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
_Re_ the neurology of gas poisoning, Neiding regards the condition as
a new nosological unit. We do not know what the ultimate results of
apparently cured cases will be. Court questions of importance will
doubtless arise with reference to their compensation. Ninety-six
of Neiding’s 274 cases failed to show any nerve symptoms whatever;
forty-six cases showed one symptom only, such as headache, dizziness,
abnormality of reflexes, or abnormality in sensation. One hundred and
thirty-two cases presented a fairly full picture. The picture of a
complete traumatic neurosis not infrequently appears, aided perhaps by
the psychic features of the gas attacks; and possibly some cases are
entirely psychogenic from the beginning. Such symptoms, for example, as
dermatographia, rapid and irregular heart, hyperidrosis, blepharospasm,
mental perturbation, hypochondria, etc., do not necessarily point to
any directly toxic effect of the gases. Thirty-seven of Neiding’s cases
showed pupillary changes, hyperreflexia, and analgesia. Thirty-one
showed analgesia and absence of laryngeal and corneal reflexes.
Twenty-six showed pupillary changes and hyperreflexia, four of these
latter showing also an absence of laryngeal and corneal reflexes. One
case yielded hyperalgesia alone; ten yielded headache, dizziness, and
analgesia.
GASSING: Mutism, tremors, depression, battle dreams.
=Case 216.= (WILTSHIRE, June, 1916.)
An infantryman, aged 27, had been at the front for three months. He was
wounded a month before coming to hospital; but when the wound healed he
went back to the front, quite mute but intelligent and able to write
the following:
“We were on our way to the trenches, and as we were going
through the railway cutting they started to shell us, with gas
shells mostly, and we had not been there more than quarter
of an hour when I was compelled to lie down from temporary
blindness and weakness through getting a dose of gas through my
mouth and eyes. I was lying down for about ten minutes when a
shell came somewhere near, and was struck by something in the
face and on my left knee and I remembered no more until I found
myself in hospital. I was all of a shake and while lying down
would frequently jump up and wonder where I was.”
The patient had been mute thereafter, depressed, and given to dreams
about fighting and shells. There was a fine tremor controllable by the
will; the knee-jerks were increased. On lateral deviation, there was
difficulty in fixing the eyes. There was a slight deafness due to an
old discharging left ear. According to Wiltshire, Shell-shock is only
exceptionally caused by chemical poisoning from gas.
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