A German soldier, 34 (non-alcoholic; married, father of five healthy children; on military service 1901-3; regarded as a very good soldier; father alcoholic), got bad leg pains from wet and cold in West front trenches September 8-13, 1914. Still he was able to march some 30 kilometers. But two days later (he had lain down in wet clothes in a barn), his legs became quite immobile. He was in a reserve hospital from November 3. The rheumatism disappeared, and suddenly, early in the morning of November 8, when he was washing, a lively tremor and shaking of the right arm set in.
Examination at Jena January 30, 1915, showed no special physical disorder. The sense of touch was slightly diminished on the right side; the pain sense was normal; movements were free. While at rest there was a continuous shaking tremor of the right arm and hand, which consisted of very rapid pronations and supinations, and shaking movements of the upper arm. At times the tremor would completely cease, and when attention was diverted the tremor became slighter or quite disappeared. The tremor increased when it was talked about in the man’s presence. The left grip was stronger than the right.
January 31, after he had been in bed one day and treated with moist packs, the shaking suddenly ceased. He then complained only of mild pains in the right shoulder and wanted to get up.
February 23, he was given three days’ home leave, which he stood very well. He now began to take part in the medical gymnastic work, but complained afterwards of more pains in right shoulder and arm. There was a lapse into the shaking tremor, which lasted with varying intensity for several weeks. Loud noises or calling made it worse.
Hypnotism and suggestive treatment of the tremor were without effect March 25. March 26, on passive extension of the right arm, patient complained of pain in shoulder and arm. Next day the tremors were more marked, but March 29, the tremors suddenly stopped altogether. April 4, the pains stopped never to return. April 15, he was given leave to go home for spring farm work.
Four weeks later he returned, sparing his right arm, which he held stiffly beside his body when walking. If he let the arm hang free in walking, rhythmical movements in it began. He complained of painful involuntary contractions in the right arm even when in complete rest. Nor did the condition afterward essentially change; the patient went home at the beginning of July.
The remarkable feature of this case is the complete lack of any emotional shock. The total genesis seems to have consisted in the prolonged exposure to wet and cold, and the heavy marching. The tremors, limited to the right upper extremity, occurred without any demonstrable psychic or bodily trouble, and set in after the disappearance of the so-called rheumatic disorder. Although there is no one psychogenic factor to single out, the psychic influencibility of the case is unmistakable; moreover, the incompleteness of the cure is doubtless, according to Binswanger, a matter of the imperfect suggestive therapy employed.
Fever patient watches barrage coming: unconsciousness, paraplegia: recovery.