Chapter XXV: Appendix: B

COMMON METHODS OF TREATMENT USED IN CASES OF NEUROSYPHILIS

The =treatment for neurosyphilis= according to the viewpoint of the authors =is treatment for syphilis=. It is necessary in order to cure a case of neurosyphilis to cure the syphilis in the patient. Accordingly, the methods of treatment best adapted for the cure of syphilis are indicated in the treatment of neurosyphilis. As experience shows that it is often more difficult to cure the neurosyphilitic cases, treatment will have to be pushed with greater intensity than in some non-nervous system syphilis. In general, then, the methods that have been applied by the syphilologist will be used in the treatment of cases of neurosyphilis. In addition, methods attempting to bring the drug into local contact with the central nervous system have been devised. The methods of treatment have been in part indicated in Chart 27.

The method chiefly used in treatment of the cases of this book is what we have called =intensive systematic intravenous treatment=. The treatment consists of intravenous injections of salvarsan (or a substitute for salvarsan, as arsenobenzol and diarsenol) given in a dose of about 0.6 gram and repeated twice a week over a period of a number of months. In addition, injections of mercury salicylate averaging 0.065 gram once a week are given and potassium iodid by mouth. As indicated, the important point is to keep up treatment for a long period of time. This method has produced practically no untoward results, certainly no more untoward results than are to be expected with salvarsan in smaller quantities and it has seemed to us that the therapeutic results have been as satisfactory as in any other form of treatment.

Specialized forms of treatment intended to place the drug in contact with the central nervous system may be described under the headings of =spinal intradural treatment= and =cerebral subdural= and =intraventricular treatment=.

Three main therapeutic agents have been largely used. These are (1) salvarsanized serum according to the =method of Swift-Ellis= (=in vivo=). The serum according to this method is prepared as follows: An intravenous injection of salvarsan is given to a patient and blood withdrawn at the end of one-half hour. This is allowed to clot. The serum is removed and after inactivation at 56° C. for one-half hour it is ready for use. The average dose is 15 to 30 cc. of serum. As a matter of fact, it is not necessary to use the blood serum from the same patient to whom the intraspinous injection is to be given. (2) The salvarsanized serum according to the =method of Ogilvie= (=in vitro=). Blood serum is prepared from any patient and to it is added salvarsan in such a strength that the amount to be injected, 10 to 30 cc. of serum, will contain 0.0001 to 0.001 gm. (3) Mercurialized serum according to the =method of Byrnes=. Mercury bichloride is added to blood serum in such proportion that the amount of serum to be injected will contain from 0.00065 gram to 0.0026 gram.

The method of intraspinous injection is to perform lumbar puncture, withdraw an amount of fluid approximately equivalent to the amount to be injected; then allow the serum to be injected to run in by gravity.

For the =cerebral=, =subdural and intraventricular= injections, the same sera may be used as for the intraspinous. Five or six times as much salvarsan may be given, but a smaller amount of serum may be advisable, that is, 10 to 15 cc. To perform injections a trephine opening is made in the calvarium about the size of a dime. The location of choice for the opening is slightly back of the longitudinal prominence just to the right of the median line, to avoid the frontal sinus. For subdural injections a curved needle is thrust between the dura and the brain and the serum allowed to flow in slowly by gravity. For the intraventricular injections a blunted spinal puncture needle is thrust through the brain substance into the 3rd ventricle. When the 3rd ventricle is reached the clear cerebral fluid will flow out; then after withdrawing a sufficient amount, the serum may be introduced by gravity. The trephining may be done under local anesthesia but as a rule it is better to induce general anesthesia. The subsequent injections can be made without recourse to any anesthesia whatsoever, as they are practically painless.

All procedures both in the injections and in the preparation of sera are naturally to be performed under aseptic conditions.

INDEX

Abscess, tonsillar, associated with neurosyphilis, 250.

Addison’s disease in juvenile paretic, 279.

Agraphia, 101.

Albumin test, 474.

Allbutt, Clifford, 257.

Alcoholism, chronic, 227.

Alcoholic dementia, 237.
epilepsy, 229.
hallucinosis, 225.
pseudoparesis, 222, 223, 451.

_Allergie_, 129, 204.

Alzheimer, 428.
method, 472.

Amboceptor, 477.

Amnesia, 195.

Anaphylaxis, 129.

Anatomical formulae, 25.

Antigens, 476.

Aortic aneurysm, 35, 439.

—— sclerosis, 41, 46, 135.

Aphasia, 31, 43, 101, 262, 445.

Apoplexy, 197.

Argyll-Robertson pupil, 209, 212, 217, 291, 450.
as isolated symptom, 217.
in alcoholism, 214, 229.

Arndt, Junius and, 249.

Arsenobenzol, 375, 377, 389, 486.

Arteriosclerosis, cerebral, 101.
not a contraindication to intensive salvarsan therapy, 359.
radial, 68.

Ascending lesion, 23.

Asymmetrical lesions, 19.

Ataxia, 31, 223.

Atheromatous degeneration, 35.

Atrophy, cerebellar, 39.
cerebral, 47, 134, 205.
parenchymal, 41.
pontine, 39.

Atypical case congenital neurosyphilis, 270.

Ayer, J. B., 472.

Ballet, 72.

Barrett, A. M., 54, 175, 187, 212, 218, 219.

Bechterew, 219.

Binet and Simon, 304.

Binet scale, 277.

Birnbaum, 403.

Blood pressure, high, 70, 262, 124.

Bly, 252.

Bonhoeffer, 404, 415, 417.

