Ten months’ field service; severe FEBRILE DISEASE: Afterward hysterical TRIPLEGIA, MUTISM, “JUMPING-JACK” reactions to stimulation of feet. Cure by anesthesia, verbal suggestion, faradism to palate.
Case 555. (Arinstein, September, 1915.)
A Russian private, 30, brought to a field reserve hospital, June 20, 1915, was in a grave condition diagnosed typhoid. By the end of June the general condition had improved and the temperature had fallen.
July 9, worse; happening to be in the company of a sanitary in a privy, he was observed suddenly to fall unconscious, with both feet and left arm paralyzed. Soon afterward he lost the power of speech. From September 30 to October 19, he lay in field hospital; but was then transferred to the nerve hospital with diagnosis: convulsive paralysis and aphasia. At entrance, complete paralysis of both legs and left hand; loss of speech and aphonia (speech understood). Upon touching a foot, strong convulsions developed with legs rapidly drawn apart and drawn together much in the manner of dancing toys. The mouth was twisted to the left. Though he silently opened his mouth and made rapid movements with the lower jaw, he could not utter a single sound, either vowel or consonant. Left hypalgesia. Hypesthesia of skin of hand and mucosa of tongue. Knee-jerks absent because of the strain of the muscles of the legs. Wassermann negative.
The history showed that the speech of the patient had been incorrect and indistinct from childhood. Moreover, in 1908, in chopping wood in the forest he had fallen under a sleigh and hurt his left hand, which had not since fully recovered. He had volunteered for the war.
The psychogenic character of the disease seemed clear. Suggestion was followed by ether narcosis, during which, on pricks of the healthy side with a pin, the patient made defensive movements with the paralyzed hands, and also moved both legs. Speech was not regained either during or immediately after the narcosis, although the patient gave forth indefinite sounds. Speech was restored on the same day, September 7, with verbal suggestion and faradic brush applied to palate. The patient at once began to speak clearly and distinctly, read his prayer book, and described distinctly and in detail how he went to war. From that moment the convulsive movements in the feet disappeared, the region of anesthesia on the left side narrowed, speech was permanently reëstablished, and the patient began to move with his feet and finally began to walk after six months of paralysis. Before that time no medical treatment had had the slightest effect. The effort to stop mechanically the jerks even temporarily by means of plaster casts had been unsuccessful. In sleep the twitches ceased, but upon reawakening, even before full consciousness returned, the jerkings would resume. It is curious to note that upon falling asleep under the anesthetic the patient would issue always one and same kind of yells—“Help, there goes the German! They are shooting! Russians, do not yield!”
Re chloroform anesthesia, Milligan remarks that the treatment should be carried out in a quiet, single room, with the chloroform slowly administered and the suggestions made by the anesthetist during the optimal phase for suggestion,—just before the stage of involuntary struggling.
Shell-shock; unconsciousness: Mutism and musical alexia. Cure by anesthesia.