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
A private, 31, was wounded December 7, 1916, by a shrapnel fragment
which entered the skull above the left ear and lodged in the brain,
an inch above and 2½ inches below the middle of the right orbital
margin. At Netley, December 30, he proved to show a complete internal
and external left sided ophthalmoplegia, with the exception of the
external rectus. On the right side, there was a complete paralysis of
the superior rectus and a partial paralysis of the inferior rectus and
levator palpebrae superioris. There was a paresis of the left side of
the face. The right plantar reflex was said to have been extensor at
the clearing station, but at Netley it and the other reflexes proved
to be normal, as were the optic. The patient was stuporous and had
incontinence of urine and feces for two days. Shortly after admission,
slurring of speech with a long latent period occurred. It was clear
that the shrapnel fragment must have passed far above the crus, and
it was not plain how isolated lesions of the third and seventh nerve
nuclei could have been brought about without injury of the long tracts
of the crus.
The Wassermann reaction of the serum was negative, but that of the
spinal fluid was positive. Iodide and mercury secured considerable
improvement in the mental condition and some diminution in the
paralysis. The patient is now extremely pleased with himself and has a
speech suggestive of paresis.
Head trauma: Shell-shock effects, over in a few months.
Manic-depressive (?) attack more than two years later. X-ray evidence
suggesting brain lesion. Serum Wassermann reaction positive.
=Case 16.= (BABONNEIX and DAVID, June, 1917.)
A bullet glancing from his gun barrel November 28, 1914, wounded a
man in the head, whereupon he lost consciousness and was carried to a
hospital and trephined. On coming to, he found that he could not hear
and felt pains; but the latter disappeared in a few months. He was
given sedentary employment and did his work properly until February,
1917, when he suddenly became sad, wept, slept poorly, stopped eating,
had an absent air, and began to complain of his head. He passed whole
days without moving, in a sort of stupor, which was then followed by a
hypomaniacal agitation in which he walked furiously up and down in the
room and threw objects about.
He was found subject to a generalized tremor and he was distinctly
weaker on the right side. The tendon reflexes were excessive. The
bony sensibility, as well as the pain and temperature sense, and
the position and stereognostic senses were completely abolished on
the right side. The scar lay on the left side. It was deep and very
sensitive to pressure, so that if it was touched ever so slightly
the patient began to weep. X-ray indicated loss of substance in the
posterior part of the left parietal region. Remains of the projectile
were found subcutaneously in the right supraorbital region. The W. R.
of the serum was positive. There was no lymphocytosis in the spinal
fluid.
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