On the morrow, two of them partially recovered hearing and got back their voices. They became loquacious and began to tell about the battle. The day after, the third patient began to speak. Two of them showed traces of auricular hemorrhage, and in fact, actual ear lesions were found in all three. One had a suppurative right middle ear, with perforation; another had both drums perforated and a suppurative middle ear, also on both sides. The third, who recovered his speech after the others, had perforation of the left tympanum with a little suppuration of the right ear tympanum and a slight tear of the right tympanum. In April, 1915, the hearing was cured.
These men had been under fire several months, and had taken part in the battle of the Marne. It was not a question of their first baptism of fire, and in fact, each of them had been previously wounded. According to Roussy, the story is, that the shell-burst produces by displacement of air tympanic perforation, and at the same time a violent nerve shock with loss of consciousness for a few minutes. The men come to, but the ear lesion, probably exaggerated by the nervous status of its bearer, creates a complete bilateral deafness. This deafness produces an absolute hysterical mutism.
Re case groups of war neurosis, several writers speak of dangers of contagion, but also emphasize the values of contact of patients with one another in the securing of therapeutic results. What Mott has termed the atmosphere of cure was no doubt present in the three instances of Roussy just cited. The cure of one may act heterosuggestively to produce the cure of a second, and so on. Functional deafmutes are somewhat refractory as a rule. H. Campbell states that there is some danger attached to allowing large numbers of functional cases to consort together too closely. He suggests making use of small wards and screens, and a process of sorting out patients so that they shall not affect one another injuriously. Steiner especially stresses the value of individual rooms in preventing psychic infection, of which, he says, the danger is large in open dormitories. The psychic contagion is as a rule that of hysterical seizures and tremors; but complaints about faulty hospital arrangements are also readily spread. Steiner advocates never questioning a nervous patient concerning his troubles in the presence of other soldiers. To reach 60 to 70 patients, Steiner had one examining and treatment room. Roussy’s institution at Salins in 1917 had a service limited to traumatic hysteria, from which, in three months’ time, 200 subjects had been discharged cured (see Boschi).
Dysentery: Milk diet persisted in: Vomiting, incontinence, inability to walk. Cure by persuasion.
Case 500. (McDowell, December, 1916.)
A soldier, 25, a low menial when war broke out, developed “dysentery and gastritis” at the Dardanelles, although even before the dysentery his nerves had gone bad. He had diarrhoea and vomiting, was sick every day, found himself unable to walk, and found himself always wet with urine dribbling day and night. Arriving in England and treated in a hospital, he still had vomiting. He had lived on milk and custard and been kept in bed.
Capt. McDowell convinced the patient that his legs were not as weak as he supposed. He was encouraged to walk, put upon light diet and then upon ordinary diet. He became an active worker in the ward, later going for five-mile route marches. Two months later he went back to duty in good health, weighing seven pounds more than before. This man was weakminded and, when his dysentery was cured, did not dare to start eating ordinary food. He was a victim of hospital régime. Individual attention would have obviated much of the subsequent state.
Re vomiting, see remarks under another case of McDowell ([Case 495]).