He was sent to Netley after three weeks of army work, as having a spasm of both hands. He was found to be mentally below par, nervous, apprehensive, stuttering in speech and not readily responsive, with defective vasomotor control, though of good average bodily development except for asymmetry of chest.
Both hands were found firmly closed; tips of fingers applied to palms; thumbs freely movable; forearms well developed, especially the flexors. Counterforce was exerted upon passive extension of fingers. There was no sensory or reflex disorder, and while the patient was asleep, it was found that the first and second fingers of both hands could be fully extended. Yet there was a definite contracture of the palmar fascia which prevented full extension of the third and fourth fingers. He was awakened by this test and the fingers became firmly flexed at once.
The man was treated by milk isolation behind screens, without permission to read, smoke, or talk. Twice a day he was encouraged to move the fingers and made to perform finger exercises. He became able to extend the fingers over half their normal excursion in three days, and was then able to abduct and adduct the fingers. He was allowed up in two weeks’ time, with full diet and screens removed. The contracture of the palmar fascia was still in evidence, but the power of movement in the hands and fingers was so satisfactory that he could be sent back to duty in three weeks. The interpretation of Fergus Hewat is that the painful condition of the hands which set in in the illness at the age of 17, had caused an obsession which had developed into a functional spasm of the hands.
Quarrel: Hysterical HEMICHOREA, DOUBLY REMINISCENT, of a former hysterical chorea, itself related with an organic chorea of the patient’s mother.
Case 300. (Dupuoy, October, 1915.)
A nineteen year old soldier, for some months a bit distressed and irritable, had a dispute with an old man whose jug he unluckily happened to smash. The old man said something was going to happen to him for that. That day, in point of fact, he fell and sustained an injury with water on the right knee. He was upbraided by the captain and evacuated to the ambulance. The fellow thought the old man with the broken jug had interfered, dreamed of the old man’s threats, and felt his hand on his shoulder.
Next day hemichorea developed on the right side, a partial and rhythmic chorea with jerky, regular contractions, fifty to sixty per minute, affecting synchronously the muscles of the leg, arm, face and tongue.
Dupuoy speaks of the reason for the hysterical “choice” of this disease, since his mother had had a probably organic hemichorea, also on the right side, with which she died at thirty years in a stroke. The boy was at that time thirteen years old and had had a rhythmic chorea six weeks, limited to the extensors of the hand on the forearm, treated in hospital.