
a proper place for such act,—he seems a restless nocturnal
automaton rather than a man. In some cases the somnolent patient
lies in a perpetual stupor.

An important fact in connection with the somnolence is that it may

develop suddenly without marked premonition. Thus in a case
reported by J. A. Ormerod40 a man who had been in good health,
save only for headache, awoke one morning in a semi-delirious
condition, and for three days slept steadily, only arousing for meals;
after this there was impairment of memory and mental faculties, but
no more marked symptoms.
40 Brain, vol. v. 260.
Apathy and indifference are the characteristics of the somnolent
state, yet the patient will sometimes show excessive irritability when
aroused, and will at other periods complain bitterly of pain in his
head, or will groan as though suffering severely in the midst of his
stupor—at a time, too, when he is not able to recognize the seat of
the pain. I have seen a man with a vacant, apathetic face, almost
complete aphasia, persistent heaviness and stupor, arouse himself
when the stir in the ward told him that the attending physician was
present, and come forward in a dazed, highly pathetic manner, by
signs and broken utterances begging for something to relieve his
head. Heubner speaks of cases in which the irritability was such that
the patient fought vigorously when aroused; this I have not seen.

This somnolent condition may last many weeks. T. Buzzard41 details

the case of a man who after a specific hemiplegia lay silent and
somnolent for a month, and yet finally recovered so completely as to
win a rowing-match on the Thames. I have seen a fair degree of
recovery after a somnolence of four months' duration.
41 Clinical Lectures on Dis. Nerv. Syst., London, 1882.

In its excessive development syphilitic stupor puts on the symptoms

of advanced brain-softening, to which it is indeed often due. Of the
two cases with fatal result of which I have notes, one at the autopsy
was found to have symmetrical purulent breaking down of the
anterior cerebral lobes; the other, softening of the right frontal and
temporal lobes, due to the pressure of a gummatous tumor, and
ending in a fatal apoplexy.

This close connection with cerebral softening explains the clinical

fact that apoplectic hemorrhage is very apt to end the life in these
cases of somnolent syphilis. But a prolonged deep stupor in persons
suffering from cerebral syphilis does not prove the existence of
extensive brain-softening, and is not incompatible with subsequent
complete recovery. As an element of prognosis it is of serious but not
of fatal import.
Paralysis.—When it is remembered that a syphilitic exudation may
appear at almost any position in the brain, that spots of encephalic
softening are a not rare result of the infection, that syphilitic disease
is a common cause of cerebral hemorrhage, it is plain that a specific
palsy may be of any conceivable variety, and affect either the
sensory, motor, or intellectual sphere. The mode of onset is as
various as the character of the palsy. The attack may be
instantaneous, sudden, or gradual. The gradual development of the
syphilitic gumma would lead us, a priori, to expect an equally gradual
development of the palsy; but experience shows that in a large
proportion of the cases the paralysis appears suddenly, with or
without the occurrence of an apoplectic or epileptic fit. Under these
circumstances it will be usually noted that the resulting palsy is
incomplete; in rare instances it may be at its worst when the patient
awakes from the apoplectic seizure, but usually it progressively
increases for a few hours, and then becomes stationary. These
sudden partial palsies probably result from an intense congestion
around the seat of disease or from stoppage of the circulation in the
same locality; whatever their mechanism may be, it is important to
distinguish them from palsies which are due to hemorrhage. I believe
this can usually be done by noting the degree of paralysis.

A suddenly-developed, complete hemiplegia or other paralysis may

be considered as in all probability either hemorrhagic or produced by
a thrombus so large that the results will be disorganization of the
brain-substance, and a future no more hopeful than that of a clot. On
the other hand, an incomplete palsy may be rationally believed to be
due to pressure or other removable cause; and this belief is much
strengthened by a gradual development. The bearing of these facts
upon prognosis it is scarcely necessary to point out.

Although the gummata may develop at almost any point, they

especially affect the base of the brain, and are prone to involve the
nerves which issue from it. Morbid exudations, not tubercular or
syphilitic, are rare in this region. Hence a rapidly but not abruptly
appearing strabismus, ptosis, dilated pupil, or any paralytic eye
symptom in the adult is usually of syphilitic nature. Syphilitic facial
palsy is not so frequent, whilst paralysis of the nerve from rheumatic
and other inflammation within its bony canal is very common.
Paralysis of the facial nerve may therefore be specific, but existing
alone is of no diagnostic value. Since syphilitic palsies about the
head are in most instances due to pressure upon the nerve-trunks,
the electrical reactions of degeneration are present in the affected
muscles.