Bordet, 427.

Bratz, 278.

Bruck test, 479.

Bruck, C., 479.

Bumke, 214.

Canavan, 256.
and Southard, 70.

Cell count, 471.

Cerebral syphilis, see diffuse neurosyphilis.

Cerebrospinal syphilis, see diffuse neurosyphilis.

Cervical hypertrophic meningitis of Charcot, 56, 441.

Chancre, extragenital, 75, 342.

Character change, neurosyphilis, 314.

Charcot, 60, 186.

Choroiditis, 242.

Christian, 407.

Cimbal, 403.

Civilization and syphilis, 76.

Clinical evidences of syphilis, 131.

Clouston, 158.

Collins, Joseph, 145.

Compensation in neurosyphilis, 309, 402, 456.

Complement, 477.

Conduct disorder, 38.

Congenital syphilis, absence of stigmata, 318.
as cause of feeblemindedness, 159, 447.
involvement of nervous system in, 274.

Congenital neurosyphilis, 270, 395.
resembling feeblemindedness, 272.

Conjugal neurosyphilis, 263.

Convulsions, 43, 101, 248, 362.
cause of in paretic neurosyphilis, 232.
in psychopathic subject with syphilis, 417.

Corneal opacity, syphilitic, 234.

Cotard, 73.

Cotton, H. A., 472.

Craig, C. B., 152, 196.

Cramer, 125.

Cranial neurosyphilis, 140.
tenderness, 139.

Crises, gastric, 367.

Cysts, ependymal, 59.
of softening, 27, 36, 54.

Cytorrhyctes luis, 381.

Dana, Charles L., 65, 77, 78.

Dazed states, 264.

Deafness, 63.

Decompression, 138.

Defective delinquent—diffuse neurosyphilis, 300, 455.

Dejerine-Tinel, 61.

Delinquency and juvenile neurosyphilis, 298.

Delirium tremens, 332.

Dementia, 137.

Dementia paralytica, see paretic neurosyphilis.

Dementia praecox, 74, 185, 247.

Depression, 95, 126.

Depressive drugs, 189.

Diabetes, and neurosyphilis, 240.
insipidus, 190.

Diabetic pseudoparesis, 238.

Diarsenol, 377, 389, 391, 486.

Differential diagnosis, alcoholism and neurosyphilis, 227, 231, 234,
236.
brain tumor, diabetic pseudoparesis and neurosyphilis, 238.
diffuse and paretic neurosyphilis, 165, 193, 247.
manic-depressive psychosis and neurosyphilis, 69.
multiple sclerosis and neurosyphilis, 253, 255.
neurasthenia and neurosyphilis, 65, 183.
senile arteriosclerotic psychosis and neurosyphilis, 262.

Diffuse neurosyphilis, cerebrospinal syphilis, cerebral syphilis,
spinal syphilis, 17, 80, 85, 97, 103, 122, 140, 183, 193, 300, 331,
342, 359, 433, 439, 443.
premonitory symptoms, 342.
prognosis, 80, 103, 124, 433, 443.
spinal fluid findings in, 348.
symptoms, 99.
treatment, 98, 103, 184, 302, 390.
treatment, results, 343.

Diplopia, 50, 184, 253, 356.
causes, 140.

Donath, 401, 403.

Drastich, 407.

Duco and Blum, 403.

Dupré, 407.

Dysdiadochokinesis, 231.

Ehrlich, 184, 428, 429.

Encephalitis, 27, 248.
disseminated, 218.

Endarteritis, 220.

Ependymal cysts, 59.

Ependymitis, 40, 47, 49, 134.

Epilepsy, 192.
alcoholic, 229.
brought out by syphilis, 415.
Jacksonian, 103.
parasyphilitic, 194.
relation to juvenile neurosyphilis, 277.
syphilitic, 103, 194.
syphilogenic, 415.

Epileptic neurosis, 195.

Erb’s syphilitic spastic paraplegia, 147.
treatment of, 148.

Euphoria, 73.

Excited states, 95.

Exner, M. J., 416.

Exophthalmic goitre, syphilitic (?), 205.

Extraocular palsy, 140, 441.

Eye changes in neurosyphilis, 257.

Eye muscles, paresis of, 17, 50.

Facial paralysis, 53.

Families of neurosyphilitics, 275, 316, 318, 320, 373, 431, 457.

Family of neurosyphilitic, normal-looking, but syphilitic, 318.

Familial syphilis, 299, 306.

Farrar, C. B., 411.

Fearnsides, Head and, 21, 140, 150, 193, 217, 374, 378.

Feeblemindedness, 395.
and congenital syphilis, 159.

Fernald, W. E., 159, 273, 396.

Fildes, McIntosh and, 129, 329.

Focal changes, 221.
meningitis, 50.
softenings, pontine, 54.

Fournier, 142, 222, 186, 194, 381.

Franz, 357.

Froissart, 413.

Fugue, hysterical, 264.

Garnier, 407.

General paresis, see paretic neurosyphilis.

Glands, 270.

Gliosis, 39, 47, 49, 136, 180.

Globulin, 229.
tests, 473.

Glycosuria, 238, 241.

Goddard, 397.

Gold sol reaction, 247, 474.
in brain tumor, 100.
paretic, 85, 98.
paretic, other tests negative, 383, 385.
in purulent meningitis, 100.
syphilitic, 85, 98, 345.

Graham, Thomas, 429.

Grandiosity, 72, 295, 455.

Graves, W. W., 157.

Grilli, 407.

