[Dramatic music]
[War Department Official Training Film][Misc. 1197, Army Service Forces]
[Produced by: Army Pictorial Service,Signal Corps]
[Combat Exhaustion]
[Stately music]
[October 20, 1943]
[Early recognition and treatment of neuropsychiatric conditions in the combat zone.]
[Circular letter no. 176scrolling on screen]
[Music continues]
[Explosions]
[Armillary shell explodes near troops]
[Army combat-zone clearing station]
[Doctor examining injured soldier]
[Doctor:] Lacerated wound.
Give him anothershot of morphine
and take him tothe surgical tent.
[Combat medic] Yes, sir.
[Doctor:] Put onanother dressing.
You'll be all right.
[John Clemens:] Oh my God.
Oh.
[Sobbing]
[Corporal:] They found himin a fox hole like this.
They had to pull him out.
[Medic:] He can't walk, but wecan't find a scratch on him.
[Doctor:] Take holdof yourself, soldier.
What's your name?
[Sobbing]
John H. Clemens
[Airplane roar overhead]
[Screams]
[Injured soldier:] Get that guyout of here. He's driving me nuts.
[Doctor:] All right,get him out of here.
[John Clemens:] [Sobbing]
[Doctor:] Shell shock-- evacuate.
[Triage, EMT tag]
[Whimpering]
[Station Hospital sign]
[Music]
[Army ambulance approaches]
[Major:] And now wehave this patient here
in our hospital two monthsafter the breakdown occurred.
The variety of neurosiswhich he exhibits
is not an unusual oneon the battlefield.
Many errors have beenmade in his case.
For one thing, his EMT tagis labeled "shell shock."
The army choice ofterm is exhaustion.
And this term willbe used exclusively
for all forms of neurosisin the echelons forward
of the evacuation hospital.
The reason is obvious.
Soldiers read their tags, andlong involved medical terms
serve only to confuse analready disturbed mind.
Now, placing yourselfin the situation
of this medical officerat the clearing station,
what would you havedone for John Clemens?
[Medical officer 1:] I don't see what elsethe officer could have done.
There seems no pointin keeping a patient
like this on the battlefield.
[Major:] Any other comments?
[Medical officer 2:] Major, we'regoing to be busy
out there are patientswho are really shot up,
and we won't have time to monkeyaround with guys like that.
[Medical officer 3:]Major, I'm a surgeon.
It looks to me like this isa job for a psychiatrist.
[Medical officer 4:] That soldier musthave been a misfit from the start
to break down like that.
[Major:] The medicalrecord shows
that the solider was ahealthy, normal individual
before he underwentthe experience that
caused his illness.
High school graduate, playedan end on the football team,
had a creditable job ina Pittsburgh steel mill
after he left schoolat the age of 18.
In brief, hedisplays the picture
of a typical Americanboy, and now he's sick.
And unless we dosomething for him,
he may remain sick for anindefinite period of time.
Gentlemen, you are not requestedto treat these patients.
You are directed to do so.
May I equate youwith a few statistics
from recent campaigns?
The size of the problemwill startle you.
These figures fromItaly seem to indicate
that 20% of allthe nonfatal battle
casualties were not wounded.
They were sufferingfrom neurosis.
In Sicily, the overall figurefor the entire campaign
was 14.9%.
When you add up the easy andthe hard days of the Tunisian
campaign, you will find that 16%of all the nonfatal casualties
were suffering from neurosis.
In prolonged engagements wherethe going is really tough,
we find that 30%to 50% of all men
coming under your carein the divisional area
are suffering fromcombat exhaustion.
Gentlemen, that meansthat one out of three,
or even one out oftwo, of all soldiers
coming under medical canvasdoes not have a drop of blood
on him.
Now, don't get the idea that theAmerican GI is the only soldier
that develops neurosis.
Parallel statistics ofthe armies of our allies
and enemies show that they arefaced with the same problem.
You are members of themedical department,
and to you is entrustedthe care all the sick.
There are no specialistson the battlefield.
If you say thatyou are a surgeon
and can handle onlythe surgically wounded,
you have failed in your mission.
Out in the mud, you've gotto be a medical soldier
and meet all comers.
In the folder issuedto you, you will
find a copy of thischart depicting
the various forms of neurosis.
Hysteria, anxiety state,reactive depression,
and the terror state.
This will act as a guide tous as we visit the wards where
we can observe actual cases.
[Chart, Anatomy of Combat Exhaustion]
[Treatment facility]
[Soldier calling men to attention]
[Major:] At ease, men.
Will you hold this, please?
You may be seated.
Good morning, McKennon.
How are you feeling now?
[McKennon:] I don't know, sir.
I'm afraid you'll have togive me up as a bad job.
