Seven days afterwards the eyes looked normal, fundi were normal, vision was reduced to the perception of hand movements; with a plus 10 sphere the right eye could count fingers at 5 c.m. and with a plus 8 sphere the left eye could count fingers at 3 c.m. There was a right frontal analgesia.
Treatment: Sweating; rest in bed for several weeks; assurance of complete recovery. There was a slow but constant improvement, aided by faradization and injections of strychnine sulphate into the temporal region, but the prospect of a return to the front retarded the improvement.
Re injections into the temple, see also [Case 521] of Bruce. Re cure of blindness, Grasset has a case of a blind deafmute who was cured by a nurse. She put a pencil in his hand and guided the pencil while she wrote a question. The patient replied in very good MSS. In blind deafmutes sight is described as returning first, hearing next, and speech last.
For other cases of blindness, see especially under [Section C], [Cases 433 to 438], with discussions thereunder.
Re retardation of improvement by the prospect of further military service, Lewandowski has insisted upon the strong factor of the wish in all such functional conditions. Lewandowski wants all functional cases, however, to be sent to duty in the rear or to be discharged as unfit.
Aphonia: manipulation in larynx.
Case 518. (O’Malley, May, 1916.)
A corporal, 28, had a bullet pass through his neck from a point in the middle line at the upper border of the thyroid cartilage to a point behind the right sternomastoid muscle, two inches below the point of entry. The corporal lost his voice at the time of injury, spat up a teaspoonful of blood, and thereafter was able to whisper only. The laryngoscopic examination betrayed no intralaryngeal lesion. Treatment as described below enabled the patient to speak. O’Malley describes his technique as follows:
The patient is placed in the common position for the examination of the larynx, the tip of the tongue being seized in a piece of linen by the left hand fingers and the laryngeal mirror introduced with the right hand. The patient is then requested to say “e” or cough, and if the cords do not approximate, they can be made to do so by using moderate friction on the fauces and pharynx with the mirror to excite secretion. The latter begins to drop into the larynx, and acting as a foreign body, a protective reflex is at once excited which adducts the cords to prevent the secretion from entering the trachea. At the same time an involuntary cough is produced to expel the mucus, and if the friction and flow of secretion are maintained and the patient is urged to cough vigorously, voluntary coughing and a tendency to retching with forced laryngeal notes will rapidly follow. It is usually best to persist until retching occurs, as the cords are then forced together to protect the larynx and trachea from the possible entrance of regurgitated stomach contents. Involuntary laryngeal sounds are thus produced and the patient is conscious of laryngeal effort. Some of these cases are at the moment very shallow breathers, which can be demonstrated by X-ray screening, but the act of retching causes a wide excursion of the diaphragm with a more pronounced expiratory blast, to be rapidly followed by deeper inspirations. This method of treatment is best carried out just before a meal, as the stomach is then practically empty and the unpleasant effects of the sudden regurgitation of food are avoided. When the explosive sounds accompanying retching have occurred two or three times the mirror is withdrawn, the tongue released, and the patient is requested to swallow, take a deep breath, and cough, and then urged to count up to ten, directing his voice to a certain point on the ceiling. This method has given me uniformly good results, and was rapidly effective in all cases coming under treatment soon after the onset of the neurosis.