antigens) is used entirely for diagnostic purposes and any specimen
showing the slightest degree of inhibition with this antigen and
stronger degrees of inhibition with the other antigens is reported as
positive. The specimens which are strongly or moderately positive with
antigens A and B and negative with antigen C are reported as doubtful.
In testing spinal fluids by the titration method, antigen C is used and
the readings are based upon the degree of inhibition of hemolysis noted.
The intensity of this inhibition is indicated by Arabic numerals: “5”
indicates complete inhibition, while “1” means a faint cloudiness, hence
a weak reaction. Intermediate numbers show relative intensity varying
between complete inhibition “5” (strong positive) and slight inhibition
“1” (weak positive); “—” equals no inhibition (negative).
Although it is commonly believed that the recent administration of
antisyphilitic treatment will affect the reaction by making it negative,
this is not our experience, and it is, therefore, not necessary that
treatment be withdrawn for a short period before the specimen is
submitted for examination.
The reaction as carried out in this laboratory has the following
diagnostic significance: =Positive indicates syphilis=, except very
rarely in acute febrile conditions such as malaria and pneumonia.
=Negative does not exclude syphilis.= In obscure conditions a series of
less than three negatives has little diagnostic significance. =Doubtful
suggests syphilis.= It is therefore advisable to submit three or more
specimens in such a case, and interpret a persistently or
predominatingly doubtful reaction as indicative of syphilitic infection.
=Bruck Test.= A new serum test for syphilis has recently been described
by C. Bruck.[152] Following are recent results in our laboratory with
this test.[153]
This new test for the diagnosis of syphilis by C. Bruck has aroused much
interest. The scientific standing of Bruck and the simplicity of the
technique led us to overcome our prejudice, that has been the offspring
of the numerous tests that have been offered of late. Bruck states that
since the discovery of the complement fixation test for syphilis by
Wassermann, Neisser and himself in 1906, he has been trying to find a
simple chemical reaction that would take the place of the complicated
technique of the Wassermann reaction. This method, as he has published
it, was worked out and is being used at the front, in the present war,
where complete laboratory equipment is not available.
Commencing our experiments with a great deal of scepticism, we were much
surprised at the results obtained, which are given below. Whatever may
be the final status of the test in the determination of syphilis, we
feel that there is a great deal of interest in the fact that this simple
chemical reaction does pick out certain differences in the composition
of blood sera and that apparently a large number of syphilitic sera
differ in their chemical composition percentage from the majority of
non-syphilitic sera.
The technique, while exceedingly simple, offers many chances for errors
and individual variations so that we have thought it well to give
directions and cautions at some length.
Bruck’s[154] technique is described as follows: “The test is made with
0.5 cc. clear serum in a test tube, to which is added 2 cc. of distilled
water, and the whole shaken. Then, with a precision pipette, 0.3 cc. of
the ac. nitr. purum of the German pharmacopeia is added and the whole
thoroughly shaken and then set aside at room temperature for ten
minutes. Then 16 cc. of distilled water at room temperature is added,
and closing the tube with the finger, it is shaken up and down three
times carefully, not vigorously enough to make it foam. This is repeated
ten minutes later, and the tube is then set aside for half an hour. By
this time the precipitate is entirely dissolved in the tube with the
normal serum, while the syphilitic serum shows a distinct, flocculent
turbidity. In two or three hours, or better still, in twelve hours, the
gelatinous and characteristic precipitate is piled up on the floor of
the test tube.”
The acid is prepared by diluting the Acidum nitricum of the U. S. P.
(Sp. gr. 1.403) with distilled water until the hydrometer shows the
specific gravity 1.149, which corresponds to the nitric acid of the
German pharmacopeia, but since this requires a special hydrometer, a
simpler method is to make a 25 per cent solution of the Acidum nitricum,
which will give about the proper specific gravity.
