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SHELL-SHOCK AND OTHER NEUROPSYCHIATRY PROBLEMS
* * * * * *
THE
CASE HISTORY SERIES
CASE HISTORIES IN MEDICINE
BY
RICHARD C. CABOT, M.D.
Third edition, revised and enlarged
DISEASES OF CHILDREN
BY
JOHN LOVETT MORSE, M.D.
Third edition, revised and enlarged
Presented in two hundred Case Histories
ONE HUNDRED SURGICAL PROBLEMS
BY
JAMES G. MUMFORD, M.D.
Second Printing
CASE HISTORIES IN NEUROLOGY
BY
E. W. TAYLOR, M.D.
Second Printing
CASE HISTORIES IN OBSTETRICS
BY
ROBERT L. DENORMANDIE, M.D.
Second Edition
DISEASES OF WOMEN
BY
CHARLES M. GREEN, M.D.
Second Edition
Presented in one hundred and seventy-three Case Histories
NEUROSYPHILIS
MODERN SYSTEMATIC DIAGNOSIS AND TREATMENT
Presented in one hundred and thirty-seven Case Histories
BY
E. E. SOUTHARD, M.D., Sc.D.
AND
H. C. SOLOMON, M.D.
Being Monograph Number Two of the Psychopathic Department of
the Boston State Hospital, Massachusetts. (Monograph Number
One was A Point Scale for Measuring Mental Ability by Robert
M. Yerkes, James W. Bridges and Rose S. Hardwick. Published by
Warwick and York. Baltimore 1915.)
SHELL SHOCK AND OTHER NEUROPSYCHIATRIC PROBLEMS
Printed in five hundred and eighty-nine Case Histories
BY
E. E. SOUTHARD, M.D., Sc.D.
Being Monograph Number Three of the Psychopathic Department of
the Boston State Hospital, Massachusetts
* * * * * *
[Illustration: HORSLEY, 1857-1916]
[Illustration: DEJERINE, 1849-1917]
[Illustration: VAN GEHUCHTEN, 1861-1914]
IN MEMORIAM
SHELL-SHOCK AND OTHER NEUROPSYCHIATRY PROBLEMS
Presented in Five Hundred and Eighty-Nine Case Histories
from the War Literature, 1914-1918
by
E. E. SOUTHARD, M.D., Sc.D.
Director (1917-1918), U. S. Army Neuropsychiatric Training
School (Boston Unit); Late Major, Chemical Warfare Service, U.
S. Army; Bullard Professor of Neuropathology, Harvard Medical
School; Director, Massachusetts State Psychiatric Institute
(of the Massachusetts Commission on Mental Diseases); Late
President, American Medico-Psychological Association
With a Bibliography by Norman Fenton, S.B., A.M.
Sergeant Medical Corps, U. S. Army (Assistant in Psychology to
the Medical Director, Base Hospital 117 A. E. F.); late interne
in Psychology, Psychopathic Department, Boston State Hospital;
Assistant in Reconstruction, National Committee for Mental
Hygiene
And an Introduction by Charles K. Mills, M.D., L.L.D.
Emeritus Professor of Neurology, University of Pennsylvania
By Vote of the Trustees of the Boston State Hospital
Monograph Number Three of the Psychopathic Department
Boston
W. M. Leonard, Publisher
1919
Copyright, 1919, by
W. M. Leonard
To
THE NATIONAL COMMITTEE FOR
MENTAL HYGIENE
AND
ITS WORK IN
WAR AND PEACE
PREFACE
This compilation was begun in the preparedness atmosphere of the U.
S. Army Neuropsychiatric Training School at Boston, 1917-18. This
particular school had to adapt itself to the clinical material of the
Psychopathic Hospital. Although war cases early began to drift into the
wards (even including some overseas material), it was thought well to
supplement the ordinary “acute, curable, and incipient” mental cases of
the hospital wards and out-patient service with representative cases
from the literature.
As time wore on, this “preparedness” ideal gave place to the ideal of
a collection of cases to serve as a source-book for reconstructionists
dealing with neuroses and psychoses. Shortage of medical staff and
delays incidental to the influenza epidemic held the book back still
further, and, as meantime Brown and Williams had served the immediate
need with their _Neuropsychiatry and the War_, it was determined to
make the compilation the beginning of a case-history book on the
neuropsychiatry of the war, following in part the traditions of various
case-books in law and medicine.
With the conclusion of the armistice, there is by no means an end of
these problems. Peace-practice in neuropsychiatry is bound to undergo
great changes and improvements, if only from the influx into the
peace-community of many more trained neuropsychiatrists than were
ever before available. This is particularly true in the American
community by reason of the many good men specially trained in camp and
hospital neuropsychiatry, both at home and in the A. E. F., through the
enlightened policy of our army in establishing special divisions of the
Surgeon-General’s Office dealing separately with those problems.
Though a book primarily for physicians, some of its material has
interest for _line-officers_, who may see how much “criming” is matter
for medical experts, by running through the boxed headings (especially
of Sections A and B) and reading the simulation cases. As Chavigny
remarks, “shooting madmen neither restrains crime nor sets a good
example.”
But parts of the book look ahead to _Reconstruction_. Surely
occupation-workers, vocationalists, war risk insurance experts, and
in fact all reconstructionists, medical and lay, must find much to
their advantage in the data of Section D (Treatment and Results). Had
time permitted, the whole old story of “Railway Spine”--Shell-shock’s
congener--might have been covered in a series of cases from last
century’s literature, together with others illustrating the effects of
suggestion and psychotherapy; but this must be a post-bellum task.
The compiler, who has personally dictated (and as a rule redictated
and twice condensed) all the cases from the originals (or in a few
instances, _e.g._, Russian, from translations), hopes he has not added
anything new to the accounts. The cases are drawn from the literature
of the belligerents, 1914-1917, English, French, Italian, Russian,
and--so far as available here--German and Austrian.
I would call the collection not so much a posey of other men’s flowers
as a handful of their _seeds_. For I have constantly not so much
transcribed men’s general conclusions as borrowed their specific
fine-print and footnotes. The lure of the 100 per cent has been very
strong in many authors; but the test of fine-print, viz., of the
actual case-protocols, saves us from premature conclusions, and the
plan of the book allows us to confront actualities with actualities.
One gets the impression of a dignified debate from the way in which
case-histories automatically confront each other, say in Section C
(Diagnosis).
Obligations to the books of Babinski and Froment, Eder, Hurst, Mott
(Lettsomian Lectures), Roussy and Lhermitte, Elliot Smith and Pear,
and others are obvious. Yealland’s book came too late for sampling its
miracles, though cases of his in the periodical literature had already
been incorporated in my selection.
Some of the cases in Section A, I, had already been abstracted in
Neurosyphilis: Modern Systematic Diagnosis and Treatment (Southard and
Solomon, 1917).
What we actually have made is a case-history book in the newly
combined fields now collectively termed _neuropsychiatry_. The
more _general_ the good general practitioner of medicine, the more
of a _neuropsychiatrist_! And this is no pious wish or counsel of
perfection. Neuropsychiatry, mental hygiene, psychotherapy and
somatotherapy--all these will flourish intra-bellum and post-bellum,
in days of destruction and in days of reconstruction. And who amongst
us, medical or lay, will not have to deal in reconstruction days with
cases like some here compiled? A minor blessing of the war will be the
incorporation of mental hygiene in general medical practice and in
auxiliary fields of applied sociology, _e.g._, medico-social work.
Subsidies aiding publication are due to the National Committee for
Mental Hygiene; the Permanent Charity Foundation (Boston Safe Deposit
and Trust Company); Mrs. Zoe D. Underhill of New York; Mr. H. T. White
of New York; and Dr. W. N. Bullard of Boston--to all of these the
various military recipients of the book will be under obligations,
as well as others who would otherwise have had to pay the great
_majoration de prix_ due to war times.
Of those great dead contributors to neurology laid (in the Epicrisis)
at the feet of the neo-Attila, perhaps only Sir Victor was in a narrow
sense the Kaiser’s victim: still, but for the war, they might all
remain to us.
By the way, just as I found John Milton had said things that fitted
neurosyphilis, so also Dante is observed in the chosen mottoes to have
had inklings even of Shell-shock. To the _Inferno_ it was natural to
turn for fitting mottoes (Carlyle’s renderings mainly used). The pages
might have been strewn with them. A glint of too great optimism might
seem to shine--in the pre-Epicrisis motto--from the lance of Achilles
with its “sad yet healing gift;” but out of Shell-shock Man may get to
know his own mind a little better, how under stress and strain the mind
lags, blocks, twists, shrinks, and even splits, but on the whole is
afterwards made good again.
E. E. SOUTHARD.
WASHINGTON,
_November, 1918_.
INTRODUCTION
The duties of an introducer, whether of a platform speaker to an
audience, or of a writer to his anticipated readers, are not always
clearly defined. It has been sometimes said that the critic or reviewer
may meet with better success if he has not acquainted himself too
thoroughly with the contents of the book about which he writes, as in
that case he will have a larger opportunity to indulge his imagination,
but a critique thus produced may have the disadvantage of possible
shortcoming or unfairness. In the case of this volume, however, I have
felt it worth while to acquaint myself with its contents, no light task
when one is confronted with a thousand pages.
