Shell-shock and other neuropsychiatric problems

A corporal, 39, had been working under shell fire at barbed-wire entanglements. The man was big and robust, but much depressed, complaining of noises in the head, pricking pains, unsteady legs, fatigue, irritability, loss of confidence. He showed tremors of arms and legs on movement, and stood unsteadily with eyes closed. He said: “My legs have been very unsteady, especially when some one is looking at me. They must have thought me drunk at times.”

The head and tongue were tremulous, the knee-jerks exaggerated, the soles insensitive to touch and pain; but sensibility to deep pressure was retained. There was a gradual return of right answers on further trials, aided by comparison with effects of stimuli applied to the dorsum of the foot. Though he gave correct replies on heat and cold tests over the arms, he gave wrong answers over the dorsum of the feet, less often over legs, sometimes over thighs.

Later during examination, the feet became tremulous. He felt a “silly childish fear,” and his hands began to feel cold and clammy; whereupon he began to reply hot or cold when the tubes were not applied at all (temperature hallucinations). There were apparently pain hallucinations in the soles and errors in response to the compasses.

Re the temperature hallucinations noted by Myers, these are to be distinguished from true vasomotor disorders. Babinski believes that he has definitely established that, though hysteria may cause a slight thermo-asymmetry, yet never a definite vasomotor or thermic disorder.

Re hysterical pains, the most frequent are probably those of hysterical pseudo sciatica, in which true signs of sciatica are absent, namely, (1) loss of Achilles jerk, (2) scoliosis, (3) Lasègue’s sign (pain on thigh flexion with leg extension), (4) Neri’s sign (with trunk bent forward, affected knee flexed), and (5) Bonnet’s sign (pain on thigh adduction).