Crisp, T.

2018-09-13T15:47:38Z

2018-09-13T15:47:38Z

1918

The subject under review has been most forcibly brought home by this great European War. The manifestations are Protean, and to the patients afflicted, such symptoms are as real as those due to organic disease.

The oáuses of the psycho-neuroses of the War - the functional disorders under the name of "Shell Shock' - are emotion and concussion.

The continued and long mental strain of anticipation; the nauseating sights around; the new methods of trench warfare with exposure to cold, wet, etc., associated with loss of sleep, all help in lowering the vital resistance of the nervous system of even the strongest men and prepare the way for the crisis.

The main etiological factor is emotion.

Traumatism alone seldom gives rise to psycho-neurosis.

Most of these nerve war-strain disorders result from the same etiological factors, and can be differentiated from organic diseases and their method of treatment is more or less the same.

It is necessary in all cases to exclude organic disease and to recognise that these psycho-neuroses are different from cases of malingering.

The prognosis on the whole is good.

Treatment must be adopt ed at once s must be scientific, individual, and consists mainly of psycho-therapy, psycho-electrical methods and re-educative measures.

Alter the war a serious problem will have to be faced, namely: - what is to be done with our War Cripples, not only the physical but the mental.

Briefly the problem resolves itself into the profession and the laymen understanding the psychological aspect of these conditions, recognising that they are real, that treatment for such must be scientific, that "colonies" will be useful and necessary for the "mental war cripples" which will be free from the asylum stigma, and where technical workshops, etc., will be erected to fit these men for new employments or re-educate then in their previous trade or calling.

Out -patient clinics for psychical disorders should be established and be under University control.

In conclusion, it is noteworthy that the German view of, and treatment of, the psycho-neuroses of the war is similar to that of our own.

The Germans lay great stress on some form of employment or course of instruction, in various kinds of work, and general industries of the district. Medical Officers state the kind and amount of work to be done, and inspect the men once a week. Carpentry has been found by them the most satisfactory for strengths the muscles of the men, for their return to the front. A point is made of always praising and encouraging the men.

Kuhn states "that there are more examples of neuroses in the general wards of Military Hospitals than there are in the Nervous Hospitals and that patients with functional nervous disorders are often treated for heart disease, disease of the lungs, Sciatica, Myalgia, etc." In some cases these disorders are of ideogenous origin, . occurring while away from the front, such cases having little psychical resistance and readily affected by psychical influence".

Again Kuhn recommends psychical measures first, and lays great importance on the personality of the physician.

http://hdl.handle.net/1842/31791

The University of Edinburgh

Annexe Thesis Digitisation Project 2018 Block 20

Shell concussion, "shell shock" and allied conditions, results of war strain, or the psycho-neuroses of the war

Thesis or Dissertation

Doctoral

MD Doctor of Medicine