Shell shock

“ THE PICKET Thousands of soldiers have suffered from shell shock, which proved to be one of the most trying conditions for the hospital nurses—nerves keyed to the highest tension for days at a time snapped under the whizzing and bursting shells which rained destruction in their midst. Horses frequently suffered from the ill effects of this trying ordeal, but it was a rare occurrence for the dog to be affected by these conditions. ”

“ Shell-shock symptoms, some initial, with recovery—others late and gradual, with deterioration.
Case 283. (Smyly, April, 1917.)
A soldier became blind, deaf and dumb, as well as paralyzed, as a result of shell explosion. When he arrived at the hospital, he was able to see but had visual hallucinations. In a few days he recovered his hearing. There was a fine tremor of the hands, controllable by suggestion. There was an almost complete amnesia, but the patient remained able to read and write. ”

“ Bombardment; shell explosion nearby: Mania; death in 24 hours. The AUTOPSY showed superficial punctate hemorrhages of brain and congestion of pia mater. CAUSE OF DEATH—small bulbar hemorrhage, congestion of veins, and nerve-cell changes of a local and differential nature (chromatolysis of vago-accessorius nucleus) . SHELL-SHOCK SYMPTOMS due to capillary anemia and chromatolysis of various regions. ”

“ Sensory disorders, especially on left side (the side more exposed to explosion) ; exaggerated reflexes on right side with slight clonus and with Babinski sign. Improvement.
Case 257. (Gerver, 1915.)
A Russian Captain, 45 (heredity good; non-alcoholic, non-syphilitic; always in good health) sustained shell-shock in a battle in southeastern Prussia, August 13, 1914, and was unconscious for two days. He was carried to one of the provisional field hospitals, and then evacuated to Petrograd, where during a period of four months, he was given electricity, suggestion, and baths. ”

“ Shell-shock; burial: Clonic spasms; later, stupor with amnesia.
Case 317. (Gaupp, March, 1915.)
A reservist, 28 (laborer in civil life, of a nervous family; even before mobilization had attacks of weakness at his work or in the company of others) January 3 or 4, 1915, fainted in the trench while shells were striking around him. On January 5 he was brought to hospital in deep stupor. He went to the reserve hospital at N. by hospital train, January 8, and arrived at the Tübingen clinic January 18. ”

“ Bad dreams began (falling into a deep hole; being shelled) . He thought of suicide, wanted a shell to incapacitate or kill him, began to have pains in the head, arms and legs, and was already groggy when a gas attack came. Whether he got a whiff of the gas or not, he at any rate felt giddy, got a swallow of water, and when the gas passed got out of his dugout in the open air. He was fatigued and much relieved when the company was ordered back. Now, however, he got shaky and fell in a collapse on a pile of straw, without, however, losing consciousness. ”

“ Could the life of the populace continue in its usual channels, indifferent to danger, removed from fear, calm as in time of peace?
We must look closer to perceive under the [140] surface the explanation of the anomaly; everywhere, people seated or standing observed a patient discipline in using only one side of the street: the one exposed to the direct shock of the shells. Only a city long exposed to bombardment could conceive such a mechanical precaution. It is a protection, because the shell, in falling, bursts; its splinters fly in the opposite direction to that taken by the projectile. ”

“ The shells came nearer, say up to about 100 meters, and the lieutenant was able to reckon closely when he would be reached. He was quite defenseless and unable to get to safety. At the very moment, he thinks, when the shells began to strike the house, the lieutenant lost consciousness from fear. He was unconscious an hour before being carried to the cellar. The shelling lasted several hours more. Immediately upon coming to the patient found that, although he bore no external wound, both legs and the right arm were paralyzed.
There were never any signs of organic disorder. ”

“ He got into bed alone.
Next day the patient could walk better and began to talk, but preserved the same absorbed attitude. He told, in monotonous voice, of the shells that his squad had received and of the dead that he saw about him. August 27 he woke up and was unable to tell how he had come to the hospital. He told how the regiment had been bombarded for a time and how a shell burst near him; how he got a splinter in the buttock (of which the contusion was still visible) ; and how he had been thrown down by the windage of the shell. ”

“ This is due to the fact that when the gun is fired, the inertia of the charge in the shell is overcome by a pressure proportional to the mass and acceleration, which pressure is communicated to the shell charge by the rear surface of the cavity, and the pressure per unit of mass will vary inversely as this surface. If, then, the quantity of explosive in the shell forms a large proportion of the total weight of the shell, we approach in powder guns a condition of shock to it which is always dangerous and frequently fatal. ”

“ Parsons describes a typical case of shell explosion amblyopia. After more or less prolonged fatigue from marching and trench exposure, the soldier is knocked down or blown into the air, and more or less severely injured or wounded by concussion, fracture, bullets, or shell splinters, losing consciousness, but perhaps not enough to prevent automatic walking in a dazed state to the dressing station. Memory of this phase is lost. The man is instantaneously stricken blind, possibly also deaf; and possibly smell and taste are also lost. Blepharospasm is intense; there is lacrimation ”

“ Accordingly, we here deal with a severe form of spinal concussion due to a shellburst, in which intraspinal lesions were produced without spinal fracture or penetration either of bone or of shell fragments into the spinal cord or the spinal fluid.
[274]
Shell explosion (1 meter distant) kills a soldier by bursting both lungs within the intact thoracic cage. ”

“ He has been given bromides.”
An M. O. attached to the same ambulance wrote: “This man is suffering from mental shock caused by having to clear away the remains of a number of men killed by a shell. He does not recognize his friends, and at frequent intervals has periods of terror, exclaiming, ‘Cover it up.’ He is sleepless (without drugs) ; he takes food badly. He is possibly suicidal or may become so.”
According to the patient himself, he had been quite well for four months at the front. He was on the La Bassée Road with the troops after a day or two of heavy work under shell fire. ”

