Neuropsychiatry and the war : a bibliography with abstracts

Preface

In order that the psychiatrists and neurologists in the neuropsychiatric hospital units attached to the base and other military hospitals of the I faited States Government may have at hand the latest information about the special problems to be met in the army camps, abstracts of books, of parts of books, and of more than 300 articles dealing with the psychiatric aspects of the war have been gathered and prepared. The abstracts are grouped under the countries in the language of which the original books or articles were published. Under each country the material is arranged chronologically according to the date of publication, so that development of theories, changes of opinion, working out of methods, and the like, may be traced throughout the progress of the war. A list of the eighty-seven periodicals from which abstracts of articles have been made is given on the sub-title pages preceding the literature of each country. Since few issues of German medical journals of a date later than 1915 have reached this country, and since the receipt of other foreign periodicals has been very irregular, omission of important articles has been unavoidable. It is hoped, however, that this omitted material will be available later, and so can be included in additional collections of abstracts to be issued from time to time by the War Work Committee of the National Committee for Mental Hygiene. In some instances, when brief and timely abstracts have been found in medical journals, these have been reprinted in the collection, but in all such cases full credit has been given to the writer of the abstract and to the journal in which it was originally published.

Thanks are due to the Library War Service of the American Library Association for approval of the binding of the abstracts, to Miss Evelyn G. Smalley who contributed references to articles in foreign periodicals, to Miss Edith M. Furbush, Statistician of the National Committee for Mental Hygiene, who compiled the tables on pages 245-247 from the Reports of the Surgeons-General of the United States Army and Navy, and to Dr. Bernard Glueck, Director of the Psychiatric Clinic at Sing Sing Prison, Ossining, N. Y., who made the translations and abstracts of the Russian literature.

Contents

PAGE

Australian Literature 7-10

British Literature . • 11-75

I

optic- centers -external geniculate bodies, optie thalami and superior colliculi.

It, too, is probably in the synapses of I li«' cortical cells, in I his ease the synapses

of the filters of the optie radial ions. Sometimes Bucb a block occurs physiologically ami it is probably l<> be explained in tin' same manner. -.J. A. M. A. 64: 1581, May 1, 1915.

Pemberton, Hugh S. Psychology of Traumatic Amblyopia following the Explosion of Shells. Lancet, Lond., May 8, 1915, p. 967 A ease in an artillery sergeant in which the following factors were present: (1) Excitement during a prolonged and critical attack, (2) Over-Stimulation of eyes and ears. The Hashes of night firing are very brilliant, while many batteries close together and all firing rapidly invariably produce temporary deafness among the gunners. (3) Some natural fear from close hostile bursts. (4) Disgust at the sight of the killed, two of whom were decapitated and one disembowelled. (5) Great physical and mental fatigue from continuous laying of the gun during twelve hours. — A. Ninian Bruce, Rev. of neurology and psychiatry 14: 24-25, Jan. 1916.

Turner, William Aldren. Cases of Nervous and Mental Shock Observed in the Base Hospitals in France. Brit. med. j., May 15, 1915, P. 833-35

"Cases of nervous and mental shock," writes Lieutenant-Colonel W. Aldren Turner, M.D., F.R.C.P., "may be counted among the more interesting and uncommon clinical products of the present war." Almost from the outset of the war such cases began to come into our hospitals and were found to be due sometimes to the bursting of heavy shell near the man, to his burial under earth and debris, or to the effects of noxious gases; in other cases to nervous exhaustion due to sleeplessness, fear, anxiety or other prolonged strain. Towards the end of 1914 Sir A. Keogh sent a special medical officer over to France to report on the number and nature of these cases and suggest the best form of treatment for them in France and at home. As a result of this officer's report it was decided to label all such cases at the base hospital and send them for treatment in England at hospitals for nervous diseases under the care of neurological experts.