There is one peculiarity about specific palsies which has already

been alluded to as frequently present—namely, a temporary,
transient, fugitive, varying character and seat. Thus an arm may be
weak to-day, strong to-morrow, and the next day feeble again, or the
recovered arm may retain its power and a leg fail in its stead. These
transient palsies are much more apt to involve large than small brain
territories. The explanation of their largeness, fugitiveness, and
incompleteness is that they are not directly due to clots or other
structural changes, but to congestions of the brain-tissues in the
neighborhood of gummatous exudations. Squint due to direct
pressure on a nerve will remain when the accompanying monoplegia
due to congestion disappears.

Motor palsies are more frequent than sensory affections in syphilis,

but hemianæsthesia, localized anæsthetic tracts, indeed any form of
sensory paralysis, may occur. Numbness, formications, all varieties
of paræsthesia, are frequently felt in the face, body, or extremities.
Violent peripheral neuralgic pains are rare, and generally when
present denote neuritis. Huguenin, however, reports42 a severe
trigeminal anæsthesia dolorosa, which was found, after death from
intercurrent disease, to have depended upon a small gumma
pressing upon the Gasserian ganglion. A somewhat similar case has
also been reported by Allen McLane Hamilton.43
42 Schwiez. Corr. Blät., 1875.

43 Alienist and Neurologist, iv. 58.

The special senses are liable to suffer from the invasion of their
territories by cerebral syphilis, and the resulting palsies follow
courses and have clinical histories parallel to those of the motor
sphere. The onset may be sudden or gradual, the result temporary
or permanent. Charles Mauriac44 reports a case in which the patient
was frequently seized with sudden attacks of severe frontal pain and
complete blindness lasting from a quarter to half an hour; at other
times the same patient had spells of aphasia lasting only for one or
two minutes. I have seen two cases of nearly complete deafness
developing in a few hours in cerebral syphilis, and disappearing
abruptly after some days. Like other syphilitic palsies, therefore,
paralyses of special senses may come on suddenly or gradually, and
may occur paroxysmally.
44 Loc. cit., p. 31.

Among the palsies of cerebral syphilis must be ranked aphasia. An

examination of recorded cases shows that syphilitic aphasia is
subject to vagaries and laws similar to those connected with other
specific cerebral palsies. It is usually a symptom of advanced
disease, but may certainly develop as one of the first evidences of
cerebral syphilis. Coming on after an apoplectic or epileptic fit, it may
be complete or incomplete: owing to the smallness of the centre
involved and the ease with which its function is held in abeyance, a
total loss of word-thought is not so decisive as to the existence of
cerebral hemorrhage as is a total motor palsy. Like hemiplegia or
monoplegia, specific aphasia is sometimes transitory and
paroxysmal. Buzzard45 records several such cases. Mauriac46 details
a very curious case in which a patient, after long suffering from
headache, was seized by sudden loss of power in the right hand and
fingers, lasting about ten minutes only, but recurring many times a
day. After this had continued some time the paroxysms became
more completely paralytic, and were accompanyed by loss of the
power of finding words, the height of the crises in the palsy and
aphasia being simultaneously reached. For a whole month these
attacks occurred five or six times a day, without other symptoms
except headache, and then the patient became persistently paralytic
and aphasic, but finally recovered. To describe the different forms of
specific aphasia and their mechanism of production would be to
enter upon a discussion of aphasia itself—a discussion out of place
here. Suffice it to say that every conceivable form of the disorder
may be induced by syphilis.
45 Loc. cit., p. 81.

46 Aphasie et Hemiplégia droite Syphilit., Paris, 1877.

Owing to the centres of speech being situated in the cortical portion

of the brain, aphasia in cerebral syphilis is very frequently associated
with epilepsy. Of course right-sided palsy and aphasia are united in
syphilitic as in other disorders. If, however, the statistics given by
Tanowsky47 be reliable, syphilitic aphasia is associated with left-
sided hemiplegia in a most extraordinarily large proportion. Thus in
53 cases collected by Tanowsky, 18 times was there right-sided
hemiplegia, and 14 times left-sided hemiplegia, the other cases
being not at all hemiplegic. Judging from the autopsy on a case
reported in Mauriac's brochure, this concurrence of left-sided
paralysis and aphasia depends partly upon the great frequency of
multiple brain lesions in syphilis, and partly upon the habitual
involvement of large territories of the gray matter secondarily to
diseased membrane. An important practical deduction is that the
conjoint existence of left hemiplegia and aphasia is almost diagnostic
of cerebral syphilis.
47 L'Aphasie syphilitique.

