21. We find a few instances in which neurosyphilis has played a part in the discipline of troops. According to one author (Thibierge, 1917), syphilis has become a genuine epidemic among French soldiers and mobilized munition workers. In Germany, also, it may be remembered that Hecht has claimed that no less than an equivalent of sixty army divisions has been temporarily withdrawn from fighting on the Teutonic side for venereal diseases. In this connection, Neisser had recommended the giving of salvarsan and mercury in the trenches. According to Hecht, the appearance of syphilis should be a signal for sending a man to the front. Hecht also made the somewhat bizarre suggestion that special companies of syphilitics should be formed, for convenience of treatment, on the firing line.
22. A more solid foundation is laid for the theory that general paresis may be evoked by trauma—a conclusion already fairly well established by civilian cases, notably those of industrial accident.
23. The question whether shell-shock (the physical event) can produce general paresis is probably to be settled in the affirmative, for it may always prove difficult to show that the physical shell-shock did not actually produce mechanical molar lesions of the brain, permitting the rapid advance of spirochetes. It is perhaps easier to prove that shell explosion may precipitate neurosyphilis in the form of tabes dorsalis (take, for example, Cases [21] and [22]). The cases of most importance in the question of traumatic neurosyphilis and traumatic paresis are cases [20], [21], [22], [24] and [25].
24. The picking out of preëxistent weak spots by Shell-shock is given clear illustration, as in the case of Shell-shock recurrence of an old syphilitic hemiplegia ([Case 28]). Only on such a basis could the syphilitic ocular palsy of [Case 19] be satisfactorily explained.
25. The coexistence of functional phenomena with organic syphilitic phenomena is demonstrated by Cases [29] and [30]; perhaps also in [Case 16].
26. It must be said that presumably there will be, unless our authorities are more successful than in the past, a considerable increase in venereal disease as the result of army life in wartime. There will be a certain number of cases of neurosyphilis a number of years after discharge from the army caused by infection acquired during service. (Germany is said to have got its crop of neurosyphilis after the War of 1870, in the early eighties of the last century.) The names of all soldiers acquiring syphilis and not considered cured at the time of discharge should, under ideal conditions, be given to health organizations in their home states so that they may be accorded proper care and treatment.
27. Shell-shock and epilepsy. The authorities have been somewhat surprised by the number of epileptics that have gotten by the draft boards. The statistics are not yet ripe, but certainly the enlistment of an epileptic is not a rarity. There are some singular instances in the war literature showing how hard it sometimes is to bring out epilepsy. There is the English case, for example, of a man, an epileptic’s son, who had himself been epileptic from 11-18, who entered the Expeditionary Force at the outbreak of hostilities, went through the retreat from Mons and through two years of active warfare without having a single epileptic convulsion. In fact, in September, 1916, he was put in charge of eight men on guard duty. Apparently the new responsibilities worried him, and two months later he had become epileptic to the extent of petit mal.
Another man who had never been epileptic (though his sisters had been) was wounded four times, was never worried by shell fire, got somewhat depressed after the death of his father and five brothers in the service, but did not become epileptic until finally he was blown up and buried three times in one day, and it was a whole month later when he became epileptic, although treatment by rest and bromides apparently resolved the affair.
Other cases seem to show that war experiences can bring out epilepsy, although in most instances it would appear that there was an epileptic or otherwise neuropathic heredity in these cases.