The system now adopted with such cases, while they are under military care, is as follows: At the base hospital a distinction is made between neurological cases (neurasthenia, functional paralysis, hysteria, etc.) and grave mental cases bordering on, if not actually, insanity. The neurological cases are sent to one of the clearing hospitals for such disorders at home and there treated. If the case is a light one, the patient may be rapidly cured by a course of rest and good feeding and returned to duty after a furlough; if more severe, he will be sent to one of several special hospitals for nervous diseases where further treatment is given. Cases of mental disorder go to another clearing hospital, and unless signs of improvement occur, are sent on to the military hospital for such cases either in England or Scotland. These cases of mental disorder often prove responsive to medical treatment, and as long as there is any hope of improvement they are kept in a military hospital; but when they are manifestly incurable they are discharged to an asylum.

A man suffering from neurasthenia, who does not prove amenable enough to treatment to enable him to return to the army, is discharged from the special hospital where he has been treated and returned to civil life. But such a man is not sent off to the ordinary local committee for advice on his further treatment; he is brought before a special medical board, presided over by Sir John Collie, which has its headquarters in London, and sends out members to examine discharged neurasthenics in other towns. This board and its local delegations consider the cases, not onlv of men immediately they are discharged, but also of those who have been given short, renewable pensions until the degree of their disability has been finally ascertained. '1 bese boards recommend t<> the special forms of treatment Buitable for them, can ord< r gratuitiefl from the ions fund for those whose disability is not likely to be permanent, and make recommendations for the final scale of pensions to which each such man is entitle.).

Work and interest in extraneous life arc the best cure for Such Cases. 0

theworsl services that can be rendered to them is to lavish in judicii • thy

upon them. From the nature of the disorder, the man is apt to pity hii unduly and to welcome greedily well-meaning but ill-advised attempts to make him think himself incapable of exertion. ( hiefiy in order to gave such men from their friends and to give them the bracing treatment that the. require, a 1 for neurasthenics discharged from the army lias recently been opened by the Pensions Ministry at Golders Green. This hospital ha- cosl some £6,000 to put in order, and is hired by the Red Cross Society at a rental of £500 a year. The upkeep is paid for by the Pensions Ministry. The staff of the neighboring Maida Vale Hospital for nervous cases will be at hand to treat the patients. Besides medical appliances such as electrical apparatus and whirlpool baths, and facilities for psychotherapeutist treatment, a leading feature of the place will be the workshops for basket-making, joinery, bootmaking and carpentry and fifteen acres suitable for agriculture; and all the patients will be encouraged to work. The number of patients is limited to 100, and no man will be allowed to stay there more than three months. During that period, wise and sympathetic treatment and insistence on work will have cured the vast majority, even of the most obdurate cases. — Recalled to life 1: 125-27, June 1917.

Abrahams, Adolphe. Case of Hysterical Paraplegia. J. of Royal army med. corps 24: 471-73, May 1915

A private was admitted to the Connaught Hospital, Aldershot, in September, 1914, suffering from paraplegia. His history was as follows: On September S, 1914, a shell had burst near him and a companion. lie was unconscious for four or five days. When he regained consciousness he found himself suffering from one slight wound, complete paralysis of both legs, and pain in the back near the fourth lumbar vertebra. He said he had paralysis of the sphincters for eleven days after the accident. The description of his condition Boon after admission reads as follows: "There is complete paraplegia below both hips. As regards sensation in the legs, there is complete loss of all forms of sensibility, including deep touch in the right leg below Poupart's ligament and behii high as the iliac crest. In the left leg there is complete anaesthesia to all forms of sensibility of the foot, including the heel and sole. There is loss of sensibility to light touch all over the limb, but pain (pin-prick) is appreciated apparently normally as far down as the ankle, where there is an abrupt change to total anaesthesia. There is some weakness of the right arm and of the muscles supplied by the ulnar nerve, and there i^ anaesthesia to touch and pain over tin area of distribution of the ulnar nerve in this hand. Sphincters normal."

As there was no evidence of trophic change in any part of the body, nor of any differences in the power or muscular condition in the upper extremities; and as the scar of the small bullet wound over the trunk of the sciatic nerve showed

itself perfectly healed, such a condition pointed almost beyond the slightest

doubt to functional paraplegia. The nature of the psychic trauma WSS arrived at by further cross-examinations, in one of w Inch the patient stated that he had

seen the legs blown off the companion at his side at the time of the shell explosion, and in another he said he had only heard that this had happened. It was learned also thai I he patient has a sister w ho has been completely pa rah Bed for years and this circumstance probably introduced an anxiety neurosis that the burden of an additional cripple upon the family should not be laid to his charge.

