Emotionality: Shell explosion; mutism. Recovery by reëducation.
Case 578. (Briand and Philippe, September, 1916.)
A plumber, 27, went into the infantry. He was very emotional and was but a short time in the trenches when the explosion of shells threw him into a state of mutism. Deafness, rather curiously, did not manifest itself for several days. He had to go back on horseback, and, as he was a poor horseman, slipped off the horse, giving himself a bad fright. When he got up, he had lost his hearing.
He was sent to several hospitals and finally to Val-de-Grâce, in July, 1915. He recovered hearing in fifteen days, but the mutism persisted several months. According to Briand and Philippe, this is a typical case, except for the duration of the mutism. The first treatment was given this patient August 6. His respiration was examined and tracing was taken. August 15, on the morning visit, he was found able to whistle very distinctly the first bars of “Au Clair de la Lune,” and then began to sing the first verses, articulating distinctly, but stammering a little. He was now left to his own resources, without special exercises, from August 15 to September 26, and completely lost the benefit of his previous exercises. A week of special treatment allowed him to recover speech again, enough to take up every day life. The patient went out well.
The general lines of the examination in this case took up attitude in abdominal respiration and the question of respiratory pauses, especially pauses in abdominal respiration, which, in the above case, were exaggerated. Expiration was deficient and disordered. The normal adaptations that had been established during his childhood learning of speech had failed, and the patient would not have been able by himself to regain proper balance of respiration for speech.
The examination was continued to learn the difficulties of innervation of the muscles of phonation whose proper delicacy had been lost. Such a patient is a kind of bad gymnast, executing an exercise known to be hard by contracting all the muscles of the region, both the antagonist and the agonist muscles. Reëducation must, therefore, endeavor to sweep away the contractions that block sound. Then the patient must be made to perform the contractions necessary in phonation and articulation unconsciously. The methods used for teaching children might here be employed, but more elaborate and designed methods can be used with the adult, e.g.,
1. Breathing exercises, especially with the idea of making respiration complete.
2. Blowing exercises.
3. Whistling.