Library Collections: Document: Full Text


The Disabled Soldier

Creator: Douglas C. McMurtrie (author)
Date: 1919
Publisher: The Macmillan Company, New York
Source: Available at selected libraries
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Cases of insanity among soldiers differ from those occurring among civilians only in the war coloring of the sufferers' delusions. In the allied countries they are treated by the army medical service until they recover or until they are recognized as incurable, when they are sent to regular hospitals for the insane.

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Classed together under the term shell shock are many different kinds and degrees of nervous disorder. These range from a temporary loss of self-control to such a severe shattering of the nerves that the patient is a mental and physical wreck. Symptoms vary greatly in different individuals and are both mental and physical in character. Some men appear tired and depressed; others are irritable, worried, or terrified. They are usually afflicted by severe headaches, and at night they are troubled by violent nightmares. A common type of war-neurosis is the hypochondriac with his thoughts constantly centered upon his real and imaginary pains. Inability to concentrate the attention on anything marks another type, and still different is the man who sinks into complete mental torpor, sitting for days indifferent to all around him, too apathetic to wipe away a tear that may roll out of his eye. Other mental symptoms are tangled thoughts and partial or total loss of memory. On the physical side, the victim of shell shock frequently has a disordered heart action and strange tremors in his limbs. His head may waggle uncontrollably and pitifully, or his feet drag helplessly along the floor. Among the severer effects are puzzling cases of muscle contractions and paralyses, authentic signs of physical injury without a scratch on the body. A large number of shell shock cases lose temporarily their sight, hearing, or speech, becoming in all reality blind, deaf, or dumb though there has been no injury to their sensory organs or nerves.

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The derangement of the nervous system Indicated by these symptoms is inadequately described by the term shell shock, for the condition occurs in men who have never heard an exploding shell. It is not necessarily caused by the concussion of high explosives with the accompanying noise and horrid sights -- the psychic trauma of battle -- but is as often brought on by the physical and emotional strains the soldier has to bear. Great fatigue, lack of sleep, cold, hunger, mud, and filth wear a man down to the breaking point. Then fear begins to clutch at him, and worse, the fear of being afraid. He struggles with his fear and conquers it, but each victory is at the cost of nervous energy. He suppresses all expression of his emotions and cultivates a soldierly indifference to the loss of comrades and the ghastly incidents of war, but the suppressed feelings wait their chance to gain the upper hand. At any time now the collapse may occur, or it may hold off until it is precipitated by some violent shock -- the explosion of a shell which buries him beneath corpses and debris, or bad news in a letter from home.

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Even when the actual atmospheric concussion from an exploding shell is violent enough to knock a man unconscious, it does not appear to be the prime cause of the nervous collapse. Men who are severely injured by shell fragments are only slightly affected by shell shock, while men who escape serious bodily injury suffer the greatest nervous disturbance. As has been said, the physical and emotional strains of the soldier's life play an important part in the result, but in many cases the determining cause is an innate nervous instability, a predisposition to hysteria or neurasthenia. Many men are temperamentally unfit to be soldiers, and these are the likeliest victims of shell shock. They are often men who have displayed great bravery, men who have volunteered for desperate trench raids or to carry despatches through a barrage, but they lack the nervous energy for keeping up their effort. Far from being a reflection on a man's courage, shell shock shows that he has spent himself to the utmost.

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When a man is nervously spent, his will loses the mastery and long suppressed desires or fears rule. In the shell shock victim the dread of battle, the fear of death and injury, so long kept under, holds sway over both mind and body. The man is not a malingerer, but his mind exerts a subconscious influence on his bodily condition. While his body is unfit, he cannot go back to the front; under the influence of his ruling wish to escape further suffering, his body therefore refuses to mend. Many cases of shell shock are clear examples of such hysteria. One case reported by an Austrian physician was of a South Slav soldier whose leg after shell shock remained stiff for many months. In the course of the man's hospital sojourn he contracted tuberculosis, a ground for discharge from service, and the leg rapidly recovered. In other recorded instances, where the eye-sight has been temporarily lost, the sight has returned most slowly to the shooting eye.

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The treatment prescribed for shell shock cases in the early acute stage is rest in bed, good food, and cheerful surroundings. This treatment is provided for the British and French armies in special shock hospitals just behind the lines. Under it a large proportion of the cases rapidly recover and in three or four weeks are usually sent back to the front. Cases which show that they will not recover quickly are evacuated to the base hospitals, and then, if they are British soldiers, are sent back to England, the milder cases to general convalescent hospitals and the severer ones to special neurological institutions. Discharged soldiers still suffering from nervous diseases are able to obtain additional treatment in certain so-called Homes of Recovery organized for their benefit by the Pensions Ministry. These Homes of Recovery have done invaluable work in restoring to nerve-shattered ex-soldiers the ability to live and work as normal men. Their success seems to have been due not a little to the fact that the men taking treatment have no fear of being returned to the front when they are cured.

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