The great war just closing has done much to enlighten us as to the
causes, nature, outcome, and treatment of injuries and diseases to
which its victims have been subjected. The object of this book is
to present both the data and the principles involved in certain
neuropsychiatry problems of the war. These are presented in a wealth
of detail through an extraordinary series of case records (589 in
all) drawn from current medical literature, during the first three
years of the conflict. Case reporting is here seen at its best, and
the experiences recorded are largely allowed to speak for themselves,
although comments are not wanting and are often illuminating.
Many criticisms have been heard on the use of the term _Shell-shock_
as applied to some of the most important psychiatric and neurological
problems of the recent war; but that the designation has meaning will
be evident if Dr. Southard’s book is not simply skimmed over by the
reader, but is studied in its entirety. The symptoms of a very large
number, if not the majority, of the cases recorded, had for their
initiating influence the psychic and physical horrors of life among
exploding shells. As the author and those from whom he has received
his clinical supply not infrequently point out, in many cases it would
appear that purely psychic influences have played the chief rôle, but
in others physical injuries have not been lacking. Much more than
this is true: in many instances the soil was prepared by previous
defect, disease, or injury, or to use one of Dr. Southard’s favorite
expressions, “weak spots” were present before martial causes became
operative.
While the contributions to the medical and surgical history of the
war have been somewhat numerous in current medical journals and in
monographs, few comprehensive volumes have appeared. The reasons for
this are not far to seek. The conflict has been of such magnitude, and
the demands on the bodily and mental activity of the medical profession
have been so intense and continuous, that time and opportunity for
the careful and complete recording of experiences have not been often
available; but works are beginning to appear in the languages of all
the belligerent countries and these will increase in number and value
during the next lustrum and decade, although it may be that some of the
most important contributions will come after a decade or more is past.
The great work before me is one that will leave its lasting impress,
not only upon military but on civil medicine, for the lessons to be
drawn from its pages are in large part as applicable to the one as to
the other.
Looking backward to our Civil War, one is strongly impressed with the
fact that the present volume, one of the earliest works of its kind
to appear in book form, deals largely with psychiatry and functional
nervous diseases, whereas during and after the American conflict the
most important contributions to neurology related to organic disease,
especially as illustrated by the work of Weir Mitchell and his
collaborators on injuries of nerves. This is the more interesting when
it is remembered that Mitchell not very long after the close of the
Civil War became the most prominent exponent of functional neurology,
from the diagnostic and therapeutic sides. To him the profession the
world over has been indebted for the development of new views as to
the nature of neurasthenia and hysteria and new methods for combating
these disorders. In this fact is to be found matter for thought. Those
who handled best the neuropsychiatric problems of the present war were
in large part qualified not merely by a knowledge of psychology and
psychiatry, but far more by a thorough training in organic neurology.
The problems of psychiatry can be grasped fully only by those who have
a fundamental knowledge of the anatomy, physiology, and diseases of the
nervous system.
Dr. Southard, preëminently a neuropathologist, is well grounded in
organic neurology, and shows at every turn his capabilities for
considering the neuroses, psychoses, and insanities from the standpoint
of the neurologist. Moreover, he clearly shows training and insight
into the problems of non-neurological internal medicine.
The ideal method of training a student for neuropsychiatric work--if
one had the opportunity of directing his course from the time of his
entry into medicine--would be to see to it, after a good grounding in
the fundamental sciences like anatomy, physiology, and chemistry, that
medicine and surgery in their broadest phases first received school and
hospital attention; that the fields of neurology, pure and applied,
were then fully explored; and that psychology and psychiatry received
late but thorough consideration. When after America’s entrance into the
world war the writer assisted in preparing medical reserve officers
for neuropsychiatric service, those men did best both during their
postgraduate work and in base hospitals and in the field, who had built
from the bottom after the manner indicated.
At the outset of Dr. Southard’s book, for more than two hundred and
fifty pages, the author considers under ten subdivisions the acquired
diseases and constitutional defects which may predispose the soldier
to functional and reflex nervous disease. Neurosyphilis, on which Dr.
Southard and Dr. Solomon have already given us a valuable treatise,
the pharmacopsychoses, especially alcoholism, and the somatopsychoses
covering fevers like typhoid and paratyphoid, are considered in
numerous carefully chosen case reports. The reader needs only to look
closely into the case records of the first quarter of the volume to
get a knowledge of the affections chiefly predisposing the soldier or
civilian to functional and reflex nervous diseases. To those familiar
with the medical history of the war it is well known that one of the
reasons for the efficiency of the American Expeditionary Force resided
in the fact that the preliminary examinations of the recruits received
the fullest attention not only from the points of view of acquired and
inherited disease, but also from those of special psychiatric and even
psychological deficiencies. Our country, however, had for its guidance
the experience of nations which were fighting for three years before we
entered the arena and in addition had a large surplus of material from
which to cull out the weaklings.
Among the predispositional affections considered--besides syphilis,
alcohol, and other drug habits, and the somatopsychoses--are the
feeble-mindednesses or hypophrenoses, the epilepsies, the psychoses
due to focal brain lesions, the presenile and senile disorders, the
schizophrenoses including dementia præcox and allied affections, the
cyclothymoses like manic depressive insanity, the psychoneuroses, and
the psychopathoses. The last two subjects indicated, considered in
special chapters, seem to some extent to be receptacles for affections
which cannot well be otherwise placed,--hallucinoses, hysteria,
neurasthenia, and psychasthenia,--and under the psychopathoses,
pathological lying, Bolshevism, delinquencies of various sorts,
homosexuality, suicide and self-mutilation, nosophobia, and even
claustrophobia with its exemplar who preferred exposure to shell-fire
to remaining in a tunnel.
Under the encephalopsychoses are found interesting illustrations of
focal lesions and the general effects of infection and toxemia. Cases
of brain abscess, of spinal focal lesions, and meningeal hemorrhage
are in evidence, aphasias, monoplegias, Jacksonian spasm, and thalamic
disease receiving consideration.
All neurologists know the difficulties in diagnosticating epilepsy
in the absence of opportunities to see attacks and to receive the
carefully analyzed statement of the observers of the patient. All this
and much more is well brought out in the chapter on the epileptoses.
Many epileptics found their way into the armies either through the
carelessness of examiners or by suppression of the facts on the part of
those who desired to serve.
The fact that an imbecile can shoot straight and face fire comes out in
one or two places, but this does not seem to prove that a good rifleman
is necessarily an all-round good soldier.
A book like Dr. Southard’s could be made of much use in teaching
students, especially postgraduates, by having them, when a particular
subject like epilepsy or schizophrenia, for instance, is under
discussion, use as collateral reading the case reports of this work.
Dr. Southard’s book will prove useful to many workers--to the medical
officer whose duty it is to examine recruits for the service or to pass
upon and treat them while in service; almost equally to the medical
officer in time of peace; to authors of textbooks and treatises and to
contributors to neurological and psychiatric journals; to lecturers and
clinical demonstrators; to the examiner for the juvenile courts; and to
members of the psychopathic, psychiatric, and neurological staffs of
our hospitals.
One is not called upon in an introduction to review at length the
contents of the volume, but it may prove of value to the reader to dip
here and there into the pages of the work to which his attention is
being invited.
It will be remembered that fifty years ago and much later, down to
the time of Babinski’s active propaganda in favor of the theories of
suggestion, counter-suggestion, and persuasion in hysteria, various
affections of a vasomotor and thermic type were included in the list
of hysterical phenomena. These and some other phenomena sometimes
classed as hysterical, Babinski and those who accord with him now find
it necessary to sweep entirely from the domain of hysteria, which being
produced by suggestion and cured by counter-suggestion or persuasion
cannot include symptoms which are beyond the control of the will and
intellect of the patient.
According to the new or rather revived pronouncement, these must be due
either to definite organic lesion, or to a disorder of reflex origin,
connoting the occurrence of changes in the nervous centers as long
ago taught by Vulpian and Charcot. In the records of cases and in the
discussions thereon this differentiation receives much consideration.
It is held that the paralysis in the reflex cases is more limited, more
persistent, and assumes special forms not observable in hysteria. The
attitudes in hysterical palsies conform more to the natural positions
of the limbs than do those observed in reflex paralysis. Probably the
presence of marked amyotrophies in the reflex nervous disorders is the
most convincing factor in separating these from pithiatic affections.
These atrophies correspond to the arthritic muscular atrophies of
Vulpian, Charcot, Gowers, and others, and cannot for a moment be
regarded as caused by suggestion or as removable by counter-suggestion
or persuasion. They are influenced, discounting the effect of time
and natural recuperation, only by methods of treatment designed to
improve the peripheral and central nutrition of the patient. Pithiatic
atrophies are slight and probably always to be accounted for by
disuse or the association of some peripheral neural disorder with the
hysteria. Affections of the sudatory and pilatory systems are more
definitely pronounced in reflex cases than in those of a strictly
hysterical character.
Some of the facts brought forward by Babinski and Froment to
demonstrate the differentiation of reflex paralyses from pithiatic
disorders of motion are challenged in the records of this volume by
others, as for instance, by Dejerine, Roussy, Marie, and Guillain.
