and high mental tension." He concludes that "The theory of a psychic mechanism as the origin of these motor and sensory symptoms is not demonstrable." "War neurology has demonstrated that emotional shock, in conjunction with other injuries, may cause a symptom complex identical in all its details with the well known clinical picture of hysteria." Wolfsohn,[94] from a study of one hundred psychoneuroses and one hundred cases of physical injury received on the firing line, reached the conclusion that war neuroses are very rarely associated with external wounds. The vast majority of cases studied had a neuropathic or psychopathic taint, as shown in the family history in fourteen per cent of the total. A previous neuropathic constitution in the patient was found in seventy-two per cent. "A gradual psychic shock from long-continued fear, together with the sudden change from quiet, peaceful environment to the extraordinary stress and strain of trench fighting, is the chief predisposing cause of war psychoneurosis in soldiers with neuropathic predisposition.... Wounded soldiers do not suffer from war neuroses except in rare instances." When the United States entered the war, Major, afterwards Colonel, Thomas W. Salmon[95] of the United States army made an exhaustive study of "The Care and Treatment of Mental Diseases and War Neuroses ("Shell Shock") in the British Army." At that time one-seventh of all discharges for disability from the British forces were due to mental and nervous disorders. As a matter of fact, they accounted for one-third of all discharges for actual diseases (eliminating wounds). England with the advantage of three years of experience had presumably completed her organization to its highest efficiency. One and one-tenth per cent of the cases in the military hospitals were suffering from mental diseases. The percentage represented by the expeditionary forces was 1.3. About six thousand "shell shock" cases were being admitted annually to the English hospitals. Col. Salmon estimated the admission rate at two per thousand in the troops at home and four per thousand in the expeditionary forces. The civilian rate during the same period was about one to one thousand of the population. The confusion which existed early in the war was shown by the fact that ten per cent of the cases sent to the Red Cross Military Hospital at Maghull as war neuroses turned out to be insane and twenty per cent of those admitted as mental cases at the Royal Victoria Hospital at Netley were subsequently found to be suffering from neuroses. The first conclusion reached by Col. Salmon was that "contrary to popular belief and to some medical reports published early in the war, no new clinical types of mental disease have been seen in soldiers. There are no war psychoses." He found that of the cases being admitted to the hospitals for mental diseases about eighteen per cent were mental defectives, two per cent