BURIAL by shell explosion: DEAFMUTISM. Treatment: phonetic reëducation.
Case 580. (Liébault, 1916.)
A machine gunner, 26, was buried at Rheims, January 5, 1915, by the explosion of a large shell bursting over the dugout. He was unconscious three days and deafmute on coming to, without amnesia but with a feeling of constriction in the throat.
After fifteen days in the ambulance he was sent for four months to the Maritime Hospital at Brest, and treated by hypnotism. Seven or eight sittings had no other result than to fatigue him. There were then three months of convalescence. Returned to Vannes, September 20, 1915, he was put into the auxiliaries. As he could not work much he was sent, December, 1915, to the Hôtel-Dieu at Nantes. Here electric vibratory massage was given, which secured a few hoarse sounds.
Phonetic reëducation was then undertaken at Prés-à-goutrière, May 10, and his respiratory capacity increased from 170 the first week to 250 and 300 the following weeks. His blowing strength was raised from 15 to 20 to 25 at the same time. In a few weeks he was much improved and June 27 passed on to his auditory reëducation. The respiratory capacity in this man was insufficient. He could not speak, but his respiratory movements were good and he learned again to speak in a voice as good as ever.
According to Liébault, it is a general principle that, if the respiratory capacity is increased, the voice will clear or become better; but, if the respiratory capacity remains stationary, the voice will not improve. It is the same with normal persons. A subject with a very subnormal respiratory capacity cannot speak loudly, but, if his respiratory capacity approaches normal, he can speak normally. According to Liébault, all cases of this sort have had some respiratory anomaly and each case must be systematically examined with the aid of anthropometric tables, including weight, height and chest capacity. The vocal disorder is proportionate to the degree of functioning of the phonating apparatus taken as a whole. It is not merely that the larynx should be examined, but the motor side of the apparatus, the respiratory muscles, the resonating apparatus, the lips, the mouth, the nasal fossæ and the pharynx.
Re curability of different types of war deafmute, Roussy and Boisseau maintain that the type (a) that comes gesticulating, pointing to the ears, and desirous of writing, is the type that responds most rapidly to psychotherapy. There are two other types less responsive: (b) is an apathetic type, with impassive and stupid facies, lies immobile in bed, or sits in a chair in mental confusion; type (c) shows a facies of terror, looks haggard and anxious, confused, disoriented, and possibly delirious.
Re general treatment of deaf cases, Zange suggests that emotion should not be aroused by intense auditory impressions, that he should not be reminded of his shock, and should be kept as cheerful as possible. Zange states that he found the static electric current of service, and got good results in hysterical deafness of sudden development by applying a strong faradic current.
A year’s service; leave: Hysterical aphonia developed at home. Respiratory gymnastics.