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 Sergeant lying down in a small dugout space, 2 × 1 m. high, had a
77 shell burst behind his head and between his head and the back of
the dugout. The patient was not moved by the explosion, but was buried
in a small amount of earth and stones to a depth of about 20 cm. He
was not wounded and showed no ecchymoses either then or later. Aided
by stretcher bearers, he was able to walk to the relief post about
400 meters from the trench. He did not lose consciousness, and got
to the relief post about a quarter of an hour after the shell burst.
Thereafter, however, he was unable to move his legs. The accident
happened February 6 at 4 o’clock. He was examined 24 hours after the
trauma. The accompanying diagrams show the variations in sensory
disorder at intervals during six months.
A lumbar puncture, February 8, 1915, showed hypertensive clear fluid
without macroscopic clot on centrifuging, but showing a number of red
blood cells and lymphocytes--3 or 4 to the microscopic field. There
was a slight hyperalbuminosis. The development of the muscular atrophy
and hypo-excitability of the left lower extremity, the exaggeration of
the left knee-jerk, together with the spinal fluid appearances, seemed
to prove the organic nature of the paraplegia. There was an intense
rhachialgia, with radiation along the sciatic nerve. This outlasted
all other symptoms. Thermo-analgesia was the most prominent sensory
disorder. There were no sphincter disorders.
During the first days, the anesthesia was of a pure segmentary type,
with nothing about it to suggest that it was later to be supplanted
by a radicular type of disorder. Hematomyelia was, years ago,
thought--according to Froment--to tend to yield sensory disorders
of a segmentary nature. At the outset this anesthesia was total,
though there was a vague, poorly localized feeling on intense
painful excitations,--as with energetic pricking or burning. Thus the
protopathic sensibility of Head had remained, whereas the epicritic
sensibility had disappeared.
Detailed examination of this case showed extreme errors in the position
sense. For example, pricking the foot might be localized as pinching
above the knee. The cremaster reflex was extremely marked and would
appear upon even slight excitation of any part of the lower extremity,
even at times when the patient declared he felt nothing. These
phenomena at the beginning early gave place to a syringomyelic type of
anesthesia.
At the time of report, July 29, 1915, Froment regarded this case as
analogous to hematomyelias of divers, although there is not such a
degree of decompression; the suddenness of the decompression is more
marked in these Shell-shock cases than in divers.
Shell explosion; bowled over; loss of consciousness: Hemiplegia
with reflex signs thought to be organic; hypertensive spinal fluid;
LYMPHOCYTOSIS.
=Case 204.= (GUILLAIN, August, 1915.)
Public-domain text, read in full here on John Shaqi.
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