The patient had been mute thereafter, depressed, and given to dreams about fighting and shells. There was a fine tremor controllable by the will; the knee-jerks were increased. On lateral deviation, there was difficulty in fixing the eyes. There was a slight deafness due to an old discharging left ear. According to Wiltshire, Shell-shock is only exceptionally caused by chemical poisoning from gas.
Re poisoning by certain German asphyxiating gases, Sereysky reports in 1917 that these gases contained, among other poisons, a nerve poison. He found that poor heredity was a favorable soil for the action of this nerve poison. The clinical pictures in the gassed soldiers rather suggested cerebral arteriosclerosis. He remarks that the logical distance between the “exogenous” and “endogenous” is greatly reduced in these gassed cases, as the syndrome of “exogenous” gassing closely approximates that of various “endogenous” disorders.
Hysterical speech disorder related to mechanical disorder of auditory apparatus.
Case 217. (Binswanger, July, 1915.)
Whenever a German officer’s servant, 23 years, was addressed on the ward in the Jena Nerve Hospital, his hands would tremble and the muscles of his face would fall into grimacing associated movements. He had a peculiar infantile type of speech, talking with a fixed glance and an anxious mien. He would carefully utter, as a rule, separate words, chiefly only nouns or infinitives. He would gesticulate with both hands to make what he said understood. Thus (freely translating the German) runs his description of a battle:
“Well—because—I—we had—no artillery and so many losses—then got in position again, then we—laid down a long time—perhaps until four o’clock in the afternoon—five—and—and it happened that—lay in Rübenfeld—couldn’t go back—then shell near me—fell in and I right near, how—how far—I don’t know and—grown better. Comrade said—10 meters—don’t know—un—unconscious.”
Long compound German words could not be repeated, since after the first or second syllable there was a severe emotional excitement; syllable articulation and phonation ceased. Finally, however, the patient could be gotten to pronounce the whole word. Reading aloud was very difficult: syllable sounding and omission of difficult syllables; after a time, weeping.
The patient was a somewhat small, muscular, well-nourished man, with a murmur at the apex, a somewhat rapid pulse, increased reflexes, especially skin reflexes, painful supra- and infra-orbital points, temples painful to percussion, pressure over spine painful from second thoracic to third lumbar vertebrae. There was an increased sensitiveness to touch and pain over the whole body. There was a bilateral, somewhat marked tremor, more marked on the left side than on the right. Swaying in Romberg position was slight. Tremor of tongue.