A case illustrating the successful treatment of parasyphilis / by Tom A. Williams.

  • Williams, Tom A. (Tom Alfred), 1870-
Date:
1909
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Licence: In copyright

Credit: A case illustrating the successful treatment of parasyphilis / by Tom A. Williams. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    1909.] 373 THE VIRGINIA MEDICAL SEMI-MONTHLY. A CASE ILLUSTRATING THE SUCCESSFUL TREATMENT OF PARASYPHILIS* By TOM A. WILLIAMS, M. B., C. M. (Edin.), Wash- ington, D. C. One of the strongest evidences against the syphilitic nature of locomotor ataxia and ^ paresis has been the apparent failure of anti- specific treatment to benefit them. The fol- lowing case is cited in order to show that this attitude is not justifiable. It will appear from it that sufficiently early diagnosis is an im- portant factor in the successful treatment, and that the method of administration of the remedy plays a large part in its success. Moreover, iodides are relatively inefficient as compared with mercury; for each, when given by the mouth, disorders assimilation, and the latter may be given endermically or by injec- tion with even greater systemic effect than by the mouth. The mere giving of a drug, however, is not all the treatment; for the diet must be most carefully controlled in order to avoid the in- dicative processes which so retard assimila- tion; and nutrition must be stimulated by adequate exercise, which will secure periodic flushing of the tissues with highly oxygenated blood. The case was seen with Dr. Main, of Wash- ington, at the suggestion of Dr. Prentiss, of that city, October 30, 1908. He was a man of 54, a farmer, who had been in a “neuras- thenic state” since the spring, for which rest, change, and a sea voyage had been prescribed without more than temporary benefit. He com- plained of insomnia, general nervousness and a state of suffering, incapacity and irritability. The family history was negative. Previous History. His wife is living and healthy. There were no children or miscar- riages. He denies syphilis, but some years ago had typhoid fever, during which he lost his hair, which has now grown. When closely questioned he recollects having been subject to spells of depression every few years, and also to periods of activity and energy, which he strikingly describes as “wanting to get at seeFthf>d *^lr, c,onceriVq? the diagnosis of such cases DiajrnotiJ l £k contributions, entitled The EarL Jufy ?90qvfT>S?»fS D°rsa.lis (Arch- of Diagnosis, N. Y. miordex*he Diagnosis of Cerebra genesis see Pn*h Zt‘ mC^mcsA do)- Concerning- Patho- 1908 Aue- /fnH %nT<lTure% D°rsa.hs Jour. Med. Sci. treatment hi * »\ M.ed. Semi-Mo., do). Concerning Med.™our Oct 9 Tool T M<£‘ Record’ A$?n> and Brit 1909. ’ 1909, also Trans, of Tri-^ate Med.Asnn it.” He had noticed no change in his speech. Present State. When seen by me, he ap- peared neither depressed, shaky, nor appre- hensive, though the previous day he had felt perturbed* and despaired of recovery. His chief trouble was insomnia. Physical Examination. In spite of the cold of the room, the window having been widely open, when he was stripped'for examination, perspiration appeared in both axillae and down the internal border of the left arm; later some drops appeared on the left leg. This want of correspondence of the sudorific function with the stimulus of heat, and the local, if not seg- mental, distribution of the anomaly indicated a serious perturbation of the autonomic nervous system. The localization of the disturbance moreover, signified organic involvement rather than general toxemia. Facial, tongue, and ocular movements were steady. Motility. The muscular power was strong, but the movements were slightly incoordinate, especially in the right hand; and when the arms were extended there was a rhythmical tremor which became irregular during the maintenance of the attitude. The diadokoki- nesis was hardly impaired. The platysma trembled when the mouth was pulled to the right. Sensibility was intact except that in the left lower extremity L. V. and S 1 were in- sensitive to the diapason. A similar anesthesia existed over the distribution of the posterior primary divisions over the sacrum. This shaded off above as far as the second lumbar spine, where the vibrations were normally per- ceived. e Reflexes. The pupils contracted, both to light and accommodation, but in each case tended to re-dilate while still stimulated. The left pupil was slightly irregular. On the right side, the radial reflex was active and that of the triceps was feeble. On the left side, the radial reflex was feeble and that of the triceps was active. The Achilles jerks were equal. The left knee-jerk was exaggerated; the right was diminished. Both abdominal reflexes were diminished, especially the left, which was almost absent. The cremaster reflexes were very faint and sometimes crossed. On strok- ing the sole of the left foot, the toes flex and the tensor fasciae femoris contracted; the right foot dorsi flexed and flexion