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Shell-shock and other neuropsychiatric problems

Chapter 523: Case 488. (Ravaut, August, 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.

Favorable effects of lumbar puncture.

Case 488. (Ravaut, August, 1915.)

An accountant, 20, in the 135th infantry sustained shock from mine explosion near his trench, March 6. He was kept two days at the relief station. March 8, at the ambulance, he did not appear to understand questions and had a fixed stare. He complained of a violent headache and kept pressing his head between his hands. He kept looking about him anxiously, and the slightest noise made him jump. He would mutter a few incomprehensible words, and in reply to a question would give only the last phrase which he happened to have been saying. Lumbar puncture showed a very slight excess of albumin. Next day, he answered his name. March 12, he could speak in monosyllables, and he began to understand what was said. After the lumbar puncture, the headache disappeared and did not set in again. March 13, he began to be able to write and say short phrases. March 16, expression was good though hesitant, and the patient wrote a letter to his parents, telling about his shock. Lumbar puncture showed that the albumin was now normal. From the rear, April 5, the patient sent Ravaut a postcard in perfect form, telling how he was ready to go back to the front.

Re lumbar puncture, Imboden quotes Podmanizky as having used lumbar puncture as a method of suggestion for the cure of abasia. See also cases 560 and 561, in which Claude cured two cases of dysbasia by the device of stovaine anesthesia of the spinal cord. Pastine also has a case in which a slight improvement was produced on removal of cerebrospinal fluid, and a sudden and complete cure was brought about by the second puncture, a very painful tap. Pastine’s case is thought by him (1916) to be in part at least organic.