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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.
Reporter
No. Symptoms. Results.—Remarks.
and Journal.
1 Luis Epilepsy, delirium of exaltation, alteration of Rapid cure with mercury.
Streisand speech, headache, failure of memory.
Die Lues als
Ursache der
Dementia,
Inaug. Diss.,
Berlin, 1878.
2 Ibid. Delusions, delirium, general mania, great Cure with mercury.
muscular weakness.
3 Müller of Symptoms resembling general paralysis, and Cure by iodide of
Leutkirch diagnosis of such made until a sternal node potassium.
Journ. of was discovered.
Mental Dis.,
1873–74,
561.
4 Esmarch Sleeplessness, great excitement, restlessness, Cure by mercury.
and W. great activity, incoherence, and violence.
Jersen
Allgem.
Zeitschrift f.
Psychiatrie.
5 Leidesdorf Complete mania; played with his excrement, Complete cure by iodide
Medizin. and entirely irrational. of potassium.
Jahrbucher,
xx., 1864, 1.
6 Beauregard Symptoms resembling those of general Cure by iodide of
Gaz. paralysis. potassium.
hébdom. de
Sci. méd. de
Bordeaux,
1880, p. 64.
7 M. Rendu Loss of memory, headache, irregularity of Mercurial treatment, cure.
Ibid. pupils, ambitious delirium, periods of
excitement, others of depression,
embarrassment of speech, access of furious
delirium, ending in stupor.
8 M. Rendu Hypochondria, irregularity of pupils, headache, Mercurial treatment, cure.
Gaz. failure of memory, melancholy, stupor.
hébdom. de
Sci. méd. de
Bordeaux,
1880, p. 64.
9 Albrecht Melancholia with hypochondriasis, Iodide of potassium, cure.
Erlenmeyer sleeplessness, fear of men, and belief they
Die were all leagued against him.
Luëtischen
Psychosen,
Neuwied,
1877.
10 Ibid. Religious melancholia, with two attempts at Iodide of potassium, cure.
suicide, ending in mania.
11 Ibid. At times very violent, yelling, shrieking, Iodide of potassium, cure.
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.
12 Ibid. Epileptic attack followed by a long soporose Cured by mercurial
condition, ending in mental confusion, he not inunction.
knowing his nearest friends, etc.; almost
dementia.
13 Ibid. Great fear of gensd'armes, etc., mania, with Cured by mercurial
hallucinations, loud crying, yelling, etc., then inunctions with iodide
convulsion, followed by great difficulty of internally; subsequently
speech. return of convulsions,
followed by hemiplegia
and death.
14 Ibid. Great unnatural vivacity and loquacity, wanted Iodide of potassium, cure.
to buy everything, bragged of enormous gains Attended to business,
at play, etc.; some trouble of speech. and seems as well as
before. Relapsed. (See
Symptoms.)
Ibid. Fifteen months after discharge from asylum Failure of various anti-
Relapse of relapse; symptoms developing very rapidly, specific treatment.
Case 14. delirium of grandeur of the most aggravated
type, with marked progressive dementia, failure
of power of speech, and finally of locomotion.
15 A. Failure of mental powers, inequality of pupils, Iodide of potassium in
Erlenmeyer trembling of lip when speaking, uncertainty of ascending doses failed.
Die gait, almost entire loss of memory, once Recovery under mercurial
Luëtischen, temporary ptosis and strabismus. inunctions.
etc.
16 Ibid. Failure of mental powers, pronounced delirium Iodide of potassium,
of grandeur, hallucinations of hearing, failure of corrosive-sublimate
memory, strabismus and ptosis coming on late. injections. Cure.
17 Ibid. Failure of memory and mental powers, slight Cure with use of iodide
ideas of grandeur, disturbance of sensibility and mercurial inunctions.
and motility, aphasia coming on late.
18 Ibid. Melancholy, great excitability, ideas of Iodide of potassium
grandeur; after a long time sudden ptosis and failed; mercurial course
strabismus. 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 Melancholia with attempted suicide, epilepsy, Iodide of potassium, cure.
Amer. Journ. headache, somnolent spells.
Insanity, vol.
xv. p. 249.
21 Ibid. Acute mania, noisy, very destructive; syphilitic Iodide of potassium, cure.
disease of tibia.
22 Snel Maniacal excitement. Cured by specific
treatment.
23 Wm. Smith Apathetic melancholy, indelicate, speaking only Rapidly cured by conjoint
Brit. Med. in monosyllables, and much of the time not at use of iodide and
Journ., July, all, sullen and menacing. mercurials. The
1868, p. 30. 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.
70 Loc. cit.
When the conditions in any case correspond with the characters just
paragraphed, or when any of the distinguishing characteristics of
brain syphilis, as previously given, are present, the probability is that
the disorder is specific and remediable. But the absence of these
marks of specific disease is not proof that the patient is not suffering
from syphilis. Headache may be absent in cerebral syphilis, as also
may insomnia and somnolence. Epileptiform attacks are not always
present in the pseudo-paralysis, and may be present in the genuine
affection; a review of the cases previously tabulated shows that in
several of them the megalomania was most pronounced; and a case
with very pronounced delirium of grandeur, in which the autopsy
revealed unquestionably specific brain lesions, may be found in
Chauvet's Thesis, p. 31.
Spinal Syphilis.
Tumors of the brain occur oftener among men than women. This fact
is dependent largely upon the difference between the habits and
occupations of the two sexes. Men, in the first place, are much more
addicted to alcoholic, venereal, and other abuses which give rise to
special degenerations or constitutional infection; and secondly, they
are more exposed to traumatisms. In 100 cases the tumors occurred
among males in 58 cases, among females in 40 cases, and sex was
not recorded in 2 cases.