Observations ON THE ETIOLOGY AND TREATMENT OF WAR NEUROSES
Authors: A. F. Hurst
Journal: BMJ (1917)

ETIOLOGY.:ALTHOLTGH it would require a very exceptional nervous :Aystem to pass unscathed tlhrouglh twelve nlontlhs or more 'of war under moderni conditions, unconmplicated neur- astlhenia due to prolonged physical strain, the utter nervous exhauistion caused by pure physical fatigue, lhas been comparatively rare since the battle of the Marne.But there were inany cases after tlle retreat from Mons, And it says nluclh for the spirit and discipline of the origilnal Expeditionary Force tllat there were Ino more.Life in tlle trenclhes is alvays accompanied by a state of nervous tension.Danger is ever present, and during periods of activity the night may only bring increased responsibility and anxiety instead of rest.Although most $men become gradually accustomed to the siglhts and sounds, which at first frighten all but tlje few who do not know what fear is, the nervous system does not wear well, and unless regular periods of rest fro'm the mental strain are given, the mlajority of men gradually become irritable, restless, and uinable to perform their duties satisfactorily.lThe sanitation of the army in France lhas been so efficient that the second great cause of neurastlheniaacute and chronic iinfections-hias been less prominent than in any previous campaign.But cornparatively sliglht toxaemiia, such as that due to diarrlroea, trenchi fever, or influenza, wlliclh is not sufficiently severe to make a man go sick, may cause nervous exhaustion, wlichl would lhave been prevented if sufficient rest lhad been taken.The armies in otlher parts of the world have, unfortunately, not shiared the immunity from seriows epidemics with the army in France.Few men remained at Gallipoli for more than a montlh witlhout suffering from chronic diarrhoea or falling victiIims to dysentery, paratyphoid fever, or epidemic jaundice, and often to more than one of these infections at the same time; added to this was the impossibiliby of withdrawing the troops from the slhell.swept area, for every corner on the peninsula was exposed to hostile fire.In Salonica conditions were more favourable, except during the summer of 1916, wlhen thel hot .weatherand the virulent formn of mnalaria'for which-the 'Struma Valley has alwaVs bofne an unenviable reputation were the clhief causes of many cases of neurasthcnia.. Tlle effect of the numerous infections rife in Mesopotamia and East Africa has been aggravhted by the great heat, and at times by the insufficient supply of food.During the :autumn of 1916 the majority of uncomplicated, cases of neurasthenia reaching England came from -Mesopotamnia,; ,in several cases thlere -was a&history of actual heat-stroke.The pain, toxaemia, and loss of blood which may result from severe septic wounds often cause neurasthenia, especially if tlle soldier is already over-fatigued from mental and physical strain.Mental and pllysical strain, severe pain, and acute and :chronic infections lead to exhaustion by their direct action upon the nervous system, and indirectly by their action upon the suprarenal glands, together with the liver and probably the thyroid.Prolonged muscular exertion and great emotions, especially fear and anger, have been shown to produce chromatolysis of the brain cells, together with definite changes in the suprarenal glands and liver.