How to Treat Shell-shock

Waikato Independent, Volume XVIII, Issue 1741, 18 April 1916, Page 6

How to Treat Shell-shock

'Hie war has made possible a degree of organisation iu medical research such ns could hardly have been contemplated before it (says the Loudon “Observer”). As a factor of the National Uealtli Insurance the Medical Research Committee had a great deal of useful work before it, but the war coalesced its activities by furnishing such imperative subjects of research as infectious 'disease iu a-rmics, wound Infections, organised methods of sanitation, aftereffects of wounds arising from septic conditions or from nerve injury. The Committee, under the presidency of Lord .Moulton, and consisting of representatives of the Army, the Government and of science, and owing not a little to its secretary, Dr \V. M. Fletcher, F.D.S., has enlisted er commandeered the Dost brains of the country in combined attack on the problems arising in these circumstances, and has arranged for co-ordinated examination of all the “material” which the casualties of war supply.

Thus all the “nerve” eases which are sent to the military hospitals are examined by trained observers, and all the symptoms, injuries, and peculiarities noted on a common plan. Fifty neurologists, among them the most brilliant and the ablest men, give their services to this work, and the examination is conducted both in England and in the hospitals in France and Flanders. Thus every “nerve case” is now cardindexed. The observers can compare notes and correlate information, ■ and meetings are held to discuss cases, tendencies and treatment. A standard practice of inquiry and treatment null emerge, and it will be valuable in cßil life as well as in warfare.

For, although the war meates a great number of ner\ous injuries, the symptoms most often follow those in groups of cases already known. The most often-named nervous injury is that of. “shell-shock ” What is shell-shock? It may be a very large number of things in -which shells have played little or no part. The commonest form is a simple concussion, which may take place because the victim has been in reach of the wind of a high-explosive shell when it burst, or may have been sand-bagged behind a parapet if the shell lias burst very near the outside of the trench. In neither case will the patient be able to say whet happened, because concussion if this kind will obliterate the memory of everything that happened for some time, it may be some hours, before be was injured. The symptoms of this kind of shell-shock are the same as those of concussion in civil life, and are followed by similar complications. Nervous Effects. But though this kind of nervous effect is the only one attributable directly to a shell, there are a number of other conditions popularly termed shellshock which are only indirectly due t' it. Thus there is the dazed condition into which officers or men may fall after a period of severe shelling, and in which, though the memory is continuous the mind is dulled, and the conduct becomes “curious.” A third condition is that in which men, apparently sound and who have been going on. without noticeable ham, break d-'Wn after a heavy shelling. If removed to a place of safety they sleep, but they cannot be moved back to the trenches again, because they are abnormally sensitive to noise. Any loud noise will undo them, which is why some of the complaints from convalescents about cab-whistling in London arc so heartfelt and so well founded.

There arc several other groups of eases: some of which can be classified as the effects of strain or want of sleep on an already over-wrought nervous system; some resemble re-awakened neurasthenia or hysteria, and there are a few of insanity, but these are very rare, and have been eliminated. Nearly all can be remedied by proper neurological treatment, and the amount of information now accumulating in the hands of the Medical Research Committee is of high value in practice.-

Shell-shock is only one form of nervous affection. For classification purposes injuries are grouped, under damage to the brain, to the peripheral nerves, and to the spine, ' The brain may lie damaged by concussion, or by pieces of bone flicked into it, or by other damage to the skull; the spine may be injured by bruising the spinal cord (wounds in the neck forming a curious subdivision). The peripheral mo ves (of the arm, the leg, etc.) may result as in the former examples. All those injuries and their symptoms' are now being catalogued and indexed for reference.