Babinski tells us that in pithiatism, properly so designated, the
tendon reflexes are not affected. He believes that even in pronounced
anesthesia of the lower extremities the plantar reflexes can always
be elicited and are not abnormal in exhibition. Dejerine, however,
produces cases to illustrate the fact that in marked hysterical
anesthesia of the feet plantar responses cannot be produced. I have
personally studied cases which lend some strength to either contention.
In some of these I was not able to conclude that either the use of the
will or the presence of contractions in extension was sufficient to
exclude the normal responses.
Differences in muscle tonicity, in mechanical irritability of the
muscles, and the presence or absence of fibrotendinous contractions are
indications of a separation between the reflex and purely functional
cases, as apparently demonstrated in some of the case records. True
trophic disorders of the skin, hair, and bones observed in the reflex
cases are also said to have no place in the illustrations of pithiatism.
The delver into the case histories of this volume will find numerous
instructive combinations of hystero-reflex and organo-hysterical
associations which are not to be enumerated in an introduction. The
great importance of what all recognize as pathognomonic signs of
organic disease--Babinski extensor toe response, persistent foot
clonus, reactions of degeneration, marked atrophy, lost tendon
jerks, etc.--is, of course, continuously in evidence. Extraordinary
associations of hysterical, organic, and reflex disorders with other
affections due to direct involvement of bone, muscle, and vessels and
with the secondary effects of cicatrization and immobilization are
brought out on many pages. In quitting this branch of our subject
it might be remarked that considerable changes must be made in
our textbook descriptions of nervous diseases in the light of the
contributions to the neurology of the present war.
One is reminded in the details of some of the cases of the discussions
some decades since on the subject of spinal traumatisms; of the work
of Erichsen which resulted in giving his name and that of “railway
spine” to many of the cases now commonly spoken of as traumatic
hysteria and traumatic neurasthenia; of the rejoinders of Page and his
views regarding spinal traumatisms; and of Oppenheim’s development of
the symptom complex of what he prefers to term the traumatic neurosis.
One who has taken part in much court work cannot but read these case
records with interest, for the neurology of the war as presented in
this volume and in numerous monographs which are now appearing, throws
much light upon many often mooted medicolegal problems. I recall
how many able and honest neurological observers have changed their
points of view since the early days of Erichsen’s “railway spine,” a
pathological suggestion which is said to have cost the corporations of
England an almost fabulous sum during a score of years. I recall also
that a certain Court of Appeals in one of our states even felt itself
called upon to promulgate an opinion intended to exorcise entirely the
plea for damages for alleged injuries if it could be shown that these
were due to fright. The data of this book do not put weapons entirely
into the hands of the attorney and the expert for either the plaintiff
or the defendant.
Some of the French writers on the neurology of the war, as illustrated
in the records collected by Dr. Southard, have brought to our attention
distinctions which they draw between _états commotionnels_ and _états
émotionnels_--happy terms, and yet not sufficient in their invention
or in the explanations which accompany them, fully to satisfy the
requirements of the facts presented. These writers seem to think of
the commotional states as denoting some real disease or condition of
the brain, and yet one which is really curable and reversible. They
explicitly tell us, however, that these commotions fall short of
being _lésionnel_. After all, is this not somewhat obscure? Is it not
something of a return to the period of “railway spine” when one of the
comparisons sometimes made was that the injury suffered by the nervous
tissues produced in them a state comparable to that of a magnet
which had been subjected to a severe blow? At any rate, in commotion
thus discussed the nervous structures are supposed to sustain some
real injury of a physiochemical character, whereas in the emotional
states the neurones are, as Southard puts it, affected somewhat after
the manner of normal emotional functioning, except perhaps that they
are called upon to deliver an excessive stream of impulses. The
latter would be classed among the psychopathic, the former among the
physiopathic affections, and yet the distinction between the two is not
always quite clear.
In not a few instances of Shell-shock--although these are not numerous,
so far as records have been obtained--actual structural lesions have
been recorded even in cases in which no direct external injury of a
material kind was experienced as a result of the explosion of shells.
In others the evidences of external injury were relatively unimportant.
Various lesions, in some cases recognizable even by the naked eye, were
present. Mott, for example, found not only minute hemorrhages, but
in one instance a bulbar extravasation of moderate massiveness, the
patient not showing external signs of injury. Cases are also recorded
of hematomyelia; others with edematous or necrotic areas in the cord;
and still others with lesions of the ependyma or even with splitting of
the spinal canal, reminding one of the classical experiments of Duret
on cerebral and cerebrospinal traumatisms.
It has been argued that too much stress should not be laid on a few
cases of this sort--but are they as few as they seem to be? The fact
is that necropsical opportunities are not often afforded. May not such
scattered lesions often be present without resulting in death or even
in long continued disturbance? There is no essential reason why minute
hemorrhages into the brain and spinal cord, and especially into their
membranes, may not undergo rapid absorption or even remain unchanged
for some time without dire results.
One of the reported cases in which lung splitting occurred from severe
concussion without external injury is not without interest in this
connection, reminding one, as the commentator says, of those cases of
severe concussion in which the interior of a building is injured while
the exterior escapes. In the same connection also the cited experiments
of Mairet and Durante on rabbits are not without instructiveness.
As a result of explosives set off close to these animals, pulmonary
apoplexy, spinal cord and root hemorrhages, and extravasations,
perivascular and ependymal, and into the cortical and bulbar gray were
found. Russca obtained direct and _contrecoup_ brain lesions, etc., in
a similar way.
Here and there throughout the book will be found references to
symptoms and syndromes which will have a particular interest for the
reader--soldier’s heart, trench foot, congealed hand, tics, tremors,
convulsions, sensory areas variously mapped, and forms of local
tetanus, the last being distinctly to be differentiated from pithiatic
contractures and those due to organic lesions of the nervous system.
Cases of an affection described by Souques as camptocormia, from Greek
words meaning to bend the trunk, were shown to the Neurological Society
of Paris in 1914 and later, the main features of this affection being
pronounced incurvation forward of the trunk from the dorsolumbar
region, with extreme abduction and outward rotation of the lower limbs,
pain in the back, and difficult and tremulous walking. In some of these
cases, organic lesions of the trunkal tissues were present, but in
addition psychic elements played a not unimportant part, and the cases
were restored to health by a combination of physical measures with
psychotherapy, enforced by electrical applications.
The part of this book given over to the discussion of treatment will
doubtless to some prove the most interesting section. The presentation
of the subject of therapeutics is in some degree a discussion also of
diagnosis and prognosis; and so it happens in various parts of the
volume that the particular subject under consideration is more or less
a reaffirmation or anticipation of remarks under other headings.
Similar results are brought about by various therapeutic procedures.
Nonne, Myers, and a few others bring hypnosis into the foreground,
although non-hypnotic suggestion plays a larger rôle by far.
Miracle cures are wrought through many pages. Mutism, deafness and
blindness, palsies, contractures, and tics disappear at times as if by
magic under various forms of suggestion. Ether or chloroform narcosis
drives out the malady at the moment when it reveals its true nature.
Verbal suggestion has many adjuvants and collaborators--electricity,
sometimes severely administered, lumbar puncture, injections of
stovaine into the cerebrospinal fluid, injections of saline solution,
colored lights, vibrations, active mechanotherapy, hydrotherapy, hot
air baths and blasts, massage, etc. Painful and punitive measures have
their place--one is inclined to think a less valuable place than is
given them by some of the recorders. In some instances the element of
suggestion, while doubtless present, is overshadowed by the material
methods employed. Persuasion and actual physical improvement are in
these cases highly important. Reëducation is not infrequently in
evidence. The patient in one way or another is taught how to do things
which he had lost the way of doing.
It is interesting to American neurologists to note how frequently
in the reports, especially of French observers, the “Weir Mitchell
treatment” was the method employed, including isolation, the faradic
current, massage, and Swedish movements, hydrotherapy, dietetic
measures, reëducative processes, and powerful suggestion variously
exhibited, especially through the mastery of the physician over
the patient. It is rather striking that few records of Freudian
psychoanalytic therapy are presented.
When all is said, however, counter-suggestion and persuasion, in
whatever guise made use of, were not always sufficient and this not
only in the clearly organic cases, but in those which are ranked under
the head of reflex nervous disorders. In these the long-continued use
of physical agencies was found necessary to supplement the purely
psychic procedures, these facts sometimes giving rise in the Paris
Society of Neurology and elsewhere to animated discussion as to the
real nature of the cases. The pithiatic features of the case at times
disappear, but leave behind much to be explained and more to be
accomplished. The cures wrought are not always permanent and in some
cases post-bellum experiences may be required to prove the real value
of the measures advocated. The reader must study well the detailed
records in order to arrive at just conclusions; nevertheless, the
tremendous efficacy of suggestion and persuasion stands out in many of
the recitals.