I'll never get well.
[Major:] Oh, it isn't asbad as all that, is it?
[McKennon:] I can't stop fromcrying like a damn fool baby.
The blues, I guess.
[Major:] You did pretty wellbefore the war, didn't you?
[McKennon:] I did allright, I suppose.
[Major:] This man hasan excellent background.
He averaged $400 a month as anautomobile salesman in Chicago.
Why did they sendyou here, McKennon?
[McKennon:] We got stuckout in Casserian Pass.
They had to sendup reinforcements.
The new CO had no use for me.
Thought I was a sad sack.
I don't blame him.
[Major:] Well, you'll feelbetter in a week or so.
Take my word for it.
McKennon went through most ofthe North African campaign.
The death of his CO, plus theloss of many of his friends,
plus prolongedphysical fatigue have
produced a reactive depression.
[Medical officer 5:] Well, lotsof other fellows
have been throughthe same thing.
Maybe a pick and shoveland a little discipline
would fix him up.
[Medical officer 2:] What does usuallyhappen in these cases, Major?
[Major:] Unless properlytreated, suicide may occur.
These gentlemen aremedical officers, Sergeant,
and they're interestedin your story.
Would you mind telling uswhat's the matter with you?
[Kosciuszki:] Well,sir, I just can't
seem to get my strength back.
I feel all in.
They get me up for chow, but Ican hardly make it to the line.
[Major:] How long hasthis been going on?
[Kosciuszki:] Well,I noticed it first
on the boat coming to England.
[Lieutenant:] When did youarrive from the States?
[Major:] Oh, I don't thinkyou understand, Lieutenant.
This man has justarrived from Sicily.
Did you see muchaction, Kosciuszki?
[Kosciuszki:] Well, sir, wetook a terrible shellacking
at Randazzo.
I lost a lot ofmy buddies there.
[Medical officer 6:] Did you stand uppretty well during that campaign?
[Kosciuszki:] Well, sir,except having the jitters
once, I stood up aswell as anybody else.
[Medical officer 6:] In what waydo you feel your weakness?
[Kosciuszki:] Well, sir, it's allover, mostly in my chest.
Got pains.
I get out of breath.
Maybe I got TB.
[Major:] Oh, I'll bet100 to 1 against that.
This is also a depressionwith accent on the physical
rather than the emotionalside, as in the first case.
Would you mindshowing us your foot?
It's all healed up, isn't it?
[Corporal:] Yes, sir.
They fixed it up inthe surgical ward.
[Major:] Tell ushow it happened.
[Corporal:] I was cleaningmy gun in the bivouac area
and it went off accidentally.
[Major:] That was outsideof Troina wasn't it?
[Corporal:] Yes, sir.
[Major:] Didn't you tryto save one of your men?
[Corporal:] Oh, that.
That was after we'dlanded in Sicily.
Our company had to retreat.
One of our men couldn't keepup with us, and he was wounded.
We lost sight of him.
Another fellow andmyself asked the CO
if we couldn't goback and get him.
We got him, all right.
As we started back,a Jerry spotted us
and laid down abarrage of mortar fire
that it was like allhell breaking loose.
We had to leave him behind.
[Major:] What happened to him?
[Corporal:] He died out there.
[Medical officer 7:] How soon afterthat did you have your accident?
[Corporal:] About a week or so.
[Medical officer 8:] What shapewere you in?
[Corporal:] Jittery.
Couldn't sleep much.
Kept thinking about that day.
[Major:] Thank you, Corporal.
[Medical officer 7:] Is thata common occurrence
in depression, Major?
[Major:] In the battleof Bautzen Lutzen,
there were 3,000cases like that.
The commander asked hischief surgeon to investigate.
He found that theywere self-inflicted.
[Lieutenant:] Bautzen Lutzen,That's a German name.
Who was the commander?
[Major:] Napoleon.
At ease, Peters.
You're in the aircorps, aren't you?
Would you mind tellingus about yourself?
[Peters:] No, sir.
Don't mind a bit.
I just refuse to fly.
[Medical officer 9:] Were you scared?
[Peters:] No, I don'tthink so, sir.
See, I'm a waistgunner on a bomber.
And bombers cruise justlike a football team.
One fellow keeps fumblingthe ball all the time,
a lot of good guys areon the losing team.
[Major:] Tell us what happenedthat you refused to fly.
[Peters:] They briefed us togo to Berlin that morning,
and I was feeling terriblynervous and shaky.
I hadn't slept forabout three nights.
And as we were walkingover towards the ship,
I felt the butterflies inmy stomach worse than ever.
So I just told them it didn'tmake any difference to me
whether they busted me or not.
A guy in that shapejust shouldn't go up.
