Shell-shock and other neuropsychiatric problems : $b Presented in five hundred and eighty-nine case histories from the war literature, 1914-1918Southard, Elmer Ernest
History
Shell-shock and other neuropsychiatric problems : $b Presented in five hundred and eighty-nine case histories from the war literature, 1914-1918
Southard, Elmer Ernest
War neuroses; World War, 1914-1918 -- Medical care; World War, 1914-1918 -- Psychological aspects
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.
Alcoholism caused amnesia in this man in the same way as the syphilitic
epilepsy now did.
Public-domain text, read in full here on John Shaqi.
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