34. The cure by studied neglect (in [Case 67]) is one of hystero-epileptic convulsions occurring in series. [Case 68] demonstrates the superposition of hysterica phenomena over a genuine epilepsy, a case therefore with two diagnoses: not hystero-epilepsy, but epilepsy and hysteria.
35. The theoretical implications of [Case 69] are striking: The case was one of musculo-cutaneous neuritis (gross enlargement), in association with which Brown-Séquard’s epilepsy developed, waxing and waning with the disease of the nerve. Another case of possible reactive epilepsy is [Case 70], and a case of epilepsia tarda brings up the same issue ([Case 71]). [Cases 72-74] are cases with strong psychogenic components, of which [Case 74] is particularly instructive on account of the gradual building up of a remarkable visual aura of an approaching fire-wheel, this aura developing after scotoma from looking at the sun. Cases [75] and [76] are cases of somewhat doubtful epilepsy, one of fugue and the other of a solitary epileptic episode following 38 artillery battles in two months.
36. Friedmann discusses narcoleptic seizures, regarded as due to the brain fag of trench life ([Case 77]). Sham fits and epileptoid attacks controllable by will appear in Cases [78] and [79] respectively. [Case 80] is a striking case of a man with epileptic taint, which two years’ service, four wounds, the death of a father and five brothers, and eventually Shell-shock and burial thrice in one day, served at last to bring out.
37. Shell-shock and bodily disease. In civilian psychopathic hospital practice, if a case is not syphilitic, not feeble-minded, not epileptic, not alcoholic, and without signs of intracranial pressure or disorder of reflexes, then we, as specialists, must consider whether the disease in question is not due to some form of bodily disorder outside the nervous system; for example, we think in practice of infectious psychoses, of exhaustive states such as the puerperium, of toxic states such as may be found in cardiorenal cases, and of glandular phenomena such as we are familiar with in the thyroid disorders.
Under the war conditions, it might be thought that these somatic disorders yielding the so-called symptomatic mental diseases would be frequently found.
Aside from these rarities in puzzling diagnosis, we find more commonly in the literature evidence of
38. The soldier’s heart, the so-called “D.A.H.,” or disordered action of the heart, of the English army reports. This soldier’s heart is sometimes associated with hyperthyroidism, and sometimes hyperthyroidism is found alone, with symptoms suggesting those of a sort of diffuse Shell-shock.
One author claims rapid cures of hyperthyroidism by the relatively simple process of hypnosis. Perhaps this is not too unlikely in view of the still obscure relations between mind and hormones. A little more surprising, perhaps, is the assertion met with that psoriasis is sometimes a Shell-shock phenomenon.
The literature clearly shows, however, that, as in most special problems, the internist is still in demand. I recall how one internist was misled on the witness stand into stating that he was a “general specialist.” This is what we would all need to be, were we to solve the problems of Shell-shock in the time allotted to us by the war.
39. Following are special cases to show how near the somatic (“symptomatic”) may be to Shell-shock.