Shell-shock and other neuropsychiatric problems : $b Presented in five hundred and eighty-nine case histories from the war literature, 1914-1918Southard, Elmer Ernest
History
Shell-shock and other neuropsychiatric problems : $b Presented in five hundred and eighty-nine case histories from the war literature, 1914-1918
Southard, Elmer Ernest
War neuroses; World War, 1914-1918 -- Medical care; World War, 1914-1918 -- Psychological aspects
He was wounded in the right buttock with a shrapnel bullet about the
end of September, 1914. He went back to his regiment two months later
and had shared in a number of actions up to the time of his evacuation.
He said he had been very tired for several weeks, and had finally been
sent to the physician. There were pains in the kidney region and in
the head, especially on the right side. The head felt empty. He could
not sleep, but did not dream. Ideas were not distinct. Memory had
become impaired. He could not keep his accounts right, and was afraid
something might go wrong.
There was no pain or nervous or reflex disorder of any sort except for
the knee-jerks and Achilles jerks (see below). A special examination
proved complete normality of eyes. There was a slight hesitation in
words, but no dysarthria. There was a slight tremor of the tongue and
fingers.
As to the tendon reflexes, April 9, on waking, the knee-jerks were
absent, but later in the day gradually came in evidence again. The
Achilles jerks were also absent at first, but could be obtained after
a prolonged examination and after percussion of the calf. In the
afternoon, after exercise, the knee-jerks and Achilles jerks were
easily demonstrable. The left Achilles jerk was always a little weaker
than the right. Massage brought these jerks out to virtual normality.
April 10 and thereafter, similar findings; percussion of the muscular
masses of the thighs and calves always brought out the reflexes.
Lumbar puncture yielded a clear fluid with hyperalbuminosis, 20 cells
per c.mm. (lymphocytes and mononuclear cells 95 per cent) and a
positive W. R. Iodide of mercury treatment was given April 18.
April 23, the patient went into a coma, with trismus, stiff neck,
Kernig’s sign, sluggish pupils, incontinence. He was transferred
to a special hospital, showed on lumbar puncture, April 23, 85 per
cent polynuclear leucocytes, and died April 27. The autopsy showed a
yellowish, quasidiffluent softening of the size of a small egg in the
first occipital gyrus on the right side. The authors comment on the
fact that the only objective sign in this case was the variable tendon
reflexes of the lower extremities, “_l’unique cri de souffrance des
centres nerveux_.”
Early recovery from a spinal cord lesion.
=Case 111.= (MENDELSSOHN, January, 1916.)
Mendelssohn reports a soldier, who was sent to a Russian hospital,
April 12, 1915, with a diagnosis of chronic appendicitis. Operated
on next day, the patient appeared to be passing through a normal
convalescence, when ten days later, he had an intense headache and some
trouble in vision, which disappeared the next day, only to be followed,
two days later, by the patient’s complaint that he could no longer
urinate or rise from bed.
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