WHEN WE CONSIDER the severity of the ordeal to which our soldiers in the firing line have been exposed, especially in the earlier days of the War, it is surprising how small a proportion have suffered from serious functional disorders of the nervous system.

Nerve shattering conditions

Conditions more calculated to shatter the strongest “nerves” it would be hard to imagine. Days and nights spent in wet, insanitary trenches, clothes swarming with vermin, food never very appetizing and often insufficient in amount, death or mutilation always imminent, comrades falling and fallen around, the groans of the wounded mingled with the ear-splitting din of bursting shells, to say nothing of the unspeakable horrors of the bayonet – all this, one would think, would more than suffice to upset the equilibrium of the most stable nervous system.

Nevertheless, only a small proportion of those who have been exposed to these conditions have been invalided from nervous breakdown. For the fact is, that the healthy nervous system has wonderful resisting and recuperative powers, and never has the fact received more forcible demonstration. Men from the front have told me that they have themselves been surprised how quickly they forget even their most trying experiences, and how readily and as a matter of course they turn to the next business in hand.

It is chiefly among those possessing unstable nervous systems that neuroses and psychoses are met with. Dr Fernsides found that of 70 soldiers suffering from nervous breakdown, seven had previously been the victims of traumatic neurasthenia, four had had a previous nervous breakdown, four gave a neurotic family history, while others were suffering from active syphilis, which is known to predispose to neurasthenia. This shows the importance of the Wassermann test in cases of war neuroses.

Warfare provides a searching test of the soundness of the nervous system. A highly unstable nervous system succumbs to the slightest strain, while a highly stable nervous system is endowed with remarkable powers of resistance.

I am referring to genuine functional disorders. Many of the war neuroses which appear to be purely functional are really, in large measure, due to organic lesions. Thus, Dr Gordon Holmes has shown that the concussion of shell shock may cause notable changes in the spinal cord, such as swelling, often very marked, of the neuraxons; and disseminated haemorrhages in the brain have been observed in several cases. It is obvious that the most stable nervous system cannot withstand injuries of this kind. Eliminating such cases, it will be found that war neuroses occur essentially among those who are temperamentally neurotic.

Aetiology

Three factors stand out prominently in the aetiology of these neuroses; the noise of the bursting shells, the violent concussion of the air which they produce, and the fear produced by the terrifying conditions of war. 

Shell concussion - blindness, deafness, mutism, paralysis

The violence of shell concussion may carry the soldier several yards away, and may concuss the brain so severely as to induce unconsciousness. When consciousness is recovered, blindness, deafness, mutism, amnesia, paralysis, and other neuroses may be left behind. In many of these cases, at least, the loss of consciousness is not absolute, inasmuch as the memory of the unconscious period may be recovered by hypnotism. Dr James Collier thinks that neuroses are less likely to occur when the shell explosion produces immediate unconsciousness, than when an interval of consciousness allows the sufferer to realize, and mentally to register, the situation.

Noise of bursting shells

The noise of bursting shells is probably an important factor in the production of deaf-mutism. Not only does it tend to paralyse the auditory centres, but the associated speech centres as well.

The mutism is possibly also partly due to the attendant fear. It is well known that a person may be “struck dumb with fear.” A sudden loud noise is peculiarly calculated to excite fear.

Witness the effect of a thunder clap. Some women continue to the end of their lives to be terrified by thunder. I have, moreover, observed the agitating effect of a thunderstorm upon nervous patients in hospital, and have noticed that, under its influence, those suffering from hysterical affections are liable to become restless and agitated, and to suffer from an exacerbation of their symptoms.

Fear and terrifying dreams

Fear is one of the most potent factors in the causation of war neuroses, and the conditions of active warfare are such as to excite this emotion in its most intense form: many of the patients present symptoms – tremor, palpitation, sweating, retracted lids – suggestive of a long drawn-out fear.

Terrifying dreams, nightmares in which the patient lives over again some dreadful experience, are common, and are followed by an intensification of symptoms. These dreams get less intense and less frequent with the progress of time.

The war neuroses differ greatly in their manifestations, and it is difficult to classify them satisfactorily. Most of them can be grouped under insanity, neurasthenia, psychasthenia and hysteria.