L9

"On April 30 the patient was anaesthetized with nitrous <>\i<l<'. During the Blighl temporary rigidity which occurred the lower limbs were seen i«> participate in the change. Before consciousness returned, the legs were Qexed and placed in a position in which the change could readily !><• Been l>y the patient) w ho. ii | ion the return of complete consciousness, was persuaded thai th< [egs had

moved during the anaesthesia, and coi anded to place them in o more con

Yemeni position. Slight vol mil a ry inoveiiieiii of the thighs immediately took place, and suggestion was continued throughout the day, movements being encouraged against resistance which the patient <li<! not realize. On the following day he was gradually raised to the vertical position and supported upright. At this stage his menial condition was one of resistance and resentment and reluctance to admit that any voluntary movement was possible. During the day the upright position was resumed at intervals, and the patient made to walk between two attendants. On the following day he walked alone. By I his time his attitude of resistance had broken down, his movements were now made without any demonstration of the great exhaustion which characterized his first efforts, and he began to express interest and pleasure in his recovery. Henceforth improvement was steadily progressive. His co-ordination and strength increased so that he was soon able to walk a hundred yards with a stick, and then unsupported. A pronounced hysterical element persisted, encouraged by the almost perpetual attention he received from visitors and other patients. When he left for an auxiliary hospital on May 25, there was sharply defined hemianaesthesia in the right side throughout the body to light tactile sensation (cotton-wool) and to slight painful sensation. On the left side sensation throughout was perfect wdth the exception of a doubtful patch of anaesthesia on the dorsum of the foot, the sole and the plantar surface of the heel."

Emslie, Isabel. War and Psychiatry. Edin. med. j. 14: 359-67, May 1915

Isabel Emslie notes that the war has not made any increase in insanity as far as civilians are concerned. Among those in which insanity may be said to have been caused by the war, the great proportion of cases are those people who have had previous attacks and those who are weak-minded or very high strung. Fewr normal persons seem to have been affected. Many of the admissions to the asylum show that though their psychoses were not actually caused by the war, nevertheless this was playing a large part in evolution. This factor was very noticeable in the admissions which occurred in the first month or two after the commencement of the war. It has gradually become less and less frequent, till nowT it is rarely seen. The mental shock of the war is apparently not so keenly felt nowr by the unstable mind as when the blow first fell. Of patients already suffering from psychosis when the war started, it could not be said that one had a relapse wThich might be traced to the war. The patients who were most affected were the paranoiacs, who, though they apparently had a normal outlook on the war, really had their own distorted views of it and had developed many and varied delusions. — Med. rec. 88: 205, July 31, 1915.

Fiessinger, Noel. Emotional Shock from Bursting of Big Shell. Med. press and circ, Lond., new series, 99 : 563-65, June 9, 1915

The writer comments upon the rare occurrence, according to his experience, of shell shock, stating that a week after a battle in which the enemy's heaviest artillery was used only one case of pronounced emotional shock and two minor cases w-ere found in an ambulance with sixty -nine wounded and sick. These disturbances supervened on the day after or two days after the battle, as is so often true in the manifestations of hystero-traumatism. "The patient broods over his experience and slowly develops his symptoms in the quiet and calm of the ambulance."

Four cases are then cited.

"It is interesting t<> note thai in the subjects oi inds this elem<

shock is conspicuously absent, [ts intensity is not proportional to the gravil the wound. The iii« > - 1 severely impressed are rather those who have escaped physical injury. . . . One man is struck by a piece of shell that knocks away his occiput and pari of the brain, ye1 there is ao shock. A week after the receipt of his injury the patient takes an interest in his progress and looks forward to being invalided home.

"As to the nature of these nervous disturbances, it can plainly be no qui of malingering, for the victims were excellent soldiers. The violent nervous impression sets up a neurotic state of variable duration. These cases recall the weO known syndrome of traumatic neurosis, and their sole interest lies in their etiology. It is obvious, too, that these accidents can only present themselves on a neurotic soil.

