The serum and fluid W. R. were positive, albumin in fluid, 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.
1. 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.
2. What is the duty of the military authorities relative to so called traumatic paresis? Medicolegally speaking, Froissart, quoted by Rayneau, states that a victim of traumatic paresis may or may not have presented mental disorders before the accident, that is, that the paretic symptoms may develop out of a clear sky as a result of the accident. The accident itself must be of a serious nature. The accident must be followed by phenomena pointing to brain injury of traumatic nature. These phenomena need not be characteristic symptoms of general paresis at the outset. The period elapsing between the trauma and the supervening condition of paresis must be occupied without notable interruption, at first by phenomena of a purely traumatic nature, later by signs indicating the onset and evolution of general paresis.
The French invaliding process called Réforme No. 1 with pension is granted according to the governmental instructions only to officers, subalterns, and soldiers whose disease is due to trauma. In view of this governmental regulation, the military surgeon must write out certificates describing every cranial trauma, however slight, which might have a bearing on the development of paresis. However, he should not too readily admit trauma as a cause of paresis. If a long period of quietude, a period in which the trauma itself seems to have undergone a complete recovery, supervenes, then general paresis should not be reported by the surgeon.
Lépine has recently noted the following features as desirable in board reports concerning paretics: nature of trauma, length of service, fatigue endured, insomnia, date of infection, treatment, W. R.
Can “gassing” light up a paresis? Example from de Massary of Issy-les-Moulineaux.
Case H. A soldier, 35, was sent to the Centre Neurologique with a hospital ticket reading:
“Neurasthenia, general weakness following intoxication by gas.”