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
February 6, another attack of fever, with shivering and perspiration,
lasted for some three hours. He could hardly stand by himself and had
to be helped in walking. Next day, another spell of three hours of
fever; definite paralysis set in, affecting both legs. February 8 the
arms were attacked by paralysis which, unlike that of the legs, was a
progressive one, attacking first the shoulders, then the elbows, the
wrists, and finally the hands. All the body muscles were in a state
of flaccid paralysis, as well as the muscles of the face. The patient
was now afebrile. February 9 there was a slight speech defect; the
tongue was slightly paralyzed, and swallowing became painful. The jaw
movements remained normal. The muscles of the face were intact and the
patient could whistle, move his lips, and move his eyeballs normally.
Vision normal. The pupils were fixed in dilatation, more widely on the
left side. There was a slight contracture of the vesical sphincter,
necessitating the catheter. The tendon and cutaneous reflexes were lost.
By February 14, when the patient was sent to the Bellay Hospital,
muscular atrophy had made its appearance. No plasmodia could now be
found in the blood, which showed 71 per cent polynuclear leukocytes, 20
per cent mononuclears, 9 per cent lymphocytes.
This state lasted til February 25. Despite the fact that the patient
ate well, emaciation rapidly progressed. The buttock showed a very
few signs of decubitus. Upon this date there was pain from a marked
orchitis of the left side, the cause for which remains unknown (no
history of gonorrhœa; catheter used for the last time, February 15).
The temperature which attended the orchitis came down in three days;
the patient’s appetite was singularly good, but the muscular atrophy
increased. The speech defect meantime disappeared, and the patient
swallowed more readily.
March 7 a slight and hardly perceptible movement could be noted in the
fingers of the left hand. Two days later, similar movements appeared in
the right. March 11 he could spread his fingers in a kind of creeping
movement. Next day slight movements were possible with the legs, and
March 13 the knees were movable. March 14 the patient could lift his
head from the pillow. The range of movement now increased all over the
body. According to the patient, those parts were the first to regain
power that had been attacked last. This certainly seemed to be the case
with respect to the left upper limb, in which first the hand and wrist,
then the elbow and shoulder, successively recovered power. The legs
regained their power in the same way proximad. March 17 the patient
could sit up and grasp objects with the left hand. The cremaster and
plantar reflexes appeared,--the former, more on the right; the latter,
more on the left. The left pupil remained in wider dilatation than the
right.
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