Case 581. (Garel, April, 1916.)
A soldier, 35, went on leave August, 1915. Arriving at his farm, he had a violent feeling of moral perturbation and suddenly lost his voice. When he returned from leave he seemed stupid, spoke very few words and seemed to look about in a vague and undecided way. He was several months in this state and sent January, 1916, to Saint-Luc.
The vocal cords were there found of a normal color and without paralysis. “It was, therefore,” remarks Garel, “a nervous aphonia susceptible of instantaneous cure.” The patient was made to make a sound in the lowest tone possible. While he was making this attempt, sharp pressure was exerted upon the lower part of the sternum, to provoke expiratory reinforcement. The sound emitted was loud, to the great astonishment of the patient, who, thus aided by suggestion, shortly began to talk aloud.
In this particular patient a temporary return of voice was readily obtained, but not maintained. Special exercises had to be instituted, whereupon the patient immediately fell back into a complete aphonia. He was then made to scan words, syllable by syllable, executing with his arms classical movements of respiratory gymnastics, or sometimes with the utterance of every syllable the epigastrium was manually compressed or the shoulders suddenly lowered. The patient could now read a book in a jerky manner, and after a few lines he could read without his shoulders being pressed.
Another plan was to have the man read or talk while walking. As soon as he was stopped and accosted, however, he lost his voice again. Up to the time of report it was impossible to secure a definite return of voice, as the patient was not willing to associate words with peculiar movements. It might make him ridiculous. Accordingly, the nurses were requested not to fulfil requests unless they were made aloud. Recovery was to be hoped for from this measure.
Wounded: Recurrent stammering: Reëducation.
Case 582. (MacMahon, August, 1917.)
A young English officer, previously cured of stammering while a boy, fell to stammering again after being twice wounded. The impediment was of the laryngeal type. When spoken to he was often quite speechless. In Shell-shock stammering, the chief difficulty according to MacMahon is in the production of voice consonants and vowel sounds. In mild cases the trouble is best left alone.
This officer was anxious to pass into the regular army from the reserve to which he was attached. The stammering prevented this. He was treated nine months and improved rapidly. He passed through the trying ordeal of the medical board successfully and went to his regiment.