Shell-shock and other neuropsychiatric problems

A married reservist was called up at the outbreak of the war and went through Mons, the Marne, and the Aisne and was finally blown up by a shell at Ypres. Early in November, 1914, he lost his speech but got it back in time to get home for Christmas. A number of teeth had been lost in the injury. Vomiting began first in England. While on leave at home he vomited at every meal. Asked whether it was his food or his thoughts, he said, “You are quite correct, Sir, you know I have always been with thinking.”

Under medical care, June, 1915, he was found suffering from hesitating speech, general tremulousness and emotionality. He worried a great deal on account of money matters at home. He lay awake thinking. A child became ill and died, and all the while he got worse, “thinking all the time.”

It was explained to him that the vomiting was a matter of emotions. The lost teeth were replaced by false ones. As he began to get control of his emotions, he vomited less and increased in weight. Finally he was boarded for discharge and was sick again on the day of the meeting. A fortnight later when sent to sign discharge papers he vomited once more.

According to McDowell, the vagus may possibly be incriminated as a cause of these gastric disturbances. Practically, the vomiting is a result of emotional stress. The cure is to produce insight on the part of the patient, the removal of worry and the restoration of self-confidence.

Roussy and Lhermitte find hysterical vomiting to be relatively common and as a rule without difficulty in diagnosis; but they remark that there is often some underlying organic condition to be sought for and treated after the neuropathic element has vanished. They remark, also, that there is no tendency to spontaneous cure of the disease. They advocate a strict dietetic régime and psychotherapy.