Head trauma: Shell-shock effects, over in a few months. Manic-depressive (?) attack more than two years later. X-ray evidence suggesting brain lesion. Serum Wassermann reaction positive.
Case 16. (Babonneix and David, June, 1917.)
A bullet glancing from his gun barrel November 28, 1914, wounded a man in the head, whereupon he lost consciousness and was carried to a hospital and trephined. On coming to, he found that he could not hear and felt pains; but the latter disappeared in a few months. He was given sedentary employment and did his work properly until February, 1917, when he suddenly became sad, wept, slept poorly, stopped eating, had an absent air, and began to complain of his head. He passed whole days without moving, in a sort of stupor, which was then followed by a hypomaniacal agitation in which he walked furiously up and down in the room and threw objects about.
He was found subject to a generalized tremor and he was distinctly weaker on the right side. The tendon reflexes were excessive. The bony sensibility, as well as the pain and temperature sense, and the position and stereognostic senses were completely abolished on the right side. The scar lay on the left side. It was deep and very sensitive to pressure, so that if it was touched ever so slightly the patient began to weep. X-ray indicated loss of substance in the posterior part of the left parietal region. Remains of the projectile were found subcutaneously in the right supraorbital region. The W. R. of the serum was positive. There was no lymphocytosis in the spinal fluid.
Interpretation of this case is manifestly difficult. Four possibilities exist: Syphilis, manic depressive psychosis, traumatic brain disease, and functional shock effects. More than two years had passed between the trauma and the change of character.
Skull trauma in a syphilitic.
Case 17. (Babonneix and David, June, 1917.)
A soldier, 31, sustained fracture of the occiput from shell-burst, and thereafter showed confusion and total loss of memory. Operation November 11 withdrew bony fragments and clots, whereupon the man returned practically to normal. He developed, however, a few seizures, in which he struggled, fell, and lost consciousness, afterward suffering from headache. The tendon reflexes were increased. The occipital cicatrix was a little depressed and slightly painful on pressure.