Syphilis in a Jamaican psychiatric hospital. A review of 52 cases including 17 of neurosyphilis.

An early report of syphilis from the Caribbean area suggested the rarity of this disease as a cause of mental illness (Ireland, 1892). More recently a decreasing incidence of neurosyphilis was noted among racially similar persons in Uganda by Billington (1966), who attributed to penicillin the remarkable fall over the 20-year period reviewed. The low incidence in developed countries probably has a similar cause (Dewhurst, 1969; Dawson-Butterworth and Heathcote, 1970). That the diagnosis of neurosyphilis has become difficult was stressed by Heathfield (1968). Joffe, Black, and Floyd, (1968), in reviewing seven cases, pointed out that the modified picture noted might have been due to courses of penicillin given previously to all their patients for other reasons. Hume (1964) suggested that subcurative therapy masks syphilitic disease, but he believed this to be eventually helpful to the community. In Jamaica the predominantly Negro and rural population of almost two million has been exposed to two treponemal diseases. Thus, up to 1956, areas of high and low incidence of yaws were identified by Grant (1956), but by 1963 the yaws prevalence rate for the island was estimated to have been reduced to 16 per 10,000 population (Gentle, 1965) although certain rural areas still showed higher rates. A later study pointed out the difficulties presented to venereologists by the occurrence of the two diseases (Ashcroft, Miall, Standard, and Urquhart, 1967). In addition, the possibility of marked cross-immunity among the treponemal organisms was raised by Cannefax, Norins, and Gillespie (1967). With the widespread use of penicillin since its introduction in this area, it seems likely that modified neurological syndromes might be present. However, unusual pictures have been identified since the 19th century, as pointed out by Cruickshank (1956) and Montgomery, Cruickshank, Robertson, and McMenemey(1964). These workers described the features Received for publication January 19, 1972 Address for reprints: 12 Cambrian Road, Richmond, Surrey of two neuropathic syndromes of uncertain aetiology seen at the University Hospital in Jamaica. Montgomery (1960) suggested a treponemal variant as of probable aetiological importance and Rodgers (1965) gave good supporting evidence of a syphilitic aetiology. Syphilitic involvement in spinal arachnoiditis has also been reported in Jamaica (Rodgers and Cruickshank, 1962). From other parts of the West Indies there have been other reports of unusual neurological presentations of syphilis (Habib, 1962). Rodgers (1964) followed up her earlier studies, and having surveyed mental hospital patients, reported that 121 (15-6 per cent.) of 773 demented chronic long-stay patients had syphilis. However, of 71 undergoing lumbar puncture, only 41 had positive cerebrospinal fluid (CSF) findings. The present study was undertaken in an attempt to determine some of the features of syphilis in patients newly admitted to the psychiatric hospital.