466 



NATURE 



Fi bruary 13, rgrg 



tional in nature, and he was admitted to Seale 

 Hayne Hospital. The condition was explained to 

 him, the muscles oi the leg were re-educated, and, 

 with :i little persuasion, he was able to run with- 

 out noticeable limp in a quarter of an hour's time. 

 A very important class ol case is where the 

 soldier lias received a bullet wound in the arm 

 or hand, and months later the whole limb ma) 

 ii Found paralysed. The hand may be absolutely 

 flaccid, or the fingers have become still ami rigid, 



smooth, blue in colour, and even wasted. It was 



ins,,] that the disability was out ..I propoi - 



lion to the wound, and it was until leeenth 

 looked upon by many as tin- result of reflex irrita- 

 tion. 



It has been found, however, that these pases 

 yield surprisingly quickly to psychotherapy. The 

 hysterical, flaccid paralysis occurs where the 

 patient is convinced that he is paralysed and has 

 given up trying to use his muscles. There may 

 have been a temporary loss of power with a splint 

 applied lor an unnecessary length of time, or the 

 man may have found at first that he experienced 

 less pain if he kept his limb absolutely motionless. 



The spastic paralysis of a hand or arm is fre- 

 quently explained by the patient contracting: both 



his flexor and extensor muscles at the same time. 

 The more lie tries to bend his fingers, the more 

 rigid they become. The cause of the apparent 

 trophic changes is due to tin- altered blood supply 

 brought about by the lack of movement in the 

 former case, anil by the continued spasm in the 

 other. It is of interest to note that a hand thrown 

 completely out of action for a year or more may 

 recover its function after a leu minutes' treat- 

 ment. 



Main soldiers have been invalided out ol the 

 Armv with a high percentage of disability as .1 

 result of gas poisoning, though many of these are 

 quickly curable by appropriate treatment. 



The commonest symptoms persisting alter this 

 injur) are loss of voice, blindness, and vomiting. 

 Any pne of these conditions may he met with 

 main months alter the original onset. When a 

 i^as shell explodes, in addition to possible in- 

 juries from concussion, the gas is liable to set 

 up inflammation of the larynx, intense irritation 

 of the eves, and vomiting from the absorption of 

 poison in the stomach. After three or four 

 weeks these symptoms have in most cases disap- 

 pi ed. When, therefore, many months later, 

 itient is still whispering, the diagnosis of 

 hysteria should at once be considered. 



The man during the acute stage oi laryngeal 



iirilation has been unable to speak, and rightl) 

 may not have attempted to do so. The frequent 

 examinations and the treatment by inhalations and 

 sprays convince him still further that his con- 

 dition is a serious one; he eventually loses control 

 over the musculature of his vocal apparatus, and 

 is content to whisper. I hie, again, with explana- 

 tion and persuasion, he recovers his voice in a 

 few minutes. Scores of such cases are on record 

 at Seale Hayne Hospital. In ;i series of sixtv- 

 seven consecutive cases it was found that the 



XO. 2572, VOL. I02] 



average length of time they had been under treat- 

 ment, before admission there, was 205 days- tlu 

 maximum being nineteen months, and the mini- 

 mum two weeks. Those were .all rapidly and per- 

 manent!) lined, the majority taking onl) a lew 

 minutes' time. 



Hysterical blindness, following inflammation of 

 tile conjunctivae, is usually caused by spasm or 



ii. a cid paralysis of the muscles of the eyelids, just 

 as in those' ol the aim after a wound. In this 

 condition, however, the mechanism <>f accommo- 

 dation or focussing has also been affected. 

 Dramatic eases of cure have been obtained of this 

 condition, and no doubt the one quoted at the 

 beginning of this article was one of these. 



The writer was fortunate in seeing a case 

 treated by l.t.-Col. Hurst and Capt. Gill. Tin 



patient in question had been blind since 1 « ) 1 -f as 

 the result of an explosion in France. At the end 

 ol 1918 a doctor eventually recognised the con- 

 dition as probably functional in nature, and found 

 that the interior of the eyeball was normal. The 

 pensioner, with all the appearance of the typical 



Street beggar, was led up to hospital. As the 

 result of his four years' blindness his hearing and 

 intelligence had been affected, and he appeared 

 extremely dull-witted. Twenty-four hours later 



this man was scarcely recognisable, for, with the 



recovery of his sight, his power of hearing also 

 returned, and he appeared alert and happy. In 

 this case the recovery was not instantaneous, for, 

 owing to the length of time his eyes had been 

 functionless, some hours elapsed before his pupil 

 reflex .and accommodation 'acted normally. 



Persistent vomiting after gas poisoning may 

 be c plained as a hysterical perpetuation of symp- 

 toms, and has been found readily~amenable to 

 ps) ' hotherapy. 



The bent back after burial from explosion, when 

 there are no symptoms of organic disease, 

 although the patient persists in walking like an 

 old man with the aid of two sticks, is a condition 

 not infrequently met with. He is convinced he is 

 unable to stand erect, in spite of the fact that 



there is no curvature of the spine when he is 

 lying in the recumbent position. If persuasion 

 and explanation fail in bringing- about recovery, 

 Lt.-Col. Hurst adopts the plan of making- the 

 patient lie upon a board with a foot-piece. This is 

 gradually raised to a right angle, and the patient, 

 who finds himself standing' in the erect position 

 the first time, perhaps, for many months — is told to 

 walk- forward. The rapidity of the cure, its appa- 

 rent simplicity, and the surprise of the patient 

 give rise to a situation not without a certain 

 elc men! k > I humour. 



These are onlv a few examples ol war neuroses. 

 Details of treatment depend upon the individual 

 case, hut it may be added that the atmosphere 

 of (ure that prevails in a neurological hospital 

 is a most powerful factor in recovery. A dis- 

 abled soldier, coming in contact with others 

 already cured, becomes more hopeful about his 

 own condition, and is the more likely to derive 

 benefit from the treatment adopted. 



