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Shell-explosion: Syphilitic ocular palsy.

Case 19. (Schuster, November, 1915.)

Schuster notes briefly a curious result of the explosion of a shell, which caused the patient in question to lose consciousness. Shortly after the explosion, the patient came to his senses again, but a surprising paresis of the eye muscles had developed. This paresis looked precisely like a syphilitic paresis clinically.

Examination of the blood serum yielded a strongly positive Wassermann reaction.

According to Schuster, the explosion of the shell had brought about hemorrhage in vessels supplying the region of the eye muscle nerves or nuclei. The reason for the selection of these vessels for rupture due to shell explosion is, according to Schuster, that the vessels were probably already syphilitically diseased.

Re hemorrhages in the neighborhood of the oculomotor nuclei, the phenomena of polioencephalitis may be recalled. In that disease, the predisposition to hemorrhage is presumed to be alcoholic, as the cases of ophthalmoplegia of this group almost always appear in alcoholics. However, the first case of hemorrhagic superior polioencephalitis was a non-alcoholic one of Gayet (1875), in which the symptoms followed three days after a boiler explosion.