The Cure of Early Paresis

Abstract

In a paper read before this society five years ago,1 I made a contention that it was possible to arrest, and probably to arrest permanently, certain cases of paresis when they were observed in the earliest stages and submitted to prompt and prolonged treatment. To the objection that the cases cited in illustration of my point, were not really cases of paresis, but of cerebral syphilis or "pseudoparesis," I could answer only by contending that there were no possible criteria by which we could distinguish "pseudoparesis" and certain forms of cerebral syphilis from paresis itself, except by saying that when the patients recovered, the cases were false, and when the patients died the cases were real. In the pseudoparetic cases as in true cases, we have headaches, convulsions, syncopal and aphasic attacks, disturbance of the pupillary reflexes, tremors, cranial nerve palsies, even attacks of hemiplegia, lymphocytosis of the cerebrospinal fluid, and positive reaction to Wassermann's test. In each kind of case also, we find changes in character, increased irritability, inability to conduct business affairs, defects of attention, somno¬ lence, confusion and quick exhaustibility of the mental processes on exertion. In cases in which paresis is firmly established, with grandiose delusions, real de¬ mentia, marked facial and tongue tremors, speech de¬ fects, involvement of the pyramidal tracts. I make no claim that the disease can receive, at the most, more than a remission.The clinical facts on which my contention is based, have been so abundant and positive since I first wrote on this subject that it seemed almost unnecessary to emphasize the point further. 1 am led to do so, how¬ ever,· because my view has been misunderstood by some who have jumped to the conclusion that I have asserted that paresis can be cured when fully developed; also, because my view as to the essential unity of nervous syphilis and parasyphilis has been so strongly confirmed by the discovery of the pale spirochete and the evidence of its activity by Wassermann and other tests in parasyphilitic conditions.The observations of Drs. Noguchi and Moore2 show that in general paresis and in cerebral and nervous syphilis, there is a positive reaction both to the butyric acid and the Wassermann test ; also that there is a prac¬ tically equal evidence of lymphocytosis in the cerebro-servations presented at the same time lead to the same conclusions. It is very well established, then, that so far as the blood and the cerebrospinal fluid tests go, there is no qualitative difference in the reactions be¬ tween paresis and so-called syphilis of the nervous sys¬ tem. There is indeed a rather stronger and more posi¬ tive reaction in paresis than in the ordinary syphilis of the nervous system.4The attempt to find a test which should distinguish between paresis and nervous syphilis or "syphilitic neur¬ asthenia," has been made by Nonne and some of his followers. The most recent observations regarding the utility of what is known as the Phase I Test of ISIonne failed t...