A German subaltern officer, 27, was wounded September 25, 1914, in a battle in France. He gave the following account:
“We had been firing without interruption four days, and then were sent back. While going back from cover we were under shell fire. Three or four horses fell. I got a glancing blow from a shell fragment in the back of the head, and fell down. I was not quite unconscious. I tried several times to get up, but I could not, for I had very bad pains in the head and a confused feeling in it, too. I remember also that a wheel ran over my foot, and that I got a sharp blow in the chest. Then I was unconscious for about an hour. When I awoke, there were two comrades busy over me and they pulled me back of the firing-line. Then I got to a field hospital.”
The man arrived at the nerve hospital (Jena), October 8, 1914, with insomnia, respiratory disturbance, sudden perspiration, feelings of cold in the right foot, and poor appetite. He had had nausea for a few days. Lungs and heart proved normal. X-ray of the right foot showed normal relations. The man was a small, powerfully-built man, well nourished, with lively reflexes, especially the knee reflexes, of which the right was greater than the left; slight patellar clonus, right; left plantar reflex greater than right; segmental disorder of touch and pain sense in the right foot and lower leg, a zone of analgesia lying above the zone of total anesthesia. Gait was lame on account of inability to move the right ankle joint. In walking, the right foot was trailed.
Treatment was suggestive and supported by active gymnastic exercises, breathing exercises, exercises in moving the right leg, massage, faradism and local hydrotherapy. The gait gradually improved, the cold feeling disappeared from the right leg, disturbances of pain and touch sense disappeared. The patient was released on the 2d of February, 1915, capable of garrison duty.
With respect to this man, who was married, he was from a healthy family and had healthy children. He is said, however, to have suffered from convulsions for a long time in early life, but thereafter had never been sick in any way. He was a good student and had been a post-office official since 1908. After two years’ military service, he became, in 1910, Unteroffizier-Aspirant. Later he was advanced to his subaltern position in the reserve.
This case seems to be a characteristic example of segmental disorder of sensations of both touch and pain, combined with a paresis in the same region. Mechanical and mental factors seem to have been present, and the case belongs in what Binswanger calls the “hysterosomatic” group.
Re Binswanger’s so-called hysterosomatic group, he defines the cases as having emotional, mechanical, and toxic (gas) factors. On the whole, they are best classified as a kind of psychoneurosis. Binswanger finds all physical and drug treatment without result except as supportives. He has used hydrotherapy and electrotherapy with the perfectly clear conception that the procedures were of suggestive value only. In fact, Binswanger had before defined such procedures as Realsuggestionen or material suggestions. Common verbal suggestion, says Binswanger, will work sometimes only when aided by these material suggestions. See also under [Case 576].
Post-traumatic (ANTEBELLUM) seizures with unconsciousness: Further seizures, astasia-abasia, anesthesias, following no special period of stress in field service. Recovery by reëducation.