Incidences of Syphilis Amongst Jefferson’s Neurosurgery Patients

There are a handful of incidents of syphilis, more specifically neurosyphilis, amongst Geoffrey Jefferson’s neurosurgery patient files. Given the prevalence of syphilis during the first half of the 20^th century prior to the widespread introduction of penicillin in the 1940s this is hardly surprising. The onset of neurological symptoms can come at any point in the course of infection and can easily be mistaken for a number of other neurological manifestations, hence why these cases were referred to Jefferson. The diagnosis of syphilis was usually unknown when these patients were first sent to Jefferson, but knowing how common neurological symptoms as a result of syphilis were the majority of Jefferson’s patients were tested for the infection soon after their admission. Once it had been determined that they were not suffering from any form of brain tumour and so would not benefit from surgical treatment these patients would be transferred over to the medical wards where mercury was still employed as a treatment.

The detrimental effects of syphilis can be seen in many different types of medical archives, most notably 19^th/20^th century asylum records where patients were admitted suffering from ‘general paralysis’. Further reading of some of Jefferson’s cases can reveal the general symptoms associated with neurosyphilis, the very varied demographics of its sufferers, and in some cases the attitudes to such a diagnosis.

Case 1

Patient 1931/96 was an 11 year old boy admitted to the Manchester Royal Infirmary (MRI) on 24 August 1931 presenting with recurrent watering from his eyes, sudden development of almost complete blindness, discharge from the ears, and headaches over his eyes. Originally a cerebellar tumour was suspected but x-rays showed no evidence of this and the Wassermann reaction (a test for syphilis) came back strongly positive. Once it was established there was nothing that could be done for the boy surgically he was transferred over to the medical wards with a diagnosis of syphilis of the central nervous system.

Case 2

Patient 1932/2, a 25 year old salesman, was admitted to the MRI on 16 January 1932 with a suspected cerebral tumour presenting with headaches, signs of aphasia, vomiting, and weakness in the right leg. Following a positive Wassermann reaction and confirmation of syphilitic meningitis Jefferson comments in the patient’s notes:

“Father told diagnosis – grieved and puzzled. [Patient] says he had intercourse only with friends of the family and sisters of his friends – plenty of them apparently! Can’t think which one infected him. (That’s his story).”

The patient was then discharged and treated for his condition at home.

Case 3

Patient 1934/238, was a 45 year old female shopkeeper admitted to the MRI in 1934. She did not present with the same psychological or neurological symptoms as some of the other patients but rather had developed large abscesses of the head and shoulder. A diagnosis of chronic syphilitic osteomyelitis (bone infection) of the skull was arrived and with consultation from the orthopaedic surgeon Sir Harry Platt her abscesses were aspirated.

The Jefferson case files are a fantastic source not only for the study of the manifestation of disease and the development of different treatments but also the various attitudes expressed by both medical staff and patients surrounding such issues as sexually transmitted diseases, fear of hospital treatment, and attitudes to women.