Neurosyphilis in the Netherlands: Then and now

In 1927 the Viennese psychiatrist Julius Wagner – Jauregg was awarded the Nobel Prize for Physiology or Medicine for his contribution to the development of malariafever therapy, specially for patients with General Paralysis of the Insane (GPI), a neuropsychiatric complication of syphilitic infection. Patients were injected with blood containing malaria parasites. The high fevers that resulted from the development of malaria were believed to help to cure these patients. In the first part of this thesis a group of 105 patients with GPI who died in a Dutch psychiatric hospital in the period 1924-1954 is described. Malariafevertherapy was administered to 43 of the GPI-patients and these patients had a longer survival time after admittance than those treated otherwise. Following the introduction of antibiotic therapy the incidence all manifestations of syphilitic disease decreased. However, in the epidemiological part of this study an increase in the incidence of syphilis the Netherlands in the first decade of this century was detected, in accordance with the worldwide increase in the incidence of syphilis. Moreover, every year 60 new patients, predominantly males, were diagnosed with neurosyphilis. A recent cohort of 34 neurosyphilis patients (1 woman and 33 men) are described, who displayed a striking wide array of signs and symptoms and a wide age range (31-84 years). As early diagnosis and treatment of neurosyphilis result in better treatment outcome, reintroduction of screening for syphilis in neurological, psychiatric and geriatric patients should be considered.

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