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One Hundred Years Ago: Shell Shock

last modified Feb 13, 2015 09:27 AM

Pages from Myers 1915.jpg On February 13th, 1915, the term 'shell shock' was used for the first time in the medical literature, in a paper in The Lancet.  The paper is now seen as seminal in the literature on war neuroses.  The author was Charles Samuel Myers, Director of the Cambridge Psychological Laboratory.  Myers had volunteered for war work the previous autumn and secured a post in the war hospital that the Duchess of Westminster had established in the Casino at Le Touquet.  By February he had been commissioned as a captain in the Royal Army Medical Corps.

Myers' paper concentrates on sensory functions and on memory, and that reflects the author's background.  Born into a prosperous Jewish family, he had read Natural Sciences at Gonville and Caius in the 1890's and had then undertaken clinical training at Barts.  But in 1898 he joined the celebrated Cambridge Anthropological Expedition to the Torres Straits and Sarawak; and his subsequent career had been in anthropology and in experimental psychology. The Duchess's consultants brought to Le Touquet the possessiveness towards patients that would have characterised London hospitals of the time.  So Myers was allowed little clinical work.  In November 1914, however, he was able to examine his first case of 'shell shock'.  Given his background in Cambridge psychology and given his special expertise in sensory psychophysics, we can readily understand why his Lancet paper concentrates on sensory functions and on memory.

Although the concept of 'shell shock' was later to be broadened to include many cases that might today be considered Post Traumatic Stress Disorder (PTSD), all three patients in Myers' paper of February 1915 had been very close to exploding shells and thus to violent changes in pressure that could have caused traumatic brain injury (TBI).  Case 1, a private aged 20, was crossing open land between trenches when he became entangled in barbed wire and several shells burst around him.  One in front 'blew his haversack clean away' and one behind gave him a shock 'like a punch on the head, without any pain after it'.  Case 2, a corporal aged 25, said that he was buried for 18 hours owing to a shell bursting and blowing in the trench in which he lay.  Case 3, a private aged 23, reported being 'blown off a heap of bricks 15 feet high owing to a shell bursting close to him'.   Cases 2 and 3 had been unconscious for indeterminate periods.

Strangely, none of these patients showed serious impairment of hearing, but all three showed losses of taste and smell.  Thus Case 1, when acid was placed on his tongue, reported no taste but 'a peculiar feeling as if it dried the tongue'.  Case 2 could not identify a strong solution of salt (reporting only that 'it feels like petrol does on the hand') and he failed to smell peppermint, ether, iodine tincture or carbolic acid.  With his left nostril, Case 3 failed to detect the smell of peppermint, ether, iodine tincture, eucalyptus or ammonia, but he recognised all but iodine with the right nostril.  All three patients had showed reduced visual acuity and restricted visual fields.  In Cases 2 and 3 (as in many subsequent shellshock patients) Myers also observed amnesia, especially for events following the trauma.  All were emotionally disturbed.

Myers judged that his shellshock patients were neither malingering on the one hand nor physiologically injured on the other.  He argued that the symptoms were 'functional', the result of strictly psychological trauma. His patients, he suggested, resembled those that in the civilian clinic of his day would have been labelled 'hysteric'.

Myers' view of shell shock was not universally accepted in the wartime literature.  His opponents held that the symptoms arose from 'minute cerebral haemorrhages' or other blast damage not externally visible.  Without modern brain-imaging technology and at a century's reach, it is difficult to judge what organic damage was present.  The anosmia seen in the three cases might suggest shearing of the olfactory nerve at the level of the cribiform plate, but Case 1 was reported to have recovered taste and smell after he had been transferred to the Middlesex Hospital, and Case 2 similarly improved.  Case 3 had a visual acuity of 6/24 initially but improved 'by encouragement and the indiscriminate use of weak + or – lenses to nearly 6/6,' – behaviour suggesting a functional condition.   In arguing against an organic basis for shell shock, Myers also pointed to his success in curing some of his patients by light hypnosis, especially if he could ensure that they recovered their repressed memories of the trauma.

Anyone reading The Lancet from a century ago will be struck by a secondary feature of Myers' paper.  Case 3 was admitted to the Duchess's hospital on January 26th, 1915, his visual fields were examined on January 30th and he was further examined on February 1st.  Myers was then on leave in England until the 5th and no doubt took the manuscript with him. The paper was assessed, typeset, proof-read, printed and published by February 13th.  And that in wartime.

J. D. Mollon