Gross, 257.

Gumma, see gummatous neurosyphilis.

Gumma of tonsil, 250.

Gummatous neurosyphilis, 53, 56, 137, 138, 140, 221, 362, 438.

Hallucinations, 53.
in paretic neurosyphilis, 249.

Hauptmann, 348.

Head and Fearnsides, 21, 140, 150, 193, 210, 217, 374, 387.

Headache, 53, 63, 122, 247, 352.
causes of, 209.

Hecht, 399.

Hemianopsia in neurosyphilis, 242.

Hemiplegia, 31, 45, 80, 122, 262, 360.
causes of, 389.

Hemitremor, 197.

Heredity, neuropathic, 84.

Herxheimer reaction, 152.

Heubner, 427, 428.

Hinton, W. A., 471.

Huntington’s chorea, 258.

Hutchinsonian teeth, 45.

Hydrocephalus, 134, 306.

Hyperreflexia, explanation of, 233.

Hypochondriacal ideas, 133.

Hysteria, 185, 301.

Hysterical symptoms, 18.

Incontinence, vesical in tabetic neurosyphilis, 144.
rectal, 56.

Incubation period of neurosyphilis, 152.

Infectiousness of neurosyphilis, 95.

Insight, 95.

Insomnia, 63.

Intracranial pressure, 139, 362.

Intraspinal lesions, 95.

Intraspinous therapy, 122, 366, 486.
unpleasant results of, 366.

Intraventricular injections, 389, 487.

Involution-melancholia, 187.

Iodine, untoward results, of, 363.

Iritis, 17.

Järisch-Herxheimer reaction, 72.

Joffroy, 214.
and Mignot, 64.

Junius and Arndt, 249.

Juvenile neurosyphilis, 438, 447.
relation to epilepsy, 277.

Juvenile paresis, see juvenile paretic neurosyphilis.

Juvenile paretic neurosyphilis, juvenile paresis, 45, 154, 157, 272,
275, 298, 306, 440.
age of onset, 158.
and Addison’s disease, 279.
and delinquency, 298.
prognosis, 156, 158, 162, 273, 275.
treatment, 154, 161, 278, 299.

Juvenile paretic neurosyphilis, with initial trauma, 306.
congenital amputation of toes in, 158.

Juvenile tabetic neurosyphilis, 161, 447.

Kaplan, 255, 471.

Kéraval, 257.

Key, 427.

Knee-jerks, absence of, 223.
lively, 75.
return of, 24.

Koefod, Solomon and, 243.

Kolmer, 471.

Kraepelin, 65, 66, 69, 88, 91, 95, 187, 225, 249.

Krafft-Ebing, 84.

Laignel-Lavastine, 413.

Lange, C., 428, 429, 474.

Lancinating pains, 92, 141.

Lépine, 408, 413.

Leptomeningitis, 47, 54, 135.

Lewandowski, 210.

Liability of paretic, 295.

Lissauer’s paralysis, 38.

Locomotor ataxia, see tabetic neurosyphilis.

Long, 418.

Lucke, Baldwin, 93, 144.

Lues maligna, 250, 452.

Lumbar puncture, untoward effects, 352.
treatment of, 354.

Lüth, 278.

Lymphocytosis, 23, 30, 40, 49.

McDonagh, 381.

McIntosh, Fildes and, 129, 329.

Malaria, cerebral, simulation of paretic neurosyphilis, 245.

Mallory and Wright, 472.

Manic-depressive psychosis, 68, 71, 77, 187, 202, 291, 384, 442.

Marie, Chatelin and Patrikios, 412.

Marie, 408, 414.

Martin, E. G., 313.

Massary, de, 414.

Mattauschek and Pilcz, 347.

Medicolegal and Social, 454.
period of paretic neurosyphilis, 414.

Meilhon, 407.

Memory, failing, 63.

Meningitis hypertrophica cervicalis of Charcot, 56.
sympathica, 19.
syphilitic, 103.

Mercurialization, 98.

Mercury, 58, 83, 85, 98, 148, 193, 235, 376, 377, 389, 391, 395, 486.
untoward results of, 363.

Metasyphilis, 89.

Metchnikoff and Roux, 427, 428.

Microgyria, occipital, 47.

Mignot, Joffroy and, 64, 66.

Migraine, 19.

Mitchell, H. W., 218.

Mœbius, 429.

Mott, F. W., 158, 257, 308, 396, 437.

Multiple sclerosis, 253, 256.
relation of syphilis to, 254.
spinal fluid findings in, 254.

Muscular atrophy, 149, 446.
syphilitic relation to amyotrophic lateral sclerosis, 150.

Muscular weakness, 279.

Myerson, A., 196.

Nageotti, 428.

Nausea, 63.

Neisser, 399.

Nerve trunk tenderness, 148, 234.

Nervousness, 63.

Nervous indigestion, 63.

Neurasthenia, 63, 183.

Neuritis, cranial, 51.
optic, 365.
root, 235.
syphilitic, 235.

Neurorecidive, 152, 153, 184, 196, 235.

Neuroses, relation of syphilis to, 186.

Neurosyphilis, 187, 238, 240, 242.
aggravated on military service, 404.
atypical, 258, 346.
atypical case resembling hysterical fugue, 264.
dates, 428.
forms of, 20, 21, 28, 29, 95.
galloping, 328.
history of, 427.
incubation period, 152.
infectiousness of, 95.
laboratory findings in, 82.
latent, 142, 203.
lesions, 303.
lighted up by stress of military service, 412.
and marriage, 319.
prevention, 320.
onset, 64.
in primary stage, 186.
in secondary stage, 185, 283, 390.
in secondary stage, prognosis, 390.
in secondary stage, treatment, 153.
spinal, 23.
and the war, 399, 466.

