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 volunteer without psychopathic signs except a slight stuttering, and
without psychopathic history of any sort, went into service at 17.
After he had been a short time in the field, a shell fragment injured
him in the upper part of the thigh. He lay up in hospital four weeks.
He then spent four weeks in the reserve.
He was then given antityphoid inoculation, and a half hour afterward
had epileptic convulsions. These appeared four times more during the
next fortnight, as a rule followed by a delirious excitement. No fever
was reported. After the fourth attack, he was transferred to the
Charité Clinic.
At the clinic there were no attacks, and there was nothing epileptic to
discern in the make-up of the patient. His nervous system was normal
to examination. There was, however, one fact in the family history of
note, namely, that an older brother of the patient, 20 years of age,
suffered from convulsions.
What is the relation of the antityphoid inoculation to the epilepsy?
According to Bonhoeffer, we must not forget the family history even
if we regard the inoculation as the liberating factor. Curiously
enough, the shell injury did not itself serve apparently to bring out
the epilepsy. Bonhoeffer has seen three other instances of epileptic
attacks or epileptoid phenomena following antityphoid inoculation.
However, in the hundreds of thousands of inoculations, it is not to
be wondered at perhaps that there should be a number of instances of
epileptic attacks. One was a man with severe epileptic taint; in the
others, there was a question of pathological intoxication.
_Re_ antityphoid inoculations, a French observer--Paris--remarks that
these inoculations may occasionally start up the symptoms of general
paresis. Compare in this connection also Case 63, in which a syphilitic
developed convulsions during antisyphilitic treatment. The psychogenic
factor of intravenous injection itself, with its possible effect upon
glands of internal secretion, can hardly be distinguished from purely
serological effects. Paris goes so far as to state that he regards it
as imprudent to vaccinate a syphilitic subject. He thinks it might be
better for a syphilitic subject to contract typhoid or paratyphoid
fever than to run the risk of developing paresis. If the soldier
happened to be not only syphilitic but alcoholic, then the danger would
be larger. Possibly, however, both Bonhoeffer’s case of antityphoid
inoculation epilepsy and the cases alluded to by Paris of antityphoid
inoculation, are merely statistical accidents.
Shell-shock; (apparently slight) scalp wound: Jacksonian seizures.
Operation, decompressing the edematous upper Rolandic region. Recovery.
=Case 66.= (LERICHE, September, 1915.)
Public-domain text, read in full here on John Shaqi.
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