WAR'S TOLL ON HEALTH.

Northern Advocate, 8 January 1920, Page 3

WAR'S TOLL ON HEALTH.

TREATING SHELL SHOOK".

THE PSYCHOLOGICAL FACTOR

DR. SPRINGTHORPE'S VIEWS.

Colonel .1. W. Springthorpe has an interesting article in "Repatriation," the official journal of the Victorian Repatriation Department, on "Shell Shock and War Neuroses." Tho maximum difficulty before repatriation (lie writes) lies, I believe, in the psychological direction. As this lias been my special study both before and during the war, I feel justified in summarising the situation. The term "shell shock," as popularly used, includes a multitude of diverso conditions —viz.: 1. The malingerers—few in number, who feign what is not. 2. The temporarily knocked out — I who speedily recover. ?>. Tho temperamentally unfit —with a past history which should have kept them away from the strain for which they proved unequal. 4. Tho concussed and wounded —who suffered much as if thrown from a horse, or shot in the head, in peace times. i). The neurasthenic —with abnormal irritability, and fatiguability, restless, discontented, and with subjective fears and worries. (i. The incorrectly called "hysteric" —with fixed circumscribed objective difficulties, really caused by suggestion, and removable thereby. 1. The true "shell sohek" —in whom j high explosives produced more through the emotions than by the concussion, a complexity of symptoms, perpetuated by suggestion more than by minute organic change. STATE'S DEBT TO MEN. There must be few of those who spent any length of time under the anxiety, terror and horror of the firing line who have not suffered somewhat from the strain imposed upon them, and who do not, upon demobilisation, find themselves more or less unequal to continuously working and living under modern civilised conditions, even though they have accepted demobilisation without disability. Statistically, there are said to bo some 12 or 15 per cent, who received some definite recognition of their disability under one or other of the last three of the previous categories. It is just that the State for whom they fought should consider itself in their debt, even though in a certain proportion of cases there may have been only aggravation and not actual causation. NOT MALINGERERS. It would astonish the public, just as it astonished the military authorities, and even the medical profession generally, to find how deeply the psychological factor has bitten into the disability framework, and how widely it has ramified through its manifestations. Even now only experts know how it lias dominated many medical and surgical conditions, that are still too often treated as if they require simply drugs, operations, or allied physical treatment.

At first, if they showed no wounds, these cases were treated as malingerers, and, even when demobilised here, many genuine cases were similarly discharged, without any pension. A very large number remained for months in the ordinary medical and surgical wards, undergoing all kinds of skilled treatment except the proper one. Frequently massage, electricity, all sorts of baths, and highly ingenuous orthopedic procedures took the place of psychoterapy, with slow, if any, movement. Even to-day the same remains true, though pshyological treatment would directly attack the cause, and frequently lead to prompt cure. INDIVIDUAL INVESTIGATION. It will, I hope, be evident from the foregoing that as each case has its own amount, and kind of vulnerability and actual disability, and its own functional possibilities, aims, and aspirations, it calls for its own separate and individual investigation and settlement. There can be no one road to restoration, even the royal road opened by departmental officials proceeding according to regulation. Nor can there be any one place or institution fitted for the needs of all. Many are unfit for any institution. Each case, indeed, requires to be treated on its own merits. Further, it is irrational to bring a patient up to a certain stage of restoration and then throw him into environment as to which there is little knowledge and over which there is mo control. The future must be the reaction of the individual to his environment. It is courting failure, to cease supervision and sympathetic assistance, with per-,, sonal touch, just when the patient be-' gins to be fit to leave an institution from which he is not infrequently sent out all the sooner because in many ways it did not meet the requirements of his case. BETWEEN THREE MASTERS. These '' nerve cases'' thus call for exceptional treatment. At present they are under three masters —Defence, Pensions, and none of whom they are receiving the best treatment, and between whom there is no satisfactory nexus. Despite advances and improvements, a number of serious defects still remain and until the triple control is replaced by one expert authority, vested with full powers, until extended provisions are made both inside and outside institutions, and until continuity of supervision is secured for probational periods after discharge, there will be many whose present condition will remain unsatisfactory, and their future imperilled. And yet, probably above all others, it is the class of cases that deserves and will repay the very best attention that their country can give them, and which the vast majority want to give them.