Burial; struck in head by beam; overcome by gas: Tremors, convulsive movements, confusion, flight toward enemy.
Case 367. (Consiglio, 1916.)
An Italian private, 28, of meager build (infantile eclampsia; brother epileptic) was buried by a shell explosion and overcome by gas. After a month’s leave he went back to the trenches.
But now, whenever a shell burst, he fell into irresistible terror and made convulsive movements which he forgot afterwards. He could not sleep. The mere memory of the scene would throw him into terror. He was tremulous, developed asymmetrical innervation of his face, was generally hypesthetic and mentally blocked.
In the midst of convulsive tremors he fled towards the enemy. He was stopped and brought back, and remained for two days confused and hallucinated.
In the original accident he had been struck in the head by a beam.
Re this Italian’s flight toward the enemy, see various cases of fugue. Clinically and medico-legally, Roussy and Lhermitte remark that these confusional escapades are of great interest, and that many cases are encountered near the front line, put under trial by court-martial, and handed over to specialists. The dream is being lived through. Such a case as this of Consiglio recalls the hystero-emotional psychoses of Claude, Dide, and Lejonne. The relation of oniric delirium to mental confusion is still a matter of polemic. According to Régis, however, the common oniric delirium of toxic or infectious origin is nothing more than a sort of somnambulism. The retrograde amnesia which follows toxic delirium is the same in principle as that which follows hysterical delirium. Régis pointed out that suggestive hypnosis could bring back the memories in both types of disease, as well as from the toxic delirium as from the hysterical somnambulism. However, the differential diagnosis between onirism and hysteria is not easy. Alcoholism and actual brain trauma need to be excluded.
Shell-shock; windage; unconsciousness: Carried on with fugue tendencies. Variety of hysterical symptoms. Fit for garrison duty four months from explosion.