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Simple treatment seemed to help him from tune to time 728 POPE: SYPHILIS. [New York Medical Journa but he could now see that he really never was well. He became gradually more nervous. He was usually, as 1 have remarked, a quiet man, rather reserved, though pleas- ant and mobile gambling free money no deposit communicative with friends on occasion. He had an unusually retentive memory which he had used freely all his life, and was able to concentrate and "get rid" of work in a quick and satisfactory manner. About a year ago his disposition began to change. He became nervous and restless, did not know what he wanted to do, fre- quently went out to the club and theatre because 'he could not stay at home." His employees found it harder to get along with him and the online gambling sites legal us family noticed that "father was a changed man, so nervous, irritable, and peevish, nothing seemed to please, even what he ordered you to do." He became quarrelsome and abusive at times; would suddenly repent and try to overcompensate by the reverse treat- ment. He was now a marked insomniac, was very de- pressed, irritable, incapable of work consecutively, and greatly troubled with his stomach. With the diagnosis of neurasthenia (that garbage can) he was sent away with a companion for a month's stay in Florida, where he fished and rested. While there he seemed better, but in ten days after his return home he was worse than ever. It was at this stage of the disease that I saw him in con- sultation. During the recital of this tale I noticed occasional ' blur- ring" of words, a lack of clear enunciation as compared with other words of similar pronunciation. These changes were most noticeable when he attempted to speak rapidly. His family had not noticed any mental confusion; he seemed to be on the contrary too active mentally. He was, as the account will show, of apparently good intelli- gence, was normally oriented and his ideation seemed top online gambling sites usa un- impaired. His memory was excellent for former events, that is, prior to six months of the time 1 saw him, but very erratic as to recent events, even of such a nature as should have made a sufficient impression upon him to remember. This was commented on by his family and seerned to irri- tate him a great deal. He himself realized that it was with difficulty that he concentrated his mental faculties upon any subject matter; that it was hard for him to learn any- thing new, and that the trouble he had in acquiring was a source of an.xiety. Upon close questioning as to why he could not sleep jt developed that his head became "tired and is online gambling legal in california 2013 sore" and frequently ached so badly as to prevent sleep. It generally disappeared if he could sleep three or four hours, but during the day the dull, tired, sore feeling would free gambling money vegas prevail. At times it disappeared for a week or a day and returned when his "stomach was out of order." Asked as to vertigo, he stated that he had at tirnes a dizzi- ness or swimming of the head, usually at the times when his headache was worse or his stomach upset. He was emotional at times during the conversation. Pliysical examination was carefully made. He was well nourished, tanned from his recent trip. The heart was slightly enlarged, the second sound was accentuated and the blood pressure (Riva-Rocci-small cuff) was sys- tolic i8o m.m. (at that time I did not use large cuff). The pulse was 84, full, strong, regular. Lungs normal, respi- ration 19. sitting ; 22 standing : expansion good. Tem- perature, 100° F. The sternum was tender to percussion. The examination of the abdomen was negative ; the stom- ach line when will online gambling be legal in the united states a little low. There were no glands enlarged, no scars, no exostoses. The tongue was tremulous, indented, and heavily coated, and upon the right side was a small scar. The motor activity as far as grip and is online gambling legal in nj use of the arms was good : he complained of nervous weakness ; there was online gambling sites distinct weakness and just a suggestion of ataxia when walking slowly. Sensation was normal. The sexual pow- er was weakened ; the urinary viscus normal, but its sphinc- ter weak at limes. Romberg's symptom was slight. The eyelids presented no unusual appearance gambling in texas slot machines when open ; when asked to online gambling sites legal close and open same, there was a distinct ptosis, more marked in the left. The pupils were sluggish, the right larger than the left. There was a slight weakness of the left external rectus and p tremor of the facial mus- cles on opening the mouth wide. Enunciation was fair although it was evident he was making an effort. The handwriting was legible .nnd without tremor. The when will online gambling be legal in the us re- flexes .showed the right knee jerk excessive over the left, both .Achilles reflexes were exaggerated ; Babinski and Gordon's signs negative. The opinion was expressed to the family physician that we had here to deal with a syphilis of the nervous sys- tem with a possible texas online gambling laws final outcome of paresis. Impossible' He was absolutely satisfied that the gentleman not_ only dia not, but could not have syphilis. Alas! my confidence in humanity was not of the type that would believe any man or woman was proof against the spirochjeta. Not even the tabulation of the symptoms, somatic, objective would influence his decision. To my mind the following facts were sufficient when taken as a whole: i. Mental symptoms referable to several catagories, neurasthenic in type, es- pecially his changed disposition. 2, Ptosis (.mild) with difference in degree in eyelids. 3, Pupillary changes (sluggish, irregular; weakness, external rectus). 4. Tre- mor (of tongue and facial muscles). 5, Reflexes (differ- ence and e.xaggeration). 6, Motor weakness in lower limbs. 7, Loss of sexual power and weakness in vesical sphincter. 8, Heart (high blood pressure and accentua- tion of second sound). Being unable to agree, I suggested that a third man be called in to act as arbiter of our differences. As this was declined there was nothing to do but retire with his and my fate in the hands of the family physician. And here is where I received the full force of my diagnosis. When the family heard of my diagnosis they proceeded to pick my bones and bleach them. The treatment they had re- ceived was outrageous and the diagnosis an insult. About six weeks later he began to make steady gains and at the end of four months was again at work. Two or three years later he again broke down in a similar manner, but returned in a short time to work. Six or seven years ago he began to have fainting attacks (apoplectiform?) with an increase of the mental symptoms. After one of his severest attacks he was taken by the wife and son to a well known neurologist in the East, who promptly diag- nosticated a past syphilis of free online gambling games win real money the nervous system, and a present paresis. Every energy was bent to eradicate, but alas ! the time had passed and he finally closed the pages of his eventual history in a private sanatorium, a paretic, an apoplectiform attack kindly terminating his existence. In the passage of time, things have come to light. His physician fearing I might be right gave him small doses of mercury under which he improved. As soon as he was able to resume work, all treatment was stopped and thus it went gambling slot machines for sale in uk until the glorious opportunity was lost. Remember this was in the pre-Wassermann days. Let us consider syphilis of the nervous system for a few tninutes. Syphilis in this domain of the human economy is so reg^tilarly irregular, that ir- refularity of symptoms, the absence of system, con- stitutes a valuable diagnostic point. When we run across a strange mixture of psychic and somatic online gambling legal in nj syinptoms, a melange gambling sites free money no deposit of no type, bizarre, unsys- tematized, transient, appearing, disappearing, re- curring, seemingly sudden changes, better now, worse again, this should lead the diagnostician to an inquiry and investigation, including a serodiag- nosis. Remember that nervous syphilis follows no law, no rule, that it is as inconsistent and fickle as femininity itself. Especially does free online gambling texas hold em this apply to the mental symptoms, which are in these cases to online gambling sites for ipad be interpreted by the somatic state. A group of men- tal symptoms, in conjunction with well marked physical ones, reads differently than when they stand online gambling texas legal alone.

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