It was eight months after the explosion when O’Hearn, at the age of 36, was admitted to the hospital with general mental impairment. O’Hearn was confused and disoriented for time and place, although he seemed to understand that he was in a hospital. He was given to foolish laughter and a silly manner. There was considerable emotional disorder; judgment was clearly impaired, and memory was poor.
Physically, there was little to be found except upon neurological examination. The right knee-jerk was greater than the left; the tongue and fingers showed marked tremor, there was a speech defect and writing disorder.
On the whole, it seemed impossible not to make the diagnosis General Paresis, especially in view of the laboratory tests, with positive W. R. in both serum and fluid, a “paretic” type of gold reaction, 59 cells per cmm., excess albumin, and a large amount of globulin.
1. What is the relation of the trauma to the paresis? Trauma is regarded as a precipitating cause, and Industrial Accident Commissions have been known to allow damages in such cases. Mott believes that the symptoms of a post-traumatic paresis must not develop until after a week’s interval of freedom from symptoms, since he believes that time is required to destroy or irritate the brain to the point of producing the paretic picture. Our data are in agreement with those of Mott. Mott also points out that gumma sometimes occurs at the site of the trauma.
False claim for compensation in neurosyphilis.
Case 91. The facts in the case of Levi Sussman can be brought out by the following extracts from a report to the Industrial Board: A claim was made to the Board that the symptoms had developed after a fall from a building, some nine months before hospital observation. No connection could be found between this accident and the Paretic Neurosyphilis found. We introduce the case to emphasize the possibility that irrelevant accidents may be regarded by ignorant or unscrupulous persons as setting up a mental disorder for which damages are claimed. If symptoms are already in existence before the accident and are not especially increased thereafter, naturally no damages should be recovered. Unscrupulous persons may falsify about the pre-traumatic history and claim the development of symptoms immediately after the accident. Such claims are beyond question to be viewed with the greatest suspicion. Some days or weeks should elapse before definite symptoms in post-traumatic paresis appear. Just how long an interval may elapse between trauma and paretic symptoms and shall entitle the case to be regarded as one of traumatic paresis, is perhaps a matter of doubt. It would seem, however, on general grounds that three months is the longest period in which the post-traumatic effects are likely to be delayed.
The question of traumatic paresis is of great interest on account of the war. The great strain under which the men at the front live and the physical injury due to being “buried” is probably responsible for an increasing number of cases of neurosyphilis. Such at least is the impression of Canadian medical officers with whom we have spoken. See Section VI, Neurosyphilis and the War.
Traumatic exacerbation(?) in PARETIC NEUROSYPHILIS (“general paresis”).
Case 92. The case of Joseph Larkin was of note from the point of view of the Industrial Accident Board. This Irish teamster was said to have been injured in his head two or three months before coming up for examination at the age of 45. For a week Larkin had had frontal headaches, had been sleeping poorly, and had been somewhat worried. In fact, he had stopped work. The W. R. of the serum was positive and a diagnosis of Paresis could be made. The case did not come up for consideration by the Industrial Board until two years after his initial appearance.
The physical examination showed irregular pupils, sluggish pupillary reactions, Achilles absent, swaying in the Romberg position, enlargement of the heart to the left, positive W. R. of the blood and of the spinal fluid.