Some people are so healthily nervously constituted that no stress will send them off their mental balance. But we meet with others who seem to be too readily affected; just as there are persons who seem to take every contagious disease which is prevalent, so there are some who always react too readily through their nervous systems, or react readily through the higher nervous or mental systems.

In fact, there are such things as patients with exaggerated mental reflex. I have met with men who, having had syphilis, felt convinced that others knew of it. (In some cases this has only been a slight exaggeration.)

The man with the scar

A man who, in consequence of syphilis, lost his nasal bones and had a very marked scar. He recognized fully the cause of this himself, and when anyone looked towards him he felt sure that they were considering his past illness, and summing him up as an immoral vagabond.

As a result of this, he secluded himself, gave up his ordinary work, only went out after dark, and became irritable and depressed. He was so irritable that on more than one occasion he assaulted people, and he became so depressed that he attempted suicide, and had to be sent to an asylum.

The English army officer

I remember also an English officer who was harassed by the knowledge that he had had syphilis. This knowledge had a great influence upon his whole career; he retired from the army, gave up all idea of marrying, and became more solitary and more and more convinced that others knew of his past trouble, and shunned him in consequence.

This isolation and self-consciousness led him at last to believe that everybody must know of what had happened to him, and he began to fancy he heard whisperings about him, so that he would no longer go to his club or to places of amusement.

Just before I saw him, he was persuaded that he heard a crowd of London roughs coming to his chambers with the idea of lynching him, so he threw himself out of the window. He recovered from the injuries, but remained a permanently deluded patient.

Wassermann hypochondriasis

This dread of syphilis and the fear that other people know about it leads to true syphilophobia.

One gets, too, not only the physical but also the moral contagion, as it were, for some of the more innocent patients whom I have met, having once or twice had immoral intercourse, have persuaded themselves that they might have contracted syphilis.

And I have more recently come upon a variety of these cases, in which with the dread of syphilis there has been a kind of Wassermann hypochondriasis.

In one such  case a German, dreading syphilis, went over to have a blood test in Germany. No sooner did he get back to England, then he had it repeated; and when I saw him he was going once more to have another test made in Germany.

So you may get insanity as a result of syphilitic disease, or you may get it as a result of the fear of syphilitic disease. And in all these cases I would say the symptoms are very grave and very dangerous.

The son of a leading Englishman

I remember the son of a leading Englishman, who held a very important position in India. He contracted syphilis, but was thoroughly and completely cured, and was considered by the greatest London authority to be perfectly well and fit to marry. Nevertheless, when he was fulfilling his duties in India, leading a rather solitary life, he developed ideas that syphilis might recur. He got leave, came over to England, and was again assured that there was nothing wrong with him; but nothing would suit him but that he must go to Aix for a complete syphilis cure. I may say that I did not see any objection to that, only I gave instructions that he was never to be left, for a man with syphilophobia is about as suicidal a patient as you can meet. After a short residence in Aix, he managed to give his attendant the slip, and committed suicide.

Imagined impotence

Another complicating delusion I have met with is the idea of impotence, so that a man having had syphilis, is convinced that he is no longer potent, and has become very depressed and suicidal. It is an axiom of mine that no patients are more suicidal than those who believe themselves impotent or affected by a sexual disorder.