The Neurosyphilitic Psychoses Today

Neurosyphilis, causing a psychotic illness of such severity as to necessitate admission to a mental hospital, though now rare, has not been completely eradicated. This study is based on 91 psychotic patients with neurosyphilis admitted to six mental hospitals between 1950 and 1965. Its main purpose is to ascertain the incidence, and to present the natural history of the neurosyphilitic psychoses during a period when antibiotics were available. It is likely that some patients in this series were given penicillin for an intercurrent infection in complete ignorance of the underlying syphilitic process. Indeed, Joffe, Black and Floyd (1968) and Heathfield (1968) have reported modifications in the clinical picture of neurosyphilis, tending to mask the diagnosis, caused by earlier administration of antibiotics for intercurrent infections. Thus the widespread use of antibiotics, though greatly reducing the incidence of neurosyphilitic psychosis, may well have increased the mutability of the disease as reflected in its changing prevalence, distribution and clinical characteristics.