Shell-shock; shell-wound; emotion: Hysterical paraplegia. Approximate recovery.
Case 236. (Abrahams, July, 1915.)
A private of the First East Lancs could remember a shell’s bursting and striking a wagon near him when he was carrying food to the firing-line. He also thought a spare wagon wheel might have fallen on him. A period of unconsciousness of four or five days duration elapsed, on recovery from which he found himself suffering from a shell-wound in the left buttock, complete paralysis of both legs, and pain in the back, by the fourth lumbar vertebra. He thought that he had suffered from sphincteric paralysis for eleven days after the accident; but by September 25, there was no sign of this. Besides the paraplegia, there was complete loss of sensation below Poupart’s ligament in the right leg, reaching as high as the iliac crest behind; and an anesthesia of the left foot including heel and sole, with anesthesia to light touch throughout the limb (pin-pricks being appreciated in a normal way as far as the ankle); and there was an anesthesia to touch and pain in the ulnar distribution.
April 20, 1915, the patient was found to be a robust, somewhat microencephalic slowly cerebrating subject. Total flaccid paralysis of legs; right knee-jerk slightly exaggerated; no plantar response of any sort was obtainable. Right leg entirely anesthetic; left leg and both arms showed a diminution of sensibility; suggestion of glove and stocking anesthesia; trophic changes absent. The scar of the healed bullet-wound lay over the trunk of the left sciatic nerve.
It seems that the man’s companion had both his legs blown off at the time the shell burst. It is questionable whether the paraplegic patient actually saw the legs blown off, or merely heard about the accident. Another psychic feature lay in the fact that the patient had a paralyzed sister—a possible financial burden.
April 30, nitrous acid anesthesia. During the temporary rigidity, the legs were found to stiffen slightly; the legs were flexed. Upon the return of consciousness, the patient was told that the legs had moved during anesthesia, and was asked to place them in a more convenient position. The thighs moved slightly, and throughout the day movements were encouraged against resistance.
The next day he was gradually raised to the vertical position and supported upright. But at this stage he had become mentally resistant and resentful. During the day the upright position was at intervals resumed, and the patient was made to walk between two attendants. The next day he walked alone and his mental resistance had broken down. There was no longer any evidence of exhaustion and effort in the movements, and the patient began to take pleasure in his recovery.
Improvement was progressive. A pronounced hysterical element persisted, encouraged by the perpetual attentions of visitors. When discharged, there was a slight hemi-anesthesia throughout the right side, and a doubtful patch of anesthesia on the dorsum of the foot, sole, and plantar surface of the heel.