Perhaps the author may permit the introducer a little liberty of
comment. His non-English interpellations, especially Latin and French,
may be regarded by some as overdone or perhaps pedantic, but are rather
piquant, giving zest to the text. _Diagnosis per exclusionem in ordine_
is sonorous and has a scholarly flavor, but does not prevent the reader
who lives beyond the faubourgs of Boston from understanding that the
author is speaking of an ancient and well-tried method of differential
diagnosis. _Passim_ may be more impressive or thought-fixing than
its English translation, but this to the reader will simply prove
a matter of individual opinion. _Psychopathia martialis_ is not
only mouth-filling like _Senegambia_ or _Mesopotamia_, but really
has a claim to appreciation through its evident applicability. It
is agreeable to note that the book seems nowhere to indicate that
_psychopathia sexualis_ and _psychopathia martialis_ are convertible
terms.
The bibliography of the volume challenges admiration because of its
magnitude and thoroughness and is largely to be credited, as the author
indicates, to the energy and efficiency of Sergeant Norman Fenton, who
did the work in connection with the Neuropsychiatric Training School
at Boston, resorting first-hand to the Boston Medical Library and the
Library of the New York Academy of Medicine. After Sergeant Fenton
joined the American Expeditionary Force, Dr. Southard greatly increased
the value of the bibliography by his personal efforts.
This bibliography covers not only the 589 case histories of the book,
but it goes beyond this, especially in the presentation of references
for 1917, 1918, and even 1919. Owing to the time when our country
entered the war, American references are, in the main, of later date
than the case histories. They will be found none the less of value to
the student of neuropsychiatric problems.
The references in the bibliography number in all more than two
thousand, distributed so far as nationalities are concerned about
as given below, although some mistakes may have crept into this
enumeration for various reasons, like the publication of the same
articles in the journals of different countries. The list of references
includes French, 895; British (English and Colonial), 396; Italian,
77; Russian, 100; American, 253; Spanish, 5; Dutch, 5; Scandinavian,
5; and Austrian and German, 476. It will be seen, therefore, that the
bibliography covers in number nearly four times the collected case
studies, most of these records being from reports made during the first
three years of the war. The author has wisely made an effort to bring
the bibliographic work up to and partially including 1919.
The manner in which the French neurologists and alienists continued
their work during the strenuous days of the terrible conflict is
worthy of all praise. The labors of the Society of Neurology of Paris
never flagged, its contributions in current medical journals having
become familiar to neurologists who have followed closely the trend of
medical events during the war. Cases and subjects were also frequently
presented and discussed at the neurological centers connected with the
French and allied armies in France.
It may be almost invidious to specify names, the work done by many
was of so much interest and value. Dejerine in the early days of the
war, before his untimely sickness and death, contributed his part.
Marie from the beginning to the end of the conflict continued to
make the neurological world his debtor. The name of Babinski stands
out in striking relief. Other names frequently appearing among the
French contributors are those of Froment, Clovis Vincent, Roussy
and Lhermitte, Léri, Guillain, Souques, Laignel-Lavastine, Courbon,
Grasset, Claude, Barre, Benisty, Foix, Chavigny, Charpentier, Meige,
Thomas, and Sollier.
For a work of this character not only as complete a bibliography as
possible, but a thorough index is absolutely necessary, and this has
been supplied. The author has not made the index too full, but with
enough cross-references to enable those in all lines of medical work
interested to cull out the cases and comments which most concern them.
My prologue finished, I step aside for the play and the player, with
the recommendation to the reader that he give close heed to the
performance--to the recital of the cases, the comments thereon, and the
general discussion of subjects--knowing that such attention will be
fully rewarded, for in this wonderful collection of Dr. Southard is to
be seen an epitome of war neurology not elsewhere to be found.
CHARLES K. MILLS.
_Philadelphia_, May, 1919.
TABLE OF CONTENTS
SECTION A. PSYCHOSES INCIDENTAL IN THE WAR
I. THE SYPHILITIC GROUP (_Syphilopsychoses_)
CASE PAGE
1. Desertion of an officer _Briand_, 1915 8
2. Visions of a naval officer _Carlill_, _Fildes_, _Baker_, 1917 9
3. Aggravation of neurosyphilis by war _Weygandt_, 1915 10
4. Same _Hurst_, 1917 10
5. Same _Beaton_, 1915 10
6. Same _Boucherot_, 1915 11
7. Same _Todd_, 1917 12
8. Same _Farrar_, 1917 13
9. Same _Marie_, _Chatelin_, _Patrikios_, 1917 14
10. Root-sciatica _Long_, 1916 15
11. Disciplinary _Kastan_, 1916 17
12. Same _Kastan_, 1916 18
13. Same? _Kastan_, 1916 19
14. Hysterical chorea _versus_ neurosyphilis
_de Massary_, _du Sonich_, 1917 20
15. Traumatic general paresis _Hurst_, 1917 22
16. Head trauma; shell-shock; mania; W. R. positive
_Babonneix_, _David_, 1917 23
17. Head trauma in a syphilitic _Babonneix_, _David_, 1917 24
18. Shell wound: general paresis _Boucherot_, 1915 25
19. “Shell-shock” ocular palsy: syphilitic _Schuster_, 1915 26
20. Shell-shock: general paresis _Donath_, 1915 27
21. Shell-shock: tabes _Logre_, 1917 28
22. Same _Duco_, _Blum_, 1917 28
23. Pseudotabes (Shell-shock) _Pitres_, _Marchand_, 1916 29
24. Shell-shock neurosyphilis _Hurst_, 1917 30
25. Shell-shock neurosyphilis _Hurst_, 1917 31
26. Pseudoparesis (Shell-shock) _Pitres_, _Marchand_, 1916 32
27. War strain and Shell-shock in a syphilitic _Karplus_, 1915 34
28. Shell-shock recurrence of syphilitic hemiplegia
_Mairet_, _Piéron_, 1915 36
29. Shell-shock (functional!) amaurosis in a neurosyphilitic
_Laignel-Lavastine_, _Courbon_, 1916 37
30. Shell-shock (functional) phenomena in a neurosyphilitic
_Babonneix_, _David_, 1917 39
31. Vestibular symptoms in a neurosyphilitic
_Guillain_, _Barré_, 1916 40
32. Syphilophobic suicidal attempts _Colin_, _Lautier_, 1917 41
33. Simulated chancre _Pick_, 1916 42
34. Exaggeration _Buscaino_, _Coppola_, 1916 43
II. THE FEEBLE-MINDED GROUP (_Hypophrenoses_)
35. A feeble-minded person fit for service _Pruvost_, 1915 44
36. An imbecile superbrave _Pruvost_, 1915 45
37. An imbecile fit for barracks work _Pruvost_, 1915 45
38. A feeble-minded inventor _Laignel-Lavastine_, _Ballet_, 1917 47
39. A feeble-minded simulator _Pruvost_, 1915 49
40. Enlistment for amelioration of character _Briand_, 1915 49
41. An imbecile fit for service at the front _Pruvost_, 1915 50
42. An imbecile with sudden initiative _Lautier_, 1915 51
43. Emotional fugue in subnormal subject _Briand_, 1915 52
44. Regimental surgeon _versus_ alienist _re_ feeble-mindedness
_Kastan_, 1916 53
45. An imbecile rifleman _Kastan_, 1916 55
46. An imbecile hypomaniacal _Haury_, 1915 57
47. Feeble-minded desire to remain at the front _Kastan_, 1916 58
48. An imbecile sent back by Germans _Lautier_, 1915 60
49. Unfit for service: feeble-mindedness? _Kastan_, 1916 61
50. Oniric delirium in a feeble-minded subject _Soukhanoff_, 1915 62
51. Shell-shock and burial: situation not rationalized
_Duprat_, 1917 63
52. Shell-shock in weak-minded subject; fear, fugues
_Pactet_, _Bonhomme_, 1917 64
III. THE EPILEPTIC GROUP (_Epileptoses_)
53. Epilepsy: neurosyphilis _Hewat_, 1917 65
54. Epilepsy brought out by syphilis _Bonhoeffer_, 1915 66
55. Syphilis in a psychopathic subject _Bonhoeffer_, 1915 67
56. Epileptic imbecile court-martialed _Lautier_, 1916 68
57. Psychogenic seizures in feeble-minded subject
_Bonhoeffer_, 1915 69
58. Drunken epileptic: responsibility? _Juquelier_, 1917 71
59. Epilepsy: disciplinary case _Pellacani_, 1917 74
60. Same _Pellacani_, 1917 76
61. Desertion: epileptic fugue _Verger_, 1916 78
62. Specialist in escapes _Logre_, 1917 80
63. Epilepsy and other factors: disciplinary case
_Consiglio_, 1917 82
64. Strange conduct and amnesia in epileptic _Hurst_, 1917 83
65. Epilepsy after antityphoid inoculation _Bonhoeffer_, 1915 84
66. Shell-shock: Jacksonian seizures--decompression
_Leriche_, 1915 86
67. Blow on head: hysterical convulsions--cure by neglect
_Clarke_, 1916 87
68. Epilepsy with superposed hysteria _Bonhoeffer_, 1915 88
69. Musculocutaneous neuritis: Brown-Séquard’s epilepsy
_Mairet_, _Piéron_, 1916 89
70. Bullet wound: reactive epilepsy? _Bonhoeffer_, 1915 92
71. _Epilepsia tarda_ _Bonhoeffer_, 1915 93
72. Convulsions by auto-suggestion _Hurst_, 1916 95
73. Epilepsy, emotional _Westphal_, _Hübner_, 1915 97
74. Hysterical convulsions _Laignel-Lavastine_, _Fay_, 1917 98
75. Desertion: fugue, probably not epileptic _Barat_, 1914 100
