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 comrade then came near to tell me to go back. I told him
that I could not move and that I must have been wounded in the
lumbar region. He looked at my kit and my coat and said there
was no trace of shot or tear. Not wanting to leave me, he
lifted me by the armpits and knees. I could not help him get
me up, and my legs hung flexed and inert. After a few steps he
had to put me down, and tried to stand me up. I immediately
crumpled. I had no sensation of my feet touching the ground. I
sent my comrade back, asking him to tell my brother, who was
in my squad. I did not lose consciousness or any feeling of my
situation, or of the danger being run by my comrade.”
The man remained four days on the battle field without food. He
was on the edge of a stream. He did not defecate, nor for two days
did he urinate. Eventually the bladder and rectal functions were
re-established, though they remained irregular. Catheterization was
never resorted to. The lumbar pains were diffuse, fixing themselves a
few days after the accident in the region below the umbilicus. There
were pains at the waist predominating on the left side. The paralysis
of the lower extremities grew rapidly better. Movements in the right
leg reappeared, and 27 days after the accident the man was able to
stand and walk around his bed. Still further movement followed (left
leg weaker).
At the time of the report, May 28, 1915, the patient could walk without
a cane, but he could get about only slowly. The left toes would rub
against the ground, and he could not support himself for any length of
time on his legs. The knee-jerks were exaggerated, especially the left.
The Achilles jerks were increased. There was a Babinski reflex on the
left side and an abduction of the fifth toe on plantar stimulation. The
same reflexes were found on the right side, but less marked. Abdominal
reflexes absent, except the right superior reflex, which was distinctly
present. Cremasteric reflexes absent. Anal reflexes preserved. The
defense reflexes were exaggerated, but more markedly on the left side.
The zone from which the defense reflexes could be elicited on the left
side included the whole lower extremity and rose as far as 2 or 3 cm.
above the nipple. Stimulation of the lateral parts of the left lower
extremity would even produce defense reflex movements on both sides
of the body. On the right side, however, the defense reflex movements
could only be tried out by scratching the anterior surface of the
ankle, which was then followed by a flexion of the foot.
Sensibility to touch and deep sensibility were preserved; but
sensibility to temperature and pain, normal on the left,--_i.e._,
paralyzed--side, was weak in the right leg. There was a marked sudation
on the left side, limited by the white line, the inguinal fold, the
iliac spines, and a horizontal line passing through the umbilicus.
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