Clinico-pathological aspects of the neurosyphilitic psychoses.

(1) The immediate causes of death of eighteen patients with neurosyphilitic psychosis are analysed. There were five females and thirteen males. Their average age was 56 years, and the mean length of stay in a mental hospital was approximately 2½ years. (2) Of the original ninety-one patients, twenty-eight had malaria therapy. There was one death due to malaria therapy, giving a mortality rate of 3·6%. It is concluded that the risk associated with malaria is too great and fever induced by bacterial pyrogens is safer and just as effective. (3) The duration of mental symptoms before treatment was started is analysed. In one group there was a delay of between 1 and 4 years before treatment was given. In six patients the disease ran a rapidly fatal course in spite of adequate antibiotics. Combined treatment may be beneficial in such cases as fever facilitates the penetration of penicillin into the cerebrospinal fluid. (4) Of the four cases that came to necropsy, only one had a full pathological and histological examination of the brain and meninges. Although these four patients had profound dementia and considerable deterioration of the personality only minimal neuropathological and histological changes were found. It would seem that the widespread use of antibiotics has modified the pathological and histological picture in neurosyphilis, corresponding to alterations recently reported in the clinical features of the disease. (5) Such adverse presenting symptoms as epilepsy, and profound dementia associated with pupillary and reflex abnormalities, are discussed.