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
There was no demonstrable paralysis but the legs seemed to have “melted
away,” _fondu_, as the patient said. Pains were spontaneously felt in
the lumbar plexus and sciatic nerve regions, not passing, however,
beyond the thighs. These pains were more intense with movements of
legs; but coughing did not intensify the pains. Neuralgic points could
be demonstrated by the finger in lumbar and gluteal regions and above
and below the iliac crests (corresponding with rami of first lumbar
nerves). The inguinal region was involved and the painful zone reached
the sciatic notch and the upper part of the posterior surface of the
thigh.
The sensory disorder had another distribution, objectively tested. The
sacral and perineal regions were free. Anesthesia of inner surfaces of
thighs, hypesthesia of the anterior surfaces of thighs and lower legs.
The anesthesia grew more and more marked lower down and was maximal in
the feet, which were practically insensible to all tests, including
those for bone sensation. There was a longitudinal strip of skin of
lower leg which retained sensation.
Position sense of toes, except great toes, was poor. There was a
slight ataxia attributable to the sensory disorder--reflexes of upper
extremities, abdominal, and cremasteric preserved, knee-jerks, Achilles
and plantar reactions absent.
The vesical sphincter shortly regained its function, though its
disorder had been an initial symptom. Pupils normal.
The “sciatica” here affects the lumbosacral plexus.
As to the syphilitic nature of this affection, there had been at
eighteen (22 years before) a colorless small induration of the penis,
lasting about three weeks. There was now evident a small oval pigmented
scar. The patient had married at 20 and had had three healthy children.
The lumbar puncture fluid yielded pleocytosis (120 per cmm.). Mercurial
treatment was instituted.
The treatment has not reduced the pains. Long thinks it was undertaken
too long (six months) after onset. The warning for early diagnosis is
manifest. There was somehow a delay under the medical conditions of the
army.
_Re_ syphilis in munition-workers Thibierge has much to say of French
conditions. Throughout his work on syphilis in the army, he stresses
the large number of venereal cases in men mobilized for munition-work.
Medical inspections ought, according to Thibierge, imperatively to be
made in the munition-works and upon all mobilized workmen, whether
French or belonging to the Colonial contingents. These men are under
military control in France, but they have more opportunities than the
soldiers for contracting and disseminating syphilis. They are, in point
of fact, very often infected and in a higher proportion than are the
soldiers at the front. The munition-workers should also be obliged to
report their infections to the physician, whether or no they are under
treatment by military or by private physicians.
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