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
As to the heredity of this soldier nothing is known. He had been
an illegitimate child; he was a sleep-walker in childhood; he had
sometimes spoken out loudly in sleep as a boy. At school he had been
somewhat backward, fought readily with his mates, and often complained
of dizziness and headaches. He could not stand smoking or drinking
well, getting drunk upon two glasses of beer. He had not held positions
well. He became a _pionier_ in 1914, working chiefly as a tailor.
Early in his time as a soldier he had obtained an ulcer of the glans,
which had been excised and burned. There had been no secondary symptoms.
According to Bonhoeffer, this is an example of a not infrequent
condition. Although the attack itself and the habitus of the patient
did not look hysterical, the manner in which the attacks repeated
themselves speaks for psychogenic components. Just as genuine
hysterical attacks may be looked on as reactions to unpleasant
situations, so may these attacks. In fact, we are probably dealing
with an hysterical fixation of the symptoms of emotional fright like
those in the true hysterias following shell explosion. A great many of
the phenomena of Shell-shock, to use the English phrase, are not in
and of themselves of a psychogenic nature, but they are, according to
Bonhoeffer, psychogenically liberated under the influence of unpleasant
ideas.
_Re_ reactive epilepsies, Bonhoeffer considers that there is a group
of reactive epilepsies in which the war process plays an important
part. The prognosis of these cases ought to be relatively favorable. In
point of fact, Case 57, although a feebleminded subject, seems to have
had a relatively favorable prognosis: at all events, no new seizures
appeared under prolonged medical observation. These reactive seizures
may occur in cases with a labile vasomotor system. They are, according
to Bonhoeffer, aligned rather more with hysteria than with genuine
epilepsy. Genuine epilepsy has not been developed in the war cases
observed by Bonhoeffer except where an endogenous factor was clearly
in evidence; or else where there was the requisite antebellum soil for
the development of an epilepsy. In short, genuine epilepsies developing
in the war are all, according to Bonhoeffer, predispositional. The
antebellum soil was clearly in evidence in Case 57. Even before the
war, according to Bonhoeffer, many German soldiers during the period
of military service gave evidence of their epileptic soil by sundry
suspicious phenomena. Among these were fainting spells during hard
drilling and other exercises, spells of enuresis, abnormally deep
sleep, and even phenomena of somnambulism. One of the Bonhoeffer
epileptics had been released during his reservist practice as unfit for
military service, and had only been put into the line at his own urgent
request at the outbreak of the war. Three volunteers concealed their
epileptic history. One man, who had had merely petit mal attacks before
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