It is doubtful whether shell-shock and burial had anything to do with the appearance ten days later of lipomata, which proved to be the initial phenomenon in a pronounced Dercum’s disease. ([Case 141]).
Hyperthyroidism is illustrated in four cases ([Cases 142-144]). The first ([Case 142]) appears to have been cured by inducing deep somnambulism (Tombleson claims cures by suggestion in eight cases of hyperthyroidism). Neurasthenia or questionable Graves’ disease ([Case 145]) followed Shell-shock. That of [Case 144] followed 10 months’ service, at times under protracted shell fire. A forme fruste of Graves’ disease is shown in [Case 145], in which the phenomena followed gassing and shelling.
A somewhat curious somatic complication in a case of Shell-shock hysteria was the finding of a needle in the left upper arm, which was then extracted. ([Case 146]).
The Nature of War Neuroses
40. Regarding our rough delimitation of the Shell-shock group as well in hand, having put upon one side three of the most disturbing groups (save one) in our process of demarcation, we must proceed to the Shell-shock material itself: a material now definable as assuredly non-syphilitic, non-epileptic, non-somatic,[11] as beyond question without narrow relations with feeble-mindedness, alcohol and drug states, schizophrenia and cyclothymia, and as probably of the general nature of the psychoneuroses.
[11] In the limited non-encephalic sense of the term somatic (“symptomatic”) of some writers.
Note that in this epicrisis I have designedly not followed the order of presentation of the text materials. The process of diagnosis per exclusionem in ordine which I find most serviceable in civilian psychopathic hospital practice is the elimination of possibilities in the order presented in [Chart 1] or in [Paragraph 10] of this epicrisis. Because this book will find its greatest use in peace times as a kind of illustrative commentary on the peace material that presents itself in general practice or in psychopathic hospital voluntary, temporary-care, and out-patient practice, I chose to arrange the delimiting material according to the order of the practical key devised for civilian practice. We may now profitably change our order of consideration and consider whether
41. The most practical key or sequence of consideration in the endeavor to delimit Shell-shock neuroses is probably: Exclude (1) syphilis, (2) epilepsy, (3) somatic disease (of a sort able to produce “symptomatic” effects somewhat like those of Shell-shock).
Below I shall still permit myself some general words concerning the other more easily excluded groups because of the light which feeble-mindedness, alcoholism, schizophrenia, cyclothymia, and even old age can theoretically throw on the nature of Shell-shock.