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
A soldier, 32, was bowled over in a first-line trench by the bursting
of a shell that he did not see coming, September 14, 1914. He regained
consciousness only in the middle of the night, finding himself half
covered with water. He was taken up by the stretcher-bearers at
eleven in the morning. Paralysis in the legs was then absolute. There
were pains in the legs and in the back, but there was no evident
lesion. Knee-jerks, plantar reflexes, and abdominal reflexes absent;
cremasteric reflex absent on the left, weak on the right. Tactile
sensations, on the contrary, were almost intact except for a slight
diminution over the feet and the external aspects of the lower legs.
Sensitiveness to pin-prick, however, was abolished throughout both
lower extremities, and diminished in the abdomen and back up to two or
three centimeters above the level of the umbilicus; that is, including
the territory of the first lumbar and the last three dorsal roots.
Sensibility to heat was abolished in the feet, the external aspect
of the lower legs, and the posterior aspect of the thighs, but was
preserved in the second and third lumbar territory, in the anterior
aspect of the thighs, as well as in the region below the umbilicus.
Micturition was impossible. Constipation the first few days yielded
spontaneously September 20. There were signs in the bases of both
lungs, corresponding with a suffocating feeling. September 22, he was
evacuated, almost well, without signs of pulmonary congestion, having
regained the power of urination and some capacity to move the legs
sidewise. February, 1915, after evacuation to a hospital at Vic, he
showed sacral decubitus, soon reaching the size of a hand, as well as
trochanteric decubitus; traces of albumin in the urine, sacral and
sciatic pains (recalcitrant to morphine).
He began to improve December 25. Camphorated oil and the sitting
posture relieved the pulmonary congestion; the temperature, which had
oscillated round 38 degrees, fell; the decubitus scarred over; the
knee-jerks reappeared to some extent, and movements began. February 5,
the patient had become able to walk without crutches. There was still a
two-franc sized area of decubitus over the sacrum, and still a little
spinal pain in walking.
It is difficult to consider this case only functional in view of the
decubitus, to say nothing of the radicular distribution of the sensory
disorder. Heitz brings this and the previously given case (No. 1) into
relation with Elliot’s case of transient paraplegia (see Case 210) and
Ravaut (see Case 201).
Shell-shock (windage?); typhoid fever; “neuritis” actually hysterical.
=Case 135.= (ROUSSY, April, 1915.)
Public-domain text, read in full here on John Shaqi.
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