76. Epileptic episode _Bonhoeffer_, 1915 102
77. Narcoleptic seizures _Friedmann_, 1915 103
78. Sham fits _Hurst_, 1917 106
79. Epileptoid attacks controllable by will _Russel_, 1917 106
80. Epileptic taint brought out at last by shell-shock
_Hurst_, 1917 107
81. Shell-shock _epilepsia larvata_ _Juquelier_, _Quellien_, 1917 108
82. To illustrate a theory of Shell-shock as epileptic
_Ballard_, 1915 110
83. Same _Ballard_, 1917 110
84. Same _Ballard_, 1917 111
85. Epileptic equivalents _Mott_, 1916 112
IV. THE ALCOHOL-DRUG-POISON GROUP (_Pharmacopsychoses_)
86. Pathological intoxication _Boucherot_, 1915 113
87. Same _Loewy_, 1915 116
88. Desertion in alcoholism: fugue _Logre_, 1916 117
89. Alcoholic amnesia experimentally reproduced _Kastan_, 1915 118
90. Desertion and drunkenness _Kastan_, 1915 119
91. Desertion by alcoholic dement _Kastan_, 1915 121
92. Desertion by alcoholic with other factors _Kastan_, 1915 124
93. Alcoholism: disciplinary case _Kastan_, 1915 126
94. Atrocity, alcoholism _Kastan_, 1915 127
95. Atrocity, alcoholic _Kastan_, 1915 128
96. Alcoholism and amnesia: disciplinary case _Kastan_, 1915 129
97. Post-traumatic intolerance of alcohol _Kastan_, 1915 130
98. Adventure with Parisian stranger _Briand_, _Haury_, 1915 131
99. Morphinism: tetanus _Briand_, 1914 131
100. Morphinism: medicolegal question _Briand_, 1914 132
101.} Two morphinists _Briand_, 1914 132
102.}
V. THE FOCAL BRAIN LESION GROUP (_Encephalopsychoses_)
103. Aphasia and left hemiplegia: local and
_contrecoup_ lesions _L’Hermitte_, 1916 133
104. Gunshot head wound and alcohol: amnesia _Kastan_, 1916 135
105. Bullet in brain: cortical blindness and hallucinations
_Lereboullet_, _Mouzon_, 1917 136
106. Content of existent psychosis changed by
head trauma _Laignel-Lavastine_, _Courbon_, 1917 139
107. Meningococcus meningitis; apparent recovery:
dementing psychosis _Maixandeau_, 1915 141
108. Meningococcus meningitis _Eschbach and Lacaze_, 1915 143
109. Shell-shock: meningitic syndrome _Pitres and Marchand_, 1916 145
110. Brain abscess in a syphilitic: matutinal loss of
knee-jerks _Dumolard_, _Rebierre_, _Quellien_, 1915 147
111. Spinal cord lesion: early recovery _Mendelssohn_, 1916 149
112. Shell explosion and meningeal hemorrhage:
pneumococcus meningitis _Guillain_, _Barré_, 1917 150
113. _Ante bellum_ cortex lesion: shrapnel wound determines
athetosis _Batten_, 1916 151
114. Hysterical _versus_ thalamic hemianesthesia _Léri_, 1916 152
115. Shell-shock: multiple sclerosis syndrome
_Pitres_, _Marchand_, 1916 154
116. Mine explosion: hysterical and organic symptoms _Smyly_, 1917 156
117. Same _Smyly_, 1917 156
VI. THE SYMPTOMATIC GROUP (_Somatopsychoses_)
118. Rabies: neuropsychiatric phenomena
_Grenier de Cardenal_, _Legrand_, _Benoit_, 1917 162
119. Tetanus, psychotic _Lumière_, _Astier_, 1917 164
120. Tetanus _fruste_ _versus_ hysteria
_Claude_, _L’Hermitte_, 1915 165
121. British officer’s letter concerning local tetanus
_Turrell_, 1917 166
122. Dysentery: psychosis _Loewy_, 1915 168
123. Typhoid fever: hysteria _Sterz_, 1914 169
124. Dementia praecox _versus_ posttyphoid encephalitis
_Nordmann_, 1916 170
125. Paratyphoid fever: psychosis outlasting fever _Merklen_, 1915 171
126. Paratyphoid fever: psychopathic taint brought out
_Merklen_, 1915 172
127. Diphtheria: post diphtheritic symptoms _Marchand_, 1916 173
128. Diphtheria: hysterical paraparesis _Marchand_, 1915 174
129. Malaria: amnesia _De Brun_, 1917 175
130. Malaria: Korsakow’s syndrome _Carlill_, 1917 176
131. Malaria: ventral horn symptoms _Blin_, 1916 178
132. Trench foot; acroparesthesia _Cottet_, 1917 180
133. Bullet injury of spine; bronchopneumonia:
_état criblé_ of spinal cord _Roussy_, 1916 181
134. Shell-shock (shell not seen); sensory and motor
symptoms: decubitus; recovery _Heitz_, 1915 183
135. Shell-shock; later typhoid fever: neuritis
(_ante bellum_ hysteria) _Roussy_, 1915 185
136. Bullet wound of pleura: hemiplegia and ulnar syndrome
_Phocas_, _Gutmann_, 1915 186
137. Tachypnoea, hysterical _Gaillard_, 1915 188
138. Soldiers’ heart _Parkinson_, 1916 190
139. Soldiers’ heart? _Parkinson_, 1916 191
140. War strain and shell wound: diabetes mellitus _Karplus_, 1915 192
141. Dercum’s disease _Hollande_, _Marchand_, 1917 193
142. Hyperthyroidism _Tombleson_, 1917 195
143. Hyperthyroidism?, neurasthenia _Dejerine_, _Gascuel_, 1914 196
144. Hyperthyroidism _Rothacker_, 1916 197
145. Graves’ disease, _forme fruste_ _Babonneix_, _Célos_, 1917 198
146. Shell-shock hysteria: surgical complications _Oppenheim_, 1915 199
VII. THE PRESENILE AND SENILE GROUP (_Geriopsychoses_)--No cases.
VIII. THE DEMENTIA PRAECOX GROUP (_Schizophrenoses_)
147. Hatred of Prussia: diagnosis, dementia praecox
_Bonhoeffer_, 1916 200
148. Dementia praecox: arrest as spy _Kastan_, 1915 201
149. Fugue, catatonic _Boucherot_, 1915 203
150. Desertion: schizophrenic? _Consiglio_, 1916 204
151. Schizophrenia; alcoholism: disciplinary case _Kastan_, 1915 206
152. Schizophrenia aggravated by service _de la Motte_, 1915 208
153. Shot himself in hand: delusions _Rouge_, 1915 209
154. Dementia praecox volunteer _Haury_, 1915 210
155. Hysteria _versus_ catatonia _Bonhoeffer_, 1916 211
156. “Hysteria” actually dementia praecox _Hoven_, 1915 213
157. Hallucinatory and delusional contents influenced
by war experiences _Gerver_, 1915 214
158. Iron cross winner, hebephrenic _Bonhoeffer_, 1915 215
159. Occipital trauma; visual hallucinations
_Claude_, _L’Hermitte_, 1915 217
160. Shell-shock: Dementia praecox _Weygandt_, 1915 219
161. Same _Dupuoy_, 1915 220
162. Shell-shock; fatigue; fugue; delusions _Rouge_, 1915 221
IX. THE MANIC-DEPRESSIVE GROUP (_Cyclothymoses_)
163. A maniacal volunteer _Boucherot_, 1915 222
164. Fugue, melancholic _Logre_, 1917 223
165. Apples in No-man’s-land _Weygandt_, 1914 224
166. Trench life: depression; hallucinations;
arteriosclerosis; age, 38 _Gerver_, 1915 225
167. War stress: manic depressive psychosis _Dumesnil_, 1915 226
168. Predisposition; war stress: melancholia _Dumesnil_, 1915 227
169. Depression; low blood pressure; pituitrin _Green_, 1916 228
X. THE PSYCHONEUROTIC GROUP (_Psychoneuroses_)
170. Three phases in a psychopath
_Laignel-Lavastine_, _Courbon_, 1917 229
171. Fugue, probably hysterical _Milian_, 1915 232
172. Hysterical Adventist _de la Motte_, 1915 234
173. Fugue, psychoneurotic _Logre_, ---- 235
174. Shell-shy; war bride pregnant: fugue with amnesia
and mutism _Myers_, 1916 236
175. A neurasthenic volunteer _E. Smith_, 1916 237
176. War stress: neurasthenia in subject without
heredity or soil _Jolly_, 1916 238
177. Arterial hypotension in psychasthenia _Crouzon_, 1915 239
178. War stress: psychasthenia _Eder_, 1916 240
179. _Ante bellum_ attacks: neurasthenia _Binswanger_, 1915 241
180. Antityphoid inoculation: neurasthenia _Consiglio_, 1917 244
181. Neurasthenia (one symptom: sympathy with the enemy)
_Steiner_, 1915 245
XI. THE PSYCHOPATHIC GROUP (_Psychopathoses_)
182. Claustrophobia: shells preferred to tunnel _Steiner_, 1915 246
183. Pathological liar _Henderson_, 1917 247
184. Psychopath almost Bolshevik _Hoven_, 1917 249
185. Hysterical mutism: persistent delusional psychosis
_Dumesnil_, 1915 250
186. Psychopathic inferiority brought out by the war
_Bennati_, 1916 251
187. Psychopathic episodes _Pellacani_, 1917 252
188. Maniacal and hysterical delinquent _Buscaino_, _Coppola_, 1916 253
189. Psychopathic delinquent _Buscaino_, _Coppola_, 1916 254
190. Psychopathic excitement _Buscaino_, _Coppola_, 1916 255
191. Desertion: dromomania _Consiglio_, 1917 256
192. Suppressed homosexuality _R. P. Smith_, 1916 257
193. Psychopathic: at first suicidal, then self-mutilative
_MacCurdy_, 1917 258
194. Bombardment: psychasthenia
_Laignel-Lavastine_, _Courbon_, 1917 259
195. Nosophobia _Colin_, _Lautier_, 1917 261
196. Psychopath: Attacks of disgust and terror
_Lattes_, _Goria_, 1915 262
SECTION B. SHELL-SHOCK: NATURE AND CAUSES
197. Shell explosion: Autopsy--hemorrhages;
vagoaccessorius chromatolysis _Mott_, 1917 265
198. Mine explosion: Autopsy--hemorrhages _Chavigny_, 1916 270
199. Mine explosion: Autopsy--hemorrhages
_Roussy_, _Boisseau_, 1916 271
200. Shell fragment in back: Autopsy--softenings in
spinal cord _Claude_, _L’Hermitte_, 1915 272
201. Shell explosion: Autopsy--lungs burst! _Sencert_, 1915 274
202. Shell explosion: Hemorrhage in spinal canal and bladder
_Ravaut_, 1915 276
203. Shell explosion: Hemorrhage and pleocytosis of
spinal fluid _Froment_, 1915 277
204. Shell explosion: Pleocytosis of spinal fluid _Guillain_, 1915 279
205. Shell explosion: Pleocytosis of spinal fluid
as late as a month after explosion _Souques_, _Donnet_, 1915 280
206. Burial: Thecal hemorrhage _Leriche_, 1915 282
207. Shell explosion: Hypertensive spinal fluid _Leriche_, 1915 283
208. Bullet wound: Hematomyelia; partial recovery
_Mendelssohn_, 1916 284
209. Shell explosion, subject prone: Hematomyelia _Babinski_, 1915 286
210. Struck by missile: Hysterical paraplegia? Herpes;
