syphilitic hallucinosis

   The term syphilitic hallucinosis is used to denote a hallucinatory state attributable to syphilis. The medical Latin name syphilis comes from the Latin sus (swine), and the Greek philos (friend of). It was introduced in a medical didactic poem entitled Syphilis sive de morbo Gallico (i.e. Syphilis or on the French disease), published in 1530 by the Italian physician Girolamo Fracastoro (14781553). Syphilis is also known as lues, lues venerea, Cupid's disease, pox, great pox, the Grandgore, French disease, Frank disease, Italian disease, British disease, Spanish disease, and Polish disease. All these names are used to denote an infectious disease caused by the spirochete Treponema pallidum. Syphilis tends to be transmitted sexually, but it may also be transmitted via open wounds, or, in utero, from mother to unborn child. The disease process follows three developmental stages, known as primary, secondary, and tertiary syphilis. The relatively symptom-free episodes in between are known as latent syphilis. Primary syphilis tends to occur 10-90 days after the initial exposure. It is characterized by one or more local skin lesions, referred to as chancres. Secondary syphilis tends to follow 1-6 months after the initial exposure. It may present in the form of a rash on the palms of the hands and the soles ofthe feet, condylomata acuminate, general malaise, fever, weight loss, lymphadenopa-thy, etc. Tertiary syphilis may occur anywhere from 1 to 50 years after the initial exposure. This stage is characterized by the formation of gummata and granulomata. When these affect the CNS, they may cause neurological complications such as tabes dorsalis, Argyll Robertson pupil, and neurosyphilis. Neurosyphilis is also known as neurolues, dementia paralytica, paralytic dementia, paretic psychosis, blaesus, Bayle disease, general paresis, general paralysis, and general paralysis of the insane (GPI). It has been estimated that near the end of the 19th century some 15% of the inhabitants of Paris were infected with syphilis. Today it is a relatively rare condition. Syphilitic hallucinosis is even rarer, occurring in 10-20% of the cases of syphilis. Although reported mainly in conjunction with tertiary syphilis, it may occur during any stage of the disease. However, it has been suggested that hallucinations which occur during the primary and secondary stages of syphilis should probably be attributed to comorbid disorders such as alcoholism, substance abuse, or * schizophrenia. The pathophysiology of true syphilitic hallucinosis is as variable as that of * Aids. Due to the considerable variety of possible lesion sites, the ensuing hallucinations may also vary considerably. Nevertheless, * auditory hallucinations are considered the most prevalent type, followed by * visual hallucinations. In 1913 the German psychiatrist Felix Plaut (1877-1940) published a retrospective study of 713 cases of syphilis. Auditory hallucinations were the most common type in the study. These included many cases of * musical hallucinations, *tinnitus, and other *nonverbal auditory hallucinations. * Verbal auditory hallucinations and * hyperacusis were also reported, and, less frequently, visual hallucinations. Whenever present, visual hallucinations (as well as *olfactory and *bodily hallucinations) tended to combine with the auditory ones to form *compound hallucinations. As a nosological category, syphilitic hallucinosis is classified as a specific type of *hallucinosic syndrome.

   References

   Hayden, D. (2003). Pox. Genius, madness, and the mysteries ofsyphilis.NewYork,NY: Basic Books.

   Nonne, M. (1909). Syphilis und Nervensystem. Neunzehn Vorlesungen für praktische Aerzte, Neurologen und Syphilidologen. Zweite, vermehrte und erweiterte Auflage. Berlin: Verlag von S. Karger.

   Plaut, F. (1913). Über Halluzinosen der Syphilitiker. Berlin: Verlag von Julius Springer.

   Quétel, C. (1992). The history of syphilis.Translated by Braddock, J., Pike, B. Baltimore, MA: Johns Hopkins University Press.