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
On the basis of the intensity of these vasomotor disorders, Babinski
felt that, in accordance with his general ideas, he was not dealing
with hysteria, and that he was in fact dealing with the so-called
physiopathic syndrome. Lacking for this syndrome was the exaggeration
of the tendon reflexes of the affected limb. Might it not be that the
improper attitude and muscular stiffness of the limb were based simply
on retractions of tendons? The patient was chloroformed. This procedure
was the more warrantable as a number of physicians had thought of the
patient as an exaggerator or even as a simulator. Under chloroform
there was in fact a slight tendon retraction; yet on the whole it
was clear that the attitude and stiffness of the limb were largely
dependent upon a contracture. When during narcosis all the other tendon
reflexes and skin reflexes had become extinct, there was still to be
observed on the affected side a hyperreflexia, and even a clonus of
the patella; and the clonus lasted an hour after recovery from the
anesthetic. This curious phenomenon of elective exaggeration of tendon
reflexes in narcosis, Babinski has observed to be not infrequent.
It is a valuable diagnostic sign for a sure proof of excess tendon
reflexes in cases where doubt prevails under ordinary circumstances.
Sometimes the contracture will yield, but only in the deepest sleep,
outlasting even the conjunctival reflex and the reactions to pricking
of the normal extremities. Moreover, the contracture would return from
20 to 25 minutes before any manifestation of consciousness. If an
endeavor was made to reduce the contracture under full anesthesia and
in complete unconsciousness, a spasmodic movement was provoked which
exaggerated the abnormal attitude of the limb. Sometimes even the leg
would be thrown into flexor contracture.
The case above described was the one which led Babinski to his new
formula of the PHYSIOPATHIC SYNDROME. This he describes in general
terms as follows:
Public-domain text, read in full here on John Shaqi.
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