Some Aspects of Lues in its Relation to the Psychoses

and Psycho Neuroses.

FRANK H. BARNES, M.D., Stamford.

Continuous observation of various patients for a period of several years has only added in my experience to the suggestion of noted neuro psychiatrists that lues in itself is an entity and must be treated as such. Whether syphilis is associated with a disease either functional or organic, it should not escape the physician's notice. It must be treated as syphilis regardless of complications or added syndrome. No matter whether associated with symptoms of a psycho neurosis or those of a psychosis it must be attacked by vigorous anti-syphilitic treatment. Many cases of lues have been recognized only too late for curative treatment. Patients suffering from syphilis where the initial symptom has been none too manifest, and having no secondary symptoms, have rested in fancied security with the idea that theirs was a very mild type of the disease and that their apparent good health would see them through. Many such individuals have married and had progeny, all apparently healthy and strong. They have lived for years with the idea that their cure was absolute. Suddenly in the cloak of a psychosis or psycho neurosis the lues acquired many years ago again manifests itself and they are again subjects for active treatment. If neglected, this condition will land them in some neurological clinic or institution for the insane without hope of future cure or very little chance for successful treatment.

In citing a few cases that have come under my observation it is not my purpose to relate all the neurological findings in each individual nor to give all the seriological or chemical data. Am relating some of the most marked symptoms present in each case. My point is to emphasize the necessity of early discovery of lues, especially in those cases whose symptoms so many times are those of a neurasthenia or one of the psycho neuroses as well as mildly depressed types of mental disease.

The case of a lawyer, Mr. G, age forty-five, prominent member of the bar in a large southern city, illustrates the fact that syphilis is many times latent in the individual and not recognized until beyond the reach of our latest methods of intensive treatment. He came to me for treatment during November 1919. For several months had shown marked neurasthenic symptoms; was easily tired on slight exertion, complained of vague pains in the head, suffered from loss of ambition and was very irritable. His memory was not up to its former standard. He became forgetful, irritable and easily angered. Finally during the winter of 1918-19 he went to his old home for a few weeks rest but felt no better. Was then sent to Florida to get the benefit of a warmer climate, but he still had all his vague symptoms. During his stay in Florida he had dizzy spells, as he termed them, and could not keep his balance, had a tendency toward falling. During April 1919 he had a cerebral hemorrhage with subsequent left hemiplegia. Later, during November he came to me for treatment and shortly after my first examination a Wassermann blood test was made which showed a four plus positive reaction. Spinal puncture was done and showed a positive Wassermann reaction of spinal fluid. For over a year he had suffered from neurasthenic symptoms but his syphilis was not discovered until he had the cerebral hemorrhage above related.

Another case comes to mind of a Mr. N., whom I first saw April 28th, 1919. He was forty-four years of age, a farmer by occupation. Family history negative. The man had been a tireless worker and had for years worked beyond his strength. He was very ambitious and had built up a large dairy business. For nearly a year had been very nervous and upset. His work seemed to tell on him and he began to lose physically. He became irritable, lost his temper easily and at times had severe headaches. During March 1919 he suddenly noticed a peculiar change in his gait and loss of power in left hand. After a few days he felt better and was able to do some work. He gradually developed a marked spacticity in his left leg, however, and had jerky incoördinated movements of the extremities. A little later he showed marked contracture of the left hand, also tendency to claw hand.

After careful examination a Wassermann test was made and showed a four plus finding. Spinal puncture showed a positive Wassermann reaction of spinal fluid. After intensive specific treatment for a period of three months the patient was able to walk around much better, showed little spacticity of the leg and was able to use his left hand quite well. When questioned as to specific history denied an initial lesion or any knowledge that he had ever acquired lues.

Another case, Mr. M., came to me for treatment during 1919. He was suffering from the depressed form of a manic depressive psychosis. The condition had developed after weeks of neurotic symptoms followed by a long period of irritability, during which time he left his wife after frequent quarrels. On admission he was typically depressed and showed marked delusions, somatic in character, also those of a religious nature. Said that he was very unworthy and unfit to live; also that he had seen and talked with the Deity on various occasions. Later said that he had a dread disease and he knew he had acquired it as a young man when out sporting and that he was rotten through and through. Had it not been for the fact that he had an eruption eczematous in character all over his scalp, am afraid we would have made no seriological tests. A Wassermann was made and it showed four plus positive. After a period of intensive anti-syphilitic treatment his eczema cleared up, his mental status brightened and he was taken home by his family, who thought him entirely cured.

