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Shell-shock and other neuropsychiatric problems

Chapter 75: Case 64. (Hurst, March, 1917.)
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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.

An epileptic goes through Mons and two years fighting without symptoms. Then strange conduct with amnesia.

Case 64. (Hurst, March, 1917.)

A private, 26, epileptic from 11 to 18 (mother also epileptic) entered the army at 20, attempted to commit suicide in 1912 (amnestic for this attempt), and went to France with the expeditionary force in August, 1914. The retreat from Mons and further fighting caused no recurrence of the symptoms. September, 1916, he was in fact put in charge of eight men doing guard duty. At this time he was able to get to bed only every other night. The charge of the telephone worried him, as he had never before been made to assume responsibility. After two months of this, he was found one night arresting civilians without cause and driving them before him with fixed bayonet. He was let off court-martial on the medical evidence, and at hospital remained confused and suspicious. November 16, he was seen by a medical officer in a typical attack of petit mal. Of all this, on reaching England December 19, he had no recollection, and was keen to return to duty.

Re the remarkable delay in the return of epilepsy to this soldier of Mons, Bonhoeffer remarks that one of the epileptics observed by him at the Charité Clinic had passed through nine battles, and another through 18 battles before the first attack of epilepsy. Bonhoeffer regarded the strenuous marching as a liberating factor of epilepsy in five cases, actual fighting in seven cases, shell explosions in two cases, and bullet wounds in three.

Re the apparently psychogenic factor in Hurst’s case (epilepsy coming on after assumption of too great responsibilities), compare remarks of Bonhoeffer under Case 57 concerning psychogenic factors. Sir George Savage has called attention to a form of functional epilepsy following shock or injury, in which recovery occurs after removal from the strain, but in which there is a relapse if the men go back to duty.