After a fortnight he was again given ether and a little chloroform was added. The yes-no test was again positive. He was allowed to recover gradually from the chloroform, but he had now lost recollection of what had happened. The left ear remained deaf. Ether was again given. He was asked to close his right ear with his finger. While answering questions addressed to his left ear, he was suddenly awakened and immediately said that his hearing had come back. This return proved permanent. He returned to his dépôt. In the conversations under ether there was no stuttering. He had been totally deaf in the left ear for five months.
Blow in neck by rifle butt: aphasia, right hemiplegia and hemianesthesia, and especially (here MEDICAL suggestion) trismus: Recovery by anesthetic and suggestion.
Case 554. (Arinstein, September, 1915.)
A Russian soldier was struck in the head and neck by a rifle butt, and developed paralysis of right arm and leg with loss of speech. After the excitement experienced by the patient when exhibited to the students by the late Prof. M. N. Szukowsky in the neurological clinic of the Military Medical Academy, trismus developed.
The patient spent a year in various hospitals, the most diverse methods of treatment by drug therapy, electricity, and suggestion yielding no results. The patient had to be fed chiefly by nose and rectum, though small quantities of fluids were fed through the mouth through an opening formed by the falling out of one tooth in the upper jaw. The patient became greatly emaciated and weak and was, October 29, 1915, brought into the nervous wards of the hospital.
He showed flaccid paralysis of left arm and leg, together with anesthesia, analgesia and thermanesthesia over the whole left side of the head, extreme general atrophy of muscles, somewhat more marked on the palsied side. The temperature of the paralyzed half of the body was not lowered. No knee or Achilles reflex obtained upon either the affected or the healthy side (general exhaustion?). Abdominal and testicular reflexes lively. The pupils responded well to light. Corneal reflexes lively. The neck was held awry to the left, and the head was inclined somewhat downwards and leftwards; hearing on left side impaired. The jaws could not be opened even with the greatest effort. Wassermann reaction negative.
Patient thought himself incurable. Purves Stewart’s case, in which chloroform and oxide of nitrogen were used, was the basis of Arinstein’s treatment. It was suggested to the patient that he submit to narcosis with the proviso that he would not be operated upon. His consent was secured; with the coöperation of others, the chloroform was administered November 6. The stage of excitability was not well marked. 8 gr. of chloroform was used altogether, by the drop system. Nevertheless, even with the weak initial excitability, the patient became capable of some movements with paralyzed hand and foot. On opening mouth, the patient yawned yet uttered no sound. Between the jaws was put a rubber insertion and upon awakening the patient was let see with his own eyes that his jaws were open and that therefore food might be introduced through the mouth. Upon repetition of the narcosis, 5 gr. of chloroform was used altogether, and the stage of excitability was this time better marked. To strengthen movements in the paralyzed extremities, the device of pricking the patient with a pin on the unaffected half of the body, with the unaffected hand and leg held horizontal by assistants, was adopted. The patient then made reflex defensive movements in the paralyzed extremities, especially the hand. At this point the narcosis was suspended, and the irritation with the pin was continued until consciousness returned. At this moment, the patient’s attention was called to the disappearance of the paralysis and his restored ability to move the paralyzed extremities.
From that time on, the patient’s condition underwent a sharp transition. Artificial feeding became unnecessary. The patient ate by mouth; the mouth was opened by the leverage of a small stick held by the patient between his teeth. Speech returned gradually. In reading aloud the patient aided the movements of his lips with his hands. At the time of report the patient spoke well, ate normally, had gained in weight, and with some effort could sit down and even stand and walk. All this was attained in a relatively short time after a whole year of paralysis.
The author felt that the success attained in this case gave him the right to use the same method where the cause was not a contusion.