segmentary symptoms _Elliot_, 1914 288
211. Mine explosion: Head bruises, labyrinth lesions,
canities unilateral _Lebar_, 1915 291
212. Shrapnel wounds: Focal canities; hysterical symptoms
_Arinstein_, 1915 292
213. Burial: Organic (?) hemiplegia _Marie_, _Lévy_, 1917 293
214. Shell explosion; no wound: Organic and functional symptoms
_Claude_, _L’Hermitte_, 1915 294
215. Gassing: Organic symptoms _Neiding_, 1917 296
216. Gassing: Mutism, battle dreams _Wiltshire_, 1916 297
217. Shell explosion: Organic deafness; hysterical
speech disorder _Binswanger_, 1915 298
218. Distant shell explosion not seen or heard: Tympanic
rupture, cerebellar symptoms _Pitres_, _Marchand_, 1916 300
219. Mine explosion: Organic and functional symptoms _Smyly_, 1917 302
220. Shrapnel skull wound: Differential recovery from
functional symptoms _Binswanger_, 1917 303
221. Shell explosion shrapnel wound: Battle memories,
scar hyperesthetic _Bennati_, 1916 305
222. Shrapnel wounds, operation: Hysterical facial spasm
_Batten_, 1917 306
223. Shell explosion: Tremors and emotional crises _Myers_, 1916 307
224. Shell explosion, comrades killed: Tremors, crises
_Meige_, 1916 308
225. Under fire: Tremophobia: French artist’s description
_Meige_, 1916 310
226. Shell explosion: German soldier’s account of
Shell-shock symptoms _Gaupp_, 1915 312
227. A British soldier’s account of shell-shock _Batten_, 1916 315
228. Blown up by shell: Crural monoplegia; hysterical
four days later _Léri_, 1915 317
229. Shell explosion nearby: Description of treatment to
demonstrate hysterical nature of characteristic
symptoms _Binswanger_, 1915 318
230. Leg wound: Pseudocoxalgic monoplegia and anesthesia
_Roussy_, _L’Hermitte_, 1917 323
231. Leg contusion: Crural monoplegia, hysterical;
later crutch paralysis, organic _Babinski_, 1917 324
232. War strain: Arthritis; crural monoplegia and
anesthesia; hysterical “conversion hysteria” _MacCurdy_, 1917 325
233. Lance thrust in back; Crural monoplegia _Binswanger_, 1915 326
234. Shell explosion: After six days, crural monoplegia
(“metatraumatic” suggesting persisting hypersensitive
phase after shell-shock) _Schuster_, 1916 329
235. Wound of foot: Acrocontracture, seven months’
duration; psycho-electric cure at one sitting
_Roussy_, _L’Hermitte_, 1917 330
236. Shell explosion: Trauma; emotion; hysterical
paraplegia _Abrahams_, 1915 332
237. Shell explosion: Burial; paraplegia _Elliot_, 1914 334
238. Shell explosion: Paraplegia and sensory symptoms,
organic? _Hurst_, 1915 335
239. War strain and rheumatism; no emotional factors:
Paraplegia, later brachial tremor _Binswanger_, 1915 336
240. Emotion in fever patient from watching barrage
creep up: Paraplegia _Mann_, 1915 338
241. Incentives, domestic and medical, to paraplegia _Russel_, 1917 338
242. Bullet in back: Hysterical bent back; “camptocormia”
_Souques_, 1915 339
243. Shell explosion: Camptocormia _Roussy_, _L’Hermitte_, 1917 340
244. Shell explosion; burial: camptocormia
_Roussy_, _L’Hermitte_, 1917 342
245. Shell explosion; burial; Paraplegia, later camptocormia
_Joltrain_, 1917 344
246. Bullet in thigh: Astasia-abasia. Wound of neck:
Again astasia-abasia _Roussy_, _L’Hermitte_, 1917 346
247. Shell explosion: Wound of thorax; astasia-abasia
_Roussy_, _L’Hermitte_, 1917 346
248. War strain and fall in trench without trauma: Dysbasia
_Nonne_, 1915 347
249. Shell explosion: Partial burial; hysterical
symptoms in parts buried _Arinstein_, 1916 349
250. Wound of hand: Acroparalysis _Roussy_, _L’Hermitte_, 1917 350
251. Wound of arm: Hysterical paralysis _Chartier_, 1915 351
252. Wound in brachial plexus region: Supinator
longus contracture _Léri_, _Roger_, 1915 353
253. Contusion of muscle with “stupefactive” paralysis
of biceps (supinator longus still functioning) _Tinel_, 1917 355
254. Wound of arm: Blockage of impulses to hand movements
_Tubby_, 1915 356
255. Shell explosion: Bilateral symmetrical phenomena
_Gerver_, 1915 357
256. Shell explosion: Paralytic symptoms on side exposed:
Contralateral irritative symptoms _Oppenheim_, 1915 359
257. Shell explosion: Bilateral asymmetrical symptoms
_Gerver_, 1915 360
258. Shell explosion: Sensory disorder on side exposed
_Gerver_, 1915 362
259. Shell explosion: Hysterical deafness and other
symptoms; relapse _Gaupp_, 1915 363
260. Shell explosion: Deafness _Marriage_, 1917 365
261. Mine explosion: Deafmutism; recovery on epistaxis
and fever _Liébault_, 1916 366
262. Shell explosion: Deafmutism _Mott_, 1916 367
263. Shell explosion: Deafmutism and convulsions _Myers_, 1916 368
264. Gunfire: Aphonia _Blässig_, 1915 370
265. Shell-shock mutism: (_a_), observed, (_b_) dreamed
of, (_c_), developed by victim of shell explosion _Mann_, 1915 370
266. Mortar explosion: Deafness _Lattes_, _Goria_, 1917 371
267. Shell-explosion: onomatopœic noises _Ballet_, 1914 371
268. Shell explosion: Gravel in eyes; eye and face symptoms
_Ginestous_, 1916 372
269. Shell explosion; burial; blow on occiput; Blindness
_Greenlees_, 1916 373
270. Shell-shock amblyopia: Composite data _Parsons_, 1915 374
271. Factors in shell-shock amblyopia: Excitement,
blinding flashes, fear, disgust, fatigue _Pemberton_, 1915 375
272. Shell explosion amblyopia _Myers_, 1915 376
273. Shell windage without explosion: Cranial nerve disorder
_Pachantoni_, 1917 378
274. Initial case in Babinski’s series to show chloroform
elective exaggeration of reflexes _Babinski_, _Froment_, 1917 380
275. Wound of ankle: Contracture, chloroform effect
_Babinski_, _Froment_, 1917 383
276. “Reflex” disorder of right leg: Chloroform effect
_Babinski_, _Froment_, 1917 384
277. Bullet in calf: Hysterical lameness cured--reflex disorder
associated therewith _not_ cured _Vincent_, 1916 385
278. Trauma of foot: Hysterical dysbasia and reflex
disorders; differential disappearance of
hysterical symptoms _Vincent_, 1917 386
279. Shell-shock and paraplegia: Vasomotor and secretory
disorder twenty months later _Roussy_, 1917 387
280. Tetanus clinically cured: Phenomena reproduced under
chloroform anesthesia _Monier-Vinard_, 1917 388
281. Example of a “reflex” disorder after shell
explosion at great distance _Ferrand_, 1917 390
282. Shell fire: Shell-shock symptoms delayed _McWalter_, 1916 391
283. Shell-shock symptoms early and late _Smyly_, 1917 392
284. Wounds: Gassing; burial; collapse on home leave
_Elliot Smith_, 1916 393
285. Late sympathetic nerve effect after bullet wound of neck
_Tubby_, 1915 394
286. Hysterical crural monoplegia after fall from
horse under fire (reminiscence of similar
_ante bellum_ accident) _Forsyth_, 1915 395
287. Shell explosion, cave-in: Right leg symptoms
(_ante bellum_ experiences) _Myers_, 1916 396
288. Shell explosion, wound of back: Paraparesis (subject
always weak in legs) _Dejerine_, 1915 397
289. Wound near heart: Fear; paraparesis (subject always
weak in legs) _Dejerine_, 1915 399
290. Wounds: Tic on walking and recovery except frontalis tic
(emphasis of _ante bellum_ habit) _Westphal_, _Hübner_, 1915 401
291. Fatigue and emotion: Hysterical hemiplegia (similar
hemiplegia _ante bellum_) _Roussy_, _L’Hermitte_, 1917 402
292. War strain: Hemiplegia (similar hemiplegia _ante bellum_,
subject’s father hemiplegic) _Duprés_, _Rist_, 1914 403
293. Shell explosion and burial: Deafmutism (speech
difficulty _ante bellum_) _MacCurdy_, 1917 405
294. War strain: Shell-shock and psychotic symptoms
determined to parts _ante bellum_ _Zanger_, 1915 406
295. Mine explosion: Emotion; delirium (previous head
trauma without unconsciousness) _Lattes_, _Goria_, 1917 407
296. Sniper stricken blind in shooting eye _Eder_, 1916 408
297. Anticipation of warfare: Fall while mounting sentry;
hysterical blindness _Forsyth_, 1915 408
298. Spasmodic neurosis from bareback riding (similar
episode _ante bellum_) _Schuster_, 1914 409
299. _Ante bellum_ spasm of hands _Hewat_, 1917 409
300. Quarrel: Hysterical chorea, reminiscent of former
attack and itself reminiscent of organic chorea
in subject’s mother _Dupuoy_, 1915 411
301. Hallucinations and delusions of _ante bellum_ origin:
Treatment by explanation _Rows_, 1916 412
302. Tremors and convulsive crises in a poor risk
_Rogues de Fursac_, 1915 413
303. Emotionality and tachycardia in a martial misfit
_Bennati_, 1916 415
304. Hereditary instability _Wolfsohn_, 1918 416
305. Genealogical tree of a shoemaker _Wolfsohn_, 1918 417
306. Traumatic hysteria without hereditary or acquired
psychopathic tendency _Donath_, 1915 418
307. Mine explosion, burial: Neurosis in perfectly
normal soldier _MacCurdy_, 1917 419
308. Shell explosion: Tremophobia _Meige_, 1916 421
309. Frozen in bog: Glossolabial hemispasm _Binswanger_, 1915 424
310. Bruise by horse: Invincible pain--subject cured
by performing heroic feat _Loewy_, 1915 426
311. Kick by horse: Hysterical symptoms including
monocular diplopia _Oppenheim_, 1915 427
312. Windage from non-exploding shell: Emotion;
homonymous hemianopsia _Steiner_, 1915 428
313. Shell-shock psoriasis _Gaucher_, _Klein_, 1916 429
314. _Croix de guerre_ and Shell-shock got simultaneously:
