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Shell-shock and other neuropsychiatric problems

Chapter 566: Case 533. (Nonne, December, 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.

Shell-shock, slight injury, unconsciousness: Astasia-abasia: Recovery under hypnosis, two séances.

Case 533. (Nonne, December, 1915.)

A musketeer, without neuropathic taint and without nervous symptoms before the war (parents both dead of tuberculosis, eleven brothers and sisters died young), saw four comrades killed by a shell October 27, 1914. The musketeer himself was slightly injured superficially in the back. He remained unconscious for three hours and on coming out showed general tremor of the body, felt pressure in the head, was lachrymose and unable to walk or stand. He was subject to insomnia. He was in four different hospitals, finally reaching Eppendorf. Diagnosis rendered at the first hospital and carried on through the others was hemorrhage into the spinal canal.

For two months at Eppendorf he lay in extension. He was then examined by Nonne, who found general neuropathic habitus, pronounced “cramp neurosis” in the lower extremities, psychogenic astasia-abasia, hyperidrosis of the lower extremities, marked cyanosis of feet and lower legs, increased tendon and skin reflexes, pseudoclonus, no Babinski or Oppenheim reflexes. The man complained of pressure in the head, sleeplessness, a feeling of depression and hopelessness. Pulse 120-130.

Hypnosis proved easy. After the first treatment the man stood and walked and showed no tremor. The next day the hypnosis was repeated and the cyanosis of the legs disappeared. Sleep on the second night was good. Appetite returned and the man fell into a good emotional state. Thereafter the patient was intentionally ignored by the physicians and could soon not be distinguished in any respect from the other non-nervous convalescents.

This case is expressly stated by Nonne to resemble in all respects those formerly described by Oppenheim as “traumatic neurosis.”