Neurologically, the pupils were irregular, left larger than right; Argyll-Robertson reaction. Right knee-jerk livelier than left. Achilles reactions absent. Slow and dissociated pain reactions in feet, lower thighs and lower quarter of upper thighs, with hypalgesia or analgesia. Station good; gait steady. Mentally depressed, slow of thought. Speech poor and of indistinct construction (mild dementia). Calculation ability poor. No pleasure in work.

Wassermann reaction of serum weakly positive.

It seems that for a year the patient had been subject to spells of anger. He was irritated by his wife who had been nervous since an earthquake.

On the occasion of the earthquake, 1911, the patient himself had had a spell of difficulty with urination. The spell had lasted two or three months. The patient had had a chancre in 1902, “cured” in four or five weeks with xeroform. In 1908, when about to marry, he had had six mercurial inunctions.

1. Is this a case of traumatic paresis? From the somewhat meagre account it would appear that Donath’s lieutenant should rather be termed “shell-shock paresis,” in the sense of a paretic neurosyphilis liberated by shell-shock (using shell-shock in the sense of a shock without direct brain injury).

2. What compensation is due such a man as Donath’s lieutenant? The ordinary principles applicable to traumatic paresis are not here in point, since no symptoms pointing to trauma of brain ever supervened. See discussion under Case G.

3. How frequent is paresis in armies? R. L. Richards in White and Jelliffe’s Treatment of Nervous and Mental Diseases writes as follows (of course concerning peace times):

“The French estimate that paresis cases are 7 per cent of all their military cases. The German estimate is 6.6 per cent. In our own army at the Government Hospital for the Insane, of 490 cases of mental diseases among officers and enlisted men, 37, or 7 per cent, were paresis. During the Russo-Japanese War, in the Russian Psychiatric Hospital at Harbin, the percentage of paresis was 5.6 per cent among the cases developing at the front.”

A French soldier “shell-shocked” (also burial) into incipient tabes dorsalis? Case from Duco and Blum of Paris.

Case B.[[25]] A French soldier was buried by effects of shell explosion September 8th, 1914. He sustained no wound or fracture.