This compilation was begun in the preparedness atmosphere of the U. S. Army Neuropsychiatric Training School at Boston, 1917-18. This particular school had to adapt itself to the clinical material of the Psychopathic Hospital. Although war cases early began to drift into the wards (even including some overseas material), it was thought well to supplement the ordinary “acute, curable, and incipient” mental cases of the hospital wards and out-patient service with representative cases from the literature.

As time wore on, this “preparedness” ideal gave place to the ideal of a collection of cases to serve as a source-book for reconstructionists dealing with neuroses and psychoses. Shortage of medical staff and delays incidental to the influenza epidemic held the book back still further, and, as meantime Brown and Williams had served the immediate need with their Neuropsychiatry and the War, it was determined to make the compilation the beginning of a case-history book on the neuropsychiatry of the war, following in part the traditions of various case-books in law and medicine.

With the conclusion of the armistice, there is by no means an end of these problems. Peace-practice in neuropsychiatry is bound to undergo great changes and improvements, if only from the influx into the peace-community of many more trained neuropsychiatrists than were ever before available. This is particularly true in the American community by reason of the many good men specially trained in camp and hospital neuropsychiatry, both at home and in the A. E. F., through the enlightened policy of our army in establishing special divisions of the Surgeon-General’s Office dealing separately with those problems.

Though a book primarily for physicians, some of its material has interest for line-officers, who may see how much “criming” is matter for medical experts, by running through the boxed headings (especially of Sections A and B) and reading the simulation cases. As Chavigny remarks, “shooting madmen neither restrains crime nor sets a good example.”

But parts of the book look ahead to Reconstruction. Surely occupation-workers, vocationalists, war risk insurance experts, and in fact all reconstructionists, medical and lay, must find much to their advantage in the data of Section D (Treatment and Results). Had time permitted, the whole old story of “Railway Spine”—Shell-shock’s congener—might have been covered in a series of cases from last century’s literature, together with others illustrating the effects of suggestion and psychotherapy; but this must be a post-bellum task.

The compiler, who has personally dictated (and as a rule redictated and twice condensed) all the cases from the originals (or in a few instances, e.g., Russian, from translations), hopes he has not added anything new to the accounts. The cases are drawn from the literature of the belligerents, 1914-1917, English, French, Italian, Russian, and—so far as available here—German and Austrian.

I would call the collection not so much a posey of other men’s flowers as a handful of their seeds. For I have constantly not so much transcribed men’s general conclusions as borrowed their specific fine-print and footnotes. The lure of the 100 per cent has been very strong in many authors; but the test of fine-print, viz., of the actual case-protocols, saves us from premature conclusions, and the plan of the book allows us to confront actualities with actualities. One gets the impression of a dignified debate from the way in which case-histories automatically confront each other, say in Section C (Diagnosis).

Obligations to the books of Babinski and Froment, Eder, Hurst, Mott (Lettsomian Lectures), Roussy and Lhermitte, Elliot Smith and Pear, and others are obvious. Yealland’s book came too late for sampling its miracles, though cases of his in the periodical literature had already been incorporated in my selection.

Some of the cases in Section A, I, had already been abstracted in Neurosyphilis: Modern Systematic Diagnosis and Treatment (Southard and Solomon, 1917).

What we actually have made is a case-history book in the newly combined fields now collectively termed neuropsychiatry. The more general the good general practitioner of medicine, the more of a neuropsychiatrist! And this is no pious wish or counsel of perfection. Neuropsychiatry, mental hygiene, psychotherapy and somatotherapy—all these will flourish intra-bellum and post-bellum, in days of destruction and in days of reconstruction. And who amongst us, medical or lay, will not have to deal in reconstruction days with cases like some here compiled? A minor blessing of the war will be the incorporation of mental hygiene in general medical practice and in auxiliary fields of applied sociology, e.g., medico-social work.

Subsidies aiding publication are due to the National Committee for Mental Hygiene; the Permanent Charity Foundation (Boston Safe Deposit and Trust Company); Mrs. Zoe D. Underhill of New York; Mr. H. T. White of New York; and Dr. W. N. Bullard of Boston—to all of these the various military recipients of the book will be under obligations, as well as others who would otherwise have had to pay the great majoration de prix due to war times.

Of those great dead contributors to neurology laid (in the Epicrisis) at the feet of the neo-Attila, perhaps only Sir Victor was in a narrow sense the Kaiser’s victim: still, but for the war, they might all remain to us.

By the way, just as I found John Milton had said things that fitted neurosyphilis, so also Dante is observed in the chosen mottoes to have had inklings even of Shell-shock. To the Inferno it was natural to turn for fitting mottoes (Carlyle’s renderings mainly used). The pages might have been strewn with them. A glint of too great optimism might seem to shine—in the pre-Epicrisis motto—from the lance of Achilles with its “sad yet healing gift;” but out of Shell-shock Man may get to know his own mind a little better, how under stress and strain the mind lags, blocks, twists, shrinks, and even splits, but on the whole is afterwards made good again.

E. E. Southard.

Washington,
November, 1918.