Shell-shock and other neuropsychiatric problems

by Elmer Ernest Southard

Here and there throughout the book will be found references to symptoms and syndromes which will have a particular interest for the reader—soldier’s heart, trench foot, congealed hand, tics, tremors, convulsions, sensory areas variously mapped, and forms of local tetanus, the last being distinctly to be differentiated from pithiatic contractures and those due to organic lesions of the nervous system. Cases of an affection described by Souques as camptocormia, from Greek words meaning to bend the trunk, were shown to the Neurological Society of Paris in 1914 and later, the main features of this affection being pronounced incurvation forward of the trunk from the dorsolumbar region, with extreme abduction and outward rotation of the lower limbs, pain in the back, and difficult and tremulous walking. In some of these cases, organic lesions of the trunkal tissues were present, but in addition psychic elements played a not unimportant part, and the cases were restored to health by a combination of physical measures with psychotherapy, enforced by electrical applications.

The part of this book given over to [the discussion of treatment] will doubtless to some prove the most interesting section. The presentation of the subject of therapeutics is in some degree a discussion also of diagnosis and prognosis; and so it happens in various parts of the volume that the particular subject under consideration is more or less a reaffirmation or anticipation of remarks under other headings.

Similar results are brought about by various therapeutic procedures. Nonne, Myers, and a few others bring hypnosis into the foreground, although non-hypnotic suggestion plays a larger rôle by far.

Miracle cures are wrought through many pages. Mutism, deafness and blindness, palsies, contractures, and tics disappear at times as if by magic under various forms of suggestion. Ether or chloroform narcosis drives out the malady at the moment when it reveals its true nature. Verbal suggestion has many adjuvants and collaborators—electricity, sometimes severely administered, lumbar puncture, injections of stovaine into the cerebrospinal fluid, injections of saline solution, colored lights, vibrations, active mechanotherapy, hydrotherapy, hot air baths and blasts, massage, etc. Painful and punitive measures have their place—one is inclined to think a less valuable place than is given them by some of the recorders. In some instances the element of suggestion, while doubtless present, is overshadowed by the material methods employed. Persuasion and actual physical improvement are in these cases highly important. Reëducation is not infrequently in evidence. The patient in one way or another is taught how to do things which he had lost the way of doing.

It is interesting to American neurologists to note how frequently in the reports, especially of French observers, the “Weir Mitchell treatment” was the method employed, including isolation, the faradic current, massage, and Swedish movements, hydrotherapy, dietetic measures, reëducative processes, and powerful suggestion variously exhibited, especially through the mastery of the physician over the patient. It is rather striking that few records of Freudian psychoanalytic therapy are presented.

When all is said, however, counter-suggestion and persuasion, in whatever guise made use of, were not always sufficient and this not only in the clearly organic cases, but in those which are ranked under the head of reflex nervous disorders. In these the long-continued use of physical agencies was found necessary to supplement the purely psychic procedures, these facts sometimes giving rise in the Paris Society of Neurology and elsewhere to animated discussion as to the real nature of the cases. The pithiatic features of the case at times disappear, but leave behind much to be explained and more to be accomplished. The cures wrought are not always permanent and in some cases post-bellum experiences may be required to prove the real value of the measures advocated. The reader must study well the detailed records in order to arrive at just conclusions; nevertheless, the tremendous efficacy of suggestion and persuasion stands out in many of the recitals.

Perhaps the author may permit the introducer a little liberty of comment. His non-English interpellations, especially Latin and French, may be regarded by some as overdone or perhaps pedantic, but are rather piquant, giving zest to the text. Diagnosis per exclusionem in ordine is sonorous and has a scholarly flavor, but does not prevent the reader who lives beyond the faubourgs of Boston from understanding that the author is speaking of an ancient and well-tried method of differential diagnosis. Passim may be more impressive or thought-fixing than its English translation, but this to the reader will simply prove a matter of individual opinion. Psychopathia martialis is not only mouth-filling like Senegambia or Mesopotamia, but really has a claim to appreciation through its evident applicability. It is agreeable to note that the book seems nowhere to indicate that psychopathia sexualis and psychopathia martialis are convertible terms.

The [bibliography] of the volume challenges admiration because of its magnitude and thoroughness and is largely to be credited, as the author indicates, to the energy and efficiency of Sergeant Norman Fenton, who did the work in connection with the Neuropsychiatric Training School at Boston, resorting first-hand to the Boston Medical Library and the Library of the New York Academy of Medicine. After Sergeant Fenton joined the American Expeditionary Force, Dr. Southard greatly increased the value of the bibliography by his personal efforts.