Case 564. (Adrian and Yealland, June, 1917.)
Adrian and Yealland give the following typical case of paralysis of the arm as a very frequent and very curable form of war neurosis, occurring as a rule after a slight wound or bruise necessitating the use of a sling. The patient, having received a slight wound of the forearm, for months had a useless arm, which he could move but slightly at the shoulder on exerting a superhuman effort. Occasionally he could flex the fingers through a small angle. There was complete anesthesia of the hand and arm of long-glove type. This anesthesia was not complained of, and might not be noticed until suggested to the patient by the physician. It is well to elicit the anesthesia, however, in view of the treatment to be applied. There was no wasting of muscles; the sensory loss was typical of hysterical anesthesia; nor could the whole arm have been involved by an injury that did not affect the upper arm and shoulder.
The patient was told that he was very lucky to have come off with such a slight injury; his arm was to be set right in five minutes by the application of a special form of electricity. He was then made to sit on a large pad electrode connected with an induction coil; the other terminal is connected with a wire brush. The first effect, he was told, would be the return of feeling in the forearm; power would return with the feeling. The wire brush with a fairly strong current was drawn downwards over the forearm from elbow to wrist. He was told that he could now feel as far as the wrist, and a pin was used to convince him that he could thus feel. If he had not felt the pinprick, the current would have been increased in strength until he could feel. The hand was now treated in the same way.
He was now told that, as feeling had returned to the arm, the power of movement would be restored shortly. Adrian and Yealland remark that laymen seem to consider that loss of power and loss of feeling are inseparably connected. The electrode was now used to produce contraction in the muscles. Under these circumstances, the arm will be used hesitatingly, with an appearance of great effort; but the patient is nevertheless convinced that power is returning.
“Rapid reëducation follows at once. He is given no time to think, but urged to move the arm more and more strongly, to grip the physician’s hand, to flex and extend the elbow, etc., and the pressure is not relaxed until the whole arm has returned to its normal vigor. If recovery is stationary, faradization is repeated with stronger and stronger currents. If it seems as though he might relapse on leaving the hospital, he is told that this is very unlikely, but that if it should occur, he should report sick at once and come back for treatment with a current far stronger than that already used.”
Adrian and Yealland claim that they have applied their combination of suggestion and reëducation in more than 250 cases (including 82 cases of mutism, 34 of deafness, 18 of aphonia, 37 brachial or crural monoplegia, 46 paraplegia, 16 hemiplegia, and 18 of non-organic gait disturbance), and that although a majority of the cases have been of several months’ standing, treatment has been almost immediately successful in at least 95 per cent of the cases.
Exposure in the retreat from Mons: Persistent hysterical sciatica. Treatment by faradism and verbal suggestion.
Case 565. (Harris, 1915.)
A soldier developed pains about the hips and down the right thigh after getting wet through in the retreat from Mons, August, 1914. He was treated for a period of nine months in various convalescent homes and military hospitals, incidentally receiving forty baths at Droitwich. He hobbled on a stick, leaning upon the left leg and dragging the right stiffly. The thigh was tender and hyperesthetic.