[ . . . ] “The conditions of present-day warfare, especially in, the desert, present much difficulty in the handling and treatment of psychiatric casualties. Evacuation is lengthy, involved, arduous, and exacting; opportunities for adequate treatment in the field are few and the difficulties of such treatment may seem at times overwhelming. On the other hand, the further back a psychiatric casualty is evacuated the less is the probability of his ultimate return, the worse is the prognosis as regards his ultimate efficiency as a soldier, and the more serious may be the effect upon the other members of the unit.
Treatment therefore must be immediate; its application must be measured in terms of minutes rather than hours, and of hours rather than days. It must be immediately effective, and it must remain effective. It must be simple, uncomplicated, and at the disposal of every R.M.O. It is unlikely that specialist advice will be available in more than a small percentage of cases, and the R.M.O. must therefore have a working knowledge of their diagnosis and treatment. The only feasible method of immediate treatment is by physical measures; the cardinal,factor throughout is rest, and in these circumstances rest can only be procured by full sedation. The choice of sedative depends on various factors, one of the most important naturally being the range of drugs actually available. Alcohol and morphine are of use in emergencies, but the small bulk and ease of administration of the barbiturates (e.g., barbitone or phenobarbitone) make these drugs the most generally acceptable. Intramuscular injections should be given where necessary. The dosage must be adequate ; too little is usually given, and it is important that adequate sedation be maintained throughout the period of evacuation to the base, if such evacuation should prove necessary.
The methods of treatment applied in the later stages do not differ materially from those applied to the neuroses in general. Prolonged narcosis was used extensively in the treatment of acute anxiety states in base centres and hospitals, and was found in most cases to be the method of election. It is of some importance to note that prolonged narcosis presents certain dangers in tropical or subtropical climates, and several cases of hyperpyrexia occurred during treatment, presumably due to disturbance of the heat-regulating mechanism.
The intravenous injection of a suitable barbiturate, reinforced by suggestion and the appropriate psychotherapeutic measures, proved a most valuable form of treatment in effecting the removal of conversion symptoms or the restoration of memory in hysterical amnesias or fugues in many cases the early application of these measures restored function and allowed of return to duty without evacuating the patient to the base.” [ . . . ]