Shell-shock and other neuropsychiatric problems

by Elmer Ernest Southard

The patient was a rather tall man of slender build, with a slightly accentuated second pulmonic sound, decidedly increased tendon reflexes, weak plantar reflexes, and many points painful on pressure in various parts of the head, over the spine, and in the sciatic regions. The vertebral sensibility to pressure was most acute in the region of the third, fourth, and fifth thoracic vertebrae. There was a marked dermatographia. There was no other sensory disorder and no motor disorder of the arms, though the left hand-grasp was weak. All passive movements could be successfully carried out with the legs. Upon bending at the hip, there were subjective feelings of tension in the posterior parts of the thighs. In active motion there was a marked limitation in leg movements, which appeared to be executed with great difficulty with but small excursion and with considerable trembling. The knee-joint could be flexed only when the sole of the foot had support. The lower leg could not be extended. The excursion in the joints of the feet and toes was slight. Muscular strength was in general decreased. There were no feelings of pain in muscular action but merely feelings of great effort. Gait was slow, shuffling, unsteady, hesitating and only possible with support. Fatigue set in after a few steps. In walking, the legs could hardly be bent at the knee. The soles of the feet dragged on the ground. The patient was unable to stand upright, and when placed upon his feet, anxiously and stiffly clung to some support. Without support, he fell over backwards. When supported he could move his legs at the hip and lift the feet from their base by bending the knee-joints. The patient could not sit in a chair or in bed except with support; otherwise he would fall to the right side. In dorsal decubitus he complained of pain in the loins.

With this hysterical picture, treatment of a psychotherapeutic nature was carried out. The patient was given methodical exercises in walking and standing, during which affirmative suggestions about his new capacity to walk and stand were given with monotonous repetition.

For the first fortnight he walked with the support of two nurses for a half hour every day. He was very industrious and willing to execute this treatment; and later began to exercise with a cane. Two days later, he omitted the cane and found himself able to walk about without support. He was shortly able to stand without swaying, although for some time the walk was upon a rather wide base and somewhat slow and suggestive of spastic paresis.

The general condition of this patient remained good. His appetite and sleep were good. After the middle of March, 1915, there were no more peculiarities in walking, and the patient was able to take somewhat long walks in the city and vicinity. He applied for work in the airship division, for which he already possessed some experience.

The youth appears to have been of a normal mental and bodily development, though his mother is said to have been nervous and a sister died of convulsions in childhood.

Shell-shock with loss of consciousness: Deafmutism, rhythmic head movements, anesthesia, asymmetrical areflexia. Recovery by suggestion with faradism, massage and reëducation.

Case 588. (Arinstein, September, 1916.)

A Russian private, 30, literate, lost consciousness upon the explosion of a large shell, November 10, 1915. He was brought to hospital, November 14, completely deaf and dumb, and with his head rhythmically swaying sidewise 60 to 70 times per minute. The swaying ceased during sleep. The head was carried inclined to the right; there was complaint of headache. The left leg, the trunk and the hairy part of the head were anesthetic. The knee-jerks were obtained with difficulty, the Achilles jerks were lively; the throat and conjunctival reflexes were absent; the abdominal and cremasteric reflexes were lively. The right plantar reflex was absent; the left normal. The vision of the right eye was impaired, and there was a monocular diplopia of this eye. The drum membranes were pulled in, and the disorder of hearing was explained on the basis of labyrinthine shock.

After a séance of written suggestion with faradism to neck and small palate and vibratory massage to throat, speech returned. November 26, the patient read in a loud voice a written phrase. He did not speak again independently until early in December, when he read aloud written matter. The return of spontaneous speech was gradual. Hearing returned December 5, when he was able to hear in the right ear by means of a tube. In the sitting posture there was less swaying of the head. If the patient lay down, rhythmic movements of the head became stronger and more rapid (120).