Hallucinatory bell-ringing reminiscent of civilian
work _Laignel-Lavastine_, _Courbon_, 1916 430
315. Waked by shell explosion: Nystagmiform tremor
(occupational reminiscence in cinema worker) and
tachycardia _Tinel_, 1915 432
316. Synesthesialgia: Foot pain on rubbing dry hands
_Lortat-Jacob_, _Sézary_, 1915 433
317. Shell-shock and burial: Clonic spasms, later stupor
_Gaupp_, 1915 435
318. War stress (liquid fire) and shell-shock: Puerilism
_Charon_, _Halberstadt_, 1916 437
319. Bombed from aeroplane: Battle dreams; dizziness; fugue
_Lattes_, _Goria_, 1917 439
320. Hyperthyroidism after box drops from aeroplane _Bennati_, 1916 440
321. Shell dropped without bursting: Stupor and delirium
_Lattes_, _Goria_, 1917 441
322. Subject carrying explosives is jostled: Unconsciousness,
deafmutism, later camptocormia _Lattes_, _Goria_, 1917 443
323. Grazed by sliding cannon: Stupor and amnesia
_Lattes_, _Goria_, 1917 444
324. Shell explosions nearby: Emotion and insomnia
_Wiltshire_, 1916 445
325. Shell explosion: symptoms after hearing artillery
twelve days later _Wiltshire_, 1916 446
326. Exhaustion (heat?): Hyperthyroidism, hemiplegia
_Oppenheim_, 1915 447
327. War strain and rheumatism: tremors _Binswanger_, 1915 448
328. Shell explosion; emotion: Fear and dreams _Mott_, 1916 451
329. Under fire; barbed wire work: tremors and sensory symptoms
_Myers_, 1916 452
330. Shell explosion: Emotional crises; twice recurrent mutism
_Mairet_, _Piéron_, _Bouzansky_, 1915 453
331. Shell explosion: Emotional crises (fright at a frog)
_Claude_, _Dide_, _Lejonne_, 1916 455
332. War strain; wound; burials; shell-shock: neurosis
with anxiety and dreams: Relapse _MacCurdy_, 1917 457
333. Bombed by airplane: Suicidal thoughts; oniric delirium;
“moving picture in the head” _Hoven_, 1917 460
334. Shell explosion; emotion at death of best friend:
Stupor and amnesia _Gaupp_, 1915 462
335. Emotional shock from shooting comrade: Horror,
sweat, stammer, nightmare _Rows_, 1916 463
336. Emotion at death of comrade: Phobias _Bennati_, 1916 464
337. Shell explosion: Fright; delayed loss of consciousness
_Wiltshire_, 1916 465
338. Shell explosion; burial work: amnesia; unpleasant ideas
reflexly conditioned by shell whistling _Wiltshire_, 1916 467
339. Comrade’s death witnessed: Suicidal depression _Steiner_, 1915 468
340. Marching and battles: Neurasthenia? _Bonhoeffer_, 1915 469
341. English schoolmaster’s account of dreams _Mott_, 1918 470
342. War dreams shifting to sex dreams _Rows_, 1916 472
343. Shock at death of comrade: War and peace dreams _Rows_, 1916 474
344. War dreams including hunger and thirst _Mott_, 1918 475
345. Burial work: Olfactory dreams and vomiting _Wiltshire_, 1916 476
346. War dreams: Phobia conditioned on postoniric suggestion
_Duprat_, 1917 477
347. Service in rear: War dreams not based on actual experiences
_Gerver_, 1915 478
348. Hysterical astasia-abasia: Heterosuggestive “big belly”
_Roussy_, _Boisseau_, _Cornil_, 1917 479
349. Collapse going over the top: Neurasthenia _Jolly_, 1916 481
350. Battles: Mania and confusion _Gerver_, 1915 483
351. Machine-gun battle: Mania and hallucinations _Gerver_, 1915 484
352. Attacks and counter-attacks: Incoherence and quick
development of scenic war hallucinations _Gerver_, 1915 485
353. Hysterical stupor under shell fire after 2 days
in the trenches _Gaupp_, 1915 486
354. Monosymptomatic amnesia _Mallet_, 1917 488
355. Aviator shot down: Mental symptoms, organic _MacCurdy_, 1917 489
356. Shell fire and corpse work: Daze with relapse; mutism
_Mann_, 1915 491
357. Mine explosion: Confusion _Wiltshire_, 1916 492
358. Shell explosion: Alternation of personality _Gaupp_, 1915 493
359. “A Horse in the Unconscious” _Eder_, 1916 497
360. Shell explosion, gassing, fatigue: Anesthesia _Myers_, 1916 498
361. Shell explosion and burial: Somnambulism;
dissolution of amnesia under hypnosis _Myers_, 1915 499
362. Shell explosion with injuries: Somnambulism _Donath_, 1915 502
363. Shock: Stupor as if dead _Régis_, 1915 503
364. Emotions over battle scenes: Twenty-four days’ somnambulism
_Milian_, 1915 504
365. Putative loss of brother in battle: Somnambulism
and mutism twenty-seven days _Milian_, 1915 506
366. Shell explosion: Trauma, windage: Somnambulism four days
_Milian_, 1915 508
367. Burial, head trauma; gassing: Tremors, convulsions,
confusion, fugue _Consiglio_, 1916 509
368. Shell explosion: Hysterical symptoms and
tendency to fugue _Binswanger_, 1915 510
369. Burial: Dissociation of personality _Feiling_, 1915 512
370. Ear Complications and hysteria _Buscaino_, _Coppola_, 1916 516
SECTION C. SHELL-SHOCK DIAGNOSIS
371. Value of lumbar puncture _Souques_, _Donnet_, 1915 524
372. Meningeal and intraspinal hemorrhage: Lumbar puncture
_Guillain_, 1915 525
373. Burial: Slight hyperalbuminosis _Ravaut_, 1915 526
374. Paraplegia, organic: Lumbar puncture _Joubert_, 1915 527
375. Gunshot of spine: Spinal concussion, quadriplegia,
cerebellospasmodic disorder _Claude_, _L’Hermitte_, 1917 528
376. Trauma of spine: Anesthesia and contracture,
homolateral, with trauma _Oppenheim_, 1915 529
377. Mine explosion combining hysterical and lesional effects
_Dupouy_, 1915 530
378. Shell explosion: Hysterical and organic symptoms _Hurst_, 1917 532
379. Gunshot: Cauda equina symptoms, combined with
functional paraplegia _Oppenheim_, 1915 533
380. Intraspinal lesion: Persistent anesthesia _Buzzard_, 1916 534
381. Functional shell-shock: Erroneous diagnosis _Buzzard_, 1916 534
382. Retention of urine after shell-shock _Guillain_, _Barré_, 1917 535
383. Same _Guillain_, _Barré_, 1917 536
384. Incontinence of urine after shell-shock and burial
_Guillain_, _Barré_, 1917 536
385. Struck by missile: Crural monoplegia; plantar
