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Table of Contents

This book is written primarily for the general practitioner and secondarily for the syphilographer, the neurologist, and the psychiatrist. Our material is drawn chiefly from a psychopathic hospital, that modern type of institution in which the mental problems of general medical practice come to a diagnostic head weeks, months, or years before the asylum is thought of.

It is this peculiar nature of psychopathic hospital material—a concentrated essence of the most difficult daily problems of general practice—that brings together such an apparent mélange of cases as are here described, ranging from mild single-symptom diseases like extraocular palsy up to genuine magazines of symptoms as in general paresis; from feeblemindedness, apparently simple, up to apparently simple dotage, both feeblemindedness and dotage really syphilitic; from the mind-clear tabetic to the maniacal or deluded subject who looks physically perfectly fit; from the early secondaries to the late tertiaries or so-called quaternaries; from peracute to the most chronic of known conditions; from the most delicate character changes to the profoundest ruin of the psyche.

Although the bulk of our case-material is drawn from general practice through the thinnest of intermediary membranes, the psychopathic hospital, yet we have tried to depict the whole story by presenting enough autopsied cases from district state hospitals to show exactly what treatment has to face. Nor have we hesitated to insert cases in which treatment has failed.

In addition to (a) the Psychopathic Hospital, Boston, group of incipient, doubtful, obscure, or complicated cases (the early clinical group) and (b) the Danvers State Hospital, Hathorne, group of longer-standing, committed, fatal cases (the finished or autopsied group) we present (c) a miscellaneous group of cases, including many from private neurological or psychiatric practice. No doubt those familiar with Boston medicine will see traces of the teaching of our former chiefs, notably Professors James Jackson Putnam and Edward Wyllys Taylor. We are obliged to them for some well-observed cases.

We have dedicated our work to the Commonwealth, but perhaps we should more specifically ascribe to the Massachusetts Commission on Mental Diseases (formerly the State Board of Insanity) the spirit that permitted our special study of neurosyphilis treatment. To these authorities, who have countenanced and encouraged a somewhat costly piece of special work since 1914, we offer our thanks, hoping that other states will be one by one stimulated to the state-endowment of research. States doing full duty by research can be counted on one hand.

To our Psychopathic Hospital colleagues and the internes, and especially to Drs. Myrtelle M. Canavan and Douglas A. Thom of the Commission’s Pathological Service, we also offer our best thanks.

The Danvers traditions are tangible here: cases of Drs. A. M. Barrett, H. A. Cotton, H. W. Mitchell, H. M. Swift, and others are presented. We have been especially aided by the more recent work of Dr. Lawson G. Lowrey.

Nor should we have been able to present our samples of brain correlation without drawing on the collection arranged and analyzed by Dr. Annie E. Taft, Custodian, Harvard Department of Neuropathology. The photographs, part of a collection of brain photographs now numbering over 10,000 representing 700 brains of all sorts, were made by Mr. Herbert W. Taylor.

The Wassermann testing work has been done by Dr. W. A. Hinton of the State Board of Health. Dr. Hinton himself wrote out the text description of the Wassermann method. The method of his laboratory is held to the standards of control set by previous chiefs, viz. by Professor F. P. Gay, who brought immunological methods direct from the laboratory of Bordet (whose method the Wassermann method essentially is), Prof. W. P. Lucas, and the late Dr. Emma W. D. Mooers, who had assisted Plaut in his first work with the Wassermann method in Kraepelin’s Munich Clinic.

The material combed by us to secure this illustrative series amounts to over 2000 cases of syphilis of the nervous system, including over 100 autopsies in all types of case. We have presented these with very varying fulness, chiefly to illustrate the contentions at the heads of the case-descriptions.

In using the book, we suggest early reference to the Summary and Key, where for convenience are placed numerous cross-references permitting extended illustration of almost every proposition from several cases.

We have not made a large feature of the Medicolegal and Social section. This kind of thing well deserves a volume by itself, with all the legal and social-service implications drawn out in their amazing richness and detail. The social service slogan, “A paretic’s child is a syphilitic’s child” has already accomplished a great deal of good in our local world. Some day we may not be compelled to drive the paretic’s spouse and offspring to the Wassermann serum test! The general practitioner must help here.

A note on the Treatment section. This is manifestly not the last word or even, we hope, our own last word, since the systematic work of the Massachusetts Commission must be kept up for some years to get a reliable verdict. Some of the results give rise to greater optimism than has prevailed in asylum circles, especially re general paresis. We are confident that no one can now successfully make a differential diagnosis between the paretic and the diffuse non-paretic forms of neurosyphilis in many phases of either disease, even with all laboratory refinements. If this be so, it is improper not to give the full benefits of modern treatment to all cases in which the diagnosis remains doubtful between the paretic and the diffuse non-paretic forms of neurosyphilis. We ourselves advocate modern treatment, not only in the diffuse, but also in early paretic forms of neurosyphilis.

It would have been out of place in a book in this Case History Series to have dealt extensively with the history of our topic. We have compensated inadequately for this lack by a few remarks at the head of the Summary and Key. We are, like all others in the field, under the inevitable obligation to Nonne of Hamburg, whose great work has gone into three editions, the second of which has appeared in English translation (Nonne’s Syphilis of the Nervous System, C. R. Ball, translator). Mott’s work, embodied in a large volume of the Power-Murphy System of Syphilis, has also been attentively consulted, as well as the various systematic works on neurology and psychiatry. The topic of Neurosyphilis is getting wide and appropriate attention in this country through special journals, both those dealing with nervous and mental diseases, and those dealing with syphilis. Syphilis is in a sense the making of psychiatry and will go far to pushing psychiatry into general practice.

At the last moment we have been led to deviate from our plan of presenting only local cases familiar and accessible to us. In a section on Neurosyphilis and the War, we present excerpts and digests of English, French, and German cases of neurosyphilis that have appeared in association with the war. Our own country has not suffered greatly as yet either from the lighting up of neurosyphilis under martial stress or from the immediate or remote effects of syphilis obtained in the unholy congress of Mars and Venus. Space forbids a large collection of these martial cases, but, as will be seen, a fair sample of problems is presented.

Speaking for the moment as the senior author of this book, I wish to say that, were it not for the energy, industry, and ingenuity of the junior author, Dr. H. C. Solomon, the book would not have been written. Nor, in all probability, would the systematic work of the Commonwealth on neurosyphilis and its treatment ever have been begun. I can also accord the highest praise to Mrs. Maida Herman Solomon for her social-service work in this new field.

Perhaps, in closing, we owe an apology to John Milton for our borrowings from the two Paradises. Had he known much about syphilis, Milton might have written still stronger mottoes for us.

E. E. Southard

74 Fenwood Road

Boston, Massachusetts