Academic journal article Indian Journal of Psychiatry

Syphilis and Psychiatry at the Mysore Government Mental Hospital (NIMHANS) in the Early 20th Century

Academic journal article Indian Journal of Psychiatry

Syphilis and Psychiatry at the Mysore Government Mental Hospital (NIMHANS) in the Early 20th Century

Article excerpt

Byline: Sarah. Ghani, Pratima. Murthy, Sanjeev. Jain, Alok. Sarin

Prior to the advent of the Wasserman Test as a diagnostic tool for Syphilis, the identification rate for Syphilis at the Mysore Government Mental Hospital in Southern India was 1%. With the introduction of the test, there was a dramatic increase in the diagnosis of Syphilis, with 17% of the patients testing positive. This paper throws light on the early notions of Syphilis and GPI, societal responses to the disease, early misdiagnosis, the advent of the Wasserman test and treatment management as reflected in the records of the early 20th century at the Mysore Government Mental Hospital (currently known as NIMHANS).

'If I were asked which is the most destructive of all diseases I should unhesitatingly reply, it is that which for some years has been raging with impunity. What contagion does thus invade the whole body, so much resist medical art, becomes inoculated so readily, and so cruelly tortures the patient?' Desiderius Erasmus, 1520.

Introduction

Syphilis was said to be endemic both in Bangalore and in the Mysore Kingdom by the mid-19th century, according to B. L. Rice, the historian, archaeologist, and educationist who compiled the first volume of the Mysore Gazetteer. Rice further observed that syphilis not only had a high prevalence, but also when neglected, as it often was, it assumed a very virulent form.[1] Somasundaram, reviewing the history of syphilis more than a century later, emphasized that syphilis in general and neurosyphilis, in particular, are 'the integral parts of the history of psychiatry'.[2] Syphilis in many ways encapsulated the entire range of psychiatric practice, from the range of definitions of its various stages and syndromes, the discovery of its biological causes, and the social response of stigma and exclusion. Its history has been extensively reviewed in the European context. In the 19th century, psychiatrists such as Griesinger and Kraepelin found that almost one-third of the psychiatric patients had various manifestation of neurosyphilis. This report explores the presentation and management of syphilis at the Mysore Government Mental Hospital (MGMH) at the turn of the twentieth century.

Syphilis and General Paralysis of the Insane

General paralysis of the insane (GPI), which is a late manifestation of syphilis, emerged as a new syndrome of insanity during the early nineteenth century. The specific etiology of GPI had been suggested as early as in 1857, but it continued to be thought of as multicausal. The course of GPI was one of steady, progressive mental and physical deterioration, ending in death. The disease resulted in muscular incoordination and paralysis along with the development of degenerative dementia; hence, the disease's pseudonym 'dementia paralytica.'[3] It was only in the early twentieth century that the 'syphilitic hypothesis' began to achieve widespread acceptance, when, in 1913, Hideyo Noguchi demonstrated the presence of the organism, then called Spirochaete pallida , in the brain of a patient who had died of GPI.[4]

The identification of Treponema pallidum, a spirochaete bacterium with subspecies that cause treponemal diseases such as syphilis,[5] by Fritz Schaudinn and Erich Hoffmann in 1905 was followed by the development of a serologic test. A specific reaction to detect antibodies, apparently indicative of infection with syphilis, by August von Wassermann, Neisser, and Bruck was developed in 1906. This was, however, discovered to be fallible later, as the assay required neither specific antibodies nor a specific antigen to yield a positive result. Fleck commented, saying that it was 'possible to obtain a positive Wassermann reaction from a normal blood sample and a negative one from a syphilitic sample without any major technical errors.'[6] Nonetheless, the Wassermann test proved to be a very popular diagnostic test for syphilis in the early years, with immense practical value in medicine. …

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