114 



NATURE 



[March 30, 1916 



or a sandbag, or by falling heavily on the ground after 

 being blown up in the air, there is a more or less 

 complete retrograde amnesia of variable length of time. 

 In a case of simple "shell shock" it is impossible to 

 say whether the patient was unconscious during- the 

 whole period of time of which he has lost all recollec- 

 tion of the events that happened, or whether during 

 the whole or a part of the time he was conscious, but 

 owing to the '* commotio cerebri " the chain of per- 

 ceptual experiences was not fixed. 



In the majority of cases "shell shock" affects only 

 the higher cortical centres ; in severe cases the vital 

 centres, as in apoplexy, alone continue to function, and 

 the patient is in a dazed condition, and he may auto- 

 matically perform complex sensori-motor purposive 

 actions of which he has no recollection* whatever. 

 Several cases of this kind have come under notice, 

 •one of the most trustworthy being a history obtained 

 from an officer. His company had dug themselves in 

 in a wood; he went out into the road to see if a convoy 

 was coming, when a large shell burst near him. It 

 was about two o'clock in the morning and quite dark; 

 about 4.30 a.m. it was quite light, and he found him- 

 self being helped off a horse by two women who came 

 out of a farm-house. He had no recollection of any- 

 thing that happened between the bursting of the shell 

 and this incident. 



The frequency with which these cases of shell shock 

 suffer from terrifying dreams at night and in the half- 

 waking state points to the conclusion that a psychic 

 trauma is exercising a powerful influence on the mind 

 "by the thoughts reverting to the terrifying experiences 

 they have gone through, and their continuous influence 

 on the subconscious mind may account partially for the 

 terrified or vacant look of depression on the face, the 

 cold blue hands, feeble pulse and respiration, sweats 

 and tremors, some or all of which signs of fear the 

 severer cases manifest. As these dreams cease to dis- 

 turb sleep, so these manifestations of fear tend to pass 

 •off and give place to the sweet unconscious quiet of 

 the mind. Occasionally during the waking state con- 

 templation of the horrors seen provokes hallucinations 

 ■or illusions which may lead to motor delirium or in- 

 •sane conduct. A number of striking illustrative cases 

 were given. 



Speech defects are a common symptom of "shell 

 shock." Of these mutism is the most common ; it may 

 l>e associated with deafness. Unable to laugh or 

 cough sonorously, to whistle, or to whisper, indeed, 

 to produce any audible sound, mutes are able never- 

 theless to express their silent thoughts by writing. The 

 cause of the muteness is due to loss of power of phona- 

 tion. Major Mott discussed this subiect very fullv in a 

 paper read before the Society of English Singers.^ 

 Besides mutism and aphonia, stuttering and stammer- 

 ing are not uncommon conditions. There is no differ- 

 •ence between the mutism and aphonia met with in 

 "shell shock" and that of hysteria; the manner in 

 which it disappears is similar; even a trivial circum- 

 stance, in which attention is taken off its guard and 

 the mute is surprised by an emotional shock, may 

 cause the patient suddenly to speak. 



A very interesting case was narrated of a grena- 

 dier who. when admitted, was blind, deaf, and mute ; 

 he was, however, extremely sensitive to skin impres- 

 sions ; indeed, it seemed as if the mind focused atten- 

 tion on the perceptual avenue which had not been 

 functionally dissociated bv the shock. His sight was 

 restored to him quite suddenly, and he was then able 

 to communicate his silent thoughts by writing. His 

 power of recocrnition was good, but his recollection 

 was a blank for the whole period of time he had been 



3 " The Psvc^ic Mechanism of the Voice in Relation to the Emotions." 

 Brit. Med Journal, December 15, iqh;. 



NO. 2422, VOL. 97] 



in France, and he could give no information regard- 

 ing the circumstances which led to the condition he 

 was in. A few days later he became very emotional, 

 and suddenly recovered his hearing and speech. 



Although mutes are unable to speak voluntarily, yet 

 under the influence of terrifying dreams they often 

 call out in their sleep. One man had been shouting 

 in his sleep and was told this the next morning by a 

 comrade; he was so surprised that he said, "1 don't 

 believe it." 



Various functional paralyses are common, and an 

 injury often determines the seat of the paralysis by 

 suggestion ; thus a man may be blown up and bruised 

 on his hip or shoulder, and a fixed iaea is engendered 

 that the limb is paralysed. Functional paralysis of 

 the lower extremities in consequence of injury of the 

 back is a common condition ; likewise various dis- 

 orders of gait and station, tremors, coarse and fine, 

 tics, and choreiform movements are other manifesta- 

 tions of motor functional disorders. Hypcraesthesia, or 

 increased sensibility of the skin to stimuli, and. 

 anaesthesia are of frequent occurrence. One of the 

 commonest and most troublesome symptoms is hyper- 

 acusis, or sensitiveness to noises ; and when the; 

 Zeppelin raid occurred many serious relapses took! 

 place. It would take too long to detail the manifold 

 symptoms that may arise in consequence of these func- 

 tional neuroses. 



Major Mott does not employ hypnosis or psycho-' 

 analysis ; he considers these modes of treatment un- 

 necessary, as he has cured numbers of cases by making 

 a careful examination of the patient, and then assur- 

 ing the paralysed, the tremulous, the mutes, and others- 

 that there is no organic disease, and that they will 

 certainly recover. An atmosphere of cure is neces- 

 sary ; therefore when a patient with functional paralysis 

 comes with crutches or sticks, the first thing he does 

 is to order them to be taken away, for they are not 

 required. Many men who had been paralysed wrecks 

 and months have thus been cured in a few hours or a 

 few days. Massage and electricity, and all other treat- 

 ment which suggests a disease, he deprecates. H< 

 stronglv advocates diversion of the mind from the 

 recollection of the late terrifying experiences by music, 

 games, and amusements of all kinds, and he appealed 

 to the charitable public to provide such for the new 

 Maudslev Hospital of the London County Council* 

 Denmark Hill, which has been recently taken over by 

 the War Office for the treatment of 200 of such cases 

 as those to which he referred. 



UNIVERSITY AND EDUCATIONAL 

 INTELLIGENCE. 



Cambridge. — The Special Board for Biology anC 

 Geology have made the following grants from th< 

 Gordon Wigan Fund : — 30Z. to the Department ol 

 Geology towards meeting the deficit in the workinj 

 of the department ; 40^. to the Department of Botany 

 for assistance to the curator of the herbarium in his 

 work on the British flora ; ^ol. to Prof. Punnett, in 

 order that the Botanic Garden Syndicate may cort- 

 tinue to offer special facilities for plant-breeding experi- 

 ments ; 5Z. to the curator in entomology for the rare 

 and development of the collections of insects; 15/. to 

 Prof. Gardner for the provision of special lectures in 

 parasitology in connection with the diagnosis of 

 disease. 



The council of the Teachers' Guild has arranged 

 for a conference on educational reform, to be held oil 

 Saturday, April 8. Specialists in various grades of 

 education — university, technical, secondary, and 