[Medical officer 9:] Do you alwaysget butterflies when you go up?
[Peters:] No, I thinkthat started when
we were shot up over the drink.
We ditched out there, and thepilot and the rear gunner
were both killed.
Took them about threedays before they finally
fished us out, and I don't thinkI've ever been the same since.
[Major:] How do you feelabout going back to flying?
[Peters:] Well, the 8thmeans a hell of a lot to me.
If my nerves clear up, I'lldo everything they want me to.
I think I'm washed out now.
Don't ever let me fly again.
[Major:] Well, let's crossthat bridge when we come to it.
Sit down, Peters.
You may call him a goldbrickif you want to, but take
a look at this.
He's had 20 missions and he'sbeen decorated four times.
This is another form ofexhaustion
known to the air corpsas operational fatigue.
We now come to anextremely common variety
of the anxiety state.
At first glance, thispatient might appear
to have Parkinson's disease.
But in reality, he'ssuffering from exhaustion.
Note the rhythmictremor of his lips,
or his hands, or hisknees, or his feet.
He was pinned downby enemy mortar fire
and cut off in anobservation post
for the betterpart of four days.
[Soldier trembles]
He was flown into us thismorning from the combat area.
Speech is difficult, so wewon't burden him with questions.
Treatment willbegin immediately.
[Nurse:] Yes, sir.
[Major:] Here we have avariety of anxiety and neurosis
with visceral dysfunction.
How is your stomach?
[Patient:] I vomited again, sir.
[Major:] At ease, soldier.
How long has this been going on?
[Patient:] It started when I wasin action about six weeks ago.
[Major:] Have youlost any weight?
[Patient:] About 30pounds, so they tell me.
[Major:] We'll soon makethat up for you here.
Any other complaints?
[Patient:] Well, everythingseems torn to pieces.
My heart beats awfully fast.
My stomach-- I just can'tseem to get over my diarrhea.
[Major:] How do you sleep?
[Patient:] It would be all rightif it weren't for those dreams.
[Major:] Do you dream aboutanything in particular?
[Patient:] Terrible stuff.
A barrage, strafing, beingstuck out in a foxhole.
Memories, sort of.
[Major:] Does noise bother you?
[Patient:] I want to jumpout of bed every time
a plane goes overhead.
I've been so nervous andjittery, I can't even write.
Lookit here.
[Letters]
[Major:] Mm-hmm.
[Paper crumpled]
Well, don't worrytoo much, soldier.
You'll be better soon.
And now we come toa case of back pain
with no organic basis.
Just where is the pain?
[Patient 2:] It's right herebetween my shoulder blades, sir.
[Major:] How longhas it been going on?
[Patient 2:] Well, it's been worsethrough the past couple weeks,
since I strained itlived in a GI camp.
But I've had this trouble eversince I was about 8 years old,
when I fell off awagon and hurt my back.
My heart is bad.
It gives me a lot of trouble.
And my nerves are bad, too.
[Major:] How do you feelabout going back to duty?
[Patient 2:] I don't know, sir.
My back, it doesn'tget any better.
And my heart stillgives me trouble.
And you can see mynerves are no better.
[Major:] All right, soldier.
That's all.
Thank you.
No organic basis has beenfound for his complaint.
Gentlemen, this is a typeof constitutional inadequacy
in which there is a fixedsomatic complaint in addition
to diffuse anxiety symptoms.
He has brought his complaintwith him into the Army.
His chances ofrehabilitation are slight,
and he should be weededout as quickly as possible,
because he would be one of thefirst to break down in combat.
If you will lookat your chart, you
will find that we havedealt with the various forms
of reactive depressionand the anxiety state.
There are other typesof combat exhaustion.
The terror stateof panic and stupor
and the hystericalstate of amnesia
are seldom met with in hospitalsthis far from the front.
However, we do havean interesting patient
in the ward who went through anepisode of hysterical amnesia
with wandering, or"fugue", as it is called.
Sit down, Kelly.
Would you mind tellingthese medical officers
something about thatlapse of memory you had?
[Kelly:] Oh, you meanthe time I went over
the hill down in Africa anddidn't know anything about it?
[Major:] Yes.
Weren't you wounded down there?
[Kelly:] Oh, that waslong before that,
near Matruh. A Jerrysniper got me in the arm.
[Major:] That's right.
They patched youup in a hospital
and sent you to anoutfit near Matruh.
What shape were you in?
Did you feel fit?
[Kelly:] Hell, no.
I was jittery, and couldn'tget my strength back.
But the Africancampaign was over,
so we just hung around doingproblem and stuff like that.
[Major:] And now, tell uswhat happened on that problem
when they were usinglive ammunition.
[Kelly:] Well, we wereout on a problem
and we went to takea hill and shoot 105.
