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Diagnosis “epilepsy” revised to neurosyphilis.

Case 53. (Hewat, March, 1917.)

A Scotch soldier, in the Royal Navy, 43, was admitted to the Royal Victoria Hospital at Netley, as major epilepsy. He had been 12 years a stoker, and 16 years before admission had suffered from syphilis, a chancre locally treated with black wash, without secondary rash.

After leaving the Navy, he had worked in a fire-brigade and as dock laborer. He had been very alcoholic when funds permitted, although never “primed.” His first convulsive seizures came at 40, while working at the docks, following a night on which he had drunk a bottle of whiskey. He thought he had been about half an hour in the fit.

He joined the A. S. C., January, 1915; served in France; later at Salonica. He had eight convulsive seizures, some in France, and others at Salonica, always after much rum.

The man was tall, powerfully built, without visceral disease, speech defect, or other symptoms except that both pupils showed the typical Argyll-Robertson phenomenon. The deep reflexes of arms and lower legs were increased. The superficial reflexes were diminished, and the Wassermann reaction strongly positive. A seizure was observed by Hewat and the diagnosis of major epilepsy was revised. The diagnosis of cerebrospinal syphilis, non-paretic, was preferred to that of paresis on account of the absence of all the ordinary symptoms of paresis and of tremor. It might be asked whether these fits were chiefly alcoholic in origin. However, the patient had two or three fits while in hospital during a period of eight teetotal weeks. Hewat remarks that the case suggests that the serum of any patient developing epileptiform seizures for the first time say between 35 and 50 years of age, should be given the Wassermann test.