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
_Re_ hemorrhages in the neighborhood of the oculomotor nuclei, the
phenomena of polioencephalitis may be recalled. In that disease, the
predisposition to hemorrhage is presumed to be alcoholic, as the cases
of ophthalmoplegia of this group almost always appear in alcoholics.
However, the first case of hemorrhagic superior polioencephalitis was a
non-alcoholic one of Gayet (1875), in which the symptoms followed three
days after a boiler explosion.
A tabetic lieutenant “shell-shocked” into paresis?
=Case 20.= (DONATH, July, 1915.)
An apparently competent German professor in an intermediate school,
a lieutenant of infantry reserves, 33 years old, on the 17th August,
1914, was stunned for a while by the shock of a cannon-firing 25 feet
away. Urination became difficult. Headaches and limb pains ensued, with
paralysis of fingers, gastric troubles, forgetfulness, especially for
names, insomnia, and general scattering of mental faculties.
Neurologically, the pupils were irregular, left larger than right;
Argyll-Robertson reaction. Right knee-jerk livelier than left. Achilles
reactions absent. Slow and dissociated pain reactions in feet, lower
thighs and lower quarter of upper thighs, with hypalgesia or analgesia.
Station good; gait steady. Mentally depressed, slow of thought. Speech
poor and of indistinct construction (mild dementia). Calculation
ability poor. No pleasure in work.
Wassermann reaction of serum weakly positive.
It seems that for a year the patient had been subject to spells of
anger. He was irritated by his wife who had been nervous since an
earthquake.
_On the occasion of the earthquake_, 1911, the patient himself had had
a spell of _difficulty with urination_. The spell had lasted two or
three months. The patient had had a chancre in 1902, “cured” in four or
five weeks with xeroform. In 1908, when about to marry, he had had six
mercurial inunctions.
_Re_ tabes, Lépine shows that tabetics are numerous. They are numerous
among officers and also in the auxiliary service, in which latter
tabetics are maintained on desk duty. Perhaps they had been admitted
to such work as unable to march or fight, on the basis of having had
so-called “rheumatism.”
Shell-explosion may precipitate neurosyphilis in the form of tabes
dorsalis.
=Case 21.= (LOGRE, March, 1917.)
An artilleryman, 38, had a large calibre shell explode very near
him and afterward could not hear the whistle of a shell without
falling down in a generalized tremor, sweating profusely, urinating
involuntarily, in a mental state approaching stupidity. Here was a case
that might be regarded as one of morbid cowardice in a psychopath,
following violent emotion.
The artilleryman proved to be a victim of tabes and of general paresis.
The incontinence of urine under the influence of emotion was nothing
but an effect of tabetic sphincter disorder. The crisis of cowardice
proved nothing but an initial symptom of general paresis.
Public-domain text, read in full here on John Shaqi.
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