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
Hysterical pes equinovarus shows the foot immobile as if frozen
(_figé_). The foot is extended with the toes lowered and the internal
border incurved, as if revolved about the axis of the leg. The surface
of the sole is directed inwards and much furrowed. The tendon of the
tibialis anticus is very prominent. The internal malleolus is hardly
visible, while the head of the astragalus is easily made out. No
passive movement is possible and the tibiotarsal and mediotarsal joints
are quite out of function. Upon palpation, the excessive contracture of
the anterior muscles of the leg is striking. Upon request to move the
foot, the foot is not moved, but muscles of the lower leg may contract,
and even those of the thigh.
There were no sensory disorders in the present case, though they often
do occur in this form of acrocontracture. It is doubtful whether
the skin changes sometimes seen, such as hypothermia, hyperidrosis,
cyanosis, and glossiness are due to circulatory disorder induced by
the contracture or to the prolonged immobility. It has been proved
by Meige, Benisty and Lévy, that even in a normal subject prolonged
immobility may cause a difference of temperature of several degrees.
Circulatory disorders sometimes cease immediately upon cessation of
the contracture. Roussy and Lhermitte insist upon energetic and early
treatment of these psychoneuropathic acrocontractures, which are apt
to proceed less favorably than the acroparalyses. If not treated
energetically and early, actual nerve, tendon, and bone lesions may
ensue.
Shell-shock; shell-wound; emotion: Hysterical paraplegia. Approximate
recovery.
=Case 236.= (ABRAHAMS, July, 1915.)
A private of the First East Lancs could remember a shell’s bursting and
striking a wagon near him when he was carrying food to the firing-line.
He also thought a spare wagon wheel might have fallen on him. A
period of unconsciousness of four or five days duration elapsed, on
recovery from which he found himself suffering from a shell-wound in
the left buttock, complete paralysis of both legs, and pain in the
back, by the fourth lumbar vertebra. He thought that he had suffered
from sphincteric paralysis for eleven days after the accident; but by
September 25, there was no sign of this. Besides the paraplegia, there
was complete loss of sensation below Poupart’s ligament in the right
leg, reaching as high as the iliac crest behind; and an anesthesia of
the left foot including heel and sole, with anesthesia to light touch
throughout the limb (pin-pricks being appreciated in a normal way as
far as the ankle); and there was an anesthesia to touch and pain in the
ulnar distribution.
Public-domain text, read in full here on John Shaqi.
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