Case 570. (Schultze, August, 1916.)
Severe dysbasia, due to monoplegia of the right leg of sudden origin (a fall), was variously treated 64 weeks without effect.
July 15, 1916, the patient walked in on a stick, and fell down on trying to walk without. August 1, 1916, at 9 o’clock, he was rapidly examined: Anesthesia to pain and temperature; inability to lift right foot; the right knee could be lifted about a hand-breadth above the body if the foot was supported.
At 9:10, a small electrode was applied: sensibility became normal at once. Second application: leg raised much better. The man was told that he was better and that his hand could be put under the heel. Third application: Leg raised 8 cm. The patient showed pleasure at the advance. Fourth application (slightly increased strength): Patient able to stand and to lift knee with flexion at 135° while standing. Walking exercises under direction. At 9:30, five minutes recess was given for fatigue, whereupon the exercises were taken up again and transition made from stationary running to walking without aid as well as a variety of other associated acts (grasping handkerchief instead of physician’s hand, and the like). The patient became exhausted after 8 or 9 minutes running about, and another pause was given.
The large brush electrode with stronger current was now given to the back and to the back of the right leg. Practice in slow walking, lifting knee, and holding hip joint firm. The patient became tired, but remained very willing. Exercises in pulling on stockings, in climbing stairs—the whole concluded at 10 o’clock, whereupon it was found that the patient could walk alone for a distance of 50 meters. The patient was a very suggestible one. It was striking that the patient in the time between 9:35 and 9:40 minutes could walk better on the right (that is, the previously affected leg) than upon the left. Rest in bed and phenacetine were ordered, with the suggestion that in the morning he would walk much better. He became irritated after the treatment but grew quieter in the afternoon.
On August 3, he was found able to walk well, better when not observed than when observed. August 5, he complained that his leg was worse and used a cane, without permission. He was roundly scolded by the physician and threatened with being sent to bed if he did not practice earnestly. August 7, he was better, and confessed that he could not walk as well on command as he could alone; the exercises were nothing but a fraud and he could go out and beat everything up (alles zerschlagen) if he did not have to carry out such exercises.
August 15, he was much better, quiet, and satisfied. The lameness was practically gone. August 30, there was no sign of lameness, even when he was observed. According to Schultze, the Kaufmann method is not merely an Erb tradition, and rather special measures need to be taken in executing it.
Re Kaufmann’s cure, Imboden sums up this “highly logical and brutal method” as a method in which powerful electric shocks and loud military orders to perform certain exercises secure results. Imboden suggests that relapses may follow, sometimes on the slightest provocation. Mann states that Kaufmann’s method of suggestion and electric shock forms very good treatment; yet Mann states there have been two deaths under this treatment: in both instances there was an enlarged thymus at autopsy. A better technique, especially the use of the faradic current alone, might have avoided these deaths. Mann himself prefers to Kaufmann’s Ueberrumpelung milder methods, such as rest. Kaufmann keeps up the sitting until the man is cured, even if it takes two hours of electricity and staccato commands. For similar persistance, see the treatment by induced fatigue of Reeve ([Cases 489-493]).
Wound of shoulder: Heterosuggestion of BRACHIAL paresis. Electrical suggestion of muscular power. Recovery in five days.