The Care and Treatment of Mental Diseases and War Neuroses (Shell Shock) In the British Army #230085

I have omitted entirely from this report any account of the treat ment of organic nervous diseases and of injuries to the central nervous system or the peripheral nerves. Organic nervous diseases are not especially frequent and seem to present no special military problems. Injuries of the central nervous system are frequent and severe. Those that do not prove fatal very quickly are well cared for at first in gen eral surgical wards where the services of neurologists and neurological surgeons are available and later in special hospitals or special hospital wards. A very serious difficulty in dealing with destructive brain and cord lesions is that the patients sooner or later pass from hospitals in which special care and nursing are provided to their homes or to poorly equipped auxiliary hospitals in which many soon get worse or die. Injuries to the peripheral nerves are frequent and important, in fact there are few extensive injuries to the extremities in which important nerves escape. With neurological advice, the surgeons deal with these cases successfully in the base hospitals and their after-treatment is well carried on in the reconstruction centers for orthopedic cases. Neither of these classes of injuries concerns us especially in a considera tion Of the treatment and military management of mental and func tional nervous diseases, except for the fact (to be commented upon later) that the treatment of the war neuroses might be carried out advantageously in home territory in co-operation with orthopedic reconstruction centers. Although the problems presented by mental and functional nervous diseases have many clinical and administrative features in common and although these disorders should be dealt with by medical officers with the same kind of special training, it seems desirable to consider their treat ment in England separately in this report. My observations as to the nature of the neuroses met with in war are based partly upon a study of the very extensive literature upon this subject which has come into existence since the commencement of the war,* but chiefly upon personal conversation with medical men engaged in treating these cases in England. It is almost needless to say that during a short period spent largely in securing information regarding facilities for treatment and administrative methods Of management and in examining special hospitals for the care of these cases, I had no opportunity to make original clinical observations, although I saw and examined superficially many cases of all degrees of severity.