Probably amongst the palsies may be considered the disturbances

of the renal functions, which are only rarely met with in cerebral
syphilis, and which are probably usually dependent upon the specific
exudation pressing upon the vaso-motor centres in the medulla.
Fournier speaks of having notes of six cases in which polyuria with
its accompaniment, polydipsia, was present, and details a case in
which the specific growth was found in the floor of the fourth
ventricle. Cases have been reported of true saccharine diabetes due
to cerebral syphilis,48 and I can add to these an observation of my
own. The symptoms, which occurred in a man of middle age, with a
distinct specific history, were headache, nearly complete hemiplegia,
and mental failure, associated with the passage of comparatively
small quantities of a urine so highly saccharine as to be really a
syrup. Under the influence of the iodide of potassium the sugar in a
few weeks disappeared from the urine.
48 Consult Servantié, Des Rapports du Diabète et de la Syphilis, Paris, Thèse, 1876;
also, case reported by L. Putzel, New York Med. Record, xxv. 450.

Epilepsy.—Epileptic attacks are a very common symptom of

meningeal syphilis, and are of great diagnostic value. The
occurrence in an adult of an epileptic attack or of an apoplectic fit, or
of a hemiplegia after a history of intense and protracted headache,
should always excite grave suspicion.

Before I had read Fournier's work on Nervous Syphilis I taught that

an epilepsy appearing after thirty years of age was very rarely, if
ever, essential epilepsy, and unless alcoholism, uræmic poison, or
other adequate cause could be found was in nine cases out of ten
specific; and I therefore quote with satisfaction Fournier's words:
“L'épilepsie vraie, ne fait jamais son premier dêbut à l'âge adulte, à
l'âge mûr. Si un homme adulte, au dessus de 30, 35, à 40 ans, vient,
à être pris pour la première fois d'une crise épileptique, et cela dans
la cours d'une bonne santé apparente, il y a, je vous le répète, hui
ou neuf chances sur dix pour que cette épilepsie soit d'origine
syphilitique.”

Syphilitic epilepsy may occur either in the form of petit mal or of haut
mal, and in either case may take on the exact characters and
sequence of phenomena which belong to the so-called idiopathic or
essential epilepsy. The momentary loss of consciousness of petit
mal will usually, however, be found to be associated with attacks in
which, although voluntary power is suspended, memory recalls what
has happened during the paroxysm—attacks, therefore, which
simulate those of hysteria, and which may lead to an error of
diagnosis.

Even in the fully-developed type of the convulsions the aura is only

rarely present. Its absence is not, however, of diagnostic value,
because it is frequently not present in essential epilepsy, and it may
be pronounced in the specific disease. It is said that when in an
individual case the aura has once appeared the same type or form of
approach of the convulsion is thereafter rigidly adhered to. The aura
is sometimes bizarre: a severe pain in the foot, a localized cramp, a
peculiar sensation, indescribable and unreal in its feeling, may be
the first warning of the attack. An aura may affect a special sense.
Thus, I have at present a patient whose attacks begin with blindness.

In many, perhaps most, cases of specific convulsions, instead of a

paroxysm of essential epilepsy being closely simulated, the
movements are in the onset, or more rarely throughout the
paroxysm, unilateral; indeed, they may be confined to one extremity.
This restriction of movement has been held to be almost
characteristic of syphilitic epilepsy, but it is not so. Whatever
diagnostic significance such restriction of the convulsion has is
simply to indicate that the fit is due to a cortical organic lesion of
some kind. Tumors, scleroses, and other organic lesions of the
brain-cortex are as prone to cause unilateral or monoplegic epilepsy
when they are not specific as when they are due to syphilis.

