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?]
Catalogue details

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.

    4/16 (page 4)
    conditions; while others maintain that, quite apart from suggestion, emotional conflict or excitement is capable of producing functional disorders. Some have distinguished a so-called commotional from an emotional syndrome ; others have insisted that whether a man has been buried in a trench or has seen his best friend’s brains scattered before him the functional symptoms are identical. All now agree that mere concussion or the poisonous action of carbon monoxide or other noxious gases does not necessarily give rise to functional nervous disturbance. Many neurologists hold that the effects of suggestion and of functional disturbance are limited to phenomena which can be imitated voluntarily by the patient ; they accordingly limit functional disturbances to those which can as well be produced by malingering. Hence local or general sweating, vaso-motor disturbances, changes in the reflexes or in muscular tone, and any disorders of movement which do not disappear during sleep or under an anaesthetic cannot, according to this view, be due to suggestion and cannot be classed as functional disorders. But cases of contracture occur which clearly cannot be imitated voluntarily2 ; so do, more seldom, cases of spasmodic movement and of incoordination. The persist¬ ence of contracture or of spasmodic movement is likewise inimitable by volition. Moreover, every physician of experi¬ ence must have met with patients suffering from functional deafness, whose sleep has not been in the least disturbed by the loudest noises, and they must have seen contractures and spasmodic movements persisting during sleep and during at least the first stages of chloroform anaesthesia. We may recall the case of persistent contracture described by G. Ballet,3 which was carefully tested during sleep by means of stamp-paper gummed to the affected region. It has, however, been objected that in such exceptional cases of contracture the possibility of joint adhesions has not been considered, or that the contractures are due to peripheral causes and are therefore to be placed in a special group of “reflex contractures.” In this country, at least, I think it difficult to exaggerate the harm that has arisen from an uncritical acceptance of Babinski’s hypothesis of “reflex ” paralysis or contracture. I have met with expert neurologists who, on diagnosing a case as belonging to the “ reflex ” group, have at once regarded it as “organic ” and have refused it admission to one of the special hospitals for functional disorders. For my part, I have never seen such a case in which the paralysis or contracture has not been cured by psycho-therapeutic measures (aided, sometimes, by manipulation under an anaesthetic), and the other so-called reflex symptoms (loss of muscular tone, coldness, sweating, 2 Cf. Roussy : Rev. Neurol., 1918, xxv., p. 204. 3 Ibid., 1915, xxii., p. 767.