After leaving the Navy, he had worked in a fire-brigade and as dock laborer. He had been very alcoholic when funds permitted, although never “primed.” His first convulsive seizures came at 40, while working at the docks, following a night on which he had drunk a bottle of whiskey. He thought he had been about half an hour in the fit.
He joined the A. S. C., January, 1915; served in France; later at Salonica. He had eight convulsive seizures, some in France, and others at Salonica, always after much rum.
The man was tall, powerfully built, without visceral disease, speech defect, or other symptoms except that both pupils showed the typical Argyll-Robertson phenomenon. The deep reflexes of arms and lower legs were increased. The superficial reflexes were diminished, and the Wassermann reaction strongly positive. A seizure was observed by Hewat and the diagnosis of major epilepsy was revised. The diagnosis of cerebrospinal syphilis, non-paretic, was preferred to that of paresis on account of the absence of all the ordinary symptoms of paresis and of tremor. It might be asked whether these fits were chiefly alcoholic in origin. However, the patient had two or three fits while in hospital during a period of eight teetotal weeks. Hewat remarks that the case suggests that the serum of any patient developing epileptiform seizures for the first time say between 35 and 50 years of age, should be given the Wassermann test.
Syphilis may bring out epilepsy in a subject having taint.
Case 54. (Bonhoeffer, July, 1915.)
A man of 35 in the Landwehr acquired syphilis some time in the summer of 1914. He was a good soldier, passed through several clashes, and was promoted to Unteroffizier.
To understand what followed it must be stated that he had been a bed-wetter to 11, had been practically a teetotaler (Bonhoeffer’s point is perhaps that otherwise epilepsy might have developed sooner?), and, when he did drink, vomited almost at once, and had amnesia for the period of drunkenness. His father drank. His sister had fits as a child.
February, 1915, the Unteroffizier lost appetite, got headaches, and went to hospital for a time. Upon getting better, he was sent on service to Berlin. In a Berlin hotel he had his first convulsions and unconsciousness, biting his tongue. He was confused for several days, and, when he had become clear, had a pronounced retrograde amnesia together with a tendency to fabricate a filling of events for the lost period.
This retrograde amnesia is uncommon in epilepsy and suggests organic disease. No sign of such was found, or signs of the epileptic make-up. The serum W. R. was negative. On the whole, Bonhoeffer regards the epilepsy as “reactive” to the syphilis, as a syphilogenic epilepsy.