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
As to the development of eschars, Roussy reports the case of a
lieutenant wounded September 25, 1915. There was a penetrating wound
of the interscapular region. The bullet had entered on the posterior
aspect of the right scapular region and had emerged at the level of the
first dorsal vertebra. October 1, a neurological examination showed
flaccid paraplegia, knee-jerks normal, Achilles jerk weak on the right,
plantar reflexes flexor, cremasteric reflex absent on the right, and
both abdominal reflexes absent. There were pains in the legs and arms.
There was retention of urine with overflow. A slight dulness on the
right; temperature from 38 to 39 degrees.
Four weeks later the knee-jerks had become very weak, and the Achilles
jerks were now absent. There was an extensive diffuse atrophy of the
lower leg and thigh muscles, and a hypesthesia of pronounced degree had
developed throughout the legs, over the buttocks, and in the lumbar
region. Anal and vesical sphincters relaxed; dejections voluminous;
sacral decubitus as well as healed eschars. December 5, the patient was
transferred to the Army neurological center; temperature rose; there
was much expectoration; paracentesis yielded no fluid; pneumococcus
in the sputum. Cystitis had developed despite extreme care. Extensive
edema of the legs developed. There was increased dulness on the right
side, coughing and dyspnea. Death, January 17.
The autopsy showed a bronchial pneumonia of the right lower lobe,
confluent, imitating a lobar pneumonia. The left lung also showed
extensive confluent bronchopneumonia at the base as well as
disseminated areas and edema of the middle and apical portions.
Infectious splenitis, large fatty liver, swollen kidneys, no
pyonephritis.
The spinous processes of the 6th and 7th cervical vertebrae were
injured. There was no obvious gross disease within the theca except
that there was a slight adhesion between the dura mater and the
anterior surface of the spinal cord at the level of the 7th cervical
and highest dorsal vertebrae. There was, however, a depression on
the anterior surface of the spinal cord at a lower level, namely, at
the level of the 4th dorsal vertebra. Microscopic examination showed
myelomalacia with small cavities in the 1st and 4th dorsal segments,
suggesting the _état criblé_.
According to Roussy, these patients injured in the spinal region are
particularly sensitive to cold and support transfer badly even when the
disease is short. Such patients should be evacuated to the interior
after the shortest delay possible. Sometimes these patients show rib
fractures; these are in the posterior portions of the ribs and are due
to the fall of the man when struck. It might be possible even that the
spinal lesions should through the action of the sympathetic nervous
system favor lung infection.
Shell-explosion: Hystero-organic symptoms; decubitus; radicular sensory
disorder.
=Case 134.= (HEITZ, May, 1915.)
Public-domain text, read in full here on John Shaqi.
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