Sometimes an epilepsy dependent upon a specific lesion implicating

the brain-cortex may be replaced by a spasm which is more or less
local and is not attended with any loss of consciousness. Thus, in a
case now convalescent in the University Hospital, a man aged about
thirty-five offered a history of repeated epileptic convulsions, but at
the time of his entrance into the hospital, instead of epileptic attacks,
there was a painless tic. The spasms, which were clonic and
occurred very many times a day, sometimes every five minutes,
were very violent, and mostly confined to the left facial nerve
distribution. The trigeminus was never affected, but in the severer
paroxysms the left hypoglossal and spinal accessory nerves were
profoundly implicated in all of their branches. Once, fatal asphyxia
from recurrent laryngeal spasm of the glottis was apparently averted
only by the free inhalation of the nitrite of amyl. The sole other
symptom was headache, but the specific history was clear and the
effect of antisyphilitic remedies rapid and pronounced.
It is very plain that such attacks as those just detailed are closely
allied to epilepsy; indeed, there are cases of cerebral syphilis in
which widespread general spasms occur similar to those of a
Jacksonian epilepsy, except that consciousness is not lost, because
the nervous discharge does not overwhelm the centres which are
connected with consciousness.49 On the other hand, these epileptoid
spasmodic cases link themselves to those in which the local brain
affection manifests itself in contractions or persistent irregular clonic
spasms. Contractures may exist and may simulate those of
descending degeneration,50 but in my own experience are very
rare.51
49 Case, Canada Med. and Surg. Journ., xi. 487.

50 Case, Centralbl. Nerv. Heilk., 1883, p. 1.

51 A case of syphilitic athetosis may be found in Lancet, 1883, ii. 989.

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.

That the attacks of syphilitic insanity, like the palsies of syphilis, may
at times be temporary and fugitive, is shown by a curious case
reported by H. Hayes Newington,59 in which, along with headache,
failure of memory, and ptosis in a syphilitic person, there was a brief
paroxysm of noisy insanity.
 59 Journ. Ment. Sci., London, xix. 555.

DIAGNOSIS.—In a diagnosis of cerebral syphilis a correct history of the

antecedents of the patients is of vital importance. Since very few of
the first manifestations of the disorder are absolutely characteristic,
whilst almost any conceivable cerebral symptoms may arise from
syphilitic disease, treatment should be at once instituted on the
appearance of any disturbance of the cerebral functions in an
infected person.

Very frequently the history of the case is defective, and not rarely
actually misleading. Patients often appear to have no suspicion of
the nature of their complaint, and will deny the possibility of syphilis,
although they confess to habitual unchastity. My own inquiries have
been so often misleading in their results that I attach but little weight
to the statements of the patient, and in private practice avoid asking
questions which might recall unpleasant memories, depending upon
the symptoms themselves for the diagnosis.

The general grounds of diagnosis have been sufficiently mapped out

in the last section, but some reiteration may be allowable. After the
exclusion of other non-specific disease, headache occurring with any
form of ocular palsy or with a history of attack of partial monoplegia
or hemiplegia, vertigo, petit mal, epileptoid convulsions, or
disturbances of consciousness, or attacks of unilateral or localized
spasms, should lead to the practical therapeutic test. Ocular palsies,
epileptic forms of attacks occurring after thirty years of age, morbid
somnolence, even when existing alone, are sufficient to put the
practitioner upon his guard. It is sometimes of vital importance that
the nature of the cephalalgia shall be recognized before the coming
on of more serious symptoms; any apparent causelessness,
severity, and persistency should arouse suspicion, to be much
increased by a tendency to nocturnal exacerbations or by the
occurrence of mental disturbance or of giddiness at the crises of the
paroxysms. Not rarely there are very early in these cases curious,
almost indefinable, disturbances of cerebral functions, which may be
easily overlooked, such as temporary and partial failures of memory,
word-stumbling, fleeting feelings of numbness or weakness,
alterations of disposition. In the absence of hysteria an indefinite and
apparently disconnected series of nerve accidents is of very urgent
import. To use the words of Hughlings-Jackson, “A random
association or a random succession of nervous symptoms is very
strong warrant for a diagnosis of a syphilitic disease of the nervous
system.” Cerebral syphilis occurring in an hysterical subject may be
readily overlooked until fatal mischief is done. When any paralysis
occurs a study of the reflexes may sometimes lead to a correct
diagnosis. Thus in a hemiplegia the reflex on the affected side in
cerebral syphilis is very frequently exaggerated, whilst in hysteria the
reflexes are usually alike on both sides. When both motion and
sensation are disturbed in an organic hemiplegia, the anæsthesia
and motor paralysis occur on the same side of the body, whilst in
hysteria they are usually on opposite sides.

