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
During the next few days he complained of violent pains in his left
knee-joint and in the ankle-joint, but he remained in good spirits and
full of confidence. Accordingly, in five days the plaster was removed
and the contracture in the knee-joint was found to be completely
absent; the knee was easily movable. The ankle-joint was but slightly
movable. He could accomplish slight active flexion of the knee-joint
while lying in bed, and the toe-joint had already, before the narcosis,
been both actively and passively mobile. After a few days, exercises
in walking were begun. The patient had a little difficulty with his
left knee-joint in walking, walking in fact as if with knock-knee. The
foot was not well raised from the ground on account of the persistent
stiffness of the ankle-joint. Walking, however, improved daily. He
walked for three hours, resting at intervals.
A sensory examination showed that the upper limit of the analgesia
had come down five centimeters from its former level, now occupying
the left foot and leg up to the junction of the lower with the middle
third. There was now a zone of anesthesia interposed between the
normal skin of the upper thigh and the anesthetic-and-analgesic skin
of the lower thigh and leg. Upon the posterior aspect of the leg, the
analgesia and anesthesia had disappeared to a point at about the middle
of the upper thigh.
About five weeks after the narcotic experiment, the extended left leg
could be actively raised while lying in bed, up to the full extent,
with slight tremors. The patient described himself as fatigued by the
active movements of this leg. The ankle-joint remained less effective.
There was still a trace of resistance to passive movements. Although
the passive movements of the toes were normal, active movements of
these were weak and hard to execute. There was still a trace of
difficulty at the knee in walking and the gait was awkward, trepidant,
precipitate. He could get about without a cane, however. If unobserved,
his posture was more certain and free. If he exerted himself hard,
severe parietal headache on the right side would develop.
It was then proposed to the patient that another narcosis would rid
him of the stiffness in his ankle-joint. He feared narcosis and was
told that regular and energetic voluntary movements would also rid him
of the stiffness. These will exercises consisted in his directing his
whole attention to his left ankle-joint until he felt it. Then he was
given the command: “Let go the joint”--whereupon he would take his
attention away from the ankle-joint at once. In this way, he was told,
his will would make the ankle-joint mobile. Meantime he was given
twice daily a gram of bromophenacetine for his parietal headache.
The result was a rapid recovery. There were still a few traces of
difficulty at date of report. The zone of sensory loss had retreated to
the ankle, with a cuff-like zone of hypalgesia above the definite zone
of analgesia and anesthesia.
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