The serum is obtained by allowing 10 cc. of blood to stand at room
temperature for an hour, and then centrifuging. Serum that has stood for
some time may be used as well as the fresh, and even bloody serum does
not seem to confuse the results to any great degree. The serum gives the
same results with or without inactivation. Post mortem blood gave
results as constant as that obtained during life, in the few cases that
we had in this series. But the reaction may be influenced markedly by
the size of the test tubes. We have found that the 13×1.9 cm. is the
most favorable size.
When one first thinks of this test it appears very simple and probably
somewhat crude as a chemical reaction, but there are certain precautions
that must be observed, and several hundred normal and syphilitic sera
should be tried before the investigator can feel that he has a refined
routine technique. There is the personal equation which must be watched,
for here is probably the greatest source of error, and readily explains
why two different persons get widely varying results with the same sera
if they have done only a few dozen tests. We must take it for granted
that the reaction is a quantitative one, where some positive reactions
may differ only slightly from the normal non-syphilitic, and,
furthermore, any normal serum may be made to give a positive reaction,
and almost any positive serum be made to give a negative by improper
manipulation at some point in the test. There are as many places for
error to creep in as there are steps in the process. Bruck has omitted
many details in his publication, which allow personal variations, and so
we have tried to develop a routine process that will eliminate as many
of these as possible.
We shall here attempt to explain the methods which we have found most
satisfactory and at the same time indicate the places where error is
likely to occur. The 0.5 cc. of serum is added to 2 cc. of distilled
water, and shaken thoroughly. Now add slowly exactly 0.3 cc. of acid
from a precision pipette, care being taken it does not flow down the
side of the tube. The tube should be shaken gently while the acid is
being added, for this prevents the formation of a flocculent precipitate
in normal serum which is difficult to dissolve later. After the acid is
added shake each tube gently to make sure that these flakes do not
persist. It is difficult to shake each tube in exactly the same manner,
as must be done if we expect uniform results.
The first 250 tests of this series were made by allowing the tubes to
stand for ten minutes as Bruck advocates. Then we found that practically
all sera gave a positive reaction if allowed to stand 15–20 minutes, and
so in the other tests of the series an attempt was made to make the
reaction more sensitive by allowing the tubes to stand only 6–7 minutes.
During this time the tubes should be shaken gently once or twice. The
manner in which the 16 cc. of water is added also influences the
reaction. If allowed to flow freely in upon the precipitate, the
positive may be forced into solution as well as the negative. Both
pipette and tube should be slanted and the water allowed to flow down
the side of the tube without disturbing the precipitate. If all has gone
well up to this point, we may see a marked difference between the normal
and syphilitic precipitates, in that the normal will begin to go into
solution at once, thus clouding the water, while a positive precipitate
will be composed of large flakes which show little or no tendency to go
into solution or cloud the water above. It must be remembered that the
most flocculent positive precipitate will go into solution if the fluid
is splashed or shaken too hard while the tube is being inverted. If any
doubt as to the character of the precipitate now exists, it may be
allowed to stand ten minutes longer, and again inverted as before, or
even repeated several times during the next hour or two. We see no
reason why the tubes should be left to stand over night, for during this
time a precipitate usually settles in the normal tubes. This, however,
differs from the syphilitic precipitate in that it is still finely
granular and goes back into solution readily when the tubes are
inverted.
In view of these possible grounds for error, it is only logical to run
controls of known positive and known negative sera along with each group
of unknown bloods, and even then certain tubes will seem doubtful, in
which event the test should be repeated with added precaution to see if
a definite positive or negative reaction may be obtained.
In the last tests of this series we seemed to aid the reaction by
rendering the serum-water solution alkaline by one or two drops of 10
per cent potassium hydroxide before the acid was added. The positive
sera have a larger precipitate, while the normal seem to dissolve more
readily.
TABLE I
Syphilis: nervous system involved.
