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
Besides the two extensive cicatrices, there were motor disorders.
Pronation and supination were almost impossible, as well as extension
of the hand and fingers and abduction of the thumb. There was a radial
paralysis without R. D. Electrical excitability of the extensors
was diminished on the right. The hand was weak. The right thumb was
atrophic. There was a hypertrichosis as well as redness, heat and
perspiration of the right hand. There was a hypesthesia for all forms
of stimulation in the hand, especially in the radial region; less in
the ulnar region. This hypesthesia rose along the posterior surface
of the forearm and covered all the territory of the ulnar nerve;
but there was a corresponding hyperesthesia in the musculocutaneous
distribution, as well as in the internal cutaneous distribution. Above
the scar there was a region of complete anesthesia. The hyperesthesia
rose higher along the circumflex nerve and the posterior branches of
the cervical nerves and included the great occipital distribution, even
involving the superficial cervical plexus, though not the territory
of the trigemini. There was some hyperesthesia of areas governed by a
few dorsal intercostal nerves. There were also spontaneous pains in
these hyperalgesic regions. The _musculocutaneous nerve_ could be felt
to be _thick and swollen_, indicating a perineuritis. There were no
neuropathic stigmata, but the knee-jerks were exaggerated a little more
on the right side.
The convulsions appeared two or three times a day, the pain would get
worse along the arm, rise to the head, following the hyperesthetic
zone, then invade the interior of the head, whereupon objects
would appear to turn and the ears would buzz. The right leg, and
especially the right arm, would begin to tremble. The man would have
to support himself to avoid falling. He saw shadows moving, colored
trees, occasionally persons. When the vertigo got stronger, he lost
consciousness. The extremities of the right side stiffened and carried
on jerky movements. These sometimes extended to the left side. The
seizure lasted from five to fifteen minutes, and sometimes occurred
in the middle of the night. Fatigue followed but headache disappeared
after an attack.
The diagnosis of Brown-Séquard’s epilepsy was made. If the
musculocutaneous trunk was compressed, a crisis was produced with
pain radiating to the head, obscuration of vision, numbness in the
arm, and tremors. Electrical treatment was resorted to for analgesic
effect. There was a certain improvement during May, so that the diurnal
dizziness disappeared. May 19 he had a period of 24 hours without any
vertigo. In June no further improvement occurred.
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