In all cases of doubtful diagnosis the so-called therapeutic test

should be employed, and if sixty grains of iodide of potassium per
day fail to produce iodism, for all practical purposes the person may
be considered to be a syphilitic. No less an authority than Seguin
has denied the validity of this, but I believe, myself, that some of his
reported cases were suffering from unsuspected syphilis. I do not
deny that there are rare individuals who, although untainted, can
resist the action of iodide, but in ten years' practice in large hospitals,
embracing probably some thousands of cases, I have not met with
more than one or two instances which I believed to be of such
character. Of course in making these statements I leave out of sight
persons who have by long custom become accustomed to the use of
the iodide, for although in most cases such use begets increase of
susceptibility, the contrary sometimes occurs. Of course the
physician who should publicly assert that a patient who did not
respond to the iodide had syphilis would be a great fool, but in my
opinion the physician who did not act upon such a basis would be
even more culpable.

PROGNOSIS.—Cerebral meningeal syphilis varies so greatly and so

unexpectedly in its course that it is very difficult to establish rules for
predicting the future in any given case. The general laws of
prognosis in brain disease hold to some extent, but may always be
favorably modified, and patients apparently at the point of death will
frequently recover under treatment. The prognosis is not, however,
as absolutely favorable as is sometimes believed, and especially
should patients be warned of the probable recurrence of the affection
even when the symptoms have entirely disappeared. The only safety
after the restoration of health consists in an immediate re-treatment
upon the recurrence of the slightest symptom. The occurrence of a
complete, sudden hemiplegia or monoplegia is sufficient to render
probable the existence of a clot, which must be subject to the same
laws as though not secondary to a specific lesion. If a rapid decided
rise of temperature occur in an apoplectic or epileptic attack, the
prognosis becomes very grave. An epileptic paroxysm very rarely
ends fatally, although it has done so in two of my cases.

The prognosis in gummatous cerebral syphilis should always be

guardedly favorable. In the great majority of cases a more or less
incomplete recovery occurs under appropriate treatment, and I have
seen repeatedly patients who were unconscious, with urinary and
fecal incontinence, and apparently dying, recover. Nevertheless, so
long as there is any particle of gummatous inflammation in the
membrane the patient is liable to sudden congestions of the brain,
which may prove rapidly fatal, or he may die in a brief epileptic fit. On
the one hand there is an element of uncertainty in the most favorable
case, and on the other so long as there is life a positively hopeless
prognosis is not justifiable.

PATHOLOGY.—Gummatous inflammation of the brain probably always

has its starting-point in the brain-membranes, although it may be
situated within the brain: thus, I have seen the gummatous tumors
spring from the velum interpositum in the lateral ventricle. The
disease most usually attacks the base of the brain, and is especially
found in the neighborhood of the pons Varolii and the optic tract. It
may, however, locate itself upon the vault of the cranium, and in my
experience has seemed to prefer the anterior or motor regions. The
mass may be well defined and roundish, but more usually it is
spread out, irregular in shape, and more or less confluent with the
substance of the brain beneath it. It varies in size from a line to
several inches in length, and when small is prone to be multiple. The
only lesion which it resembles in gross appearance is tubercle, from
which it sometimes cannot be certainly distinguished without
microscopic examination.

The large gummata have not rarely two distinct zones, the inner one
of which is drier, somewhat yellowish in color, opaque, and
resembles the region of caseous degeneration in the tubercle. The
outer zone is more pinkish and more vascular, and is semi-
translucent.

