An apparently competent German professor in an intermediate school, a lieutenant of infantry reserves, 33 years old, on the 17th August, 1914, was stunned for a while by the shock of a cannon-firing 25 feet away. Urination became difficult. Headaches and limb pains ensued, with paralysis of fingers, gastric troubles, forgetfulness, especially for names, insomnia, and general scattering of mental faculties.
Neurologically, the pupils were irregular, left larger than right; Argyll-Robertson reaction. Right knee-jerk livelier than left. Achilles reactions absent. Slow and dissociated pain reactions in feet, lower thighs and lower quarter of upper thighs, with hypalgesia or analgesia. Station good; gait steady. Mentally depressed, slow of thought. Speech poor and of indistinct construction (mild dementia). Calculation ability poor. No pleasure in work.
Wassermann reaction of serum weakly positive.
It seems that for a year the patient had been subject to spells of anger. He was irritated by his wife who had been nervous since an earthquake.
On the occasion of the earthquake, 1911, the patient himself had had a spell of difficulty with urination. The spell had lasted two or three months. The patient had had a chancre in 1902, “cured” in four or five weeks with xeroform. In 1908, when about to marry, he had had six mercurial inunctions.
Re tabes, Lépine shows that tabetics are numerous. They are numerous among officers and also in the auxiliary service, in which latter tabetics are maintained on desk duty. Perhaps they had been admitted to such work as unable to march or fight, on the basis of having had so-called “rheumatism.”
Shell-explosion may precipitate neurosyphilis in the form of tabes dorsalis.
Case 21. (Logre, March, 1917.)
An artilleryman, 38, had a large calibre shell explode very near him and afterward could not hear the whistle of a shell without falling down in a generalized tremor, sweating profusely, urinating involuntarily, in a mental state approaching stupidity. Here was a case that might be regarded as one of morbid cowardice in a psychopath, following violent emotion.
The artilleryman proved to be a victim of tabes and of general paresis. The incontinence of urine under the influence of emotion was nothing but an effect of tabetic sphincter disorder. The crisis of cowardice proved nothing but an initial symptom of general paresis.