A Colonial infantryman, 32, was wounded December 17, 1914, at the Boisselle, being struck by a bullet which entered on the right side in the upper part of the neck and came out behind the left side of the mouth, having traversed the tongue, broken two teeth, and caused a good deal of hemorrhage by mouth. The patient felt his tongue swell, and from this time on he could not pronounce a word. He was sent to the ambulance, then to Mien, then to Saint Germain, and finally to Morestin’s surgical service. With wounds by this time healed, the patient found it hard to open his mouth. There was no trace of fracture of the lower jaw. The tongue could be only incompletely examined. The man swallowed liquids easily but could take no solid food. He tried hard to speak, made pantomime movements, grew emotional and lachrymose.
On the whole, however, it seemed that his inability to articulate sound could not be due directly to the lesion. There must be either simulation or hysteria. For four days he was attentively watched, and not once did he pronounce a word. He grew more and more stricken and humiliated by his plight. Rigorous diet did not cause his mutism to cease. Isolation and ennui did not decide him to talk. Accordingly, it was announced, in the man’s hearing, that an operation was to be done to restore speech. January 9, 1915, his face was copiously washed with alcohol and ether. Cocaine was injected to secure anesthesia and resolution of the muscles of mastication. Six c.c. of a 1-100 solution on each side. Shortly the surgeon began to open the jaws, against decreasing resistance. The tongue, which was not spastic, was seized with a tractor and rhythmic movements were executed with it. After a few of these movements, joy was painted on the features of the patient. He said that he wanted to speak and that he was about to speak. He shook the surgeon’s hands effusively and said, “Merci.” Although the first words came hard, little by little speech became free and a perfectly sincere elation at having recovered speech set in.
This man was neuropathic, having always been a rather strange, irritable and restless person, and given to nervous crises in anger, in which he lost consciousness entirely.
Re pseudo operations as forms of disguised persuasion, almost countless methods have been used. See Cases 514, 515, 518, 519, especially 521, 560, 561. Sham injections under ethyl chloride have been made (Goldstein). See also under [Case 484], re continuous bath, and under [Case 488], re lumbar puncture. Very close to these methods are the methods of torpillage of Vincent and the methods employed by Yealland in England and Kaufmann in Germany. See under Cases 574, 563, and 564, and 570.
Léri quotes Babinski as saying, “We cannot fight hysteria in trench warfare; manoeuvres are necessary.”
Re treatment of mutism, Chavigny remarks that the principle of treatment for mutism is quite different from the principles of treatment of paralysis. The reëducation of mutism is psychic. Chavigny claims probably absolute success in the treatment of mutism through faradism to the larynx region simultaneously with a signal given to the patient to make an effort to pronounce the letter A. Garel modifies the treatment (in case the faradic apparatus is not at hand), by a vigorous and sudden blow to the patient’s epigastrium simultaneously with the patient’s endeavor to imitate the movement of the doctor’s lips.
Shell-shock: Impairment of vision (even commanded men to fire on kindred troops!) Improvement by verbal suggestion, faradization, injections.
Case 517. (Mills, October, 1915.)
A sergeant-major, 29, in private life a bookkeeper, said that shrapnel struck the ground in front of him and burst as it struck. Unconscious for a moment, the sergeant-major thereafter saw everything imperfectly, led his men in the wrong direction, and even commanded them to fire in the direction of his own troops.