WAR AND THE NERVES.

Pukekohe & Waiuku Times, Volume 6, Issue 284, 15 June 1917, Page 1 (Supplement)

WAR AND THE NERVES.

TRIUMPH OF MEDICAL SCIENCE. REMARKABLE CASES OF HYSTERIA. Dr. t». R. Houston, author of tho striking article published below, is an eminent neurologist who spent soveral months working at the front in a French war hospital in order to make a special study of the offo t on tho nervous system of men struck by shells or sufier'ng from shell-shock. Tho beautiful city of Lyon ri (he says in his communication to the New York Tillies), lying at the confluence of tho Rhone and the Si to no, has been mad© the Hospital City of 1" ranee. More tuan 35,000 sick and wounded a.ro cared for there. A thousand of these are a-signed to the Neurological Centre and housed in the handsome building, of the Nouvollo Lycee, the new boys' college at tho entrance to the park. In each of the 20 medical districts into which France is divided, tnore t a simlar ho-pita 1 for men who have suffered damage to the nervous system. The centre Neurologif]iio at Lyons is, how ever, tho largest of these ventres, and for certain reasons the most interesting. The director i. Dr. Sollietr.

rTtHERE are opportunities offered in -*■ this hospital for the study of evenin,jury to the nerves and to the brain. There are many illustrations of wounds to tho several nerves of the extremities taken individually and in groups. There are instance.-; of tho iso- j lated dostructon of tho small single j nerves that control one muscle, as of • tho nerve controlling tho muscle that j supports tho shoulder blade, or the one j that activates tne muscle \yhich rotates j tho shoulder blade forward when the i rjni is ra'sed above the head. There j aro wounds at all levels of the spine and rents in the skull that Amve torn | away those highly specialised areas of . tiio brain substanco that preside over j speech or vision or hearing. When tho entire manhood of a nation is mustered into battle, it follows mat tho nervously frail, the men of unstable equilibrium, must go, too. The shocks and sudden emotional strains of civil life have made a certain number hysterical. It might bo expected that under the .stress of warfare many would j break. The number of such cases arising in the course of war is far greater j than in t'me of peace, but, after all, j they form but a small fraction of the l tot:;l numlier of nervous oases in the j neurological centres. A\ e have consid- j ered them, however, less because of the'r intmsic interest than for com- i parison with another class of cases.—the Com 1110 tic line-, that very largo and i novel group of cases, comprising several j thousand admissions to tlie neurological hospitals of France, which the French physic'ons named cerebral commotion, tho English shell shock. 1 In tho accounts of the groat bombard- j ments we have all j-cad of men who wero found dead in the trenches unwoiuided. Death liad resulted from air concussion j in the zone contiguous to tho cxplc l'Ug . shell. The concussion is more interne ; and tho danger greater if the shell ex- 1 plodes in a closed space, as in tho deep chambered trenches of the western front. I

Host of the commot'on cases were injured in the trenches. Often they were hurled some distance, daihcxl against a wall and buried alive. If aai oxanvnat : on is made ot the bodies of j these dead or of those, who have sur- | vived a few days before death, it is found that there has taken place an , intimato tearing of the finer structures throughout the body. The lungs are torn; there are abundant hemorrhages in the pleura and stomach. Toe blood in the brain are ruptured and minute hemorrhages are found throughout. I Many aro killed outright but most ; .survive. Even those survivors bleed in many cases from tho rats, the lungs, the stomach, tho bladder, and bowels. Thero arc sometimes hemorrhiigcs into the retina and under the conjunctivae. , The normally clear cerebrospinal fluid . i.s found blood t : nged. Even after blood is no longer found the fluid is often discovered to be under high pressure. the white* cells and globulins that , indicate damage to the meninges cont'liuc to 1)0 found in it tor n»onths.

The patients seldom regain memory of tho beginning of their accidents. At most they recall a wiiistLmg sound t-nnt i,receded tho arrival of the shell. In cerUi'ii eases there will be found only a more or less transient clouding of consciousness, or a very pain'lu station of having Imkjh beaten 011 the head. I'siuallv th o patient is una bio to walk, ami a,i ho is carr'.ed -on the stretcher everv movement is painful. Iho lini >s arc inert, tho head drops 011 the snouldor. Even when sitting ho collapses it not supported. Any movements niadt are maladroit and imprecise. lue sphincters are relaxed; almost all arrive at the .aid stations soiled with exrrenionts. La-tor they may have retention, but in the beginning tho contra'y 10 ho rule. . . , Tho facial expression is tvp.C'l co-ni-parable to tnat seen in the cerebral ' of infantile p«ralys;s-the corners of tho mouth droop, the tongue is pr«cti", the Hds droop, and the eyeballs are without motion. The pupil* are dilated almost always unequal. lu nil case* is found the .s gn <>l llai'iiisli-—irritation of the lootso.e p'.ovokin" an obvious and prompt elation of tho*great too, and a fanlike sproadi„.r of the other to.s-an unequ-.voj-al indication of damage to tho motor pathways leading from tiio brain; and, as further ind.cat'on of thu damage ho tendinous reflexes are generally stiouKly exaggerated. Kormg s sign ol <oit - cal irritation is present. In < ai-es of moderate seventy wo 0 >- ; ,(>rve a. rapid retrocession of symptoms. \Vitlrn twentv-four hours the nienta ,-loud.nes, ton'.l> to disappear. iho ox-pro-s on cl 1 bo lace changes, tho -t-r.ibii - miu diininishos and disappears, the ret'exes approach normal. i ' in severe va.es, however, ana sometimes from milder ones, there d.'Uio, . iv'ie-, ol nio-t bizarre cl'ineal It, is 1 lie general nervous system tha. is „io-t often and »i.*t ,uikingl> a - r,.,-t.nl As Ibo patient "-merge* 1 10111 11 s eli.udmg of consciousness, bo seems tll !- : n a state of oentus'.m. His 1110 - "I V i; weakened, lie has lost :iw |H»y ■ ~,'vol.Hilary attention He has 1. - r l;l t'o,K Te.se ,, yeborat.be -ta m;lv pc-ist for days or mom lis, and

