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Shell-shock and other neuropsychiatric problems

Chapter 244: Case 219. (Smyly, April, 1917.)
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About This Book

The work assembles nearly six hundred clinical case histories drawn from wartime medical literature to document combat-related neuropsychiatric disorders. It presents concise case protocols illustrating varied symptom patterns, diagnostic dilemmas, malingering and simulation, therapeutic interventions, and treatment outcomes, and includes bibliographic references and introductory commentary. Sections juxtapose cases to illuminate contested diagnoses and to inform postwar rehabilitation and mental-hygiene efforts, aiming to provide clinicians and reconstruction workers with detailed clinical material for recognizing, classifying, and managing neuropsychiatric consequences of war.

Mine explosion: Tremors, mutism, hemiplegia. Tremors cleared by hypnosis. Mutism replaced by stuttering. Persistent hemiplegia, probably organic.

Case 219. (Smyly, April, 1917.)

A soldier was blown up by a mine and rendered unconscious. Upon recovery of consciousness, the patient was dumb, unable to work, very nervous, paralyzed as to left arm and leg. The paralysis improved so that in the hospital at home the patient became able to get about. However, he threw his legs about in an unusual fashion. Several months later the patient was much improved.

Shortly, there was a relapse. Transferred to a hospital for chronic cases, the patient was unable to walk without assistance on account of complete paralysis of the leg. There was insomnia, a general tremor, bad stuttering, and a habit of starting in terror at the slightest noise.

Hypnotic treatment was followed by almost complete disappearance of the tremor. The patient began to sleep six or seven hours a night; nervousness diminished, and the stuttering slowly improved; but neither the paralysis nor the anesthesia of the left leg was affected by suggestion. The leg remained cold, livid, anesthetic, and flaccidly paralyzed to the hip. A slight improvement has followed upon faradization but the patient still can walk only with assistance.

Smyly regards this case as probably not a true case of Shell-shock, depending as he states “more on a lesion in the nervous system than in the psyche.”