On microscopic examination the most characteristic structures are

small cells, such as are found in gummatous tumors in other portions
of the body. These cells are most abundant in the inner zone, which,
indeed, may be entirely composed of them. In the centre of the
tumor they are more or less granular and atrophied; in some cases
the caseous degeneration has progressed so far that the centre of
the gumma consists of minute acicular crystals of fat. In the external
or peripheral zone of the tumor the mass may pass imperceptibly
into the normal nerve tissue, and under these circumstances it is that
it contains the spider-shaped cells or stellate bodies described by
Jastrowitch, and especially commented upon by Charcot and
Gombault and by Coyne. These are large cells containing an
exaggerated nucleus and a granular protoplasm, which continues
into multiple, branching, rigid, refracting prolongations, which
prolongations are scarcely stained by carmine. Alongside of these
cells other largish cells are often found without prolongations, but
furnished with oval nuclei and granular protoplasm. Amongst these
cells will be seen the true gummatous cells, as well as the more or
less altered neuroglia and nerve-elements. In the perivascular
lymphatic sheaths in the outer part of the gumma is usually a great
abundance of small cells. The spider-shaped cells are probably
hypertrophied normal cells of the neuroglia, and have been
considered by Charcot and Gombault as characteristic of syphilitic
gummata of the brain. In a solitary gumma, however, of considerable
size from the neighborhood of the cerebellum, studied by Coyne and
Peltier, there were no stellated cells. Coyne considers that their
presence is due to their previous existence in the normal state of the
regions affected by the gumma. Exactly what becomes of syphilitic
gumma of the brain in cases of recovery it is difficult to determine. It
is certain that they become softened and disappear more or less
completely, and it is probable that the cicatrices or the small
peripheral cysts which are not rarely found in the surfaces of the
brain are sometimes remnants of gummatous tumors. In a number of
cases collected by Gros and Lancereaux there were small areas of
softened tissue or small calcareous and caseous masses or cerebral
lacunæ corresponding to the cicatrices of softening or imperfect
cysts, coincident with evidences of syphilis elsewhere. V. Cornil also
states that he has found small areas of softening with well-
established syphilitic lesions of the dura mater and cranium, but
believes that the lacunæ or cysts depend rather upon chronic
syphilitic lesions of cerebral arteries than upon gummatous
inflammation.

When a gummatous tumor comes in contact with an artery, the latter

is usually compressed and its walls undergo degeneration. The
specific arteritis may pass beyond the limit of the syphilome and
extend along the arterial wall. Not rarely there is under these
circumstances a thrombus, and if the artery be a large one
secondary softening of its distributive brain-area occurs.

TREATMENT.—The treatment of cerebral syphilis is best studied under

two heads: First, the treatment of the accidents which occur in the
course of the disease; second, the general treatment of the disease
itself.

It must be remembered that in the great majority of cases in which

death occurs in properly-treated cerebral syphilis the fatal result is
produced by an exacerbation—or, as I have termed it, an accident—
of the disease. Under these circumstances the treatment should be
that which is adapted to the relief of the same acute affection when
dependent upon other than specific cause. In a large proportion of
cases the acute outbreak takes the form either of a meningitis or
else of a brain congestion. In either instance when the symptoms are
severe free bleeding should be at once resorted to. The amount of
blood taken is of course to be proportionate to the severity of the
symptoms and the strength of the patient. I have seen life saved by
the abstraction of about a quart of blood, whilst in other cases a few
ounces suffice. Care must be, of course, taken not to mistake a
simple epileptic fit for a severe cerebral attack; but when this fit has
been preceded by severe headache and is accompanied by stupor,
with marked disturbance of the respiration, measures for immediate
relief are usually required; and if the convulsions be perpetually
repeated or if there be violent delirious excitement, the symptoms
may be considered as very urgent. In taking blood the orifice should
be large, so as to favor a rapid flow, and the bleeding be continued
until a distinct impression is made upon the pulse. In some cases
which I have seen in which the action of the heart continued to be
violent after as much blood as was deemed prudent had been taken,
good results were obtained by the hypodermic injection of three
drops of the tincture of aconite-root every half hour until the
reduction of the pulse and the free sweating indicated that the
system was coming under the influence of the cardiac sedative.

Of course, I do not mean to encourage the improper or too free use

of the lancet in these cases, but in the few fatal cases which I have
seen I have almost invariably regretted that blood had not been
taken at once very freely at the beginning of the acute attack. In
most of these cases the symptoms had progressed too far for good
to be achieved before I reached the patient. After venesection, or in
feeble cases as a substitute for it, the usual measures of relief in
cerebral congestion should be instituted. I shall not occupy space
with a discussion of these measures, as they are in no way different
from those to be employed in cases not syphilitic.

