General Nature of Shell-shock
Project Gutenberg EPUB3 edition
Southard, Elmer Ernest
87.Differential between Reflex (Physiopathic) Contracture and Paralysis, and Hysterical Contracture and Paralysis. Babinski, 1917.
Reflex
Hysterical
1. Paralysis usually limited but severe and obstinate even when methodically treated.
1. Paralysis usually extensive but superficial and transient if treated.
2. In the hypertonic forms attitude of the limb does not correspond to any natural attitude.
2. The hysterical contracture as a rule resembles a natural attitude fixed.
3. Amyotrophy marked and of rapid development.
3. Amyotrophy, as a rule, absent, even when the paralysis is of long standing. If existent, it is not marked.
4. Vasomotor and thermic disorder often very marked, accompanied by an often very pronounced reduction in amplitude of oscillations measured by oscillometer.
4. There may be thermo-asymmetry but it is slight. There are no very characteristic vasomotor disorders nor modifications in amplitude of oscillations.
5. Sometimes very marked hyperidrosis.
5. No sharply defined hyperidrosis.
6. Tendon reflexes often exaggerated.
6. No modifications of tendon reflexes.
7. Hypotonia sometimes very well marked, and in arm paralysis main ballante.
7. Hypotonia absent.
8. Mechanical over excitability of muscles, often accompanied by slow response (?).
8. Over-excitability of muscles absent.
9. Fibrotendinous retractions of rapid development except in the rare completely flaccid forms.
9. No retractions even if paralysis is of long duration.
10. Trophic disorders of bone, decalcification of the hairs and of the phanères.
10. No trophic disorders.
88. The section on Shell-shock diagnosis contains 102 cases (Cases 371-472). These cases differ in no respect from those of Section B except that many of them are more puzzling and dubious and have been presented by their reporters more from the standpoint of diagnosis than from that of etiology or therapeutics. In general arrangement, the cases roughly correspond to those of Section B. First are four cases illustrating the value of lumbar puncture data (Cases 371-374). There follow cases with either a mixture of organic and functional symptoms, or such a constellation of symptoms as might readily lead to erroneous diagnosis (Cases 375-381). Retention and incontinence of urine after shell-shock are illustrated in Cases 382-384. Crural monoplegia, monocontractures, and other affections of one leg are shown in Cases 385-392; but these monocrural cases are in many respects peculiar or even unique as compared with the monocrural cases of Section B. Peculiar paraplegias or spasms affecting both legs are found in the series 393-395. Then follow (Cases 396-400) other cases of doubtful spinal cord lesion or shock, including several with dysbasia. Camptocormia, astasia-abasia and abdominothoracic contracture are found respectively in 401, 402, and 403. Affections of one arm follow (Cases 404-409). An assortment of peculiar cases in which the differentiation between hysteria and structural disease is in question, is found in Cases 410-415.
Peripheral nerve injuries of a sort which might be confused with Shell-shock phenomena, including one of light tetanus, are considered in Cases 416-419. A variety of cases bearing upon the question of the reflex or physiopathic disorders of Babinski is found in the series of Cases 420-432. Peculiar eye phenomena are presented by Cases 433-438; and cases of otological interest are 439 and 440. Epileptoid, obsessive, fugue, and amnestic phenomena follow in Cases 441-450; 451 and 452 are cases of soldier’s heart. The simulation question is presented in a series of 20 cases (Cases 453-472).
Source notes
[12] More energetic contraction of platysma on healthy side when mouth is opened or when head is flexed against resistance.