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Shell shock (functional) phenomena in a syphilitic.

Case 30. (Babonneix and David, June, 1917.)

A marine, 26, on land service March, 1916, was buried by the explosion of a large calibre shell which killed most of his comrades. He remained for a time in a sort of lethargy. Coming to, he found himself victim of a right hemiplegia and deafmutism, which phenomena vanished under electricity.

In July, however, he had to be sent to a hospital on account of his sufferings, which received the diagnoses commotio cerebri, disorder of consciousness, disorientation, delirium, amnesia, over-emotionality. He was sent back to the front in December, 1916, but promptly reported sick, with headaches and insomnia.

Examination showed nonorganic nervous disorders, consisting in a variable and patchy anesthesia of the legs, anesthesia of the conjunctiva and pharynx, and over-reaction, with sighing, during the course of the examination. The organic signs were: exaggeration of tendon reflexes, equilibration disorder, and incapacity to stand on one foot or execute a half turn or to stand still with eyes closed, and disorder of position sense. The lumbar puncture showed no cells, a slight globulin reaction, and an albumin titer within the normal. There was a leucoplakia and a positive W. R. The man was emaciated, febrile, and showed signs, with the X-ray, of bronchial lymph node disease. According to Babonneix and David, the normality of the fluid indicates that the phenomena here were Shell-shock phenomena, despite the indisputable syphilis of the blood serum.

Re occurrence of functional phenomena in syphilitics, Freud’s remark may be recalled to the effect that a large proportion of his hysterics and other psychoneurotics are the offspring of syphilitics.

Consider in this connection also Case 28: an old syphilitic hemiplegia was followed by a probably psychogenic or hysterical hemiplegia on the same side.