SRELL-SHOCK.
Few diseased conditions have given rise to so much earnest study and debate as this symptom-complex. The kaleidoscopic picture in which neurasthenic, hysterical and psychasthenic elements combine in be wildering complexity has only become familiar during the late world-war, though surgeons have long been acquainted with its milder analogue in the state following severe railway accidents and various types of spinal and cerebral concussion. One of the most remarkable features of shell shock is its rarity in those individuals who have been severely wounded by shrapnel in the same explosion which caused the shock to his compan ions. No practitioner will probably ever see a fresh typical example of this condition during the present generation or possibly ever after; nevertheless, a short outline of the general principles of treatment is desirable.
The first duty of the physician after placing the patient in a position of absolute physical and mental rest in a ward by himself, or in company with those who have not been severely wounded, is to make an attempt to unravel the tangled skein and discover the prominent thread which dominates his mentality. In many cases a history of mental or neurotic instability may be obtained from his relations or comrades, and the power ful agent of Suggestion should be wisely and firmly exercised by the phy sician. The calm assurance of the absence of organic or incurable disease, coupled with the verdict that the victim will not be expected to return to trench or other form of active warfare, often produces an immediate, and sometimes a lasting benefit. In the hands of those who have given
special study to the action of Hypnosis, this agent has been beneficially exercised, when followed up immediately by Re-education, continuously employed till the natural functions are regained. In acute cases the symptoms must be treated on general principles. Mott recommends prolonged immersion in the warm bath till restlessness and mental excitement or delirium is relieved.
Insomnia, if not overcome by this treatment, will require supplementing by Simple l I ypnotics. headache should he relieved by cold to the head, sinapisms to the nucha, and analgesics like Antipyrine and Aspirin.
the neurasthenic element is the predominant one the treatment of this condition as detailed under its own heading should be carried out. hysterical phenomena may be treated at a later stage by Electricity. Strong Faradic shocks or the sinusoidal current are often of considerable value.
Strict discipline by most observers is considered an important element in treatment, and, above all, such alteration in the environment as games, exercises, and a change from pre-war sedentary occupations to gardening or farming.
Those cases where the psychic or mental phenomena are persistent and prominent should be placed under the care of the specialist trained in the treatment of the various psychoses.