Case 331. (Claude, Dide and Lejonne, April, 1916.)
A lieutenant, 28 (mother nervous; father had nervous spells at fifteen; patient himself nervous as a child), was under a great moral strain at the outbreak of war, and was utterly exhausted in a hard battle that lasted more than twenty-four hours.
A shell burst near him September 25 at the Somme, whereupon he fainted. He was evacuated to Amiens for three weeks; kept his bed; somnambulistic; subject to nervous crises.
He passed to the hospital of Ferté-Bernard for a month, the crises becoming more frequent. He was sent to a convalescent dépôt for three days, thence for three months to La Plisse; got better; lived at home, but went to a show where they played the Marseillaise, was profoundly moved thereby, and had more crises; accordingly went back under medical care and finally to his dépôt, where, upon seeing his old comrades, he had more crises, and was finally evacuated to the neurological center of the Eighth Region.
He there seemed mistrustful when asked to tell his story. There was a noise of cannon, whereupon he got up, ran in all directions in the garden, bumping into trees in the greatest terror, yelling, “There they are!”; gesticulating, soliloquizing: “Bomb! Shell! Bayonet!” His pulse was rapid. After he was calmed down, he began to talk again in a very clear, distinct, somewhat tremulous voice. A metallic sound made him shudder and cry out, “The drums!” and another scene of rushing about followed.
In the consulting office he wept. Battle dreams and nightmares, soliloquies and terror, seminal losses, occurred during the next few days.
August 4, while alone in the garden, he heard a noise, went toward it and spied a frog, whereupon he had another crisis of fear and emotion. He got another lieutenant, and both returned, sticks in hand. Pointing to a hole in the earth, Lieutenant A. said, “Trenches! There they are!” “What? Who?” said Lieutenant B. “The Boches!” said Lieutenant A. Whereupon Lieutenant B also saw them and cried out bravely, “Go away!” However, the second lieutenant immediately saw that he had been the subject of suggestive hallucination.
Fifteen days of calm followed, during which the lieutenant became more sociable and grew better having no more crises.
Four other cases of “hysteroemotive nature” are reported by Claude, all of them showing a special constitutional basis before the war. In the differential diagnosis, alcoholism, cyclothymia, obsessive psychosis and occasionally systematized delusional psychosis may be considered. There were occasional stereotypical features in the cases, but of a very fugitive nature. Dementia praecox is hardly to be considered.
Re “hysteroemotive” cases, Babinski holds that the claim of emotion as a single factor capable of causing hysteria by itself, is a false claim. To be sure, the patients themselves may give accounts which lead to the idea of an emotional hysteria. Dide, one of the authors of the above case, states that functional disorders occur only in subjects whose emotional tone has been relaxed. The heaviest bombardments are not in line to produce these disorders when the morale of the troops is good. The bloodiest affairs may leave no single case of nervous disorder when the morale is good. Dide found in a whole year’s work but a single functional case,—an oniric delirium, following a trench mortar explosion. Roselle and Oberthür also state on the basis of intensive experience, that large projectiles do not cause any intensive emotional reactions. Clunet’s observations upon the shipwrecked La Provence II, quoted by Babinski, run in the same direction. It will be noted that the five cases called “hysteroemotive” showed a special constitutional basis antebellum.