The Board of Pension Commissioners ruled that the condition had been aggravated by service. (See Case E, “aggravated on service.”)
1. In view of the fact that the majority of the cases here abstracted happen to be in common soldiers, is there any evidence bearing on relative incidence in officers and men? Quoting R. L. Richards:
“The percentage of paresis cases among officers alone is variously estimated from 50 per cent in the German army (Stier) to 58.9 per cent in the Austrian army (Drastich). Since paresis is a disease of more advanced life, it is but natural that the percentage of paresis among officers, non-commissioned officers, and older soldiers should be higher than among the whole military body, where the average age is, as we have seen, well below thirty years. Hence the above figures do not mean a greater prevalence of syphilis among those classes, but that we have no means of knowing how many of the others develop paresis. If anything it shows that these ‘soldiers by calling,’ have a more stable mental make-up, since they succumb chiefly to an exogenous toxin.”
Rayneau at the 19th Congress of French Alienists and Neurologists at Nantes in 1909, discussing the insane of the army from a medicolegal point of view, states that the most frequent mental disease amongst officers and soldiers is general paresis. At least, this disease is the most frequent basis of invaliding, retirement, or placing in the inactive list. He states that French and foreign statistics are at one upon this matter, quoting Christian as finding 32% among the soldiers interned at Charenton; Gamier at Dijon, 59%; Meilhon at Quimper, 42% and Talon at Marseilles, 33.8%. Grilli found 31 of 40 officers interned in Florence, Sienna and Milan victims of general paresis. Stier’s German statistics indicate about 50%. Rayneau himself found 16 of 20 officers paretic and 17 out of 27 subalterns and gendarmes.
The Neurological Society of Paris held a conference December 15, 1916, with the chiefs of the neurological and psychiatric military centres of France, and discussed a variety of questions concerning invaliding, incapacity, and compensation in neuroses and psychoses of war. Dupré dealt especially with the psychoses of war as caused by trauma, strain, infection, and intoxication. General paresis is regarded by Dupré as the most important of the dementias found in the army. The medicolegal point of view is, of course, that general paresis is necessarily related to an old syphilis, but its late development leads to misinterpretations as to its probable cause, both by the family and friends and even by magistrates. The war acts in the French nomenclature as an agent revélateur or as an agent accélérateur. Although its cause is prior and exterior to the war, general paresis in a majority of cases is brought out (revélé) by the lack of adaptability of the general paretic to the novelty and difficulties of his surroundings and duties in war. Trauma, strain, and alcohol in a certain number of cases accelerate the progress of a general paresis. The aggravation of paresis is produced by these same factors, but especially by violent cerebral trauma. According to Dupré, the Val-de-Grace statistics show that the number of paretics has not been increased by the war. Medicolegally, the victim of general paresis, like the victim of traumatic or infectious chronic mental disorder, may be assigned an incapacity of from 50 to 100%, and these patients are invalided under Réforme No. 1,—a permanent invaliding.
Lépine of Lyons also discusses the compensation question in general paresis. Lépine thinks that, although syphilis is indispensable in paresis, yet the truth is that syphilis plus something else unknown to us is responsible for general paresis. This something else is neither a special kind of virus nor is it a particular kind of prepared soil alone. Trauma, physical, intellectual, and moral strain, and insomnia are the factors to which he calls special attention as adjuncts in the production of general paresis. As to the responsibility of the State for the production of general paresis, according to Lépine, the maximal responsibility should be 40% on account of the very considerable predisposition to paresis created by pre-existent syphilis.
Marie remarked that, although there had been thousands of head cases at the Salpétrière, there had not been a single case of general paresis. Dupré agreed with Marie that trauma was not a frequent etiological factor; strain and alcohol were more important. The Society agreed that in exceptional cases, where an encephalic trauma could be regarded as accelerating or aggravating the disease, the degree of incapacity might be set at from 10 to 30 per cent.
Syphilis contracted before enlistment, “AGGRAVATED ON SERVICE.” Canadian case, courtesy of Dr. J. L. Todd, Canadian Board of Pension Commissioners.
Case E. A laboring man, 44, acquired syphilis at a time unknown. Ten months after enlistment this man developed symptoms on the firing line. He was inattentive, irrational, incoherent. The diagnosis was then “mania.”
There were, however, scars at angle of mouth and on lower lip. Occipital glands were palpable, fine tremor of hands. The W. R. was +++.