Nissl-Alzheimer method, 427.

Noguchi, 381.
and Moore, 428, 429.

Nonne, 82, 125, 152, 186, 195, 196, 214, 216, 235, 254, 265.
-Apelt test, 473.

Numbness, 56.

Nystagmus, 45, 253, 256, 279.

Obersteiner, 249.

Occupation-neurosis, 312.

Ogilvie method, 487.

Operation for gumma, 139.

Optic atrophy, 256.
in juvenile paretic neurosyphilis, 154.

Optic thalamus, syphilitic lesion of, 205.

Osteitis, syphilitic, 311.

Ozena, 350.

Pains, 31.

Pandy test, 474.

Paralysis, 123.
recovery from, 342.
of respiration, 248.

Paranoia, syphilitic, 225.

Paraphasia, 19, 43.

Paraplegia, 26, 30.

Parasyphilis, 89.

_Paresis sine paresi_, 126, 186, 204, 303, 445.

Paresis, see paretic neurosyphilis.

Paretic neurosyphilis, dementia paralytica, general paresis, softening
of the brain, 37, 63, 68, 74, 78, 80, 85, 97, 131, 188, 192, 197,
199, 202, 227, 241, 262, 289, 295, 309, 314, 323, 338, 372, 375,
377, 382, 384, 386, 388, 392, 435, 440, 442.
adjuvant causes of, 414.
causing social complications, 289.
causes of death in, 197.
course, 85.
duration, 88.
forms, 95.
improvement, 377.
incidence among officers, 407.
incidence among soldiers, 402.
lesions of, 131.
“lighted up” by domestic stress in civil life, 420.
“lighted up” by “gassing,” 414.
mortality from, 89.
nomenclature, 88.
onset, 192.
pathology of, 436.
prognosis, 435, 444.
symptoms, 90, 131.
symptoms, mental, 87.
symptoms, physical, 86.
versus diffuse neurosyphilis, 165.
versus vascular neurosyphilis, 169, 172.
with very marked meningitis, 332.
with very marked brain atrophy, 335.
without mental symptoms, 315.
traumatic exacerbation, 310.
traumatic form, 308, 413.
traumatic, shell-shock, 401.
treatment of, 85, 370, 372, 377, 382, 384, 386, 388, 392.
treatment, results of, 351.

Pensions for disabilities resulting from venereal disease, 409.

Pensions for neurosyphilis, 411.

Peripheral neurosyphilis, 19.

Perivascular infiltration, 41.

Pernicious anemia with spinal symptoms, 267.

Petit mal attacks, 195.

Pförringer, 61.

Phobia, 67.

Pilcz, Mattauschek and, 347.

Pitres and Marchand, 421, 424.

Plaut, 249, 348, 428.

Plaut, Rehm and Schottmüller, 471.

Plasmocytosis, 40, 49, 55.

Pleocytosis, 23, 220, 247, 344.
effect of antisyphilitic treatment on, 244, 376.
in remissions, 243.
significance of, 243.
spinal fluid otherwise negative, 270.

Polydipsia, 190.

Polyuria, 190.

Pontine hemorrhage, 219.
softening, 54.

Posey and Spiller, 257.

Potassium iodid, 58, 85, 98, 193, 222, 376, 377, 389, 486.

Preparesis, 65, 77, 78.

Prince, Morton, 195.

Psammoma, 213.

Pseudoneurasthenia, 66.

Pseudoparesis, 449.
alcoholic, 222, 229, 451.
diabetic, 238.
senile, 263.
shell-shock, 421.
syphilitic, 223, 371.

Pseudoparetic neurosyphilis, 222.

Pseudotabes, shell-shock, 424.

Psychogenic neurosyphilis, 189.

Psychographic disturbance, 228.

Psychopathic personality, 302.

Ptosis, 350.

Pupillary reaction, changes in, 261.
signs, 69.

Pupils, Argyll-Robertson, see Argyll-Robertson pupils.
irregular, 79, 201.
normally reacting in paretic neurosyphilis, 199.
sluggish reaction to light, 188.
stiff as isolated symptom, 265.

Purkinje cells, binucleate, 48.

Putnam, James J., 19, 56.

Pyramidal tract lesion, bilateral, 326.
sclerosis, 44.

Quadriplegia in juvenile paretic neurosyphilis, 275.

Quincke, 427, 428.

_Randsklerose_, 24.

Ravaut, 428.

Ravaut, Sicard, Nageotti, Widal, 428.

Rayneau, 407, 413, 414.

Recovery, 77.

Recurrences, 70.

Redlich, 403.

Régis, 73.

Remissions, 122, 435, 445.

Retardation, 187.

Retention of urine, 56.

Retinitis, hemorrhages, 365.

Richards, R. L., 402, 404, 406, 409.

Robertson, A. R., 59.

Rod cells, 226, 297.

Romberg sign, 141, 216, 279.

Root-sciatica, syphilitic, 418.

Rosenau, 471.

Ross-Jones test, 473.

“Rum fit,” 229.

Ryder, Charles T., 42.

Saddle-shaped nose, 210.

Salivation, 98.

Salmon, Thomas W., 89.

Salvarsan, 75, 83, 85, 193, 222, 377, 389, 486.
provocative, 78, 79.
untoward results of, 363.

