<P> In World War II and thereafter, diagnosis of' shell shock' was replaced by that of combat stress reaction, a similar but not identical response to the trauma of warfare and bombardment . </P> <P> During the early stages of World War I in 1914, soldiers from the British Expeditionary Force began to report medical symptoms after combat, including tinnitus, amnesia, headaches, dizziness, tremors, and hypersensitivity to noise . While these symptoms resembled those that would be expected after a physical wound to the brain, many of those reporting sick showed no signs of head wounds . By December 1914 as many as 10% of British officers and 4% of enlisted men were suffering from "nervous and mental shock". </P> <P> The term "shell shock" came into use to reflect an assumed link between the symptoms and the effects of explosions from artillery shells . The term was first published in 1915 in an article in The Lancet by Charles Myers . Some 60--80% of shell shock cases displayed acute neurasthenia, while 10% displayed what would now be termed symptoms of conversion disorder, including mutism and fugue . </P> <P> The number of shell shock cases grew during 1915 and 1916 but it remained poorly understood medically and psychologically . Some doctors held the view that it was a result of hidden physical damage to the brain, with the shock waves from bursting shells creating a cerebral lesion that caused the symptoms and could potentially prove fatal . Another explanation was that shell shock resulted from poisoning by the carbon monoxide formed by explosions . </P>

When was the term shell shock first used