Shell-shock and other neuropsychiatric problems

by Elmer Ernest Southard

The hysterical psychosis of an Adventist ([Case 172]) might be regarded as liberated by military service; the terrible fear of the guns shown by the psychoneurotic ([Case 173]) proceeded to the point of fugue. A Shell-shock victim whose war bride was pregnant, developed fugue with amnesia and mutism ([Case 174]). Under hypnosis, it appeared that his fugue began with his running away from shells. [Case 175] was that of a neurasthenic who volunteered and had to be sent back from the front after three months. In this case, war dreams were supplanted by sex dreams, and the fear of insanity became ingrained. The phenomena here were largely ante-bellum and the war brought them out once more, as might other disturbing experiences.

[Case 176] is here introduced to show that neurasthenia may develop in a man without hereditary taint or acquired soil. There was a very slight shrapnel injury of the skull, which somewhat clouds the diagnosis in the case. Five months’ war experience brought out the neurasthenia. [Case 177] deals with a point in the diagnosis of psychasthenia, which, according to Crouzon, shows arterial hypotension, a condition important to distinguish from that of pulmonary tuberculosis and of Addison’s disease. Compare this case with [Case 169]: a case of depression treated by pituitrin. [Case 178] is a case of psychasthenia following several months’ service by a man who probably should never have entered military service.

Another case of ante-bellum origin is [Case 179]. Antityphoid inoculation appears to have been the initial factor in the case of neurasthenia [No. 180]. Compare [Case 65], epilepsy after antityphoid inoculation. [Case 181] was that of a non-commissioned reserve German officer whose neurasthenia was distinguished by sympathy with the enemy. He did not want to let his men shoot at the enemy because the idea came forcibly to him that the enemy soldiers had wives and children. This symptom of sympathy with the enemy was also shown by another German ([Case 229]). Compare the sentiments of a Russian under narcosis ([Case 555]).

To sum up concerning the small group of psychoneuroses presented in the section on Psychoses Incidental in the War, we are dealing with cases in which the phenomena are either continuous with ante-bellum phenomena, or are of such a nature that they might well have been brought out by other factors than those of war. These cases by the design of their choice throw little or no light upon the relation of physical shell-shock or its equivalent to the psychoneuroses, though in a few instances the factor of shell explosion is not entirely to be excluded, and in one instance ([Case 170]) a hallucination may be regarded as a virtual equivalent of an emotional shock of great compelling power.

Examples are available of hysteria (Cases [171], [172], [173], [174]), of neurasthenia (Cases [175], [176], [179], [180], and [181]), and of psychasthenia (Cases [177], [178], and possibly [170]).

49. Let us now contrast with these specified ante-bellum or non-war cases the situation which will face us in the war group.

[Section B] contains 174 cases ([Cases 197-370]). Autopsied cases ([Cases 197-201]) are put first and are followed by cases in which lumbar puncture data are available ([Cases 202-207]). A third group of cases is that in which so-called organic symptoms are much in evidence, either independently or in association with functional symptoms ([Cases 208-219]). There follows a small group of three cases with shrapnel wound ([Cases 220-222]), in which hysterical symptoms were prominent, as against the prevalent and correct conception that wounded cases are not so prone to psychoneurosis as non-wounded cases. Three cases specially marked by tremors ([Cases 223-225]) follow, the last of which gives the victim’s (a French artist) own account of his feelings. The next two cases (Cases [226] and [227]) give respectively a German and a British soldier’s account of Shell-shock symptoms.

There then follows a great group of cases ([Cases 228-273]) arranged according to the part of the body chiefly affected by hysterical symptoms. The arrangement is one of toe to top, or as one might more technically say, cephalad. This cephalad arrangement naturally begins with cases with symptoms affecting one leg or foot ([Cases 228-235]). Then follow cases of paraplegia ([Cases 236-241]). As we proceed cephalad then follow four cases of the so-called hysterical bent back, or camptocormia (Souques). Then come walking disorders ([Cases 246-248]). Still proceeding cephalad, disorders of one arm and hand are considered in a series of six cases ([Cases 249-254]). Bilateral phenomena, symmetrical or asymmetrical, follow in [Cases 255-258]. Now reaching the head, we deal with cases of deafness ([Cases 259-260]), of deafmutism ([Cases 261-263]), of speech disorder (Cases [264] and [265]), with two special cases (Cases [266] and [267]). Eye symptoms are dealt with in a series of cases ([Cases 268-272]), and [Case 273] deals with cranial nerve disorder supposed to be due to shell windage without explosion.

The idea of the above arrangement of 46 cases ([Cases 228-273]) is that the reader dealing with cases of hysterical disorder due to physical shell-shock, or some equivalent thereof, may inspect the data in a few analogous cases described more or less fully in the literature. By reference to the index, the reader will be able to find still further cases to illustrate the symptom in question.