PARETIC DEMENTIA AND SYPHILIS. By JAS. G. KIERNAN, M. D., Honorary President Section on Mental Diseases, Pan-American Congress; Fellow of the Chicago Academy of Medicine; Lecturer on Forensic Psy SINCE chiatry, Kent Law School, of Chicago. INCE the publication of my article, nearly a decade ago, on this subject* increasing attention has been paid to it. Nearly all the contributions are permeated by the tendency to view this subject from the stand-point of syphilitic ætiology. I had analyzed a series of dicta and a single case; the analysis tending to show that demarcation of syphilitic dementia was impossible from either a clinical, therapeutic or prognostic stand-point. Savage,† while admitting that a large proportion of cases have not only a syphilitic history but a true syphilitic origin, cited some conclusive arguments against the luetic origin of paretic dementia. He cited the case of twin paretic dements who led totally different lives-one, sober and diligent; the other, intemperate and licentious. He, as Dr. Jacobson, of Copenhagen, points out, took substantially the same ground as I did anent the demarcation of syphilitic from non-syphilitic paretic dementia. Many tests have been suggested, but one of the most interesting is that of Minor,§ who has made a decidedly interesting analysis of 1842 Russian neuropaths. Of these 760 were Russians (496 males, 264 females) and 882 Jews (449 men and 433 females). Seven per cent. of the male Jews, three-two per cent. of the females were luetic; twentyfive per cent. of the Russian males and eleven per cent. of the females were luetic. Six per cent. of the Russian males were tabetic. Of these ninety per cent. were luetic; two * ALIENIST AND NEUROLOGIST, 1883. † International Medical Congress, 1887. § Neurologisches Centralblatt, July 1, 1892. and a half per cent. were paretic dements; of these eighty per cent. luetic. One female was tabetic and luetic: three were paretic dements, of whom syphilis was certain in one and probable in two. Six-tenths of one per cent. of the Jews were tabetic and the same percentage luetic. Fourtenths of one per cent. were paretic dements and the same percentage was luetic. There were no paretic dements among the Jewesses and but one tabetic, who was luetic. Paretic dementia and lues were therefore five times as frequent among Russians as among Jews, and this percentage was equally true of lues. Major asks of a case if paretic dementia has ever been observed in which hard chancre has been contracted since the onset of the psychosis? * Minor is evidently unacquainted with the results of Ripping and Snell, who found that syphilis was sometimes merely an epiphenomenon of paretic dementia, concomitant, as I pointed out about a decade ago,† on the sexual excitement of the earlier stages of this psychosis. This period is one in which syphilis is very likely to be contracted by men who have led hitherto blameless lives. I reported one such case half a decade ago, and ten others have come under observation: CASE I.-Came under my observation at the Cook County Hospital for the Insane, and was that of a 73-yearold, married, Irish hotel man. The patient, about six months before admission, suddenly began to display wandering tendencies and dissipated habits. He had a congestive chill, from which he passed into a condition of stupor, from which he recovered, complaining of cold (his temperature is subnormal). He contracted the initial lesion of syphilis about this time and in the course of a month complained of being dead, had hallucinations of hearing and delusions of persecution by a priest. On admission he had these delusions and hallucinations well marked. He had secondary luetic ulcers on his limbs. Under the modified McDade anti syphilitic treatment (mercury bichloride gr. 1-32, being added to the original "Allgemeine Zeitschrift f. Psych.," B. XXXVIII. † ALIENIST AND NEUROLOGIST, 1883. formula) the ulcers improved, and with them the patient's delusions of persecution and hallucinations grew fainter, until he was not certain that they were aught but imagination. He presented, on admission, slight physical evidences of paretic dementia. These are now well marked, and he displays a silly optimism and contentment with his surroundings. His temperature is 94.5°F. right, 96°F. left side. The tendon reflex was normal. CASE II-A 42-year-old American woman; had been a respectable wife and mother up to the approach of the menopause, which occurred at thirty-nine. She then became very boisterous in manner, negligent of household affairs and became gay in attire. These symptoms improved and her former neat habits were resumed six months after an apoplectiform attack occurred, which was followed by the physical symptoms of paretic dementia, attended with somewhat grandiose delusions. There was then considerable remission of all symptoms, followed by an emotional state, in which she contracted a chancre, followed by secondary fever and eruption. During this period she was much depressed. She died a year later in an apoplectiform attack. CASE III. was that of a German, 45 years old, who came under care with decidedly well-marked physical and emotional symptoms of paretic dementia. He was taken out by friends and returned in two months with a hard chancre. During the secondary fever he was relatively quiet. He became hemiplegic during an apoplectic attack and died extremely demented. CASE IV. was that of an Irish contractor, who had been very sober, diligent and industrious up to the age of 50, when he suddenly began to squander money in wild dissipation. During one of these orgies he contracted a chancre of the corner of the mouth. This was at first regarded as an epithelioma, but its history was suspicious and it disappeared under mercurial treatment. The psychosis ran its usual course. CASE V. was that of a careful, industrious Scandinavian, who manifested the physical and psychical symptoms of paretic dementia after undue financial strain. He then went on sprees, squandered money lavishly and on one occasion slept in a low lodging house. Here he exchanged clothes with a tramp in a fit of paretic generosity. The result was luetic infection of the side of the scrotum, which yielded to mercurial treatment. The patient died in an apoplectiform attack. CASES VI. and VII. were those of a 60-year-old man, who, together with his wife, became paretic dements after a two-years' financial struggle, in which their all was involved. He was induced to enter a disreputable negro den in one of his wandering periods and there contracted syphilis. This he communicated to his wife. Both died within a year after the primary luetic infection, but three after the onset of paretic dementia. CASE VIII. was that of an Italian woman, who became a paretic dement secondary to traumatism. During a remission she contracted the initial lesion of syphilis. CASES IX. and X. were two brothers, who broke down under excessive business strain. During the resultant emotional exaltation of paretic dementia they visited various disreputable dens. One of them contracted the initial lesion and became so excitable as to require hospital treatment. The other continued his course and became sexually impotent on normal coitus. He came under care with a tongue chancre. These cases simply answer Minor, who, in his application of his test, has ignored the possibility of syphilitic reinfection. Progressive Muscular Atrophy. By PHILIP ZENNER, A. M., M. D., Cincinnati, Clinical Lecturer on Diseases of the Nervous System in the Medical College of Ohio. HE theories and teachings of the nature of progressive muscular atrophy have varied much since the disease was first recognized, and are still far from settled. Duchenne and Aran, to whom we owe the full description of the disease, the most common type of which still goes by their name, believed it to be primarily muscular in character, a belief which was long and generally entertained. Then Remak and others, taught that it was due to lesions in the sympathetic nervous system. When, with improved methods of examination, changes were frequently found in the cord, as well as the muscles and peripheral nerves, the spinal origin of the disease was generally recognized; and, finally, Charcot and his school taught us to seek the disease in the large ganglion cells of the anterior cornua, the trophic centers of the muscles. With few exceptions, then, progressive muscular atrophy was considered to be a spinal disease; but, gradually, the opinion grew that under this term were included different diseases, quite distinct in character. Leyden, in his classical work on "Diseases of the Spinal Cord,” published in 1875, describes separately what he terms the hereditary form of progressive muscular atrophy, which is characterized both by its hereditary features, often occurring in quite a number of different generations, and by its mode of onset, affecting first the inferior extremities. Leyden expressed a doubt whether this form of the disease, like the common type, was of spinal origin. NOTE.-An address, with presentation of patients before the Academy of Medicine, Nov. 14, 1892. |