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
There were also sensorimotor disorders in the ulnar distribution on
both sides, with complete anesthesia to pin prick. There was also an
area of hyperesthesia of the anterior and postero-internal aspect
of the right forearm from below the elbow to the wrist. The tendon
reflexes were weak but distinct on the right side. The left arm had
feelings of pain, with _élancements_ and formication from the shoulder
to the fingers on the ulnar distribution. There was, of course, also,
local hyperesthesia due to the wound of the thorax.
Lumbar puncture showed a fluid normal in all respects. We deal with
a hemiplegia of organic nature, associated with the bilateral ulnar
syndrome. The hemiplegia followed the trauma immediately. When the
ulnar phenomena appeared is unknown.
The lung complications cleared. The pains disappeared; motion returned
up to the level of the facialis. The patient got up and three months
later went on convalescence, still presenting Babinski, exaggerated
knee-jerk and weak arm reflexes on the left side. The bilateral
ulnar syndrome had disappeared six weeks after the patient entered
hospital. Phocas and Gutmann cite a considerable literature on
nerve complications of pleural trauma, among them syncopes of grave
prognosis; a relatively frequent pleural epilepsy (forty-five per cent
fatal) or epileptic status (seventy per cent fatal); and the rare
hemiplegia. Accidents and death have followed exploratory puncture of
the pleura. Air embolism is probably not the cause. Phocas and Gutmann
prefer the theory of a reflex disorder starting from the pleura.
Hysterical tachypnoea.
=Case 137.= (GAILLARD, December, 1915.)
A man, 23, came to the Lariboisière November 29, 1915, in a hurry
to show evidence that he had been invalided for valvular lesion of
the heart. In point of fact, the interne found a murmur at the base.
Yet there were things in the military papers suggesting caution. The
patient next morning showed no malaise, dyspnoea, or any evidence of
serious disorder. The contractions of the thorax beat in time with
contractions of the alae of the nose, about 112 per minute. Here, then,
was a cardiopulmonary patient. The heart impulse was exaggerated; the
patient could not or would not stop breathing to aid the auscultation,
but almost absolutely normal sounds could be heard at the apex and the
base. A valvular lesion could be excluded. The lungs were perfectly
normal. The patient was requested to stop his gymnastics, which might
have succeeded elsewhere but could not at the Lariboisière!
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