Shell-shock and other neuropsychiatric problems

by Elmer Ernest Southard

A German youth of 19 volunteered at the outset of the war as a motor cycle rider. About the end of October, he was hurled from his wheel by a shell which struck close beside him and exploded, knocking his back against a pile of beams. He lost consciousness. There may have been hemorrhage.

He came to, two hours later, in the dressing station, hardly able to move his limbs. Such movements as he could make were painful. There was an evident contusion of the back. He had a fainting fit after his bath in the field hospital and then could get to bed only with support. Severe pains in the legs, especially in the knee.

In the reserve hospital, there was a second similar fainting spell, followed by buzzing in the head, feelings of pressure in the chest and an irregular pulse; all of which phenomena disappeared the morning after the fit.

A careful examination about the middle of November showed the persistence of a severe paresis of the left arm, and a less marked motor weakness of the right arm. Both legs were paretic, and there were no spontaneous movements of the leg. This paresis of the legs was combined with complete anesthesia and analgesia. Sensory impairment was found only in the right arm and trunk, and there was no evidence of sensory impairment in the left arm. Both motor and sensory disturbances of the arm disappeared rapidly.

However, at the beginning of December, 1914, the complete insensibility of the lower extremities up to the groin still persisted. The anesthesia then began to retreat, so that four days later, the upper limit of anesthesia was somewhat below the groin. There could be found a circumscribed area of anesthetic skin over the os sacrum up as far as the second vertebra of the os sacrum; but the skin around this area, as well as over each tuber ischii, gave normal sensation.

The anesthesia continued to retreat: to the middle of the thigh at the middle of December; to a level 3 cm. above the knee-cap at the end of December; to the upper end of the knee-cap on the right side and the middle of the left knee-cap, January 1. January 11, the anesthesia had retreated to a level 10 cm. below both right and left patella. February 8, sensibility in the legs had entirely returned.

While the anesthesia was pursuing this favorable course, the motor symptoms failed to improve to any marked extent, although active motion of the legs with the patient in dorsal decubitus had gradually returned to a limited degree.

The diagnosis upon arrival at the Jena Nerve Hospital was “rheumatism of the left side of the body and dislocation of the spine.”

The treatment consisted at first of rest in bed and moist dressings of the legs, but the treatment had to depend greatly upon the diagnosis. The patient complained of difficult micturition; yet there were no other positive signs of organic disease, of spine or cord.

Hysteria was the diagnosis preferred to rheumatism, despite the fact that examination at the Jena Hospital failed to show any disorder in pain or tactile sense.