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
The treatment planned for this case of isolated contracture of the
supinator longus was surgical operation of the irritative focus.
According to Léri and Roger, it is sometimes dangerous to use such
measures as massage and electric baths for a paralyzed limb, since the
massage or electricity excite not only the affected muscles, but also
the other sound muscles,--muscles that are already more powerful than
the paralyzed muscles and may go into antagonistic contracture. Even in
limited galvanization, it is desirable to work with weak currents, so
as not to diffuse the current into non-paralyzed muscles. In case of
radial or sciatic paralysis, apparatus permitting the extremities to
rest without over-action of the muscles antagonistic to the paralyzed
ones may well be applied.
We here deal with a case, therefore, which looked purely functional,
but in which careful examination and X-ray served to show an organic
focus of irritation.
_Re_ nerve concussion, Tubby offers the following definition: Nerve
concussion is damage to a nerve trunk without actual destruction of the
axis cylinders. The damage may consist of an effusion of blood between
the nerve fibres following compression of a nerve against the bone by
rapid passage of a foreign body near the nerve. Sometimes, however,
the lesion which causes damage to the nerve trunk without actual
destruction to the axis cylinders is nothing more than a temporary
anemia or hyperemia. In most instances, both motor and sensory function
are together interfered with, but in the case of large nerve trunks,
_e.g._, the popliteal, there may be a separate concussion of motor or
sensory bundles.
Contusion may effect a sort of STUPEFACTION OF MUSCLE and paralyze it
by a non-psychic process: The SYNERGY in contraction of biceps and
supinator longus is thus SPLIT. Biceps restored to synergy with the
supinator by massage and faradism.
=Case 253.= (TINEL, June, 1917.)
A man was wounded at about the middle of his biceps and three weeks
later was found to be able to flex the forearm only by means of the
supinator longus. The biceps remained absolutely flaccid and soft, so
that the diagnosis of a lesion of the musculocutaneous nerve (unlikely
as this seemed on account of the low site of the wound) was entertained.
However, the biceps and the musculocutaneous nerve proved electrically
normal. In short, this paralysis of biceps was functional in nature.
But, according to Tinel, there could be no voluntary suggestive or
hysterical element in such a paralysis, since flexion of the forearm
is normally produced by a synergic contraction of biceps and supinator
longus that cannot be separated voluntarily.
Treatment by massage and rhythmic faradization caused the biceps
function to return to normal, so that voluntary synergic contractions
of the biceps took place along with those of the supinator longus.
Public-domain text, read in full here on John Shaqi.
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