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Shell-shock and other neuropsychiatric problems

Chapter 353: Case 328. (Mott, January, 1916.)
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About This Book

The work assembles nearly six hundred clinical case histories drawn from wartime medical literature to document combat-related neuropsychiatric disorders. It presents concise case protocols illustrating varied symptom patterns, diagnostic dilemmas, malingering and simulation, therapeutic interventions, and treatment outcomes, and includes bibliographic references and introductory commentary. Sections juxtapose cases to illuminate contested diagnoses and to inform postwar rehabilitation and mental-hygiene efforts, aiming to provide clinicians and reconstruction workers with detailed clinical material for recognizing, classifying, and managing neuropsychiatric consequences of war.

Shell-shock; emotion: Hyperkinesis, fear, dreams.

Case 328. (Mott, January, 1916.)

A private, 21, was with 30 men carrying sandbags in the daylight, under shell fire. He was thrown into a deep hole by an explosion, climbed out, and saw all his mates dead.

He was admitted to the Fourth London General Hospital, June 20, 1915, having been at Boulogne for a fortnight. He was lying in bed on his back, making continuous jerky lateral movements of head, and movements of arms, especially of the left arm. He was groaning slightly, now and then raising his eyelids with a staring expression of bewilderment and terror. He was able to mutter answers to questions. He would occasionally raise his right hand to his forehead. If he was observed, these movements became exaggerated. They ceased in sleep. He muttered even when unobserved. He continually said, “You won’t let me back.” Asked as to dreams, he replied, “Guns.” Voluntary movements were made, which prevented obtaining reflexes. When his pupils were to be examined by a man in uniform, he showed a marked facies of terror; his pupils were dilated; the eyes opened wide, the brows were furrowed, and there was an anxious scowl. The flash of an electric light produced the same effect.

June 24 the patient was much better. He said the explosion which had killed his friends after he had been only a few weeks at the front, was the first serious event in his service. He kept seeing it again, with bright lights and bursting shells. Sometimes he would hear the men shouting. In dreams he both saw and heard shells and men. There was pain in the back and right side of the head.

June 26 he was improved but still had pain in the back of the head, especially when trying to remember, and a slight tremor of the hands. He had been given hot baths at Boulogne on account of being very cold and shivering. He had always felt sick at the sight of blood. He was boarded for Home Service six months after admission.