Some of them fell short.
They were busting right over us.
Enough to giveanyone the jitters.
Then, one bustedright over my head.
I ducked.
Next thing I remember,I found myself
beside a side-street in Algiers,several days later.
I looked at myself,and it looked like I'd
been on a three-week drunk.
I was pretty dirty, so Iducked into a barber shop,
got a shave and a brush-up.
Then I called on the MPs.
[Laughter]
[Major:] And whatdid the MPs do?
[Kelly:] Well, nobodybelieved my story,
so they tossed me in the clink.
[Laughter]
While I was there, a medicalofficer saw how jumpy I was,
so they shipped me here.
[Major:] Although nobodywould believe his story,
you may bet on it asa true one, because it
is so typical of what isencountered on the battlefield.
Rather strange, don't you think?
He went through ahalf a dozen battles
and then brokedown on a maneuver.
And now we come to the casethat was under discussion
in the classroom--
John Clemens.
May I have his record?
[Paper rustle]
He represents anotherof the hysterias--
the conversion type.
Since no definitive treatmenthas been given to him,
you will find that hisclinical condition has not
changed between the time heleft combat and his arrival
here a few days ago.
And now, Clemens, wewant to see you walk.
[John Clemens:] Yes, sir.
Only I'll have tohave some help, sir.
[Major:] Will youhelp him, Sergeant?
Now walk down that way.
[Footsteps]
I think you can walkby yourself, Clemens.
Try it.
Go ahead.
That's it.
Now back.
That's it.
Come along.
All right.
Now bend forwardas far as you can.
Is that as much as you can bend?
[John Clemens:] Yes, sir.
[Major:] Now bend back.
Is that as far as you can bend?
[John Clemens:] I'mafraid so, sir.
[Major:] Carefuldiagnostic studies
have been made on this patient.
No orthopedic or neurologicdisease is present.
X-rays are negative.
This is a conversion phenomenonknown as camptocormia,
which is Greek for bent back.
Will you bring hima chair, Sergeant?
Now, Clemens, will youtell these gentlemen
all you can remember ofthe way this started?
[John Clemens:] There's notmuch I can remember, sir.
I was on the side of amountain lane lair one night
when Jerry opened upwith everything he had.
So I dove for thenearest foxhole.
And then I don't know.
It's all hazy.
I was scared.
I'm sorry, sir.
I just can't think of much more.
And suddenly I feltpeople pulling me out.
I was all twisted up.
[Major:] Oh, yes.
You told us about themedics pulling you out.
And that's all of hisstory that he remembers.
And now, gentlemen, we cometo the subject of treatment.
The other patientsyou've just seen
will be treated by prolongeddeep sleep or narcosis therapy.
But we are going to treat thispatient with chemical hypnosis.
This should restorehis normal posture.
Chemical hypnosisproduces a state
of semi-sleep, ortwilight state,
in which suggestibilityis increased,
as it is in true hypnotism.
By using this suggestibilityand by inducing ab reaction,
a cure of his conditioncan be brought about.
If you will follow me, thetreatment of this patient
will be demonstrated.
[Everyone moves to another room]
Major, will youtake over, please?
[Major at clinic:] Yes.
While we are waitingfor the patient,
let us review some of thedrugs used in narcosis therapy
and chemical hypnosis.
The drugs of choiceare the barbiturates.
The most practical one forproducing and maintaining
narcosis is thisone, sodium amytal.
There is an ample supply ofit in your number two chest.
On the average, 9 to 12 grainswill produce adequate narcosis
for from seven to eight hours.
When he wakes up, thepatient can be fed and taken
to the latrine.
This dose of amytalmay then be repeated,
and the narcosis thuscontinued as long as necessary.
Patients with fully developedvarieties of combat exhaustion
will require a minimum of 24hours of continuous narcosis.
Some will require48 to 72 hours.
A second barbiturate withan action almost identical
with that of sodiumamytal is nembutal.
4 and 1/2, to six grains,every seven or eight hours.
You will note thatin combat exhaustion,
massive doses of thesedrugs are needed in therapy.
A third barbiturate is thefamiliar drug, phenobarbital.
Tablets are 1/2 grain.
4 and 1/2 grains will usuallyproduce adequate narcosis,
but on occasion, sixgrains may be necessary.
You can expect sleepfor longer periods
than with sodiumamytal or nembutal.
Its action may be estimated at10 to 12 hours, after which you
may proceed as withthe first two drugs.
Another drug availableto you is sodium bromide.
Its use is suggested only whenothers cannot be obtained.
Dosage is extremely variable.
Its action isinconstant, and it tends
to pile up in the bloodstream sothat toxic states may develop.
