Camptocormia - another disease blamed on conversion disorder

Recently, I randomly came across yet another poorly understood disease that was once blamed on psychogenic factors:

I wonder which branch of pseudo-scientific nonsense peddled by charlatans just after WWI brought this about...

 

Do we have a comprehensive list of these somewhere? Should probably add it there.

How nice would it be to have a mega class action lawsuit against doctors for the harm they've caused patients through psychologizing illness? Don't know how realistic it is though.

 

I have written a paper on Camptocormia in the past, having studied a case in an elderly woman.

I don't think the article is very accurate and I don't think we should dismiss the very likely explanation that during WWI camptocormia was a manifestation of post-traumatic stress disorder. If you had been to the trenches and had all your friends blown to bits around you , you might well end up with a psychiatric disorder that included this, just as soldiers developed tremors or inability to speak.

Camptocormia as seen nowadays is in fact due to failure to contract the hip extensors - the gluteal muscles. The lumbar spine does not flex a huge amount anyway. In camptocormia the person is more or less bent at right angles at the hips so that the whole body is horizontal. It occurs in the elderly with gluteal muscle wasting although I could not find evidence about whether that was primary or secondary. It is not due to generalised muscle weakness and does not occur in polymyositis or genetic myopathies as far as I know. Apparently significant numbers of servicemen in WWI developed a grossly bent posture. It is virtually never seen in young men now. I am not sure that their posture was the same as seen nowadays and from photographs looks to have included spinal rather than just hip flexion. It may well have been a quite different condition. I think PTSD or something similar is a very likely basis.

 

How does PTSD relate to posture? I don't get it. Plenty of people have PTSD nowadays and none of them have this posture problem as far as I can tell? Is it because soldiers were often ducking in the trenches?

 

They noted the patient was receiving secondary benefits, that is, constant reassuring parental attention and care [14].my god what criminals these parents are, reassuring their child, caring for them.... how utterly terrible! Lock em up i say!

 

That is certainly another way of analysing it. But if you were as terrified as people had a right to be I think it may become hard to draw a line between a 'fad' and something that people found taking over them. You could call it malingering but if you are being expected to return to a likely horrible death malingering starts to be a doubtful concept.

Head injuries are common enough nowadays and they do not produce camptocormia as far as I know.

It is probably better to forget the term altogether since there is unlikely to be much in common with recent cases and the syndrome that led to the name.

 

There are just too many variables affecting WW1 populations. One element that can't be discounted in any postural condition in 1914-18 is dietary insufficiency so that even in young adults osteomalacia & osteoporosis become relevant as does osteoarthritis where spinal damage sets in from prolonged mechanical stresses which ordinary soldiers were regularly subject to.

 

I don't really buy that. These are soldiers considered fit to fight in the first place. Certainly in those days people were stunted and had chest disease but they probably got better nutrition in the army than they had before. Osteoarthritis doesn't really exist as a disease. Spinal disc disease, which could well have been a problem, is often lumped in with it but doesn't produce camptocormia. I have assessed thousands of people with spinal disc disease and none had camptocormia. The only case I did see was an eighty year old woman and, as I said, the problem was actually in the glutei. The spine was not painful. You could not maintain the posture of camptocormia with dic pain.

 

Off topic but out of curiosity, roughly how many people did you see during your practice that most definitely had ME?

 

I can think of one, or maybe two, over thirty odd years.

It is an interesting question. I have to assume that in general PWME are not referred to rheumatologists. On the other hand my paediatric and adolescent service colleagues saw a lot - but they were part of the regional Great Ormond Street service.

The other thing is that one of my colleagues had an interest in disorders thought to have a psychological component so he may have had all the referrals. Later on in my practice I saw a relatively high proportion of people with rheumatoid arthritis although I still saw general problems like frozen shoulder and back pain.

 

I couldn't find references to this as being a common finding in subsequent wars. Vietnam, Iraq, Afghanistan have all lasted longer than WW1 and WW2. That suggests something different about the environments. Perhaps as Hutan said it was the frequent artillery bombardment, more than the IEDs and small arms fire that were more common in the later conflicts.

Also, I wonder whether it was more common for the soldiers to be flexed while moving in the trench warfare of muddy fields, rather than fully prone or semi-hunkered, but then moving more upright in jungle/urban/desert environments.



There were conflicting views in 1990.

Camptocormia (1990, Br J Psych) said —

Camptocormia (1990, Military Med) said —

 

I wasn't clear, I didn't mean I was supporting what we now understand as camptocormia as being the condition that affected WW1 soldiers, just that there are so many confounders that it's difficult to make any certain finding of what might have been behind any given postural pathology.

It's true that by the early 20thC the British Army had a reasonably sound grasp of basic nutritional need, although of course the more detailed understanding of the role of individual vitamins and minerals was to follow WW1. The notional allocation of food per soldier certainly met calorific need however what was available in barracks could be very different to what was available on the front lines and there's good reason to think that many soldiers regularly failed to have the 3,000+ calories a day it was estimated they required. Also the overall quality of food delivered from kitchens way behind the front lines to those men in the trenches was often reported as poor. So while some soldiers from less wealthy backgrounds could have been 'built up' under the army regime, equally there will have been periods when many front line soldiers were exposed to chronic poor nutrition. Add in the many afflictions of digestion, including stress induced anorexia (difficult to build an appetite when surrounded by corpses) as well as the rife Trench Fever, then a portion of soldiers may have been effectively malnourished. And for those on the Western Front many lived a subterranean existence that actually kept them out of the sun raising the possibility of Vitamin D deficiency. And of course a week at time spent in a dug out, relieved only by hours hunched on a firing step might well induce an occupational stoop.

Selection processes should have kept less fit men out the ranks altogether or streamed the less physically capable to non front lines duties however at various points in the war recruitment was chaotic and/or desperate and the quality of soldiers engaged in fighting certainly didn't match the regulations over all the four years of war - witness the number of 'boy soldiers' including 14 - 16 year olds, who made it through selection to end up in combat roles when they should never have left UK territory. The scale of what we now call PTSD certainly was never recognised, and no doubt many postural symptoms could have been psychological responses but with individual soldiers exposed to everything from combat fatigue, to blast injury, to gas (4 varieties), to typhus, to syphilis, to influenza I'm not sure how it is possible to parse any one causation or contributor from any other.

I thought this paragraph from an essay on Souques was interesting:

"In 1915, Souques coined the term ‘camptocormia’, with Mrs. Rosanoff-Saloff, to describe the stooped posture of the trunk, disappearing on lying down, in soldiers injured during trench warfare [10]. They assumed the disorder could be caused by organic injury, but also by neurosis. Indeed, some soldiers had camptocormia from mental stress in anticipation of the battle, while others were afraid to suffer again from a previous spinal injury."

The key point seemed to be that the ‘camptocormia’ was not the primary reason for hospitalisation but were under medical care because they had been injured, including spinal injury.