The most important part of the treatment of cerebral syphilis itself is

antisyphilitic, and the practitioner is at once forced to select between
the iodide of potassium and the mercurial preparations. In such
choice it must be remembered that even a very small amount of
syphilitic deposit in the brain may at any time cause a sudden
congestion or other acute attack, and is therefore a very dangerous
lesion. I have seen a cerebral syphilis which was manifested only by
an epileptic attack occurring once in many months, and in which
after death the affected membrane was found to be not larger than a
quarter of a dollar, and the deposit not more than an eighth of an
inch in thickness, suddenly produce a rapidly fatal congestion; and I
have known a case fast progressing toward recovery suddenly
ended by the too long continuance of the arrest of respiration during
an epileptic fit. I have, myself, no doubt of the superiority of the
mercurials over the iodide of potassium as a means of producing
absorption of gummatous exudates; and as these exudates in the
brain are so very dangerous, a mercurial course should in the
majority of cases of cerebral syphilis be instituted so soon as the
patient comes under the practitioner's care. When, however, there is
a history of a recent prolonged free use of the mercurial, or when
there is marked specific cachexia, the iodide should be chosen.
Cachexia is, however, a distinctly rare condition in cerebral syphilis,
the disease usually developing in those who have long had apparent
immunity from the constitutional disorder. In my opinion the best
preparation of the mercurial for internal use is calomel. It should be
given in small doses, one-quarter of one grain every two hours,
guarded with opium and astringents, so as to prevent as far as
possible disturbance of the bowels, and should be continued until
soreness of the teeth, sponginess of the gums, or other evidences of
commencing ptyalism are induced. After this the dose of the
mercurial should be so reduced as simply to maintain the slight
impression which has been created, and the patient should be kept
under the mercurial influence for some weeks.

A very effective method of using the mercury is by inunction, and

where the surroundings of the patient are suitable the mercurial
ointment may be substituted for the calomel. It should be applied
regularly, according to the method laid down in my treatise on
therapeutics. I have sometimes gained advantage by practising the
mercurial unction and at the same time giving large doses of iodide
of potassium internally.
After a mercurial course the iodide of potassium should always be
exhibited freely, the object being not only to overcome the natural
disease, but also to bring about the complete elimination of the
mercury from the system. There is no use in giving the iodide in
small doses; at least a drachm and a half should be administered in
the twenty-four hours, and my own custom has been to increase this
to three drachms unless evidences of iodism are produced. The
compound syrup of sarsaparilla covers the disagreeable taste of the
iodide of potassium better than any other substance of which I have
knowledge. Moreover, I am well convinced that there is some truth in
the old belief that the so-called “Woods” are of value in the treatment
of chronic syphilis. I have seen cases in which both the iodide of
potassium and the mercurials had failed to bring about the desired
relief, but in which the same alteratives, when given along with the
“Woods,” rapidly produced favorable results. The old-fashioned
Zittmann's decoction, made according to the formula of the United
States Dispensatory, may be occasionally used with very excellent
effect. But I have gradually come into the habit of substituting a
mixture of the compound fluid extract and the compound syrup of
sarsaparilla in equal proportions. The syrup itself is too feeble to
have any influence upon the system, but is here employed on
account of its flavor. A favorite method of administration is to furnish
the patient with two bottles—one containing a watery solution of the
iodide of potassium of such strength that two drops represent one
grain of the drug, and the other the sarsaparilla mixture above
mentioned. From one to two drachms of the solution of the iodide
may be administered in a tablespoonful of the sarsaparilla well
diluted after meals. When the patient has been previously
mercurialized, or there is any doubt as to the propriety of using
mercurials, corrosive sublimate in small doses may be added to the
solution of the iodide, so that one-tenth to one-fifteenth of a grain
shall be given in each dose. I have never seen especial advantage
obtained by the use of the iodides of mercury. They are no doubt
effective, but are not superior to the simpler forms of the drug.
 Syphilitic Disease of the Brain-Cortex.

The psychical symptoms which are produced by syphilis are often

very pronounced in cases in which the paralysis, headache,
epilepsy, and other palpable manifestations show the presence of
gross brain lesions. In the study of syphilitic disease of the brain-
membranes sufficient has been said in regard to these psychical
disturbances, but the problem which now offers itself for solution is
as to the existence or non-existence of syphilitic insanity—i.e. of an
insanity produced by specific contagion without the obvious
presence of gummatous disease of the brain-membranes. Very few
alienists recognize the existence of a distinct affection entitled to be
called syphilitic insanity, and there are some who deny that insanity
is ever directly caused by syphilis. It is certain that insanity often
occurs in the syphilitic, but syphilis is abundantly joined with
alcoholism, poverty, mental distress, physical ruin, and various
depressing emotions and conditions which are well known to be
active exciting causes of mental disorder. It may well be that syphilis
is in such way an indirect cause of an insanity which under the
circumstances could not be properly styled syphilitic.

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