Case 220. (Binswanger, October, 1917.)
A French tailor, aged 22, of healthy stock, was wounded in the left frontal bone in August, 1914. The shrapnel bullet, from an unknown distance, made a penetrative wound. The man was able to remember how at the moment he was injured he felt a sort of strain in his brain, felt his head with his hand, found he was bleeding, took out a bandage from his kit, removed it from its cover and without unfolding it put it on his head. At this moment he fell unconscious and there was then complete loss of memory for three weeks. This patient, who was intellectually keen, distinguished exactly between what he could himself remember and what he was told by his comrades. One of these had told him that he had cried out indistinctly that in a matter of fifteen days he would be well. He estimated the interval between his wound and the loss of consciousness as about five minutes.
After three weeks, the tailor came to and remembers that the first word he heard was Munich. Astonished to be in Bavaria he asked for paper and pen to write to his people, but found he could not write, though still able to dictate a little to his comrades. Besides agraphia there was hemiplegia on the right side, marked exhaustion, rapid fatiguability of vision, power of concentration but slightly diminished, and apathy for his surroundings; emotions normal.
Three weeks later the power to write returned; after six weeks, sleep; memory was restored in from six to eight weeks; the paralysis disappeared in twelve weeks; vision became normal in three or four months; the dreams ceased after seven months. The mood for the first two months after regaining consciousness was slightly elevated; for another two months slightly depressed. The mood then became normal. There was, then, in this case complete recovery save for slight overfatiguability in a period of seven months. There were still a few residuals of hemiplegia. An operation in November, 1916, removed a shrapnel ball, one centimeter in diameter, from a dural scar.
This is a case of acute reaction psychosis of exogenous origin lasting three weeks and leading to complete recovery in an after phase of from four to seven months.
Normal subject, wounded and thrown to ground by shell explosion: Recurring MEMORIES of battle scene; persistently HYPERESTHETIC healed shell WOUND, with pupil and pulse changes on pressure of the scar.
Case 221. (Bennati, October, 1916.)
A lieutenant of artillery, student (one of his brothers dead of meningitis), suffered somewhat from diarrhœa on the battlefield. He was, however, always able to obtain the best of food. External conditions did not seriously interfere with sleep. In particular there was no excessive dampness where he was. He was preoccupied with having to act as substitute for the commandant of the battery. He was not afflicted by the thought of his parents far away; their financial affairs were entirely satisfactory.
This almost normal man was wounded after a day of incessant fighting five months after going to the front. When firing ceased, he withdrew with his soldiers to a trench. Here he was followed by an enemy gas shell which killed some and wounded others. While outside the trench shifting mutilated soldiers to the rear, he was hit by another shell of which a chip wounded him in the left thigh. He felt a terrible spanking blow that threw him to the ground and gave him great pain. He was carried on a stretcher to the medical post across the zone of fire; thence to a field hospital and from there to a hospital further from the front. He had been for almost seven hours in a sector of the fighting line which had been almost continuously active.