In an emergency, inhalationanesthetics, such as ether,
may be used to put astruggling, panicky patient
to sleep quickly.
Drugs may also beused intravenously.
A 10% solution of sodiumamytal may be administered
with orthodox technique.
The rate of administration isone cubic centimeter a minute.
The average patientwill go to sleep
after the administrationof 5 to 8 cc's
and will remain asleepfor seven to eight hours.
In our case, however, we willuse another intravenous drug,
pentothal.
Lieutenant, willyou prepare this?
Pentothal is not a gooddrug for narcosis therapy.
It will put your patient tosleep quickly and effectively,
but its action isextremely short.
For our purposes, thechief value of pentothal
is in producingchemical hypnosis,
a form of semi-narcosis,or twilight state.
We will use a 2%solution of pentothal.
Pre-medication withatropine has been given.
Our patient is ready now.
Clemens, this medicine willrelax your muscles completely
and help your back.
The rate of administrationis 2 cc's per minute.
Major, will youkeep time, please?
You'll feel the prickof the needle now.
There you are.
[Rubber snaps]
Do you feel any effect?
[John Clemens:] No, sir.
Only my head's swimming a bit.
[Major keeping time:] One minute.
[Major at clinic:] We continue theadministration of the rate
of 2 cc's per minute.
How do you feel now, Clemens?
[John Clemens:] Getting kindof drunk, like a keep jag.
[Major at clinic:] Don't you mind.
One of the early effectsof pentothal administration
is this feeling of well-being.
[Major keeping time:] Two minutes.
[Major at clinic:] Now say MethodistEpiscopal for me, Clemens.
[John Clemens:]Methodist Episo-pal.
[Major at clinic:] You will noticethe slurring of speech.
He is beginning to havedifficulty with enunciation.
This shows that thedrug is having effect.
[Major keeping time:] Three minutes.
[Major at clinic:] We have now injected6 cc's of the solution.
How are you feeling?
[John Clemens:] I'm beginningto feel awful drunk, sir.
[Major at clinic:] Don't letthat bother you.
That just shows it'staking effect, doesn't it?
[John Clemens:] Yes, sirree.
[Major at clinic:] This is greatstuff for your back.
It'll help you straighten out.
[Major keeping time:] Four minutes.
[Major at clinic:] We havenow almost reached
the level of chemical hypnosis.
[John Clemens:] What thehell does that mean?
[Major at clinic:] That means we'rereally going to fix you up.
There is a very simpletest for the determination
of the optimum levelof chemical hypnosis.
We'll have the patientcount backwards from 100,
and when he becomesconfused, we'll
know he is at the right stage.
And tomorrow, he won'tremember having counted at all.
At this level, he willbe extremely suggestible.
[Major keeping time:] Five minutes.
[John Clemens:] I'mgetting awful sleepy.
I think I'm going to pass out.
[Major at clinic:] Hey, don'tyou go to sleep on me.
I want you to count backwards.
Count backwards from 100.
[John Clemens:] 100,99, 98, 87, 86.
[Major at clinic:] Now we canremove the needle.
Let's straighten him out in bed.
Put him on his back.
[John Clemens:] [Shrikes]
[Artillery shells whirringand exploding]
I'm shot--
Something hit me.
Burning.
[Panting]
[INAUDIBLE]
Damn mortar--
I've got to get out of here.
I'm bleeding.
I can't move.
[Explosions and aircraft engines]
Who's that running by?
Must reach out to the boys.
They've got to helpme out of here.
[Gunfire]
They are retreating.
They're leaving.
Medics always leftthe guys who die go.
A guy just getsleft behind to die.
Why don't they stop and look?
Can't they see somebody'sstuck in a fox hole?
Where the hell arethose damn medics?
Please, somebody.
[Explosion, machine gun firing]
Got to push myself up.
Save me.
Oh, my back.
[Explosion, machine gun firing]
It's busted.
Oh.
[Crying]
Oh, my back.
[Explosion, machine gun firing]
Burn in hell, Nazis.
Why don't those sons bitchescome out and fight like men?
Always retreatingto a higher hill.
Always looking down our throats.
[Explosion, machine gun firing]
I can hear their feetsloshing through the mud.
A German.
Oh, no.
I'm sure it's a German.
If I could only turn aroundand see what he's doing,
I could stick him in the back.
But I can't move.
He's pulling me.
Oh.
Oh, my back.
Let go.
Let go. You're breakingmy back.
[Crying out in pain]
Let go.
You're breaking my back.
[Major at clinic:] Take it easy, soldier.
Take it easy.
Your muscles are relaxed now.
Lie quietly and rest.
Your back is all straight.
This, gentleman, was thephenomenon of ab reaction.
