Читать книгу Shell-Shock and Other Neuropsychiatric Problems - Elmer Ernest Southard - Страница 90

To illustrate an epileptic theory of Shell-shock; three cases:

1. Fugue; minor symptoms: later, epilepsy.

2. Epileptic confusion eight months after explosion.

3. Mine explosion: stammering replaced by mutism; mutism replaced by epilepsy.

Case 82. (Ballard, 1917.)

Atmospheric concussion from shell explosion, October, 1915, was followed by unconsciousness in a soldier described by Ballard.

Blindness for a month followed recovery of consciousness. “Neurasthenia” (anxiety neurosis) after return of sight. Apparently nearly complete recovery after latent period of a few weeks. Return of blindness in one eye in December. Five days automatic wandering (the man was found in a west country town five days after leaving home to rejoin his dépôt and seen by a medical officer who reported that he was dazed and amnestic for that period); admission to second Eastern General Hospital, December 15.

On admission he proved to be suffering from minor hysterical symptoms such as an inability to open his eyes and to see clearly when the lids were raised. The symptoms rapidly cleared up under suggestive conversation and did not return except for amnesia and slight emotional depression. He remained well until December 25. On that day he began for the first time to have definite epileptic fits and nocturnal epileptic delirium. In January he was discharged as an epileptic. There was no epileptic temperament or feeblemindedness. Finally, there had never been any personal or family neuropathic or psychopathic history.

Case 83. (Ballard, 1917.)

A soldier was blown up, April, 1915, and had a spell of unconsciousness. Later, pains in the head, slight amnesia and a condition of asthenia developed.

He was eventually admitted to the second Eastern General Hospital at Brighton, January, 1916. At the time of admission he was semiconscious, stuporous, confused, disoriented, anxious in a dull sort of way, talking about his expectation of “a sailor with a card.” Speech was intelligible, though fragmentary and infrequent. The man obeyed commands but gave no replies to questions. The mental processes were slow and impaired.

According to Ballard, we have here a case of epileptic confusion, eight months after the initial concussion. This particular attack ceased three days later, leaving amnesia for the attack and a certain amount of mental retardation. The man was not epileptic in temperament and his personal and family history proved negative.

Case 84. (Ballard, 1917.)

A soldier was buried in a mine explosion, October, 1915, and for several days thereafter was unconscious or semi-conscious. He emerged deaf and subject to stammering and a condition termed “neurasthenic.” The stammering was soon replaced by mutism, which lasted several weeks. The mutism was then supplanted by epileptic fits.

He was observed by Ballard in a dreamlike, disoriented and inaccessible state, in which he was anesthetic to pin pricks, lay awestruck, dumbly following with his finger hallucinatory airplanes. Flexibilitas cerea was also shown at this time.

Next day he emerged from the dreamlike state with mental processes somewhat slowed, disorientation for time, amnesia for the attack, memory disturbance and a return of the stammer. On the next day following, all these symptoms had disappeared except amnesia for the attack. Another spell of epileptic fits occurred later. It seems that the man had had a convulsion thirteen years before and occasional convulsions since. In fact, he, seven years before, had had what was called “a stroke” and residuals of a slight hemiplegia were still present. (There is no statement in the case report relative to syphilis.)