reflex absent _Paulian_, 1915 537
386. Shell explosion: Crural monoplegia; sciatica (neuritis?)
_Souques_, 1915 538
387. Functional paraplegia and internal popliteal neuritis
_Roussy_, 1915 540
388. Bullet in hip: Local “stupor” of leg _Sebileau_, 1914 542
389. Localized catalepsy: Hysterotraumatic _Sollier_, 1917 544
390. Contracture: Hysterotraumatic _Sollier_, 1917 545
391. Crural monoplegia, tetanic: Recovery _Routier_, 1915 546
392. Spasms, contracture, crises--tetanic _Mériel_, 1916 548
393. Shell explosion, windage, flaccid paraplegia,
_not_ “spinal contusion” _Léri_, 1915 550
394. Scalp wound: Quadriparesis; paraplegia, cataleptic
rigidity of anesthetic legs _Clarke_, 1916 551
395. Shell explosion: Spasmodic contractions of sartorii,
persistent in sleep _Myers_, 1916 553
396. Shell explosion: Brown-Séquard’s syndrome, hematomyelic?
_Ballet_, 1915 555
397. Question of structural injury of spinal cord _Smyly_, 1917 557
398. Dysbasia, psychogenic round an organic nucleus (cerebellar?)
_Cassirer_, 1916 557
399. Shell explosion: Dysbasia, in part hysterical,
in part organic? _Hurst_, 1915 558
400. Peculiar walking tic _Chavigny_, 1917 559
401. Mine explosion: Camptocormia. Hospital rounder
twenty months--cure by electrotherapy, 1 hour
_Marie_, _Meige_, _Béhagne_, _Souques_, _Megevand_, 1917 561
402. Astasia-abasia _Guillain_, _Barré_, 1916 563
403. Shell wounds: Abdominothoracic contracture, tetanic,
four months after injury _Marie_, 1916 564
404. Shoulder dislocation: Hysterical paralysis of arm
_Walther_, 1914 566
405. Gunshot: Paralysis of arm increasing in degree
_Oppenheim_, 1915 567
406. Wound of wrist: Differential glove anesthesias _Römner_, 1915 568
407. Hysterical contracture combined with edema and
vasomotor disorder _Ballet_, 1915 569
408. Hemiparesis with syringomyelic dissociation
of sensations: Hematomyelia? _Ravaut_, 1915 570
409. Brachial monoplegia: Tetanic _Routier_, 1915 571
410. Paralysis of right leg: Hysterical? Organic? “Microörganic”?
_Von Sarbo_, 1915 572
411. Shell explosion: Burial: Paralysis on third day
_Léri_, _Froment_, _Mahar_, 1915 573
412. Shell explosion: Hemiplegia. Plantar areflexia
_Dejerine_, 1915 575
413. Shell explosion: Tic _versus_ spasm _Meige_, 1916 577
414. Shell explosion: Tremors, anæsthesias _Mott_, 1916 580
415. Hysteria, appendix to trauma _MacCurdy_, 1917 582
416. Peripheral nerve injury: Neurasthenic hyperalgesia
_Weygandt_, 1915 583
417. Soldier lead worker: Peripheral neuritis _Shufflebotham_, 1915 584
418. “Peripheral neuritis” cured by faradism _Cargill_, 1916 585
419. Late tetanus _Bouquet_, 1916 586
420. Spasmodic neurosis and neurasthenia _Oppenheim_, 1915 588
421. Hysterical and reflex (“physiopathic”) disorders
_Babinski_, 1916 590
422. Bullet wound: Paralysis non-“organic,”
non-hysterical, _i.e._ reflex _Babinski_, _Froment_, 1917 592
423. Asymmetry of reflexes under chloroform
_Babinski_, _Froment_, 1917 594
424. Reflexes under chloroform _Babinski_, _Froment_, 1915 595
425. Same _Babinski_, _Froment_, 1915 596
426. Shrapnel wound: Monoplegia, hysterical and organic
_Babinski_, _Froment_, 1917 597
427. Gunshot, later Erb’s palsy: “reflex”? _Oppenheim_, 1915 598
428. Paralysis hysterical? Organic? _Gougerot_, _Charpentier_, 1916 600
429. Same _Gougerot_, _Charpentier_, 1916 602
430. Same _Gougerot_, _Charpentier_, 1916 604
431.} Reflex “paralysis” _Delherm_, 1916 606
432.}
433. Shell explosion: Functional blindness, monosymptomatic
_Crouzon_, 1915 609
434. Retrobulbar neuritis (nitrophenol) _Sollier_, _Jousset_, 1917 611
435. Eye symptoms, hysterical _Westphal_, 1915 613
436. Sandbag on head: Eye symptoms: Lenses _Harwood_, 1916 615
437. Hemianopsia, organic or functional? _Steiner_, 1915 616
438. Hysterical pseudoptosis _Laignel-Lavastine_, _Ballet_, 1916 617
439. Shell explosion: Rombergism _Beck_, 1915 620
440. Case for otologists _and_ neurologists
_Roussy_, _Boisseau_, 1917 622
441. Jacksonian syndrome: Hysterical _Jeanselme_, _Huet_, 1915 625
442. Leg tic: Phobia against crabs _Duprat_, 1917 627
443. Convulsions reminiscent of fright _Duprat_, 1917 628
444. Fatigue, delusions, fugue _Mallet_, 1917 629
445. Obsessions and fugue _Mallet_, 1917 631
446. Aprosexia and birdlike movements _Chavigny_, 1915 632
447. Shell explosion: Unconsciousness (45 days): Mutism
_Liébault_, 1916 633
448. Shell explosion: Recurrent amnesia _Mairet_, _Piéron_, 1917 634
449. Shell explosion: Comrade killed: Amnesia _Gaupp_, 1915 635
450. Shell explosion: Recurrent amnesia _Mairet_, _Piéron_, 1915 636
451. Soldiers’ heart, neurotic and organic _MacCurdy_, 1917 639
452. Soldiers’ heart, neurotic _MacCurdy_, 1917 640
453. Shell explosion: Hysteria: Malingering (?) _Myers_, 1916 642
454. Officer who could not kick _Mills_, 1917 644
455. “Simulation”: Diagnosis incorrect _Voss_, 1916 645
456. Wound: Hysterical edema? _Lebar_, 1915 646
457. Head trauma: simulation? Hysteria? Surgical? _Voss_, 1916 648
458. Disease and disorder to avoid service _Collie_, 1916 649
459. Yes-No test in anesthesia _Mills_, 1917 651
460. Guardhouse test _Roussy_, 1915 651
461. Light in a dark room _Briand_, _Kalt_, 1917 652
462. Mutism simulated _Sicard_, 1915 654
463. Deafmutism simulated _Myers_, 1916 655
464. Same: Explained by patient _Myers_, 1916 657
465. Deafmutism: Appearance of malingering _Gradenigo_, 1917 658
466. A lame rascal _Gilles_, 1917 659
467. Picric acid jaundice _Briand_, _Haury_, 1916 660
468. Swelling of hand and arm, 7 months _Léri_, _Roger_, 1915 663
469. Shell-shy German _Gaupp_, 1915 664
470. Germany sends back a simulator _Marie_, 1915 664
471. Simulation of Quincke’s disease _Lewitus_, 1915 665
472. “Pensionitis” _Collie_, 1915 666