Sharp gunfire: TREMORS; TREMOPHOBIA. A patient’s (an artist) description of his feelings.
Case 225. (Meige, February, 1916.)
One of Meige’s victims of shell-shock tremors was an artist. He stood the hardest sort of trench life for many months without disorder. Under particularly sharp fire, “the machine went off the track,” as the artist said, and he began to tremble. Both arms and head trembled, but especially the head, which was subject to small sidewise oscillations, variable in degree, and almost permanent,—a sort of vibration which the patient could diminish somewhat by stiffening his neck muscles. His manual tremor was not exaggerated by voluntary movements. Superficially he resembled a Parkinsonian case. He presented a curious appearance of combined vibrations and stiffness.
There was no doubt that this tremor had an emotional origin. In fact, the psychopathic status of the patient was described by the artist himself. “My nervous state, which I thought ought to last not more than a fortnight, still persists more than three, or almost four, months after being evacuated, although the trembling is a little less. I am calmer and palpitate less, and my hands perspire less when I am emotional or making an effort. At first, the slightest shock immediately ran through me, followed by an uncontrollable trembling. Now there is an appreciable delay between the shock and the trembling; I can control it for a few seconds but not longer. The subway gate noises, a flaring light, a locomotive whistle, the barking of a dog, or some boyish prank is enough to set off the trembling; going to the theater, listening to music, reading a poem, or being present at a religious ceremony, acts the same way. Recently when a flag was being raised at the Invalides, I thought at first that I was going to be cured by so moving a spectacle, but then I suddenly began to tremble so violently that I had to cry out, and I had to sit down, weeping like a child. Sometimes the trembling comes on suddenly without any cause. I went to a novelty shop to do some errands with my wife. The crowd, the lights, the rustling of the silk, the colors of the goods—everything was a delight to me to look upon,—a contrast to our trench misery. I was happy and chatted merrily, like a schoolboy on a vacation. All of a sudden I felt that my strength was leaving me. I stopped talking; I felt a bad sensation in my back; I felt my cheeks hollowing in. I began to stare, and the trembling came on again, together with a great feeling of discomfort. If I can lean against something, sit down, or better, lie down, the trembling gets better and pretty soon stops. There are three conditions in which I feel well: first, upon waking after 11 or 12 hours’ sleep; next, after a meal, especially if it is a good one; and lastly, and above all, when I get the electric douche. Then, as if by magic, my ideas get clear, cheerful, and regain color; I feel myself again. That lasts for an hour or so; then I relapse into my sad state.”
As to the tremophobia, this patient says “In the tramway or in the subway, I perceive that people are looking at me, and that gives me a terrible feeling. I feel that I am inspiring pity. Some excellent woman offers me her seat. I am deeply touched; but if they look at me and say nothing, what are they thinking of me? This anxiety makes me suffer a good deal. If I am able to speak it is less painful to me, for then it is obvious that, despite my trembling, I am not a coward. What a sad situation this is!”
Meige remarks that therapeutics is not especially successful in these cases of tremor. Sedative drugs, hyoscyamin, hyoscin, duboisin, and scopolamin, do not last long and should be used cautiously. Static electricity works well in some cases. Rest, isolation, and calm.
As for the military prognosis, a period of observation of some three to four months may be necessary to learn the nature of the tremor. If the tremor then fails to alter, a convalescent leave for one or two months may be given. The patient should then be re-observed by the same physician. Upon persistence of tremor, temporary invaliding. Tremors may be wittingly cultivated for medicolegal purposes (Brissaud’s sinistrosis.)
Letters of a German soldier about his shell-shock.