The wound healed in less than a week. But what he had seen and felt kept tormenting his mind. There remained slight numbness in the wound where there was to be seen a spot of pigment, the size of a two-cent coin, with somewhat obscure outlines. The pain was irritated by damp weather, in certain positions, and by touch, and the pain on pressure was reflected in the pupils and in the pulse.
No other disturbance, organic or functional, was found.
Wounds; operation: Hysterical FACIAL SPASM.
Case 222. (Batten, January, 1917.)
A 23-year old soldier was admitted to the National Hospital for the Paralyzed and Epileptic, June 18, 1915, in the following state: He sat in bed, gasping, with the left side of the face set in a strong tonic spasm and jaws tightly set. The contraction of the masseters was such that his mouth could not be forcibly opened. He himself could separate his teeth for about a half a centimeter, but the jaws came together when a spatula was brought for insertion and then failed to relax. The facial spasm increased as the jaw was clenched more tightly. The patient said he was unable to breathe excepting when sitting upright, and when put into dorsal decubitus he breathed violently through his clenched teeth and held his breath as long as he could, “assuming a purple tinge,” as Dr. Batten states, “which was apt to be disconcerting until one was accustomed to it.” Faradism and force permitted the removal of false teeth but only to the accompaniment of shrieks, foaming, and violent movements of the arms, lacrimation, and sweating. During sleep, the face was at rest. The spasm of left face and of jaw would come on a few seconds after waking, when an observer was perceived. Attempts to force the mouth open invoked the same procedure as before in spite of the fact that the patient ate well. In a month he was virtually normal.
It appears that May 13, about five weeks before, the patient had been struck by shrapnel on the right hand, forearm, and shoulder, and base of the nose, while in France. He had been dazed but had not lost consciousness, and the wounds had completely healed before arrival at hospital. It was about a week after being wounded that the patient was operated upon for removal of shrapnel from the face. Upon recovery from the anesthetic, the patient found himself unable to move the right side of the face. Unable to remove his teeth, he had been fed by rubber tube.
Shell-shock: Hyperesthesia and over-reaction.