"By way of treatment, rest, 'suggestion,' and manual occupation Buffice in most instances. The very man who has presented these symptoms may, on a subsequent occasion, prove 3 hero; in short, they are the minor consequence! violent emotion."

Grasset, Joseph. Clinical Lecture on The Psychoneuroses of War. Med. press and circ, Lond., new series, 99 : 560 63, 586 87, June 9 and 16, 1915

In common with Dr. W. A. Turner, writing separately in the British Medical Journal, under date of May 15, 1915, on "Cases of nervous and mental shock observed in the base hospitals in France," Dr. Grasset describes deaf-mutism (occasionally, but less frequently, blind deaf-mutism) as one of the clinical surprises of the great war. These cases are caused by the explosion of big shells in close proximity to the patient. The shock is both physical and mental. "A typical instance is the bursting of a shell at close quarters by which a soldier is hurled several yards through the air and more or less completely buried beneath earth or the bodies of his comrades. He loses consciousness, and on recovery! especially if he be in an emotional or overtaxed condition, finds that he can neither see, hear, nor speak. . . . He is unable either to convey or receive impressions."

Dr. Grasset suggests, as an explanation of the psychology of these cases, that these patients probably think that they have died, as the only thing which unites such a patient to existence is the preservation of his sensibility and sense of movement. The remarkable example is cited of an ingenious nurse who placed a pencil in the hand of one of these blind deaf-mutes, and guided it while she wrote a question on a piece of paper. The patient replied to the question, writing the answer in a firm round hand. "In these cases sight usually returns first, hearing next, and speech last of all. Both sight and hearing may suddenly return."

Among the less interesting psychoneuroses produced by shell shock are traumatic neuroses, the mos t important clinical manifestation of which is hemiplej or, rather, anesthetic hemi-impotence; hysteria, neurasthenia, disturbance^ of sleep, and changes in character, as well as various psychoses. The opinion is

expressed that personal and hereditary antecedents ante helium' have comparatively little value in the psychoneuroses >>f war. hut that in the etiology of the psychoses the personal and hereditary elements play infinitely the more

important role.

Out of ]!•:> cases of traumatic lesions of the nervous system examined hy Dr.

Grasset during the fir.^t three months (.f his service, fifty-nine cas bo-

neuroses were found.

It is stated that the marked psychoneuroses are n. it as a rule provoked by

the graver injuries. "The origin is more dramatic. The explosion of a bursting shell which hurls the victim three or Pour yards through the air iiu<l frequently buries him beneath corpses and debris; the explosion <'f s shell in the

trenches in his immediate vicinity by which the comrades at his side are killed, men who are perhaps breakfasting with him; an explosion which kills a comrade and perhaps hurls the lifeless body al him; the impact of a projectile which bruises and stuns without actually wounding him; these are the originating

causes of the psyehoncuroses of war. . . . When the victim recovers consciousness, which he does sooner or later, he finds that he IS paralyzed < "'• thinks that he has lost, one of his liinhs. He is blind, deaf, ami dumb, or he is

in a shattered and anxious mental condition. " . . . The number of patients

Suffering from mental disease is hound to be greatly increased as the war continues. War conditions "try men's souls" probably more than any other human experience. Psychoses and psyehoncuroses are certain to claim a tremendous toll as one of the aftermaths of war. — H. Butts, U. S. naval med. bull. 10:127-88, Jan. 1916.

