Case 571. (Hewat, March, 1917.)

A reënlisted soldier arrived at the Royal Victoria Hospital, as a case of ulnar paralysis. He had been wounded in France six months before by a bullet which passed through the fleshy part of the shoulder, above the middle third of the clavicle. Power in the right arm gradually diminished; yet two months after the wound he seemed fit enough to be sent to Egypt. The paresis developed, and in a month’s time he was invalided home. He had been unable to use a rifle for months.

The healed bullet wounds were found about the region of the brachial plexus. The patient was sure the bullet had damaged the nerves in that region. The right arm and hand were limp and over-inclined to blueness, and the muscles were flabby. Active movements of all sorts could be carried out with the arm but not against resistance. There was a definite anesthesia and analgesia throughout, and responses to touch and pain stimuli were irregular.

By way of treatment, the patient had the muscles of the paretic arm stimulated electrically, and at the same time he was told that no nerve of the neck had been injured. He was greatly surprised to see his palsied arm move vigorously.

A milk isolation treatment in bed behind screens was adopted, whereat the patient was angry, looking upon the Weir-Mitchell treatment as punishment.

On the next day, another electrical application secured complete power in the arm and abolished sensory disturbance. Three days later the man went back to full duty. According to Fergus Hewat, someone doubtless had suggested to this patient that he had received a nerve injury. He had become obsessed thereby and developed a typical functional paralysis. This was a “cortical misinterpretation,” which disappeared upon forcible demonstration of the error.