Shell-shock and other neuropsychiatric problems : $b Presented in five hundred and eighty-nine case histories from the war literature, 1914-1918Southard, Elmer Ernest
History
Shell-shock and other neuropsychiatric problems : $b Presented in five hundred and eighty-nine case histories from the war literature, 1914-1918
Southard, Elmer Ernest
War neuroses; World War, 1914-1918 -- Medical care; World War, 1914-1918 -- Psychological aspects
He quickly got well of his scalp-wound but remained in hospital,
very weak, extremely impressionable, jumping at every noise. He got
somewhat better with the rest in bed, though even a month after his
hallucination, he had a spell of insomnia, thinking about his future
and the possibility of a relapse, and having war dreams from which he
would awake in a sweat. Once on awaking, he distinctly heard a voice
saying, “_Well, Charles?_” This hallucination occurred five times,
under exactly the same circumstances, except that once it was in the
daylight. Adrenalin was given, 1:1000, 10 drops the first day, 20 the
second, 30 the third, and a like amount on the following days. After
three days of such treatment, the patient said he felt much better.
Later he had a period in which he had lost self-control and could no
longer take any initiative. Thus, if he wanted to reply to his mother,
it seemed to him that some one not himself was ordering him to write.
He now asked himself if he were not really dreaming. He would not be
sure of his actual existence unless something happened to prove it,
such as the nurse’s bringing him a plate.
In short as the first phase of diffuse over-emotionality had been
succeeded by a second of obsessions, so the obsessive phase was
succeeded by a third phase of mild loss of the feeling of reality.
The first phase following the wound was one of disorder of attention,
of memory, and in fact of all the mental functions, associated with
tremors, tachycardia and dizziness. The second phase seemed, as it
were, to crystallize intellectually the anxious apprehensiveness of the
first phase. There were fears that the ceiling would fall; there were
scruples concerning the past; there were fearful premonitions for the
future (such as, that any bomb he might pick up would burst). According
to Laignel-Lavastine and Courbon, there may have been a predisposition
in the vegetative system of this subject, or even a basis in his
tuberculosis, of which, in fact, the X-ray showed still some slight
evidences. The obsessions appeared at night, at a time, namely, when
the vital rhythm is passing from a sympathotonic period over into a
vagotonic period, at a time when the organic sensations are apt to swim
to the fore. According to this analysis, these somatic sensations,
precisely those that the battlefield had also brought out, brought out
again the other emotions which he had felt on service. It was always
the emotions first developed in military service that were revived in
the disease. In the third phase, the physical condition of the patient
had grown much better _pari passu_ with disappearance of the obsessions
and the onset of the personality disorder. The adrenalin raised
arterial tension, and going down to the sympathetic caused the anxiety
and war emotions linked therewith to disappear; but the adrenalin
treatment, according to Laignel-Lavastine and Courbon, disturbed the
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