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Shell-explosion: Neurosyphilis. Fit for light duty.

Case 25. (Hurst, April, 1917.)

A corporal, 26, blown up by a shell December 7, 1916, was admitted to the hospital on the 13th, dazed and with symptoms of a left-sided hemiplegia of organic origin. The right pupil was larger than the left. There was a bruise of the scalp in the right parietal region. The man had had syphilis at 16. The Wassermann reaction of the serum was strongly positive. Rest, salvarsan, mercury, and iodides were given, and the general symptoms and hemiplegia gradually disappeared, until on December 12 there was only a moderate weakness of the left side, with knee-jerks in excess, abdominal reflexes absent, and the Babinski reaction.

The Wassermann reaction was still strongly positive. Salvarsan, mercury, and iodide were continued. January 6, 1917, the plantar reflex had become flexor. The abdominal reflex returned. Babinski’s second sign (combined flexion of thigh and pelvis) was now the only evidence of organic disease. Further antisyphilitic treatment removed this sign also. February 28, the man was discharged fit for light duty, with unequal pupils and positive Wassermann reaction, and a complete amnesia for the four weeks following his blowing up in the trenches.

Re fitness for light duty, see remarks on Case 20 concerning desk duty for certain tabetics.

Re the premature or unexpectedly early appearance of neurosyphilis under war conditions, the early claims of some authors have not been maintained. In the above instance, the infection was at 16 and the shell explosion occurred at 26, namely, at about the right interval for the development of neurosyphilitic signs. Gerver states that military service brings out the lesions of paresis earlier than they would otherwise come. Bonhoeffer has been unable to show that cerebrospinal syphilis is favored in its development by the exhaustion factor.