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Shell-shock and other neuropsychiatric problems

Chapter 572: Case 539. (Podiapolsky, August, 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.

Appendix operation: Post-operative retention of urine. Relief by hypnosis.

Case 539. (Podiapolsky, August, 1917.)

A soldier, 32, operated for appendicitis, had a post-operative retention of urine. Hypnotic suggestion was requested to reëstablish excretion of urine before resort should be had to the catheter.

Somnambulistic amnesia was obtained at once and without questioning him P. suggested to him directly that he must feel the need of micturition. The suggestion was unsuccessful. However, bearing in mind psychogenic obstacles of an unknown nature, P. questioned the patient as to sensations and learned that in the operation the skin had been burned about the urinary passage and that the patient feared micturition. Besides this, micturition was painful on account of the wound above the appendix. The patient also feared that the sutures would yield.

Accordingly assurance was given that the burned parts would be insensible and that the bladder could be emptied without effort and without endangering the sutures. Analgesia was produced by a few passages of the hand upon the bed clothes. Complying with post-hypnotic suggestion the patient urinated after a quarter of an hour of sleep, and in thirty-six hours retention was relieved.

With respect to frequency of immediate somnambulism for the first trial, P. states that, although authorities set the percentage of successful immediate somnambulisms at 17-20 per cent, war conditions yield three or four times as high a percentage. The war has produced a suitable soil for hypnotism. Hypnosis is impossible in from 1½ to 2 per cent of cases.