Feiling, Anthony. Loss of Personality from "Shell Shock." Lancet, Lond., July io, 1915, p. 63-66

The case is described of a bandsman, aged 24, who was buried in a trench at Ypres. He seems to have been dug out twelve hours later, was unconscious for twenty-four hours, and deaf and dumb for three days. He then did not know his father or relatives, and his mind was found to be a complete blank to all events previous to his being buried. He was "regarded as a case of loss of memory, or amnesia, of such a degree that all conscious memories of his life, as well as the countless memories forming his knowledge of letters, objects, and life in general, were completely suppressed." He was thus a case of complete dissociation, or obliteration, of personality, the term "double personality" being hardly applicable. He was happy and contented on the whole, but could remember nothing previous to his injury. When taken to the zoo, he tried to stroke one of the lions, had no interest in the war, but was interested in music. He was hypnotized, and it was suggested to him that his lost memory would gradually return on awakening. This had no effect. At the second sitting he answered all questions of his past life freely, and it was possible to reconstruct his whole story. He thus presented two personalities. No. 1, i. e., during ordinary life in hospital, was his personality since the date of his "coming to himself" in a hospital in Manchester. No. 2, i. e., the state during hypnosis, was his old personality endowed with all the memories of his past life, and with the more recent and lively memories of experiences on active service in Flanders, up to the time of the burial in the trench. Persons seen and known to him in his ordinary state were always complete strangers to him in his hypnotic state, and vice versa. In his ordinary state he took no great interest in his father; under hypnosis he regarded him with great, affection.

About twenty-five sittings were held, but no improvement resulted, and as a certain amount of psychical disturbance seemed to be caused, further hypnotic treatment was abandoned. He wTas sent home, but his condition remained unaltered. He had no recollection of his previous life at home, and failed to recognize old friends. — A. Ninian Bruce, Rev. of neurology and psychiatry 14: 20-21, Jan. 1916.

Milligan, William, and Westmacott, F. H. Warfare Injuries and Neuroses. J. of laryngol., rhinol. and otol., Lond., 30: 297-303, Aug. 1915. Illus.

. . . A number of interesting cases are briefly described with skiagrams showing the position of the bullet. "Concussion deafness" is merely a passing phase in the temporary abolition of sensory impulses in a brain already anaemic as the result of physical fatigue and mental strain. Nine of ten cases of the deaf and dumb state all recovered within six weeks. The abrogation of function is not due to any organic lesion, but to a temporary suspension of neurone impulses from the higher cortical cells of the central nervous system to the peripheral. In functional aphonia there is no paresis of the adductors as in true hysterical aphonia; there is a total inability to put the vocal cords in motion. Something has happened, probably in the cortical cells of the centers for speech, to prevent volitional impulses necessary to set the machinery of speech in action. — A. Ninian Bruce, Rev. of neurology and psychiatry 13: 457, Sept. 1915.

Proctor, A. P. Three Cases of Concussion Aphasia; Treatment by General Anaesthesia. Lancet, Lond., Oct. 30, 1915, p. 977

The first case was allowed out of hospital with some of his companions, and while in a village became intoxicated. In this condition he "found his voice," and for two days talked and sang incessantly. He was discharged cured.

The other two cases were cured by light ether anaesthesia, the patients being induced to speak during the period of excitement. — A. Ninian Bruce, Rev. of neurology and psychiatry 14: 25, Jan. 1916.

Beaton, Thomas. Some Observations on Mental Conditions as Observed Amongst the Ship's Company of a Battleship in War Time. J. of Royal naval med. service 1 : 447-52, Oct. 1915

A very interesting psychological analysis. It begins with a description of the type of men who composed the ship's company and the influence of their previous environment. Passing then to a consideration of the nature of the influences to which they were subjected and the consequent reactions, the writer divides the time covered by these influences into three periods: First, a period of prolonged and monotonous stress during the four months that the ship was lying in an exposed position on the East Coast; second, a period of sudden and increased stress, amounting to two days, while the ship was at sea; and last a period of quiescence while the ship was lying in a protected harbor. The writer describes with vivid analysis the critical four months in which the men passed from patriotic eagerness and pleasure in their new duties to the sorting out of friends and acquaintances, to loss of novelty and merging of individuality in component of ship's company, to automaticity in duties, to mental attention to remote matters, such as duration of war, to loss of intelligent anticipation, to unstable apathy, with nothing left to think about, when routine becomes an ever increasing stress and morbid tendencies develop, resulting in mild neurasthenia with hypochondriacal tendencies. Arrived at this stage of minor accidents all had a mental sequence of some kind. The conclusion can only be that lengthy periods of such character as the first four months should be prevented if possible. That the results were not more regrettable than they were can only be due to the standard of the men and their fine morale. — Mil. surg. 37: 608, Dec. 1915.

