Occipital trauma. Mystical visual hallucinations and explanatory delusions.
Case 159. (Claude, Lhermitte, Vigouroux, 1917.)
A soldier, 33, single, was wounded in the right occipital region by a shell burst September 25, 1915. There was no sign of focal lesion, but a trephining operation was done, which healed perfectly. No disturbance of vision ensued. The soldier was sent to convalesce two months after having been examined by P. Marie at the Salpêtrière. He went back to his regimental station and was put into the auxiliary service April 26, 1916.
In the early days of September, that is to say, a year after his injury, he had a vision. Above the church cross at Chantenay, where he then was, he saw a rainbow-colored bird, passing slowly in the sky. He lowered his eyes and the apparition followed and was projected on the white walls around him. After some time it disappeared. The soldier himself wondered whether his brain injury might not have something to do with the vision, but none of his comrades wounded in the head had had any such vision. So then he thought of tobacco, of which he was a moderate user, and stopped smoking, but the vision returned in the same intensity four months later. On examining the bird’s face carefully, he found that it was the Holy Virgin’s. In dreams he also had analogous visions and in the dreams the Holy Virgin spoke to him, but what she said he did not remember. The bird’s head did not speak to him. The soldier was now convinced that it really was the Holy Virgin who had visited him in the form of a bird. He remembered that he had asked Notre Dame de Lourdes to protect him on the day when he was injured. He had, in fact, eaten a bit of cheese that day upon which he had inscribed a prayer to the Holy Virgin.
Sometimes he saw a red globe shining like a church lamp; sometimes white or black ladies descending from the sky; sometimes other visions. Now the Holy Virgin was to direct all the soldier’s life, but why should he be specially favored? Was he not to be called sooner or later to hold a high rank? He confessed, in fact, that he was to be the King of France, and, like Joan of Arc, was to save his country. Now the soldier began to understand the hidden significance of his surroundings. Everything around him was symbolic, thus, white, of purity, order and royalty; red, of anarchy, disorder and atheism. Some white ship which he saw outstripping some darker ship showed him how the kingdom of France was arriving once more. In fact, there was a symbolism in the whites and yolks of eggs, and the proportion of yolk to white was as one to five. He made talismans to exorcise bad spirits.
Were there auditory hallucinations? If so, they were only episodic and took no part in either the construction or the fixation of the man’s delusional system. Thus, a voice once said to him, “All is not lost. You will be ——.” May 25, 1917, he entered the neurological center at Bourges.
As to the interpretation of this case, it seems that the patient’s mother had crises of depression which at one time caused her to be interned in the Charité. The contributors of this case do not believe that there can be any causal link set up between the mystical delusions and the brain injury.
As an auxiliary the soldier has a right to twenty per cent compensation for his head wound with loss of substance without bulging of the dura mater. Of course, as an insane person he must be retired. The aggravating or accelerating part played by fatigue, emotion and cranial trauma must, from the standpoint of compensation, be taken into account.
Shell-shock dementia praecox.