A final contribution to the study of shell shock : being a consideration of unsettled points needing investigation / by Charles S. Myers.

  • Myers, Charles S. (Charles Samuel), 1873-1946.
Date:
1919?]
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Licence: In copyright

Credit: A final contribution to the study of shell shock : being a consideration of unsettled points needing investigation / by Charles S. Myers. Source: Wellcome Collection.

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    V2 after the onset of “shell shock,” I could find no sphygmo- manometric evidence of increased blood pressure, nor by Fehling’s fluid could I detect (save in one case) the slightest trace of sugar even in the first urine passed by these patients since they left the trenches. But sympathetic (or vagal) neuroses may be associated with glandular exhaustion, as well as with glandular over-action. We need a careful record of the effects of glandular extracts on the emotional condition of cases of war neuroses, and of their effect on the psycho-galvanic reactions and on the reaction times of such patients in association tests. We are as yet uncertain of the range of action of the sympathetic system, and hence of the extent of its influence in the war neuroses.12 That it can control the tone of voluntary muscles and affect the steadiness of their contrac¬ tion there is little doubt. Can it also produce the osteo¬ porosis and muscular atrophy which is observed in many so-called “reflex” cases? Every experienced physician must have occasionally met with a surprising degree of atrophy, alike in cases where there has been some local wound or central concussion and in cases where there has not. This atrophy is often very slow to disappear and in the experience of some is intensified by the returning use of the affected muscles. In certain cases it may arise from vaso¬ motor disturbances in the cord, induced by the sympathetic system. In addition to the collection of data bearing on this obscure subject we need a series of investigations by modern methods on the electrical reactions of functionally disordered muscles. In this country, at least, we have been paying so much attention to the mental aspect of the war neuroses that a detailed examination of the accompanying bodily symptoms has been generally neglected. We have yet to ascertain what symptoms usually occur in combination. My own experience, for example, leads me to think that a feeble or absent plantar response is usually associated with a sluggish reaction of the pupils to light and with a tendency to clonus and catatonia, while an unusually brisk flexor plantar response is associated with an extra-active pupil reaction. Rigidity of the limbs often seems to go with hypersesthesia, weakness with anaesthesia. But much more information is needed on this subject. A more careful study is also needed of the mental and physical changes occurring during recovery. A most promising subject of investigation would be the changes that I2 In agreement with Pighini (Riv. sperim. di Freniat., 1917, xlii., 298), Orr and Rows have pointed out (Brain, 1918, xli., 19) how intimately the sensori-motor and psychic areas of the cerebral cortex are associated with the sympathetic system, and hence how disordered functional activity of the former may spread through the latter to lower centres in the mid-brain, bulb, and cord, causing dilatation of the pupils and cardio-vascular and other disturbances.