General Paresis Wassermann and Bruck agree positively 47
Wassermann and Bruck agree negatively 7
Wassermann and Bruck at variance 10
Tabes Dorsalis Wassermann and Bruck agree positively 3
Cerebrospinal Wassermann and Bruck agree positively 8
Wassermann and Bruck agree negatively 3
Juvenile Paresis Wassermann and Bruck agree positively 1
Summary: Wassermann and Bruck agree positively 59
Wassermann and Bruck agree negatively 10
Wassermann and Bruck at variance 10
TABLE II
Syphilis: nervous system not involved.
Syphilis Wassermann and Bruck agree positively 12
Wassermann and Bruck at variance 5
Congenital Syph. Wassermann and Bruck agree positively 3
Wassermann and Bruck agree negatively 2
Summary: Wassermann and Bruck agree positively 15
Wassermann and Bruck agree negatively 2
Wassermann and Bruck at variance 5
TABLE III
Non-syphilitic: Wassermann reaction negative.
Doubtful or positive Bruck 86
Bruck test negative 216
Total for three groups:
Wassermann and Bruck agree positively 74
Wassermann and Bruck agree negatively 230
Wassermann and Bruck at variance 101
The tests here reported were made on blood sera obtained from patients
admitted to the Psychopathic Hospital and its Out-Patient Department. As
a routine Wassermann test is made on each patient who enters the
hospital, it was only necessary to take another tube of blood from each
patient, and check the results in each instance with the Wassermann
reaction. As it takes several days to get the report from the Wassermann
laboratory of the State Board of Health, there was no chance of being
prejudiced by a previous knowledge of the Wassermann reaction. The cases
for the most part were those of mental disease; the majority in good
general physical health.
A comparison of the total number with the Wassermann reaction shows that
there was a general agreement of 304 of the 405 cases tested, or a
percentage agreement of practically 75%. In considering the cases of
syphilis of the central nervous system in a group by themselves, we find
that the agreement is closer, since 69 of the 79 cases tested, or 87%
agreed without any question of doubt. It will be noted that in several
cases of general paresis, the Wassermann reaction, which was repeated at
intervals, was negative, and in most of these cases the Bruck test was
negative also. Our few cases of congenital and latent syphilis also
checked very closely with the Wassermann test. In the various groups of
mental cases in this series, no factor of interference was discovered.
It is also of interest that in the cases where the blood was obtained
post mortem, the Bruck test agreed with the Wassermann result obtained
on ante mortem blood serum. Further work on post mortem sera will be
reported. Some of the patients not included in the syphilitic groups
that have a negative Wassermann and no clinical signs of syphilis, give
a history of previous infection at some time, which might partly account
for the variations in the two tests.
CONCLUSIONS
1. We present results of the Bruck sero-chemical test in 405 cases.
In 101 of these cases there were definite clinical manifestations
of syphilis, in which the Wassermann and Bruck tests agreed
positively in 74 or 75%. The two tests agreed negatively in 12
instances, and were at variance in 15.
2. In the group which showed syphilis of the nervous system we had
64 cases of clinically certain general paresis, of which the
Wassermann and Bruck tests agreed in 54 instances, or practically
85%. In other forms of central nervous system involvement the
agreement was 100% in the 15 cases tested.
3. In the cases with no apparent involvement of the nervous system
the agreement was somewhat less, being 76%. This may be in keeping
with the fact that the Wassermann test was not so strongly
positive in these cases.
4. The advantages of the test are: (1) the short time required to do
the test; (2) the limited amount of apparatus necessary, and (3)
the simplicity of the technique.
5. The disadvantages of the test seem, for the most part, to be
bound up in the personal variations that are apt to occur.
6. We are here dealing, most probably, with a quantitative chemical
difference in the protein content of syphilitic and non-syphilitic
sera, the nature of which is not understood by us. It is our hope
that this may be brought to light in the near future in the field
of chemistry.
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.
------------------------------------------------------------------------
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.