Objective
The purpose of this historical master thesis is to rediscover the medical semiology of the neurosyphilis during the XIXth and XXth centuries and to see its evolution up to the present day. This work also approaches the great scientific breakthroughs, particularly in neurosciences, made during those two centuries. We can see those advances through the evolution of the scientific theories concerning neurosyphilis. Arthur Van Gehuchten (1861-1914), a Belgian neurologist and a Professor of neurology at the Université Catholique de Louvain (UCL), is an emblematic figure of the Neurology during the XIXth century. He left many documents and illustrations concerning neurological diseases which are the basis of our analysis. His work about the neurosyphilis is rich in useful lessons, still relevant for the present caregivers.
Context
The syphilis was a widespread venereal disease during the XIXth century. There was no efficient cure and the syphilis often evolved until the neurological stage of the disease. In 1905, Schaudinn and Hoffman identified the causal organism of syphilis : Treponema Pallidum Pallidum. One year later, August Wassermann, Albert Neisser and Carl Bruck developed a diagnostic test : the Wassermann reaction. Despite those major steps, no treatment was yet developed and the neurosyphilis was still a significant problem for the neurologists at the beginning of the XXth century. The clinical presentations were impressive and the descriptions of the symptoms were detailed and comprehensive at that time. Nowadays, despite the introduction of the penicillin treatment, new cases of neurosyphilis are still diagnosed. This disease and its clinical presentation were well known during the XIXth century but they seem to have been forgotten nowadays. The right diagnosis could thus be missed! Remembering the clinical signs of the neurosyphilis as well as its differential diagnosis is still useful for the clinician.
Method
The main source of this master thesis is the work of Arthur Van Gehuchten. Their analysis offers a precise idea of the knowledge of the time concerning the neurosyphilis. His two masterpieces ‘L’anatomie du système nerveux de l’homme’ and ‘Les Maladies Nerveuses’ as well as his five scientific articles concerning neurosyphilitic patients represent the basis of our work. These documents were found in the archives and then deeply analyzed. Moreover, one of the riches of Arthur Van Gehuchten’s work resides in its illustration. Arthur Van Gehuchten drew diagrams and took photographs of his patients, his dissections and his animal experimentation. He wanted to facilitate the understanding of his work. In order to be more didactic, he filmed his patients to show the clinical examination to his students. Among those films, 548 cinematographic sequences and more than 630 photographs were found without any related medical file. They have been gathered at the UCL. This collection is an inestimable historical heritage. Thanks to the clinical descriptions of Arthur Van Gehuchten, we have found 41 photographs and 43 cinematographic sequences of patients with symptoms corresponding to those of the neurosyphilis among those iconographic documents. In this master thesis, we have analyzed and compared the semiotic descriptions and the illustrations of Arthur Van Gehuchten with neurosyphilitic presentations met in the current scientific literature. So we can see how far Arthur Van Gehuchten’s work remains valid till today.
Conclusion
Arthur Van Gehuchten was a world-famous scientist. His work is a proof of his pioneer’s spirit. He offers us a precise and brilliant base of work to analyze the neurosyphilis and its expression at that time. Even if we have to be critical about the diagnostic criteria from this period and to keep in mind the differential diagnosis, Arthur Van Gehuchten’s work offers us a semiotic description of ‘typical’ neurosyphilis (and mostly tabes) that should be known by every clinician.