Incontinence of urine developed. Anesthesia of penis and scrotum. Reflexes absent; pupils sluggish. Wassermann reactions suspicious.
The diagnosis tabes dorsalis incipiens was made (hematomyelia of conus terminalis eliminated).
The patient was estimated to be “40% incapacitated,” according to the French “échelle de gravité” of conditions. A full pension would not be justified in the opinion of the French authors.
1. Is there evidence of an increase or exacerbation of tabes dorsalis in the war? Birnbaum,[[26]] reviewing German war neurology, quotes Weygandt as believing that the war has probably had to do with the production of both tabes and paresis in many instances. Other cases, however, have merely been made worse by the war stress. Thirdly, there are cases in which the war stress has done no harm whatever. Westphal has seen both tabes and paresis develop in men who had never before shown any mental or physical symptoms whatever, and accordingly, Westphal must be counted among those who regard war stress as a liberating factor for these diseases. Redlich and Donath are cited in the same connection. (The case of Donath is the case presented above as Case A.)
A very interesting claim was made by Cimbal to the effect that he found many examples of paresis developing in the early period of the war, particularly in November and December, 1914. Later, according to Cimbal, cerebrospinal syphilis and tabes became more prevalent.
Neurosyphilis in a German recruit, possibly AGGRAVATED ON military SERVICE. Pension not allowable. Case from Weygandt.
Case C.[[27]] A German, long alcoholic and thought to be weakminded, volunteered, but shortly had to be released from service. He began to be forgetful and obstinate, cried, and even appeared to be subject to hallucinations. The pupils were unequal and sluggish. The uvula hung to the right. The left knee-jerk was lively, right weak. Fine tremors of hands. Hypalgesia of backs of hands. Stumbling speech. Attention poor.
It appeared that he had been infected with syphilis in 1881 and in 1903 had had an ulcer of the left leg.
The military commission denied that his service had brought about the disease. In the phrase of the Canadian Pension Board the German commission would probably have rendered a report “aggravated on service,” not “by service.” (See Canadian cases D, E, and F.)
1. Has paresis increased in the war? Both French and German figures controvert the claim. Marie, for example, found not a single paretic amongst the skull injury cases at the Salpétrière. Most authors are found demonstrating cases which they clearly regard as in some way produced or unfavorably influenced by the war. There seems, therefore, to be a little inconsistency between the general statement that paresis has not increased in the war and the somewhat frequent cases described as occurring in and modified by the war. However, Bonhoeffer, on the basis of nine months’ war experience, also holds it to be probable that paresis is no more frequent in the field than in the home population.