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Shell-shock and other neuropsychiatric problems

Chapter 336: Case 311. (Oppenheim, July, 1915.)
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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.

Kick in abdomen by horse: General spasticity; tremors; eye symptoms (e.g. monocular diplopia); convulsions. Improvement.

Case 311. (Oppenheim, July, 1915.)

A cuirassier was kicked by a horse on left side of abdomen, November 24, and lost consciousness. A month later, in hospital, hardness and tenderness to pressure of abdominal wall, spastic muscles everywhere, pseudospastic tremor of legs, and complaints of double vision were noted. He also had attacks of convulsions, in which he became unconscious, twitchings appeared, but the tongue was not bitten. Urine was often involuntarily passed in these attacks, but he was not always continent outside attacks, as, for instance, in coughing.

On admission to nerve hospital: Right-sided monocular diplopia; mild ptosis; ocular movements free. Rapid tremor on shaking hands. Stood with straddling legs affected by vibrating tremor. Knee-jerks considerably increased. In the dorsal position movements of the left leg were accompanied by marked tremor. He even could not go to sleep easily on account of twitching of the left leg.

His comrades observed that he had convulsions at night, and often spoke in his sleep. Inoculation against typhoid fever was made early in December. Later, permanent rise of temperature to 37.8. Several attacks, lasting about ten minutes, came under observation of the physician.

In January, progressive improvement in the motor sphere and also psychically. The urinary disturbance likewise disappeared, but the spasms persisted.