(a) gross, or (b) microscopic, or perhaps (c) chemical.
DYNAMOPATHIC (functional, irritative, inhibitory,—but reversible ad originem):
(a) psychopathic; (b) physiopathic (“reflex”).
58. As to the high psychic functions, we had thought of them as split in hysteria, in dissociation of personality. And we had roughly distinguished these conditions as psychopathic from conditions we called neuropathic, regarding the latter neuropathic disorders as on the model of the effects of cutting off or destroying certain necessary neurons. However clear or unclear we were as to the nature of the neuropathic, it does not here matter. Babinski’s point is that there is another kind of dynamic disease that operates, not after the manner of hysteria, but after a manner reminding one of the forgotten “reflex” disorders of Charcot—disorders that fitted the textbooks so poorly that the textbooks dropped them out. In short, what you might call the dynamopathic or functional in nervous disease has been shown to fall into two parts—a psychopathic fraction and a non-psychopathic fraction. Babinski calls this non-psychopathic fraction physiopathic or reflex. And these reflex or physiopathic disorders have a different order of curability from that of hysterical or psychopathic disorders. By what simple device did Babinski prove this? By chloroforming the patient. Under chloroform, when all the other reflexes were stilled, Babinski could bring out, in relief as it were, certain reflexes, or even hypertonuses, that were in the waking life wholly concealed,—yet at the same time consciousness, in the usual sense of that term, had vanished. Accordingly, the proof of a new type of functional disease, at times concealed by the overlay of higher neurones, was now plain. Does not this offer new leads of the greatest value in that most intricate of fields, psychopathology? Is not the model here offered of diseased nervous functions, non-psychic in nature (in the ordinary sense of psychic) but of almost equally complex nature:
Whoever wins the great war from the military point of view, there can be no doubt as to what writers contributed most from the war data concerning the doctrine of hysteria, especially concerning the theoretical delimitation of hysteria from other forms of functional nervous disease: There can be no other answer than that, in theoretical neurology at least, the French have already won the war, if only by means of the remarkable concept set up by Babinski of the so-called physiopathic (that is, non-neuropathic and non-psychopathic).
But how has this splitting of functional neuroses into psychopathic and physiopathic been rendered certain? By the tremendous modern sharpening of differential diagnosis dating from, e.g., the discovery of the Babinski reflex. This brings us to the brink of considerations concerning the differential diagnostic problem.
First it may be well to regard the whole problem in the light of those mental diseases that we slid over when we were delimiting Shell-shock as against syphilis, epilepsy and somatic disease.
59. Why do some authors think of Shell-shock as an “officer’s disease”? It is clear that they cannot be thinking so much of the physiopathic cases as of the psychopathic ones. But psychopathic conditions are obviously more readily brought about in complex and labile apparatus. This point comes out strongly in relation with the comparative stability of the feeble-minded, at least of most feeble-minded, that get into war relations.
The possible relations of Shell-shock to feeble-mindedness are of some interest. We know that Shell-shock picks out certain nervous and mental weaklings and indeed that one author claims as high a percentage as 74 for war neuroses having a hereditary or acquired neuropathic basis. How far does feeble-mindedness itself count among these supposedly susceptible nervous and mental weaklings? Is a feeble-minded person especially in condition for Shell-shock?
There are rumors of experiments to show that if in an aquarium containing some jelly fish alongside bony fishes, you explode a substance, the jelly fish ride through unscathed whereas the bony fishes are killed by the shock. The jelly fish presumably had too simple an organization.