|(I1 ~,, s;lfl . W nud ! » lllt ' rr:,r of t'io war zone. • • T|,i s uiKvdntc, iiis!<initii"int. sis it i l i'vHFor.lso,no, ( .n I forttot.l,<;^ho. uithoii.' it. illicit, consi<W 1 Hit;.son 0. r. kill „f .hri- <* *>» v ri-Ti',™ 1 )' lor

aro accompanied almost always by persistent nightmares of fire and battle that startle and disturb the rest.

It is at this stage extraordinarily difficult to disentangle symptoms that aro doo to gross organic injury from thoso that would be reckoned hysterical. Very frequently there are convulsive attacks that seem frankly similar to that described above; occasionally a case that resembles true Jaoksonian epilepsy. / lhero is often deafness associated with injury to the ears; again, deafness is present with ears apparently normal. Sometime.; tho deafness is associated with vertigo such a; suggests damage to the inner ear. As to the sight, ave encounter every degrco of disabdiy, from slight cloudiness of vision and narrowing of the visual field to complete blindness. In a considerable number of cases these troubles are duo to damage done to the retina. In ,a larger number, however, so far as examination can determine, they are purely subjective. These troubles ol sight and hearing are almost. never isolated They aro found associated with an assemblage of other symptom; referable to the nervous system-

Much more frequent than troubles of the special sensas are the paral .>es — paralyses of a 3in«le member , of both legs, or of lateral half of the body. Some of there paralyses are obviously due to hemorrhage within the brain, others aro a flaccid paralysis with loss of sensation. In all the characteristics that are accessible to investigation most resemble hysterical paralysis, and the greater number are associated with contracture of the muscles. Tho foot •will be drawn into the position of a clubfoot and firmly fixed there. Tho hand is tightly clenched, and the wrist ard el'»ow. bent. The contracted muscles of half the body may draw tne trunk and head to one side. The neck may bo fixed as a wry neck. A very ircquent deformity is the bent back. A peculiar c'.rcumstanco is the violent fit of coughing that is induced by any attempt to straighten the bent back, either in !:e:l or against the wall. The vocal cords may bo paralysed, and the tongue incapable of boing protruded, so that the patient's entirely mute, unable to make the slightest sound, to whistle or to blow, or even to imitate tho movements of the lips in speech. His breathing muscles are contracted so that he cannot draw a long breath. In milder cases there is a stammering to the clegivo of almost complete unintel'igibility. A muscular trouble, often ol tne most striking and startling sort, is the shaking and trembling. Ill's may ho a fine tremor, such as we have in Grave.' dbor.se, and Graves' disoa.se is a complication that is superadded to tho picture in a large percentage of caws, or a very coarse, irregular shaking and jerking of tho l ead, arms, locs, in contortions that make walking or" any co-ordinated movement nearly or fiiiito impossible. . Dr. Sullier is a largo and vigorous man both morally and physically, a mai\ whom one would fancy inclined by temperament to snatch his patients lrack to health, rather than coax them back. His cvuieiit kmdne-s and goodness to his men. however, give them courage TO endure the rigours of the physical treatment to which they are submitt> without qurst : on. The centra idea ot hw treatment is that the cordial centres must be awakened from their doi2it state by physical measures addressed to the parts of the both (Oim ponding to the cerebral involvement. In addition to thwo trcatmen s cai-i-ied out by the attending I>hyscuns and bv trained masseurs working undii the'r 'direction, an interesting am - deed most inspiring part of the work tho restoration ct these men i> tlio .systematic motor re-education canied out bv the men themselves. M «t> morning from 8 until •' ° j- 4 n<rain of an afternoon from 2int . in the quadrangle of the Lyeee the men nro {Fathered at the sound of the bugk grouped m squads accord Jto their several dUab.liues. The (1 [ih-footecl squ id, the - tured squad.*, the rontilactu - 0 t left arm. the contra, -tun* of t,u i, 1 t , rlll , and so on. Each squad Ms I_ non-eoninii ss'oned ofiieer. w • * • r .nvalescum frt.ni the sain- «i order.'and the whole battalion is um er tho t onmiand of a Sergeant. uhn is rnvtiillv recovered from severe oi.,in .„,d junctional <1 sturbam es The rppartus employed m tlm in ~ic' -es i of the sinij) est a manual ot arms e.rred out with a ,ome board plationns for the »su ■ , i„> t ik. ii lvnitr down. a. f"» we-_fii ■ ~,,,1 „„IWs. The nitwit™ « 'o In™* tin- (I,'lVl'livO I I" 1 " ' > ' i' V . ™ tnl rUd: f r

;>l " s frnm croup *<• n'mn!V.f them. T'no ehoorful ntmo--2* : ( linilll Mill 11.-nhiUK. '■ , • f ; ( , ir ,i ,I' Miund: tl.o rmnlifoii « th soldiers t<> nttiiii the pi ixire * t.'M h 0 ,0 utlu'i v l.nvo nrn'.o -nil eiv<* f prlicux'.wHl:-!- wlii(!i t.icv \^ uv - nn ; l I , , ~,.{ „f oi U'O tIM - t"'i» this « I nt( .a to this community of offnit.