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
An infantryman, wounded at Notre Dame de Lorette, May 9, 1915, by a
shell fragment in the right popliteal space, was given a preventive
injection of 5 c.c. of antitetanic serum, evacuated to a hospital, May
12, and developed signs of tetanus August 1, with trismus and pains and
spasms in the right leg.
The disease progressed with dysphagia, stiffness and paroxysmal
hypertonia of the legs, especially of the right leg, fixed orthotonus
of the trunk, neck hyperextended, arms stiff but able to move.
Antitetanic serum was given daily. At the end of eight days there was a
marked improvement and the whole course ran to approximate recovery in
25 days from the onset of tetanic symptoms, at which time the man was
able to get up and walk on a crutch. The external popliteal nerve had
been sectioned, and the foot was in a marked equinovarus.
Chloroform was administered for the purpose of straightening the foot,
September 2, that is, about five weeks after the apparent end of the
tetanus. The first stage of the anesthesia lasted about two minutes,
but at this point the trunk and leg muscles passed into a state of
diffuse contracture. In fact, a _tetanic syndrome_ took place _in
the midst of the anesthesia_. At a time when the corneal reflex was
completely abolished, it was still impossible, with the exertion of
the greatest strength, to flex the segments of the lower extremities.
Moreover, the trunk was stiffly extended and the jaws were in trismus.
Tonic and clonic contractions were produced by the efforts made to
straighten the foot, and these contractions passed from the right
side to the left. The chloroform was now increased and a transient
resolution of the muscles was obtained, lasting hardly more than a half
minute. As all efforts to reduce the pedal deformity failed, anesthesia
was stopped. The contractures and paroxysms lasted a few minutes. The
knee-jerks were extremely exaggerated and there was a bilateral ankle
clonus. After a brief phase of excitement, the patient emerged from
anesthesia, began to talk with his comrades, and ate his usual meal
without inconvenience. The chloroform anesthesia had lasted twenty
minutes, and 60 grams had been administered.
It was now determined to section the tendo Achilles and the tibialis
posticus. September 8 the man was chloroformed again and the same
phenomena were exactly reproduced. Sixty grams of chloroform was again
administered. The tendon resections permitted placing the foot in the
proper attitude. Next day the patient was examined neurologically.
The skin reflexes were found normal. The Achilles and knee-jerks
were somewhat exaggerated, but equal on the two sides. There was
no ankle clonus. Sensations proved normal. There was a mechanical
hyperexcitability of the muscles of the anterior aspect of the thighs
and of the calf.
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