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
_Re_ windage and internal effects in the human body, Ravaut recalls the
fact that the internal and intraneural hemorrhages of Caisson disease
(“bends”) are well known. The external hemorrhages of aeronauts and
mountain climbers belong in the same physical class. Dynamite exploded
in a pond kills fish. Dynamite may break pillars inside a building
without damaging its front. Cases like Chavigny’s (198), Roussy and
Boisseau’s (199), Claude and Lhermitte’s (200), as well as Ravaut’s own
case (202) are in point.
Shell explosion near by: Paraplegia, interpreted as due to windage. Two
foci of HEMORRHAGE (SPINAL CANAL, BLADDER) clinically proved to exist
in a case without external sign of injury.
=Case 202.= (RAVAUT, February, 1915.)
An infantry sergeant was brought to the ambulance, one day in November,
1914, with a paralysis which had set in immediately upon the explosion
of a large shell a short distance away. Both legs were paralyzed and
there was anesthesia to the navel. He could not urinate. It was early
in the war, and Ravaut thought he would find an injury to the vertebral
column, but on undressing the soldier there was no wound. The skin was
intact, and there was not even an ecchymosis. The patient was suffering
not at all, but said that after the shell exploded he felt a forcible
shock, was stunned for a moment, and when he wanted to rise, found
that his legs were inert. His state did not change during the day and
he did not urinate. Catheterization showed a urine full of blood. This
indicated a lumbar puncture, and a bloody fluid emerged under great
pressure. Thus two foci of hemorrhage were proven to exist in this
patient despite the fact that there was no external lesion.
_Re_ windage effects, see suggestions of Ravaut under Case 201. Ravaut
also suggests that certain cases of emotional jaundice may be similarly
explained on the basis of internal lesion due to windage. Sundry cases
of gastro-intestinal disorder and of hemoptysis fall into the same
class; possibly the cases of death in a fixed posture belong there,
too. Ravaut thinks, despite the look of hysteria about the shell-shock
cases of paraplegia, deafness, mutism, and the like, that the cases
are actually ones in which there has been at the beginning a slight or
severe hemorrhage, clearing up in a few days. He states that there is a
pretty definite parallelism between the course of the clinical symptoms
and the chemical characteristics of the spinal fluid.
Shell-explosion in confined space; paraplegia after fifteen minutes;
slight hemorrhage and LYMPHOCYTOSIS of spinal fluid; Hematomyelia.
=Case 203.= (FROMENT, July, 1915.)
Public-domain text, read in full here on John Shaqi.
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