Case 489. (Reeve, September, 1917.)

A soldier, 28, was thrice wounded between August 18, 1914, and July 14, 1916. The third time, a bullet passed through the fleshy part of the forearm, whereupon the hand became clenched and remained so after the wound was surgically healed. As a case of war neurosis, the man was treated by electricity, massage, passive movements, and fixation in a straight splint during a period of nine months, without result. He was admitted to Maghull Military Hospital, April 18, 1917.

Two days after admission a treatment was given whose principle consists in producing a condition of fatigue in the muscles responsible for contracture. This fatigue is produced by continuous passive movements in a direction opposed to the normal action of the muscles in question. Many hours of forcible movement are sometimes necessary in the case of the more powerful muscles before the limp, toneless fatigue condition is brought about. Relays of men are told off for this purpose. Patients are got to assist in the work, particularly such as have been cured by the treatment. Also, the patient is himself told about the nature of spasms and the relief which the method will bring. This patient was told that after the flexor muscles were fatigued they would no longer be able to pull the fingers into the clenched position, whereupon the antagonistic muscles on the back of the forearm would begin to work.

The fingers were forcibly opened without interruption for six hours, in each case as soon as the fingers closed into the palm. In a few hours they began to return more slowly, and at the end of the six hours remained extended. The extended position was still found the following morning. The extensor muscles were feeble in action, but improved day by day. The spasm did not return. The patient was discharged July 2, 1917, about two and a half months after admission to Maghull. The hand was now strong and useful.