Examination showed nonorganic nervous disorders, consisting in a variable and patchy anesthesia of the legs, anesthesia of the conjunctiva and pharynx, and over-reaction, with sighing, during the course of the examination. The organic signs were: exaggeration of tendon reflexes, equilibration disorder, and incapacity to stand on one foot or execute a half turn or to stand still with eyes closed, and disorder of position sense. The lumbar puncture showed no cells, a slight globulin reaction, and an albumin titer within the normal. There was a leucoplakia and a positive W. R. The man was emaciated, febrile, and showed signs, with the X-ray, of bronchial lymph node disease. According to Babonneix and David, the normality of the fluid indicates that the phenomena here were Shell-shock phenomena, despite the indisputable syphilis of the blood serum.
Re occurrence of functional phenomena in syphilitics, Freud’s remark may be recalled to the effect that a large proportion of his hysterics and other psychoneurotics are the offspring of syphilitics.
Consider in this connection also [Case 28]: an old syphilitic hemiplegia was followed by a probably psychogenic or hysterical hemiplegia on the same side.
Vestibular symptoms in a neurosyphilitic.
Case 31. (Guillain and Barré, April, 1916.)
A soldier, Colonial, 29, was twice in the 6th Army neurological centre. The first time, February, 1916, he was under observation for astasia-abasia, having been invalided twice for this disease,—once in 1915. This man had had syphilis at 21, and was then taken care of at Saint-Louis Hospital and at Cochin. A volunteer for the duration of war, September, 1914, he had intermittent disorders of station and walking, which caused his invaliding January, 1915. As the trouble stopped, he asked to go back to the front in September, but the same difficulty reappeared with fatigue, and he was sent to the army neurological centre. When standing, there was a ceaseless trembling of the whole body but especially of the legs, with tendency to propulsion. In walking also, there was a trepidant abasia, sometimes dizziness, and even a sudden fall. Standing on one foot he trembled and fell.
Examined on his back, muscular strength was found intact in all limbs, and there was no trembling or incoördination or intention tremor in the performance of any movements, though there was a slight trembling of the raised fingers and hand. Reflexes were normal. The right pupil was dilated; the left pupil reacted sluggishly. There were lateral nystagmiform movements to the left. Caloric nystagmus appeared from the right ear in 15 seconds, from the left in 30. Rotatory nystagmus appeared in 35 seconds on both sides. Lumbar puncture yielded a fluid with a slight lymphocytosis; albumin, .3 grams; chloride, 7.30; sugar normal.
Rest in bed improved the astasia-abasia, and the man was sent back to his corps, February 20, 1916. He came back March 16, having had a dizzy spell, with suffocation feeling and a fall, whereupon the trepidant astasia-abasia had reappeared. There were none of the so-called defensive reflexes. The neuromuscular excitability of gastrocnemii was less on the right than on the left. A von Graefe sign was sometimes found; no diplopia save on looking far to right.