Salvarsanized serum, 75.

Schaudinn, 427, 429.

Sciatic pain in neurosyphilis, 149.

Seizures, 31, 64, 83, 103, 444.
causes of in paretic neurosyphilis, 194.
Jacksonian, 392.
minor, 392.

Senile arteriosclerotic psychosis, 262.

Sensitized cells, 478.

Sérieux and Ducaste, 96.

Shaikewicz, 404.

Shanahan, 278.

Sheep’s corpuscles, 477.

Shock, 42, 81.

Sicard, 428.

Six tests, 80, 85.
in tabetic neurosyphilis, 141.

Smith and Solomon, 479.

Social cases, 454.
service, 232.

Solomon, 142, 255.
and Koefod, 243.
Smith and, 479.
Southard and, 202, 303.

Somnolence, 45.

Southard, E. E., 48, 134, 212.
and Canavan, 70.
and Solomon, 202, 303.
and Taft, 397.

Spasms, clonic, 326.

Spastic hemiplegia in paretic neurosyphilis, 323.

Spastic paraplegia, Erb’s, 147, 306.

Spasticity, 18, 256.

Speech defect, 69, 133.

Spiller, 150.
Posey and, 257.

Spinal fluid findings in secondary stage of syphilis, 151, 185, 283.
in juvenile paretic neurosyphilis, 275.
negative in diffuse neurosyphilis, 140.
negative in gummatous neurosyphilis, 138.
negative in neurosyphilis, 216.
negative in tabetic neurosyphilis, 269.
in tabetic neurosyphilis, 141.

Spinal fluid, withdrawal for therapeutic purposes, 377, 379.

Spinal syphilis, see diffuse neurosyphilis.

Spirochetes, “drug fastness,” 381, 394.
strains, 76, 263, 276, 381, 394.

Steida, 405.

Sterility in tabetic neurosyphilis, 144.

Stier, 407.

Stokes, Wile and, 186.

Suicide, 92, 126, 240, 296, 301.

Summary, 427.

Syphilis aggravated by service, 406, 411.
on service, 409.

Syphilis as cause of diabetes, 241.
as cause of feeblemindedness, 396.
hereditaria tarda, 160, 318.
history of, 427.
lesions in, 329.
of lung, 211.
from Mongolian, 76.
primary, 65.
secondary, 65.
tertiary, lesions in, 329.

Syphilitic feeblemindedness, pathology of, 160.
neuritis, 312.
psychosis, 91.

Syphilophobia, 67, 361.

Syphilotoxins, 72.

Swift, 129, 212.

Swift and Ellis, 428, 429.
method, 428, 487.

Tabes dorsalis, see tabetic neurosyphilis.

Tabetic neurosyphilis, tabes dorsalis, locomotor ataxia, 30, 31, 141,
146, 366, 367, 434, 446.
associated with cerebral symptoms, 177.
atypical, 143.
cervical, 146.
course, 141.
with negative spinal fluid findings, 269.
prognosis, 94.
shell-shock, 403.
“shell-shocked” into paretic neurosyphilis, 401.
symptoms, 93.
symptoms in order of frequency, 145.
treatment, 145, 366, 367.
plus vascular neurosyphilis, 175.
with vascular insult, 30, 439.
versus pernicious anemia, 267.

Taboparesis, see Taboparetic neurosyphilis.

Taboparetic neurosyphilis, taboparesis, 92, 135, 195, 284, 443.
course, 92.
nomenclature, 94.
prognosis, 92, 443.
and typhoid meningitis, 284.

Taft, A. E., Southard, E. E., and,

Talon, 407.

Taylor, E. W., 50.

Temperature, paretic, 376.

Tests, changes under treatment, 102.
changed to negative in paretic neurosyphilis without clinical
improvement, 385.
changed to less strongly positive in paretic neurosyphilis without
clinical improvement, 386.

Therapeutic conception, 324.

Thibierge, 399.

Thierry, 158.

Throbbing in head, 63.

Thrombosis, cerebral, 36, 42, 342, 357, 360, 124.

Thymus, persistent, 282.

Tibial exostoses, 100.

Tigges’ formula, 248.

Todd, J. L., 406, 409.

Transient deafness, 18.
blindness, 18.
paralysis, 124.
paralysis, condition in which occurs, 123.

Trauma and juvenile neurosyphilis, 278, 306.
neurosyphilis, 456.
paretic neurosyphilis, 199, 308, 310.
syphilitic osteitis, 311.

Treatment of neurosyphilis, 67, 75, 83, 124, 148, 184, 222, 235, 299,
328, 332, 335, 342, 346, 350, 351, 355, 384, 390, 392, 395, 419,
439, 457.
case in which theoretically of no avail, 323.
methods, 356, 486.

Treatment of syphilis, effect on development of neurosyphilis, 142,
347.

Tremor, 197.
intention, 256

Tubercle, 80.

Tuberous sclerosis of Bourneville, 47.

Tumor, cerebral, 53, 191, 238, 253.
pineal, 213.

Unconsciousness, 53.
causes of, 389.

Vascular changes, 220.

Vascular neurosyphilis, 31, 42, 72, 296, 359, 433, 440.
plus tabetic neurosyphilis, 175.
prognosis, 433.
versus paretic neurosyphilis, 169, 172.

Veeder, B. S., 274.

Vertigo, 122.

Viet, 278.

Virchow, 427, 428.

Vomiting, 53, 63.

Warthin, 241.