“ From 100 to 150 yards they are killed by the fumes or poisonous gases which the shell ex-hales. From 150 to 200 they are not killed, but knocked senseless, and their skin is turned to a brilliant green colour. From 200 to 250 they are so dazed and stupefied as to be incapable of action, and, generally speaking, after that any one in the district or neighbourhood of the shock is "never the same man again." ”

“ An infantryman, aged 22, previously healthy and from a healthy family, was struck by a shell fragment in the forehead and lay for several hours unconscious. He did not vomit. He had a number of furuncles on his body and his urine, upon examination, showed a severe diabetes mellitus which increased despite treatment. Upon an attempt to withdraw carbohydrate, the sugar suddenly sank from six to four per cent. Acetone at the same time increased. An abrasion had been noticed by the patient a few days before the shell explosion on the spot rubbed by the tornister. ”

“ You can just hear, through the crash, the shriek of a third and fourth shell as they come tearing down the vault of heaven—crash—crash. Clouds of dust are floating over you. A swifter shriek and something breaks like a glass bottle in front of the parapet, sending its fragments slithering low overhead. It bursts like a rainstorm, sheet upon sheet, smash, smash, smash, with one or two more of the heavier shells punctuating the shower of the lighter ones. The lighter shell is shrapnel from field guns, sent, I dare say, to keep you in the trench while the heavier shell pounds you there. ”

“ The vessel trembled from bowsprit to rudder at the shock. The shell failed to explode, however. Had it done so, the effect must have been serious and might have changed the result of the battle. A thirty-two pounder shell entered forward and lodged under [Pg 196] the forward pivot gun, tilting it out of range, but did not explode. A rifle shell struck the smoke stack, broke through, and exploded inside, tearing a ragged hole three feet in diameter Only two of the boats escaped damage. ”

“ One followed the communication-trench, took up gun or shovel, as the order might happen to be, and became either soldier or laborer; or, more often, both at once. Everything was done at night. Everything was dismal, dangerous, frightful. There was no real repose, no relaxation. The incessant shell-fire added its horror to our other discomforts and dangers. The shell! that insensate creature of chance, which bursts over the innocent, scatters its fragments over the plain, and in stupid indifference crushes a clod of earth or snuffs out the lives of a hundred [123] human beings. ”

“ Really, if you're planted out in the open, the peculiar awfulness of big shell-fire--what is it more than the peculiar awfulness of being run over by express trains let loose about the sky? Tell Don that when shrapnel empties itself over your head like an old tin pail, you might feel injured, but the big shell has a most disarming air of not being able to help itself, of not looking for anybody in particular. ”

“ Hal and Chester, braving the enemy fire, both crawled out of their funk holes and started for Sergeant Bowers, who had fallen just outside the funk hole in which he had sought refuge. But they were back quicker than a man could say "Jack Robinson."
A shell can be heard coming when it is passing to one side or overhead, but when it is headed straight toward you its cry is heard usually after the explosion, or is drowned out by the explosion. Common mathematics will show why. Air conditions also help. ”

“ Leaving the horses in a farm, we slipped from tree to tree. There was the column, still advancing. A first shell, ten mètres in front of it, stopped it short; immediately a second fell on the left, wounding some men, and [14] a horse reared and upset its rider. A third shell struck mercilessly into the centre of the column and caused an explosion which sent flying, right and left, dark shapes which we guessed to be fragments of bodies. It rained shell, which struck the road with mathematical precision, sowing death and panic. ”

“ Bang! rumph! r-r-r-rumph! Bang! Shrapnel and high explosive seemed to come together.
Another and another shell followed, then a [147] blinding crash as I was turning my car and a shell burst in the square not far away, showering bits of shell and débris over me. ”

“ You would think a tornado was howling through the forest, followed by billows of fire, and yet men live through it—aye! press forward to capture the battery! We can hear their shouts as they form for the rush.
Now the shells are changed for grape and canister, and the guns are served so fast that all reports blend into one mighty roar. The shriek of a shell is the wickedest sound in war, but nothing makes the flesh crawl like the demoniac singing, purring, whistling grape-shot and the serpent-like hiss of canister. Men's legs and arms are not shot through, but torn off. ”

“ To say truth, shells generally go where no one is; I saw only one man killed by a shell. I had raised my head from the ground and was listening for the burst of a coming shell, when I saw a man among the advance ranks of the 13th Brigade on my right stop suddenly in the midst of a blinding flash. An arm and hand flew through the air in a horrible curve; the smoke belched, the air was rent by the explosion, the smoke blew and drifted away, and there on the hillside lay what [Pg 126] was left of the man, folded in the deep quietness of death. ”

“ At that moment it burst, and limbs, and head, and entrails, were seen flying in the air, with the fragments of the shell, and prostrate and struggling forms lay writhing on every hand in the last, fierce agonies of death. ”

“ Much as people throng to the spot where some appalling catastrophe has occurred, so, a minute after the shell exploded, people appeared from all directions to run to the scene, and although the shell had caused no very great damage, the noise which it had made, its unusual size and explosive force, did not tend to pacify people. ”

“ When a shell falls, it whirls round, burrows, and excavates the earth to a considerable extent, and bursting, makes dreadful havoc around. I have more than once witnessed fragments of the mangled bodies and limbs of the British soldiers thrown into the air by the bursting of our shells, and by one from the enemy, Captain White, of the seventh Massachusetts regiment, and one soldier were killed, and another wounded near where I was standing. ”

“ The noise of the shells from field guns is exactly like that of a rocket going up. When the shell is coming towards you, there is a sharper hiss in it, like a whip. It gives you a second or two to get under cover and then crack-whizz as the shrapnel whizzes out. ”