Mrs. L. W., brought to me by her husband, Dr. W., for examination and treatment January 1919. For several months she had shown periods of great irritability, was morose and discontented. At times had fits of violent anger and was very abusive. She became so upset mentally that she interfered with her husband's practice and caused him much trouble. At last he found it absolutely necessary to remove her to some institution. During examination and while the doctor was relating the above facts in her presence, it was noticable that the patient was very nervous and excited. She showed marked tremor .of the facial muscles and those about her mouth. When interrogated spoke in short jerky phrases. On further examination she showed a marked

romberg, loss of light reaction in both pupils as well as irregularity of pupils. Knee jerks were absent and she was markedly incoördinated. Found that neither Wassermann blood test nor spinal puncture had been made. Suggested such procedure and found blood Wassermann four plus positive, also positive spinal fluid Wassermann. Her husband could not believe it possible when I gave him the seriological findings. Had to tell him his wife was a case of general paralysis of the insane. He was broken-hearted over the matter and shortly afterward committed suicide. During my talk with Dr. W. he admitted that his wife had not been the same for the past five years. Previous to that time she was most dignified in her demeanor, lovable, quiet and always friendly with his patients and their relatives, in fact, a woman beloved in her community. That she should suddenly change in her disposition and become the opposite did not rouse his slightest suspicion. Had she been the victim of drink or drugs it would quite naturally follow that she would become irritable, coarse and entirely different in her attitude toward those about her.

A recent case sent me from a local hospital proved to be very interesting and is an example of the necessity of making proper seriological tests in all of our suspicious cases. Mr. K., aged thirty-seven years, associated with a large business organization, suddenly during January last became very nervous and upset. He laid his trouble to the hard work and strain he had undergone during the recent war. During his stay at the hospital he had been very noisy and upset at night, causing much confusion among the other patients and nurses. On examination he presented a wild, frightened appearance and showed a marked fear state. Later became greatly confused and was unable to answer questions about his condition. The following day he was very haughty and aggressive in his manner. Said that he was entirely rational and needed no treatment. His neurological examination showed patellar reflexes much increased, marked swaying in romberg position, tremor of extended tongue and facial muscles, marked tremor of extended hands and pupils reacted sluggishly to light and accommodation. His general appearance, the history of mental upset at the hospital and the marked fear state he had

shown, also exaggerated ego in his conversation, led me to have seriological tests made. The findings were a four plus blood Wassermann, a three plus spinal fluid Wassermann, a plus globulin increase and a cell count of 52. Patient was put in bed, given absolute rest and sedative treatment. He is rapidly getting into normal condition and his physician has recommended his return home. He must have intensive anti-syphilitic treatment at once as undoubtedly he has an active neuro-syphilis.

Mrs. D. came under treatment during July 1919. She related that at the age of twenty-four she had developed an infection of her tongue, the result of the prick of a pin. After an illness of three weeks she was apparently all right. Was very well after that until she reached the age of thirty-nine, fifteen years later. At that time she suffered from severe pains in her limbs. Her physician became suspicious and had a Wassermann blood test made with a slightly positive finding. Intensive mercurial treatment was administered and the pains disappeared. Patient remained quite well after that until two years ago during March 1919, when she became much upset but was kept at home under treatment. On admission she was easily tired and greatly worried. Had lightning pains in her extremities and was very weak physically. Was very hysterical and cried a good deal. Wassermann test was made and showed a four plus positive finding. She was given modified rest treatment, also intensive mercurial treatment. After a few weeks brightened up materially and was taken home very much improved. Recently met the lady and she reported that she had felt quite herself for some months. Later we found that she suffered from a neurasthenic attack of some months duration at the age of thirty. Had intensive antisyphilitic treatment been carried on at that time she might have been saved months of suffering. This case only emphasizes the necessity of Wassermann tests over a long period even though we believe the case cured.

Mr. F., another interesting case, came to me for treatment during June 1920. He had suffered for years from mild manic depressive attack of the depressed form. These attacks were followed by periods of extreme dissipation. During such periods