Wassermann reaction, 191.
and alcoholism, 230.
in congenital syphilis, 160, 271.
meaning of “doubtful,” 360.
negative in diffuse neurosyphilis, 184.
negative in juvenile paretic neurosyphilis, 298.
negative in spinal fluid in spinal syphilis, 148.
negative in spinal fluid in neurosyphilis, 101.
negative in neurosyphilis, 252.
negative in paretic neurosyphilis, 77.
technique, 476.
titrations in spinal fluid, 348.

Wassermann, Neisser and Bruck, 428.

Weiler, 214.

Weygandt, 403, 404.

Widal, Sicard, Ravaut, 428.

Wiles and Stokes, 186.

Word-deafness, 35, 43.

X-ray diagnosis of bone conditions, 136.

Yerkes-Bridges, 304.

Ziehen, 409.

Zsigmondi, 429, 474.

-----

Footnote 1:

The cases chosen to illustrate the propositions of the boxed headings
always illustrate several other points. See the footnotes of Section
VI for lists of cases illustrating special points. The names assigned
to the cases are fictitious and chosen to suggest race or descent.

Footnote 2:

Notes of Dr. James J. Putnam.

Footnote 3:

M = meningeal
V = vascular
P = parenchymatous

Footnote 4:

E. E. Southard: Lesions of the granule layer of the human cerebellum;
_Journal of Medical Research_, XVI, 1907.

Footnote 5:

Proof of marked parenchymatous lesions must hang on post mortem data;
the inference here as to the presence of parenchymatous lesions is a
clinical inference.

Footnote 6:

Reprinted from an article by Southard & Solomon: “Latent neurosyphilis
and the question of _Paresis sine paresi_.” Boston Medical & Surgical
Journal, XXIV, 1.

Footnote 7:

Solomon: “How Shall Latent Syphilis be Treated? The Prophylaxis of
Syphilis of the Central Nervous System.” Interstate Medical Journal,
XXIII, 8.

Footnote 8:

Joseph Collins: Syphilis of the Brain, _Journal American Medical
Association_, July 10, 1915, Vol. LXV, pp. 139–144.

Footnote 9:

A. M. Barrett has recently discussed this subject in a paper in the
_Journal of the American Medical Association_, Vol. LXVII, Dec. 2,
1916.

Footnote 10:

Reprinted from an article by Southard & Solomon: “Latent neurosyphilis
and the Question of _Paresis sine paresi_.” Boston Medical and
Surgical Journal, XXIV, 1.

Footnote 11:

E. E. Southard. A case of glioma of the pineal region, _Am. Jour. of
Ins._, Vol. LXI, 1905.

Footnote 12:

Since this was written Collins has had further difficulties related to
his neurosyphilis, improving under treatment.

Footnote 13:

Warthin: “Persistence of active lesions and spirochetes in the tissues
of clinically inactive or ‘cured’ syphilitics,” _American Journal of
Medical Sciences_, CLII, 1916.

Footnote 14:

“The Significance of Changes in Cellular Content of Cerebrospinal
Fluid in Neurosyphilis,” _Boston Medical and Surgical Journal_,
CLXXIII, 27.

Footnote 15:

Plaut: Ueber Halluzinosen der Syphilitiker, Berlin, 1913.

Footnote 16:

Borden S. Veeder: Hereditary Syphilis in the Light of Recent Clinical
Studies; Am. Jour. of Med. Sc., CLII, 1916.

Footnote 17:

Reprinted from article by Southard and Solomon: “Latent Neurosyphilis,
the Question of _Paresis sine paresi_,” _Boston Medical and Surgical
Journal_, XXIV, 1.

Footnote 18:

(This case was furnished by Dr. D. A. Haller from the Peter Bent
Brigham Hospital series.)

Footnote 19:

Fernald, W. E. Standardized Fields of Inquiry for Clinical Studies of
Borderline Defectives. Mental Hygiene, Vol. 1, No. 2, April, 1917.

Footnote 20:

Goddard, H. H., Feeblemindedness, its Causes and Consequences, 1914.

Footnote 21:

W. E. Fernald and E. E. Southard. Waverley Research Series in the
Pathology of the Feebleminded. Proceedings of the American Academy of
Arts and Sciences, 1917.

Footnote 22:

Thibierge. La Syphilis dans l’armée, 1917.

Footnote 23:

Hecht. Wien. klin. Woch., xxix, 51.

Footnote 24:

Donath. Beiträge zu den Kriegsverletzungen und -er-krankungen des
Nervensystems. Wiener klin. Wehnschr., No. 27–8, 1915.

Footnote 25:

Duco et Blum. Guide pratique du Médecin dans les Expertises
médicolégales militaires. Paris, 1917.

Footnote 26:

Birnbaum. Kriegsneurosen und -psychosen auf Grund der gegenwärtigen
Kriegsbeobachtungen: Sammelbericht. Z. f. d. ges. Neurol. u.
Psychiat., Bd. XII, H. 1, 1915.

Footnote 27:

Weygandt. Kriegseinflüsse und Psychiatrie. Jahreskurse f. ärztl.
Fortbildung, Maiheft, 1915.

Footnote 28:

Bonhoeffer. Erfahrungen über Epilepsie und Verwandtes im Feldzuge.
Monatschr. f. Psychiat u. Neurol., Bd. 38, H. 1–2, 1915.

Footnote 29:

Exner, M. J., Prostitution in its relation to the army on the Mexican
Border, _Social Hygiene_, Vol. 3, 2, April, 1917.

