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Fall and blow to head: Hysterical convulsions. Cure by studied neglect.

Case 67. (Clarke, July, 1916.)

Clarke had seen in the war but one case of hysterical convulsions, though this particular patient had severe hystero-epileptic fits occurring in series. The man had never suffered from epilepsy and was 20 years of age. He received a slight wound and fell back into the trench a distance of six feet, striking but not contusing the back of his head.

On admission to the hospital he was found drowsy and dull. Fits occurred a week later, following one another at brief intervals in series that lasted one or two hours. The arms would be raised and extended in clonic spasm; the patient would resist violently if held, and then turn to his right side with rigid extension of legs and back in opisthotonos. The eyeballs underwent irregular movements, and there was a well marked hippus. Though the tongue was protruded in these attacks, it was never bitten. It was doubtful whether there was a complete loss of consciousness. Between attacks, the patient was morose and sullen, and showed a varying incoördination of the movements of the left leg, which was anesthetic to the knee. There was also a glove anesthesia of the right forearm and hand. Fields of vision were contracted.

The fits recurred with intervals of a day or two, for a fortnight. The patient was then strictly isolated in a small room with an observation window. His bed was made up on the floor. He then had very slight attacks, as a rule when the nurse came into the ward; no notice was taken of these attacks and in a fortnight they ceased. The paresis of the leg and the anesthesia also cleared up without treatment. He remained in the general ward three weeks longer, at first dull and listless, but later cheerful and active. Clarke suggests that this patient was below normal intelligence.