The deafness was evidently exaggerated. Voltaic vertigo tested normal. Reflexes normal.
The diagnosis psychoneurosis was made and the patient was rigorously isolated, given a long psychotherapeutic talk concerning the nonreality of his deafness and his vertigo and the possibility of cure by means of a very disagreeable electrical treatment. He made improvement upon psycho-electrical treatment and the next day both tremors and deafness had greatly diminished. September 4, the patient was considered completely well. There was a slight diminution of hearing in the right ear, the whispered voice was heard at 50 centimeters on the right side, the watch at 25 centimeters on the right and 60 on the left.
October 5 the patient was sent back to his corps. On the evening of his departure, angry at not having received leave, he boasted to his comrades of having passed but three days at the front since his injury.
It is remarkable, according to Roussy and Boisseau that this patient had passed sixteen months without ever having been taken for a neuropath or treated as one. The otologists gave the diagnosis of labyrinthine shock, but did not attend to the tremors. The pseudo-symptoms disappeared in six days at the neurological center and the cure had lasted six weeks at the time of report.
Re otology in these cases, see Bourgeois and Sourdille’s book mentioned under [Case No. 439], particularly Chapter III, upon the functional examination of hearing. In the present instance, it will be noted that voltaic vertigo tested out normal. According to Bourgeois and Sourdille, the Babinski electrical test is the most convenient one to begin with, to learn in a few moments whether the vestibular system is working normally or not. These authors found amongst twelve patients, three normal reactions and one instance of hypo-excitability amongst four subjects who, by other tests, failed to show vestibular disturbance. Inexcitability as to voltaic vertigo was found in one man with a destroyed labyrinth. There were four instances of hyperexcitability in Babinski’s cases with marked equilibrium disorder. A case of Ménière’s disease yielded the same results. According to the intensity of the current, the following phenomena (in addition to the pricking sensation) are noted; (a) salty taste; (b) sidewise swaying with slight vertigo; (c) nystagmus with more pronounced vertigo; (d) sensations of sound. In short, nerve branches that go through the petrous bone, namely, the chorda tympani, the vestibular nerve, and the cochlear nerve, have been successively stimulated. Babinski’s test was published before the Barany work on induced nystagmus, but Barany’s rotation test for the physiological excitation of the semi-circular canals, and his caloric test for the investigation of the ears and canals separately are to be utilized in addition to the Babinski voltaic test. Babinski’s law of voltaic vertigo is that a normal subject inclines to the side of the positive pole; a pathologic subject falls to the side to which he tends to incline spontaneously. If the labyrinth has been destroyed, there has been no reaction.
Re [Case 440], Roussy and Boisseau in their capacity as neuropsychiatrists, point out the inadequacy of an otological examination taken by itself. They insist that neuropsychiatrists should be called in. It is probably equally true that neuropsychiatric work upon deaf cases is often inadequate on account of the lack of otological examinations. According to Bourgeois and Sourdille, the expert otologist’s problems are as follows: (a) Deafmutism; here Gault’s cochleopalpebral reflex is of value. The hearing of a sudden noise causes contraction of the orbicularis palpebrarum on the side upon which the noise is suddenly and unexpectedly made. Eyelash tips are particularly watched.
(b) Complete bilateral deafness. This is practically never organic; complete bilateral deafness is a phenomenon either of traumatic hysteria or of simulation. Sundry methods of surprising the patient into hearing have been adopted. The practice of teaching lip-reading to simulators and hysterics has led to some difficulties in diagnosis, but tests have been produced by Gosset (of one sound with the lips set to form another, and the like) which are of service.
(c) Extreme bilateral dulness of hearing.
(d) Total unilateral deafness. For the minutiae of tests for these types of hearing disorder and their simulation and exaggeration, see the War Manual of Bourgeois and Sourdille.