Soldiers heart, neurotic.
Case 452. (MacCurdy, July, 1917.)
An Australian gunner, 35, of a neurotic make-up (night terrors; horror of blood; fear of thunderstorms, high places, tunnels, horses; shy with both sexes), benefited by military training physically, but remained as neurotic as ever. On the way to his first service in Egypt, he feared shipwreck, and in Egypt was troubled by the weather and occasional palpitations and sinking feelings. He was transferred to the French front, May, 1916. He was terrified and depressed under shell fire, and horrified by blood. Peculiar sinking sensations or feelings that the soul was leaving the body came to him as he was going off to sleep; from which he woke at times with sudden starts. Later he had nightmares of things, mainly shells, falling on him. He worried, wanted death, and thought of suicide. In May, 1917, he was blown off his feet by a shell. Thereafter he began to feel that shells were being especially aimed at him, and four days later got a pain in the side, and began to tremble and breathe with difficulty, as if his throat were swelled up and he were going to choke. He ascribed this to gas. The bombardier finally sent him back to a hospital, where he grew weaker and screamed aloud on being awakened by his dreams. After six weeks in a special heart hospital, all the symptoms cleared up except the choking feelings and fear of instant death. Organically the man appeared normal. An initial pulse of 96 ran up to 168 after exercise, and down to 84 after two minutes’ rest.
Re soldier’s heart, Abrahams speaks of sundry hypotheses that he regards as erroneous. Soldier’s heart has been thought to be (a) athlete’s heart; others regard it as (b) a toxemic condition, possibly of bacterial origin; (c) hyperthyroidism (a larval form of Graves’ disease has been incriminated); (d) excessive cigarette smoking; and (e) deficiency of buffer salts in the blood, have been proposed by other authors.
Gallavardin has especially studied the tachycardial cases revealed by the war, cases in which auscultation is frequently unable to detect aught. These tachycardiacs are often hypertensive. Sedentary service should be found for them.
Re pulse 168 after exercise, Gallavardin found 8 per cent of 500 non-organic and non-tuberculous cases to run up from 150 to 175 (125 to 150 in 27 per cent; 100 to 125 in 37 per cent; 75 to 100 in 26 per cent; 50 to 75 in 2 per cent).
Re cardiac neuroses, Brasch points out that cardiac neuroses in the male in war time have found a strange new association with hyperesthesia of the skin. The patients showed dermatographia and hyperreflexia. The hyperesthetic zones of Head and Mackenzie were found by Brasch in all cases of organic cardiac disease, but also in two cases of cardiac neurosis in hysterics.
Moore calls attention to somewhat similar phenomena in the somatic group of nervous and depressed cases found in the war. These patients are fatigued, exhausted, sleepless, tremulous, vascular, and cardiac cases, with dermatographia, areas of paresthesia, and pains in the neighborhood of wound scars.