Footnote 30:

Bonhoeffer, _loc. cit._

Footnote 31:

We have recently reviewed the outcome in 300 _untreated_ cases of
paretic neurosyphilis (Psychopathic Hospital material, strictly
comparable with treated cases) finding but 5 now capable of
self-support and 10 more in normal-looking remission. This percentage
is far lower than that in treated cases (at present, July, 1917, 50 in
200 capable of self-support).

Footnote 32:

Alice Morton (1).

Footnote 33:

Francis Garfield (2).

Footnote 34:

John Dixon (3).

Footnote 35:

James Pierce (4).

Footnote 36:

John Lawrence (5).

Footnote 37:

Flora Black (6).

Footnote 38:

Mrs. Lecompte (7).

Footnote 39:

John Wyman (8).

Footnote 40:

Greeley Harrison (9). _Also_
Albert Robinson (45),
Alice Caperson (46),
Abel Bachmann (74).

Footnote 41:

Lyman Agnew (10). _Also_
Ethel Hunter (47),
Bessie Vogel (52),
Isaac Thompson (83),
Juliette Lachine (11).

Footnote 42:

Juliette Lachine (11). _Also_
Lyman Agnew (10),
Ethel Hunter (47),
Bessie Vogel (52),
Isaac Thompson (83).

Footnote 43:

Henry Philipps (12). _Also_
Bridget Curley (59),
Margaret O’Brien (68),
Annie Martin (117).

Footnote 44:

William Twist (13). _Also_
Lester Crane (20),
Thomas Donovan (23).

Footnote 45:

John Jackson (14). _Also_
Martha Bartlett (21),
Paolo Marini (28),
Margaret O’Brien (68).

Footnote 46:

Pietro Martiro (15). _Also_
Meyer Levenson (22),
Achilles Akropovlos (50).

Footnote 47:

Joseph Sullivan (16).

Footnote 48:

Gregorian Petrofski (17). _Also_
Richard Lawlor (25),
John Bennett (34),
Julius Kantor (54),
Albert Forest (112).

Footnote 49:

Frederick Wescott (18). _Also_
Martha Bartlett (21),
James Burns (56),
Victor Friedburg (108).

Footnote 50:

Agnes O’Neil (19). _Also_
Michael O’Donnell (24).
John Edwards (104).
Arthur Bright (121).

Footnote 51:

Lester Crane (20). _Also_
Greeley Harrison (9).
David Borofski (49).
David Collins (61).

Footnote 52:

Martha Bartlett (21). _Also_
Agnes O’Neil (19),
Vivian Walker (87).

Footnote 53:

Meyer Levenson (22). _Also_
Albert Forest (112).

Footnote 54:

Thomas Donovan (23). _Also_
William Twist (13),
Bessie Vogel (52),
David Collins (61).

Footnote 55:

Michael O’Donnell (24). _Also_
Alice Morton (1).

Footnote 56:

Richard Lawlor (25). _Also_
Bessie Vogel (52),
—— —— (88).

Footnote 57:

John Morrill (26).

Footnote 58:

David Tannenbaum (27).
_Also_ Mrs. LeCompte (7),
Annie Rivers (109).

Footnote 59:

Paolo Marini (28). _Also_
Flora Black (6).

Footnote 60:

Mario Sanzi (29). _Also_
Stephen Green (30),
Paul Halleck (31).

Footnote 61:

Stephen Green (30). _Also_
Paul Halleck (31),
Henri Lepère (105),
Ivan Rokicki (111).

Footnote 62:

Paul Halleck (31).

Footnote 63:

Margaret Neal (32).

Footnote 64:

Joseph Graham (33).

Footnote 65:

John Bennett (34). _Also_
Alice Caperson (46),
Florence Fitzgerald (81),
Vivian Walker (87),
Arthur Bright (121).

Footnote 66:

Mary Coughlin (35).

Footnote 67:

Theresa Mullen (36). _Also_
John Lawrence (5),
John Friedreich (77),
Gridley Ringer (78),
James Arnold (80).

Footnote 68:

Isaac Goldstein (37).

Footnote 69:

Archibald Sherry (38).

Footnote 70:

Caroline Davis (39).
H. F. (40).
Samuel North (41).
Elizabeth Brown (42).
Robert Allen (43).
John Hughes (44).

Footnote 71:

Albert Robinson (45). _Also_
Greeley Harrison (9).

Footnote 72:

Alice Caperson (46). _Also_
Florence Fitzgerald (81).

Footnote 73:

Ethel Hunter (47). _Also_
Lyman Agnew (10),
Bessie Vogel (52),
Juliette Lachine (11).

Footnote 74:

Milton Safsky (48). _Also_
Daniel Falvey (55).

Footnote 75:

David Borofski (49). _Also_
Lester Crane (20).

Footnote 76:

Achilles Akropovlos (50).

Footnote 77:

Daniel Wheelwright (51).

Footnote 78:

Bessie Vogel (52). _Also_
Lyman Agnew (10),
Juliette Lachine (11),
Ethel Hunter (47).

Footnote 79:

Carrie Pearson (53).

Footnote 80:

Julius Kantor (54). _Cf._
James Burns (56).
Henri Lepère (105).
Frederick Stone (106).

Footnote 81:

Daniel Falvey (55). _Cf._
Francis Murphy (60).

Footnote 82:

James Burns (56). _Also_
Frederick Wescott (18),
Martha Bartlett (21),
Victor Friedburg (108).

Footnote 83:

John Summers (57).

Footnote 84:

Peter Burkhardt (58).

Footnote 85:

Bridget Curley (59).

Footnote 86:

Francis Murphy (60).

