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
An infantry subaltern, 23 years old, was injured September 24, 1914,
by a rifle bullet, which entered above the left clavicle and emerged
between the right scapula and the vertebral column. The patient
leaped into the air when he was struck, but fell at once and found
that his legs were paralyzed. A feeling of cold crept up from the
feet to the region of the umbilicus. Consciousness was preserved.
There was hemoptysis because of the bullet’s passing through the left
lung. The wounds all healed quickly. There was retention, followed by
incontinence, of urine and feces; and the situation was complicated by
eschars in the gluteal and trochanteric region.
For three months there was no change in the paraplegia, except that at
the beginning of the third month the patient could move his fingers a
little and raise his knees slightly. He was transferred back through
three hospital units, with a diagnosis of spinal cord lesion or
fracture due to a vertebral column lesion at the second and third
dorsal vertebrae.
Seven months after injury, he reached a Russian hospital for a
laminectomy, incapable of standing or walking without support,
although able to sit and rise with extreme difficulty. He could now
very slightly flex and extend the knees, and very slightly flex and
rotate the ankle, and weakly move the toes. Passive movements could be
carried out without much difficulty, though there was a slight joint
and muscle stiffness. Both quadriceps muscles were markedly atrophied.
There was slight amyotrophy of the lower legs. Tendon reflexes were
exaggerated, and there was a marked ankle clonus, a Babinski reflex,
and an abolition of the abdominal and cremasteric reflexes.
There was a sensory disorder of an incomplete syringomyelic pattern,
with diminished sensibility to heat and complete abolition of pain
sensibility. Touch and electric sensations were somewhat delayed.
There was a diminution in the faradic and galvanic excitability of
the legs and feet; vasomotor disturbance (slight hyperidrosis) of
the paralyzed limbs. Two of the eschars had not yet cicatrized. The
sphincteric disturbances had diminished. For the rest the patient
was normal. The second and third vertebrae showed deformity and were
painful to pressure and percussion of spinous processes.
The patient was treated by galvanization of the spine, with a current
descending at first and then ascending, and by faradization of the
paralyzed muscles. There was progressive improvement, irregular but
constant. At the time of report, July 1, 1915, he was perfectly well,
able to take long walks, and without sphincter or sensory disturbance.
The tendon reflexes were still exaggerated, and there was still a
slight ankle clonus and Babinski. The abdominal and cremasteric
reflexes were still abolished. The last of the seven eschars had not
yet healed over.
Public-domain text, read in full here on John Shaqi.
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