The next series of cases ([Cases 274-281]) are to illustrate the contentions of Babinski concerning the elective exaggeration of reflexes under chloroform, and the conception of reflex or physiopathic disorders based thereon—a topic to which return is made in [Section C on Diagnosis], and elsewhere. A small group of cases ([Cases 282-285]) illustrate the delay of Shell-shock and kindred symptoms in certain instances, cases that suggest a refractory period of greater length than usual, or the interposition of some unusual factor.
The next group of cases ([Cases 286-301]) is of special note, bringing out what is discussed below, namely, the emphasis, reminiscence, or repetition of antebellum phenomena, and the picking out of weak spots in the organism by Shell-shock. Possibly [Cases 302-303] belong in the same group of illustrations of the driving in of ante-bellum effects. Cases [304] and [305] are definitively cases in which hereditary instability is a factor, whereas Cases [306] and [307] form a foil to these, in that the phenomena develop in subjects confidently stated to be without hereditary or acquired psychopathic tendency.
The next series of cases ([Cases 308-320]) shows peculiar phenomena; e.g., monocular diplopia, shell-shock psoriasis, synesthesia, puerilism, and the like. Shell-shock equivalents of various sorts are placed in a group of cases ([Cases 321-325]). The next series of cases ([Cases 326 to the end of this Section: 370]) show tendencies to general neurasthenic, psychasthenic, and other psychopathic phenomena, rather than the more definite phenomena discussed in the early part of this section in the series arranged “cephalad.”
50. Rehearsing more briefly these findings, what is the nature of these disorders? The literature is practically unanimous on the point: We have to do merely with the classical problem of the neuroses, and when all the data are some day united, we shall doubtless know a great deal more about the neuroses.
51. Locus minoris resistentiae. That the process, whatever else it does, is rather apt to pick out pre-existent weak spots in the patient (the habitual gastropath becoming subject to vomiting; the old stammerer stammering once more or even becoming mute; the man always “hit in the legs” by exertion, now becoming paraplegic) is obvious. The striking instances in which an old cured syphilitic monoplegia, or an old hysterical hemichorea, comes back under the influence of shell explosion in precisely the limits and with precisely the appearance of the former disease, indicate how various a factor may be the locus minoris resistentiae.
52. But, without weak spot, without acquired soil, without heredity, we must now erect the hypothesis that, the classical neuroses may in some, though certainly a minority of cases, afflict normal men. Under the war conditions of investigation touching the family and personal histories of the men, perhaps we should not be too sure of this hypothesis; but the army records will after the war allow us to make or break the point forever and thereby throw the clearest light upon the vexing problems of industrial medicine, wherein progress in general has been so slow on account of the partisanship of the corporation and plaintiff’s attorneys.
53. Purely psychogenic war cases exist: Though Shell-shock denotes, to say the least, shocks and shells—yet we know Shell-shock sans any shock and sans any shell, nay sans either shell or shock.
The fact that a soldier may get war dreams though he has never been in the fighting zone and never by any chance observed the circumstance of war, or the fact that a man can become mute on the second day after a shell explosion because the night before he had dreamed of some hysterically mute patients in his ward—these facts again, although they argue a psychogenic origin for the phenomena of so-called “Shell-shock,” do not at all mean that actual physical explosion in other cases may not be tremendously important.
54. This is shown by the exceedingly interesting phenomena of localization or determination of symptoms to a given region under the special local influence of the explosion. Thus, in the schematic case, an explosion to the left of the soldier produces anesthesia and paralysis on the left or exposed side. Now and again a case will show such anesthetic and paralytic phenomena upon the side exposed to the explosion and some hypertonic, irritative phenomena upon the other side. One gets the figure in one’s mind of an organism fixed, immobile and numb, on the spot by the explosion—and the other half of the body, as it were, attempting to run away from the situation. One side of the body, as it were, plays ’possum, the other tends to flight.