General paresis lighted up by the stress of military service without injury or disease?
Case 9. (Marie, Chatelin, Patrikios, January, 1917.)
In apparently good health a French soldier repaired to the colors, in August, 1914, being then 23 years old.
Two years later, August, 1916, symptoms appeared: speech disorder with stammering, change of character (had become easily excitable), stumbling gait. He became more and more preoccupied with his own affairs, grew worse, and was sent to hospital in October, 1916.
He was then foolish and overhappy, especially when interviewed. There was marked rapid tremor of face and tongue. Speech hesitant, monotonous, and stammering to the point of unintelligibility. His memory, at first preserved, became impaired so that half of a test phrase was forgotten. Simple addition was impossible and fantastic sums would be given instead of right answers. Handwriting tremulous, letters often missed, others irregular, unequal, and misshapen.
Excitable from onset, the patient now became at times suddenly violent, striking his wife without provocation. After visit at home, he would forget to return to hospital. Often he would leave hospital without permission (of course the more surprising in a disciplined soldier). No delusions.
Serum and fluid W. R. positive; albumin; lymphocytosis.
Neurological examination: Unequal pupils, slight right-side mydriasis, pupils stiff to light, weakly responsive in accommodation, reflexes lively, fingers tremulous on extension of arms.
The patient had, December 5, 1916, an epileptiform attack with head rotation, limb-contractions and clonic movements. Should this soldier recover for disability obtained in service? Marie was inclined to think military service in part responsible for the development of the paresis. Laignel-Lavastine thought so also, but that the amount assigned should be 5%-10% of the maximum assignable.