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_ epilepsy in the army, Lépine notes the serious theoretical and
practical problems to which it gives rise. In the first place, epilepsy
occurs in the army more frequently than in the same number of men in
civilian life. Consequently, the diagnosis as to the really epileptic
nature of the attacks observed is not too easy. Again, the situation
affords much opportunity for simulation (see, for example, the case
of sham fits (Case 78, Hurst), and the case of epileptoid attacks
controllable by the will (Case 79 of Russell)). Wounds may produce it,
and even wounds which do not affect the brain; besides which, a variety
of war conditions, short of trauma, may produce it. When the ordinary
impulsiveness of the epileptic turns into automatism and to epileptic
equivalents (_états seconds_), much of medicolegal interest may
happen. Case 58 was just short of a murderer. Cases of actual murder
in epileptic equivalents have been known under military conditions.
Fugues with amnesia for the phenomena (which look to the military man
like intentional desertions) form another group of epileptic events;
but aside from the manias and the fugues, there are still more dubious
epileptoid phenomena of a delusional and confusional nature, such that
the proof of epilepsy comes only afterward, when frank convulsions
supervene. _Re_ fugues and desertion (the most frequent of military
delinquencies according to Régis), we may think of the fugue reaction,
according to Lépine, as a natural reaction on the part of both the true
delinquent and the mentally sick subject. The loss of liberty, alcohol,
fatigue, minor phenomena of _commotio cerebri_, may lead to states
of mental depression that favor the fugue. It is an affair of the
greatest delicacy for the expert to build up again the exact plight of
the soldier at the time of his desertion. Special inquiry must be made
of the man’s mates. Only in this way can the wheat be separated from
the chaff and punishment allotted to those only who deserve it.
According to Lépine, there are fewer guilty fugitives than there are
innocent ones, or at least partially innocent ones. In the decision,
one takes account of the duration, the course, and the peculiarities
in the termination of the suspicious flight. According to the military
code, there are cases like Case 58 in which the fugue itself was
carried out in an unconscious state, and yet in which the martial
responsibility of the man was absolute. Drunkenness is no excuse for
the fugue, even if the latter is automatically carried out. Of course,
the paretic is not responsible for his fugue any more than the organic
dement, the delirious uremic, or the chronic alcoholic, who is already
severely demented. For a case of this sort, see Case 1 (Briand).
In the differential diagnosis, we must also consider that fugues may be
carried out in confused states as well as at times in various paranoid
states, and even in melancholia.
A disciplinary case: Epilepsy.
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