1. This thesis consists of the systematic clinical
analysis of twenty-six personally observed cases of cerebral
syphilis in seven of which the diagnosis was confirmed by
2. Cerebral syphilis plays an important part in
the production of mental disease, and should occupy a. more
prominent place among the organic psychoses than it heretofore has done.
3. The spirochaeta pallida has for long been surmised to be the causal organism, but it was not until 1910
that Strasmann first demonstrated its presence in the central
nervous system of an adult with acquired syphilis; the second
case is reported in this thesis.
Trauma, alcoholism, and physical and mental strain
are important contributory factors.
Reinfection with syphilis is quite possible provided
the initial infection has been thoroughly cured.
4. Anatomically three main types of cerebral
syphilis are differentiated, viz: meningitis, endarteritis,
and gumma; clinically this differentiation is seldom possible,
and is without practical value as the treatment is the same
in all irrespective of the type.
5. The majority of cases of cerebral syphilis
develop within the first three years after primary infection,
and rarely more than ten years after infection; this is in
striking contrast to cases of general paralysis and locomotor
ataxia which almost invariably develop at a period more than
ten years after infection.
6. In regard to the physical signs the Argyll
Robertson phenomenon is the one on which most weight should
be laid in differential diagnosis as it is rarely present in
cases of cerebral syphilis. Other.important features are
(a) an acute onset with headache, dizziness, and vomiting
(b) cranial nerve palsies (c) convulsions without loss of
consciousness but usually followed by permanent focal symp¬
toms (d) intactness of speech and writing (e) absence of
7. The mental symptoms of cerebral syphilis are
of the nature of those seen in acute organic reactions and
consist of confusion, delirium, amnesia, hallucinations, retention defect, and a poor memory for recent events; in addition
there is relatively little disintegration of the personality.
8. The Wasserraann reaction must be considered in
relation with the clinical picture in each individual case;
when the Wassermann reaction with the cerebro-spinal fluid
is negative the diagnosis of cerebral syphilis is indicated.
9. It is frankly admitted that there is no pathognomonic sign for cerebral syphilis, but if the nature and
character of the onset, and the above mentioned physical and
mental symptoms and signs are correlated, a disease entity
is formed which has every right to be considered characteristic
10. Cerebral syphilis not infrequently causes pseudo-bulbar paralysis, and six cases of this affection
have been here reported.
11. Anomalous features, among which may be mentioned euphoria and grandiose ideas, and confabulatory states,
are more common in cerebral syphilis than in generally recognised; special attention must be paid to the setting in
which these features occur because when occurring in a setting of confusion they mean practically nothing.
12. Recent statistics confirm one in the opinion
that the prognosis of cerebral syphilis as compared with other
organic affections of the nervous system is relatively good; the most favorable eases are those which develop soon after
the primary infection, and those of a meningitic or gummatous
13. Mercury, no matter in what form administered,
is an exceedingly valuable drug in the treatment of syphilis
provided that it is given in a systematic way, The best results are, however, probably obtained by combining mercurial
and salvursan treatment. Potassium iodide acts simply as an
eliminative agent and has no specific action on the spirochaeta
The only safe treatment is prophylaxis.