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Shell-wound in battle: General paresis.

Case 18. (Boucherot, 1915.)

A soldier in the Territorial Infantry, 42, a gardener who went to taverns, as he said, “like everybody else,” a widower with two children, a good worker though irascible, had had syphilis as a youth. He was called to the colors at the outbreak of the war and got on well despite tremendous strain. March 9, 1915, he was in a bayonet charge with his regiment and was bowled over by a shell of which a fragment wounded him above the knee and several fragments in the thorax. All these fragments were extracted at a temporary hospital, March 11. The man now became strange, refused to obey orders and did a number of peculiar things so that he was sent to Orléans temporary hospital whence he was evacuated to Fleury Asylum, March 19. He refused to give up his things because he was the master. He did not want to go to bed and wanted to keep on walking constantly. He was without sense of shame, satisfied with himself, grandiose as to his millions in bank and the thirty-six decorations he believed had been awarded him. He mistook the identity of the landscape and of the people about him.

Tongue tremulous; pupils unequal; knee-jerks exaggerated; dysarthria; gaps in memory. In May occurred a number of violent reactions.

In June, however, there was a remission; the ideas of grandeur disappeared first, then the tremors and reflex disorder and finally the speech disorder. There was a slight seizure at this point and the man said he had had another such just before he came to the army. July 20 he was invalided out much improved.

In this case of general paresis there is, besides the syphilis, also alcoholism to consider, so that it is not entirely plain that the exertions of campaign liberated the paresis.

Re wounds and paresis, see also Case 5 (Beaton), in which neurosyphilis advanced rapidly from the time of a trivial injury.