Mott, Frederick W. Psychic Mechanism of the Voice in Relation to the Emotions. Brit. med. j., Dec. 11, 1915, p. 845-47

Abstracts of Pabagbaphs on War Neuroses "In my experience at the military hospitals a number of remarkable cases have come under my care illustrating several points in connection with the psychic mechanism of the voice in relation to the emotions. A large number of men suffering from shell-shock, and having no visible signs of injury, have lost their speech, and yet are quite able to write a lucid account of their experiences. This mutism is really an exaggerated form of hysterical aphonia. A woman, owing to an emotional shock may lose her voice; she can, however, as a rule whisper. These men cannot whisper or produce any audible sound. They

2.'}

occasionally show the bodily signs of extreme terror." Sometimes in tin ir dreams these soldiers call out expressions they have used in battle or in the trenches. Occasionally this is followed by a return of speech. The frequency with which these cases of shell-shock suffer with terrifying dreams at night and sometimes in half-waking stales during the day means that the emotional shock is exercising an effect upon the mind by thoughts reverting to terrifying experiences, and the same thing probably accounts for the terrified, vacant look of depression on their faces, the cold, blue hands, feeble pulse and respiration, and sweats and tremors.

"The sudden and varied manner in which these mute patients recover their speech is indicative of a refractory condition of respiration in its function of voluntary production of audible sounds in all forms." The author then mentions cases of recovery caused by unexpectedly feeling pain, by tickling, by shouting out in dreams, by involuntarily joining in a well-known chorus, and by various other kinds of surprises.

"As depressing emotional conditions . . . play an important part in aggravating the shock effects of shell fire and maintaining subsequently a more or less transitory functional neurosis in the form of deafness, blindness, paralysis, tremors, and mutism, we may suppose the sudden emotional excitement, especially if it be connected with the preservation of the individual, is followed by such a powerful stimulating reaction on those depressed nervous centres that the refractory phase established in them by the shock is suddenly overcome. I believe this mutism is due primarily to an inhibitory functional paralysis of the voluntary cerebral nervous centres which control the management of the breath and direct its mode of escape through the glottis, mouth and nostrils, for I have seen many cases where they have involuntarily and unconsciously in their dreams talked and uttered cries and swears, but in their conscious state were unable, not only to talk and sing, but to whisper, whistle, utter a cry, cough, or laugh aloud. The worst cases were unable even to blow a candle out. I examined one with the X-rays and found the diaphragm hardly moved in respiration; he could not expand the chest necessary to fill the bellows. Latterly he has acquired this power; he can now take a fairly deep inspiration, yet he cannot talk or even whisper, cry or laugh aloud; he blows a candle out with the mouth open instead of moulding the lips. Therefore in his case there is an inhibition of the whole voluntary mechanism of audible sound production." The author then describes this mechanism and its double interdependent action of phonation and breath control.

He then discusses the difference between symbolic language, or that produced by civilization, and the universal language of primitive human beings, which expresses itself through mimicry and gesture, and is dependent upon an instinctive preorganized mechanism in the central nervous system. "The effect of emotional shock in the production of mutism is upon this preorganized mechanism which controls the force and mode of escape of the breath in the expression of the emotions and passions. . . ."

"The terror sometimes observed in soldiers suffering from shell-shock is contemplative fear; it is fear made more or less permanent by the imagination fixing in the memory past terrifying experiences, repressed in great measure by conscious activity of the mind during the waking state, but evident in the dreams which afflict nearly all these soldiers suffering from shell-shock and trench warfare."

Mott then cites the case of a soldier through whose brain a bullet had passed, damaging the half in which are located the centres controlling articulate speech, so that he was able to make no voluntary sounds except "oot" for no, and "ah" for yes; yet, if the first word or bar of music of any of several songs was given to him, he was able to sing it through without difficulty. "It must be concluded either that the song had been repeated so often as to have become organized in both halves of the brain or in subcortical lower centres." The soldier recovered a month later his ability to walk and speak.