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
About a month later, he was given twenty more intravenous injections,
whereupon the choreic movements now decreased, and July 15 he was given
convalescence for three months. October 15 he went back to his dépôt
cured; and October 20, on request, went to the front. He was potted
and under machine-gun fire at times during the next three months, but
the choreic movements did not reappear. January 1 he left the trenches
as the division went into billets. January 8, suddenly, without
any emotional cause, he began to “dance” again. Accordingly, he was
evacuated for the second time, January 10, 1917, with the diagnosis:
choreic movements, especially on left; evacuate to special centre.
At Royallieu, a lumbar puncture showed a slight lymphocytosis.
The headache improved. He was evacuated January 24, 1917, to
Val-de-Grâce, with a diagnosis: Recurrent chorea; first attack followed
commotio cerebri, nervous depression, inequality of pupils, various
pains, contracted in the army. Another W. R. was positive. Twelve
intramuscular injections of oxygen cyanide were given, besides baths.
He was then sent to Issy-les-Moulineaux with a diagnosis of tic. He
showed choreiform movements affecting the legs alone. When sitting,
legs extended and flexed, the knees would abduct, then adduct;
the thighs flexed. When standing, flexor movements were produced
alternately on the left and the right, the knee being raised high,
sometimes striking the patient’s hand. In walking, the thigh and lower
leg flexion was always out of proportion to the required step. There
was thus a sort of saltatory chorea limited to the legs. The reflexes
so far as they could be tested were normal save that the left pupil
was fixed to light and accommodation; the right pupil was sluggish to
light but accommodated normally. Leucoplakia of the cheeks; nocturnal
headaches; and pains resembling lightning pains in arms and legs.
Lumbar puncture, March 26, showed blood-stained fluid, and the puncture
was followed by headache, vomiting, and slow pulse. The fluid showed a
slight lymphocytosis; W. R. negative.
It is clear that a diagnosis limiting itself to the leg trouble would
probably content itself with “hysterical chorea.” The lieutenant said
that when he saw people “dance” he did have a tendency to imitate
them; and when he was cured of that, he did not want to go to Lamalou
because he would see the ataxic patients there and might fall back
into his “dancing.” However, in view of the pupillary inequality, the
lymphocytosis, the leucoplakia, the W. R., and the initial neurasthenia
and depression found in the very first hospital in which he was
examined, we probably should be entitled to consider that general
paresis played a part in the chorea.
Shrapnel fragment driven through skull: General paresis.
=Case 15.= (HURST, April, 1917.)
Public-domain text, read in full here on John Shaqi.
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