Sometimes it is necessaryto coax the patient
to relive the emotional stressesof the events which produced
his hysteria, but itis more common for it
to happen spontaneously,as it did here.
Now he has it off his chest.
And this is the timefor suggestive therapy.
Remember that pentothalincreases the suggestibility.
Your back isstraight and strong.
Your back is fine and straight.
[John Clemens:] Really.
[Major at clinic:] Of course.
Let's sit up.
[John Clemens:] But I can't, sir.
[Major at clinic:] We'll help you.
Of course you can.
There you are.
[John Clemens:] But it hurts.
[Major at clinic:] That's onlythose muscles you
haven't used for a long time.
Let's bend forward.
Way down.
Now back.
There you are.
[John Clemens:] It is better.
[Major at clinic:] Of course.
Now backward.
Why, you do it aswell as any of us.
Wouldn't you like to seehow well you can walk?
[John Clemens:] ButI'll fall, sir.
[Major at clinic:] Oh, no.
We'll help you.
Your back's all right now.
[A corporal assists Clemens]
Walk by yourself, soldier.
[Clemens walking unassisted]
[Clemens pauses due to dizziness]
[John Clemens:] Where am I?
What's happening?
[Major at clinic:] We straightenedyour back for you.
See? You're walking straight.
Turn around.
Throw back your shoulders.
Now let's see youwalk like a soldier.
Come back.
[John Clemens:] Gee.
[Major at clinic:] Treatment is notcomplete in this case.
Clemens will now go through ageneral reconditioning program
which will give him confidenceand which will complete what
we started here this morning.
OK.
[Lieutenant:] What kind oftreatment will he get, Major?
[Major:] That questioncan best be answered
by giving you a summaryof the operational plan
of this hospital.
It is divided intothree sections--
admission, treatment,and rehabilitation.
Shortly after hisarrival, each patient
is given a complete physicalexamination in order
to ascertain thecause of his illness.
This includes dental survey,and any necessary laboratory
studies.
[Music]
These are followedby intelligence tests
and complete mentalexaminations.
[Music]
If necessary, specializedpsychiatric studies
such as the Rorschach techniqueor other personality tests
are made.
After careful summaryof these findings,
treatment is based upon thephysical and psychological
background of the patientand the symptoms he presents.
Narcosis therapy orcontinuous sleep treatment
have proved of great valuein a large series of cases.
Many patients showingmarked anxiety, tension,
inability to sleep,chronic fatigue,
or emotional instabilityrespond to this treatment.
By giving them sodium amytalor other barbiturates,
the patients are kept tosleep 18 to 20 hours per day
for several days.
In other wards, narcosis andmodified insulin therapies
are combined.
Insulin is given in the morningand narcosis is carried out
in the afternoon and evening.
As Ward Mitchell found inthe American Civil War,
soldiers with combat exhaustionalmost invariably suffer
great loss of weight.
The insulin treatmentconsists of the administration
of from 40 to 100 units eachmorning before breakfast.
With this chemicalstimulation of appetite,
the patient eats onan average 12 and 1/2
pounds of food per day, whichis more than twice the amount
normally consumed.
By means of thiscombination of therapies,
symptoms of acutetension are relieved,
and the restorationof weight can
be expected at the rateof 1/2 to 1 pound per day.
Careful attention todiet is an important part
of the therapeutic program.
Balanced meals are plannedfor high caloric value
and proper vitamin content.
Patients who show markedsymptoms of reactive depression
may be given electricalshock treatment in addition
to the combination insulinand narcosis therapy.
As previously demonstrated,narcoanalysis and hypnosis
are used to eliminateamnesiac symptoms.
Suggestion, either director in the form of hypnosis,
or narcosuggestion, is employedin conversion hysteria.
During the therapeuticperiod, patients
go through a programof exercise designed
to maintain physical fitness.
Individual or groupreeducation is
undertaken so thatpatients may understand
the cause of their illness.
After patients havecompleted their treatment,
they are placed ina training company.
Here, they live in abarracks and are given
a review of military training.
[Marching cadence]
Tent-pitching, shorthikes, detail work,
sensible occupationaltherapy projects
leading to constructiveends and of a type
consistent with thejob of a field soldier.
Sports are included forphysical hardening, coordination
of muscle, and thefostering of team spirit.
During the training companyperiod, a series of discussions
is undertaken toreview for the soldier
the reasons why we fight.
All serve torehabilitate the soldier,
observe him undermilitary conditions,
prepare him oncemore for Army life,
and ultimately returnhim to active duty.
Are there any questions?
[Medical officer 2:] Whatpercentage of cases
are you returning to activeduty from this hospital?
[Medical officer 8:] Major, we're allproud of what we've seen.
You've got a swell set up here.
Everything you need.