Footnote 87:

David Collins (61).

Footnote 88:

Joseph Buck (62).

Footnote 89:

Albert Fielding (63).

Footnote 90:

Calvin Hall (64).

Footnote 91:

Donald Barrie (65).

Footnote 92:

Lawrence Washington (66).

Footnote 93:

Joseph Temple (67).

Footnote 94:

Margaret O’Brien (68). _Also_
Henry Phillips (12).
Bridget Curley (59).
Annie Martin (117).

Footnote 95:

Frank Mason (69).

Footnote 96:

Annie Kelly (70).
James Lauder (71).

Footnote 97:

James Lauder (71).

Footnote 98:

Margaret Green (72).

Footnote 99:

Marcus Chatterton (73).

Footnote 100:

Abel Bachmann (74).

Footnote 101:

Mrs. Brown (75).

Footnote 102:

James Seabrook (76).

Footnote 103:

John Friedreich (77). _Cf._
Isaac Goldstein (37).

Footnote 104:

Gridley Ringer (78).

Footnote 105:

John Doran (79).

Footnote 106:

James Arnold (80).

Footnote 107:

Florence Fitzgerald (81). _Also_
John Bennett (34),
Alice Caperson (46),
Vivian Walker (87),
Arthur Bright (121).

Footnote 108:

Frederick Estabrook (82).

Footnote 109:

Maj. Isaac Thompson, M.D. (83).

Footnote 110:

Lester Smith (84).

Footnote 111:

Annie Marks (85).

Footnote 112:

Frank Johnson (86).

Footnote 113:

Vivian Walker (87).

Footnote 114:

—— —— (88). _Cf._
Richard Lawlor (25).
Bessie Vogel (52).

Footnote 115:

Margaret Tennyson (89).
John Lawrence (5).
Mary Coughlin (35).
Theresa Mullen (36).
John Friedreich (77).
Gridley Ringer (78).
James Arnold (80).

Footnote 116:

Joseph O’Hearn (90).

Footnote 117:

Levi Sussman (91).

Footnote 118:

Joseph Larkin (92).

Footnote 119:

Richard Marshall (93).

Footnote 120:

David Fitzpatrick (94).

Footnote 121:

Joseph Wilson (95).

Footnote 122:

Becky Bornstein (96).
Walter Heinmas (97).
Mr. Jacobs (98).

Footnote 123:

Walter Heinmas (97).

Footnote 124:

Mr. Jacobs (98).

Footnote 125:

James McDevitt (99).

Footnote 126:

Jacob Methuen (100).

Footnote 127:

John Baxter (101).

Footnote 128:

Theodosia Jewett (102).

Footnote 129:

A. W. (103).

Footnote 130:

John Edwards (104). _Cf._
Henri Lepère (105),
Frederick Stone (106),
Arthur Bright (121),
Agnes O’Neil (19),
Paolo Marini (28).

Footnote 131:

Henri Lepère (105). _Cf._
Julius Kantor (54).

Footnote 132:

Frederick Stone (106).

Footnote 133:

Greta Meyer (107). _Cf._
John Jackson (14).

Footnote 134:

Victor Friedburg (108).

Footnote 135:

Annie Rivers (109).

Footnote 136:

Mr. McKenzie (110). _Cf._
Ivan Rokicki (111).

Footnote 137:

Ivan Rokicki (111).

Footnote 138:

Albert Forest (112). _Cf._
Gussie Silverman (113),
Walter Henry (114),
William Rosetti (116),
Annie Martin (117),
Levi Morovitz (122),
Peter Burkhardt (58).

Footnote 139:

Gussie Silverman (113).

Footnote 140:

Walter Henry (114).

Footnote 141:

Henry Ryan (115).

Footnote 142:

William Rosetti (116).

Footnote 143:

Annie Martin (117). _Cf._
William Roberts (118).

Footnote 144:

William Roberts (118).
John Silver (119).

Footnote 145:

John Silver (119).

Footnote 146:

James McGinnis (120).

Footnote 147:

Arthur Bright (121). _Cf._
Levi Morovitz (122),
John Bennett (34).

Footnote 148:

Levi Morovitz (122).

Footnote 149:

Robert Matthews (23). _Cf._
Isaac Goldstein (37).

Footnote 150:

For cases in which, without autopsy we have risked the diagnosis
neurosyphilis _in the absence of W. R. in serum or fluid_, see William
Twist (13), Frederick Wescott (18), Martha Bartlett (21), Thomas
Donovan (23), Paolo Marini (28), Margaret Neal (32), Bridget Curley
(59), Victor Friedburg (108), Ivan Rokicki (111).

Footnote 151:

From Mallory and Wright: Manual of Laboratory Technique.

Footnote 152:

Bruck. Münch. med. Wochen. Jan. 22, 1917.

Footnote 153:

Smith and Solomon. Boston Medical and Surgical Jour.

Footnote 154:

Bruck: Journal of American Medical Association, Vol. lviii, No. 12,
March 24, 1917, p. 944.

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TRANSCRIBER’S NOTES

1. Pg. 456, added footnote anchor for footnote A. 2. Silently corrected typographical errors and variations in spelling. 3. Archaic, non-standard, and uncertain spellings retained as printed. 4. Footnotes were re-indexed using numbers and collected together at the end of the last chapter. 5. Enclosed italics font in _underscores_. 6. Enclosed bold font in =equals=. 7. Subscripts are denoted by an underscore before a series of subscripted characters enclosed in curly braces, e.g. H_{2}O.