Vicissitudes in fifteen months of a Shell-shock case with mutism and amnesia. Attacks of mania. Hyperthyroidism?
Case 475. (Purser, October, 1917.)
An Englishman, 21, in a rifle regiment, arrived in May, 1915, at the Dublin University V. A. D. Hospital, being dumb, impaired as to vision and hearing, having dilated pupils, tremors, restlessness and weakness, and giving the impression of visual hallucinations. Although suspicious, he was treated kindly for a few days, recovered his hearing, and wrote the few things that he remembered about home and the war, now and then tremulously and perspiringly writing down, “Asylum; do not lock up; I am not mad.”
With the idea of hypnosis, his bed was surrounded by screens, whereupon he grew so perturbed that the attempted hypnosis could not be executed. He learned the letters PP, TT, SSS, A-OOO, and finally AA-SS, AA-TT, T-OO, and after many weeks SS-SST-R and B-TT-R. His father visited him and probably was recognized.
At the end of September another dumb Shell-shock case recovered speech upon being given ether. Maj. Purser asked the sister to arrange for a like treatment for the first case, explaining that an examination of his throat might be painful. The cure of the second case by anesthesia got into the papers and before he was treated the account was possibly seen by the hitherto gentle rifleman. At any rate, he was seized with a sort of spasm, became furious and could only see Germans coming and carrying off his machine gun. He shouted for help. A half grain of morphine was given him and when it began to take effect the fighting spirit gave way to despair. He trembled over the loss of the gun, and remained in this state of despair for three days, remembering his regiment number and the like, but amnestic for his life during the past few months. He could not read now because print was indistinct. Words, when he had spelled them out, conveyed no meaning. He had a functional alexia. When he saw a picture of a bunch of flowers in a notebook of his, he had another spell of excitement and regained his power of speech, remembering about his experiences only that he had been locked up. He had now completely forgotten his father, who came to call.
By the end of October he was stronger, but his horizon was still limited to the hospital surroundings and a little newspaper reading. Headaches and impaired vision persisted. Sight temporarily left him early in November, and there was a suggestion of an epileptic fit one day early in that month. Tonic and sedative drugs and suggestive remedies were of no avail. Hypnotism made him worse, and psychanalysis was, perforce, ineffective through the amnesia. At the end of November depression and suicidal thoughts set in, with an elevation of blood pressure to 178 m.m., pulse 80 to 90. Maj. Dawson then thought he was a suicidal melancholic. Rest in bed and thyroid extract were given, but the latter threw up his pulse on the fifth day to 140. He grew better mentally on the treatment, however, and his blood pressure fell to 140 in three weeks. He was now over-emotional, unable to stand or walk or feed himself or to pull on his socks.
For change of scene he was transferred to Mercer’s Hospital in February, 1916. He suffered from astasia-abasia. The tremor became jerky, coarse and persistent. The thyroid gland grew a good deal in size during the spring and the pulse went up to 120 per minute. There was also well-marked dermographia and there was a suggestion of the clinical picture of Graves’ disease. Even a quarter grain of morphine had little or no effect upon an ineradicable insomnia.
Maj. Purser gave the case up as a bad job and the man was discharged and sent home September 2, 1916. During the next two months at home he improved in steadiness, though he flushed if dealing with strangers, and improved as to memory. He began to be able to read better. He had begun to be able to get about on his feet without so much support. The ultimate outcome could not be reported by Maj. Purser.