[Medical officer 5:] Yes, but whatabout us in the combat
area, with our hands fulland not a thing to work with?
[Major:] I was comingto all that, gentlemen.
Early treatmentin the combat zone
does not requireelaborate facilities
and would eliminatemost of our setup here.
We, in the communication zone,despite all the facilities,
can return only a verysmall percentage of patients
to actual combat duty, whereasyou, out in the forward area,
can, by getting at them early,send 70% to 80% back to duty
in the frontline.
You have been shown aroundthis hospital in order
to acquaint you with theprinciples underlying
the treatment ofcombat exhaustion.
Treatment in theforward area is based
on identicalprinciples, modified
to meet the tactical demand.
[Army ambulance approaches]
When patients arrive atthe clearing station,
it is of primary importance toseparate the exhaustion cases
from the physically injured.
[Army ambulance unloaded]
[Soldier:] Let me go.
What are you trying to do to me?
Let me go.
What are you doing to me?
Let me out of here.
Let me go.
They're going toshell this place.
We got to get out of here.
Even the other side said so.
Let go of me.
What are you trying to do to me?
[Medical officer:] Take it easy, soldier.
You're in a protected area.
Where's your MP tag?
[Soldier:] Mortars.
Can't you hear them?
Let me out of here.
They're going to shellthis place, I tell you.
You're all crazy.
[Medical officer:] Mark him exhaustion.
Take him to tentfive right away.
We'll get the restof the information
after he's had treatment.
[Interposing voices]
[Rumbling]
[Soldier:] Let me go.
I got to get to a fox hole.
The fox hole.
Let them get it.
Those 88s.
Let me go.
Don't put your hand.
Let me go.
[Interposing voices]
[Medical officer:] Take off his helmet.
[Soldier:] Don't youtake my helmet off.
Get off.
I got to get out of here.
You're all crazy.
They're going to shell us.
Even the other doc said so.
Hey, you guys.
Get out of here.
I don't get this place.
They're trying to smother me.
[Medical officer:] That'seither--
you'll be all right.
Take it easy.
You're all right.
Take it easy.
Take it easy.
Take it easy, soldier.
You're in a hospital.
[Soldier:] You're smothering me.
Let me go.
Let me go.
[Medical officer:] You saw theRed Cross outside.
That means you're in a hospital.
[Soldier:] Thatdoesn't say anything.
Let me go.
[Medical officer:] You're in a tent.
Take it easy, soldier.
You're all right.
Just relax.
Take it easy.
That's right.
Take it easy.
You're in a tent.
Nothing will hurt you now.
We'll take care of you.
That'll hold him.
He'll be quiet now.
Better put him ina pack, though,
in case he's excitedwhen he wakes.
Take him and put him inthe end space over there.
[Medics move soldier on litter]
[Another soldier enters]
Sit him down on this litter.
Bring him some soup.
Campbell, put 7 and 1/2 grainssodium amytal in a syringe.
[Soldier given soup cup]
[Another soldier enters]
[Footsteps]
Sit on this chest, soldier.
Take off your pack.
[Rustling]
What's your trouble, soldier?
[Soldier:] I'm all tired out.
My head aches.
I ache all over.
[Medical officer:] Are youwounded anywhere?
[Soldier:] No, sir.
That's just it.
I never was a goldbrick.
Now I don't even wantto clean out my gun.
Can't understand it.
[Medical officer:] Oh.
You're from thatoutfit that had hell
shot out of it a while back.
[Soldier:] Yes, sir.
[Medical officer:] That's your trouble.
You're just worn out.
What you need is somerest and some food.
Bring me 12 grainsof amytal, Campbell.
[Campbell prepares medication]
[Campbell brings medicationand water]
That's right.
Take them all.
That's fine.
You'll feel better now.
Bring him some soupand some blankets.
Pick up your pack, soldier.
Put him in the third space.
Drink that soup, soldier.
Get some sleep andyou'll be all right.
[Footsteps]
Now we can take care of you.
Just lie back, soldier.
Roll up his sleeve, Campbell.
Swab off his arm.
What I want you to realizethat you're exhausted.
The strain has worn you down.
This strain causesmuscle tension.
It's this muscle tension thatmakes you shake like that.
Don't worry about that.
I'm going to injectsome medicine that
will work through your entirebody, relax your muscles.
When the muscles are relaxed,the shakes will be gone.
Don't move now.
You'll feel a little stick.
You can breathe easier now.
Take a deep breath.
Try it.
[Breathing]
That's it.
Look at your hand.
It's not shaking anymore.
That's because themuscles are relaxed.
I'll give you therest of the medicine
and you will go sound asleep.
When you wake, theshakes will be gone.
You will feel well.
You hear me?
The shakes will be gone.
You feel well.
You feel perfectly well.
[Medical officer removinginjection needle]
He's asleep now.
You can cover him up.
[Patient Pat appears exhausted]
[Medical officer:] Justa minute, Pat.
How are you feeling?
[Pat:] The pain mychest seems gone, sir.
I feel a little dizzy, though.
[Medical officer:] That pain is gone.
The dizziness will wearoff in an hour or two.
How are the shakes?
Let's see your hands.
[Pat hold hands outstretched]
Put on your helmet.
Let's go outside.
[Footsteps]
Now, Pat, I'd like tofind something for you
to do until weget transportation
back to your outfit.
[Pat:] OK.I'll do what I can.
[Medical officer:] Good.Come with me.
[Men move to back of a truck]
[Soldiers salute]
Sergeant, when areyou pulling out?
[Sergeant:] This afternoon, sir.
[Medical officer:] Need somehelp with the loading?
[Sergeant:] Yes, sir.
[Medical officer:] Good.Here's your man.
Report back to mewhen you're finished.
I'll find somethingelse for you to do.
[Pat:] Yes, sir.
[Medical officer:] That will be all.[Soldiers salute]
[Pat helps load truck]
Soldier.
[Mechanic:] Good afternoon, sir.
[Medical officer:] Don't get up.
How are you feeling?
[Mechanic:] Fine, sir.
Haven't had any moretrouble with my hand.
It's good as new.
But I keep on wonderingwhy it went bad on me.
I wasn't hurt.
[Medical officer:] Well, here's oneway it could have happened.
When the bomb struck, yourhand was buried in the dirt.
You couldn't move it.
You made a mistake andthought it was injured.
[Mechanic:] I believeyou're right, sir.
That sounds kind offishy, doesn't it?
[Medical officer:] Not at all.
When you're scared, and we allget scared on the battlefield,
you imagine a lot of things.
Then, too, whenyour mind is tired,
you're liable to make mistakes.
That's what happened to you.
You had treatment inyour hand as well.
You're ready toreturn to duty now.
[Mechanic:] Sure glad of that, sir.
[Medical officer:] Good.
There's an outfit goingup in just a few minutes
near where your old outfit is.
Think you can make it?
[Mechanic:] I'll be withyou in a moment, sir.
[Medical officer:] Get your stuff.
[Lieutenant Burke:]So long, Major.
[Medical officer:] Just asecond, Lieutenant.
You're going forward.
I've got a passenger for you.
[Lieutenant Burke:]We'll have to hurry.
The old man wants me.
[Medical officer:] Report immediatelyto the disposition tent.
I'll clear your papersin a few minutes.
[Lieutenant Burke:] After that,report to Sergeant Might.
[Mechanic:] Yes, sir.
[Soldiers salute]
[Lieutenant Burke:] He's anexhaustion case, isn't he?
[Medical officer:] Yes.
That's why I want you to payspecial attention to him.
See that he gets an even break.
Too often, line officersconfuse cowardice with fear.
[Lieutenant Burke:] That's true.
[Medical officer:] Keep an eye on him.
See that he getshis old assignment
without preferential treatment.
Good luck.
[Lieutenant Burke:] Thanks.
[Soldiers salute]
[Lieutenant Burke enters tent]
[Lieutenant Burke:] Sir, Lieutenant Burke.
[The old man:] All packed, Lieutenant?
[The old man:] Yes, sir.
Ready to leave now.
[The old man:] At ease.
Now, that's an important jobout there, especially right now.
I guess you know thetactical situation.
[Lieutenant Burke:] Yes, sir.
I've just been to S3.
[The old man:] Good.
The thing I wantto go over with you
is the fact that those troopsup there have been driving hard
for a long time now,and they're beginning
to show evidence ofcombat exhaustion.
I want you to catch thembefore this develops.
The prodromal stage is thetime to treat these men.
Watch for the early signs.
The most prominent of theseare poor physical coordination,
slowing of mental processes,excessive reaction to noise,
inability to relax or resteven when there is opportunity,
and outbursts of temperover trivial matters.
[Soldier kicks machine gun]
[Medic:] Hey, what'sthe trouble, soldier?
[Frustrated soldier:] I'm fed upwith the whole damn thing.
[Medic:] Been gettingany sleep lately?
[Frustrated soldier:] You can'tsleep around here.
[The old man:] You have the facilitiesof sedation and reassurance.
Use them.
[Medic hands soldiers pills]
See that he gets a wash, ahot meal,
[Music]
a good night's rest.
Such treatment preventscasualties [Explosions]
from combat exhaustion,prevents long evacuation,
and preserves fighting strength.
[Rousing music]
[The End]
[M-1197, 1943]
[Fade to black]