The neurological centers near the front, with their discipline, inaccessibility to friends, and nearness to the front, present a situation which yields easier and quicker cures than the interior; but after the two-years’ experience which proved this fact, according to Roussy and Lhermitte, many cases still get sent back into the interior for many months,—cases that ought to be cured near the front. Cases having convulsive attacks get confinement in separate rooms; chronic neuropaths are kept in bed on a milk diet.
The general features of the treatment of psychoneuroses commended by Roussy and Lhermitte are summed up in what they call the psychoelectric and reëducative method, divided into four stages: A stage (a) of persuasive conversation; (b) isolation; (c) faradization; and (d) physical and psychical reëducation. Roussy and Lhermitte got during six months in one of the army neurological centers, 98 to 99 per cent of recoveries. Clovis Vincent, in a special interior hospital (see for Clovis Vincent’s treatment, a summary under [Case 575]). Re the first stage of persuasive conversations, Roussy and Lhermitte discuss on the day of admission the general nature of the patient’s condition, and place him in the atmosphere of cure, in contact with recovered patients. The conversation takes place in the physician’s consulting room. The patient is gotten to promise on oath that he will submit to any methods of treatment. Although one may pass from the first stage to the third or electrical stage, forthwith, Roussy and Lhermitte recommend several days of isolation. The patient is placed in a separate room, and kept in bed on a milk diet. This isolation treatment of Weir Mitchell allows reinforcement of the suggestion by talks on the medical rounds, allows the patient, perhaps, to beg for the electrical treatment, which he may have refused at first, and lengthens the period of observation. According to Roussy and Lhermitte, spontaneous recovery not infrequently takes place during this phase of isolation. Lameness of long standing, tremors, and deafmutism disappear.
The third stage is that of faradization, executed by the physician with only such attendants as may be necessary to support the patient. At first, the man lies nude upon the bed, but later may be treated while sitting, standing, walking, or running. Feeble currents are used at first; later stronger ones. The poles are applied to the affected parts, and sometimes to especially sensitive parts of the skin, such as the ears, neck, lips, soles, perineum, and scrotum. Energetic treatment by the rapid method is indicated in the vast majority of cases, especially at the front. If a case is seen early, the rapid energetic treatment almost always cures at once. The success of the method depends upon the production of a crisis, which ought to be produced at the first sitting. Sometimes this sitting has to be continued for hours. Some patients require two or three sittings; some, still more. Instead of faradism, a cold jet of water, or even painful subcutaneous injections of ether, may be used.
The fourth stage is that of physical and psychical reëducation, important in long-standing cases. The various forms of physiotherapy are carried out by special assistants or head nurses, accompanied by psychotherapy, and if necessary by electricity. According to Roussy and Lhermitte, these reëducative methods used alone, without previous faradic treatment, are not successful. Relapse follows premature transference from the front to hospitals in the interior, and too early sick leave.
Shell-shock deafmutism. Speech recovered by suggestion and reëducation; hearing by reëducation.
Case 585. (Liébault, October, 1916.)
A corporal, 20, was exposed to the shock of an aerial torpedo, January 18, 1916, at Souchez. The torpedo fell a meter away. There was no loss of consciousness, but the patient was agitated for several hours, not knowing what he was doing. Evacuated to hospital, he remained several days in a stupid state. He was completely deaf and remembered poorly what had happened. He made every effort to speak, but could not. His head felt on fire. He could not open his mouth well and his lower jaw was almost in a state of contracture. He felt that his tongue could not move easily. In this status he remained until February, always trying to talk, but not succeeding.
He then arrived at Hôtel-Dieu. The mouth was now opening better and he was in a better general status, though always feeling fatigued. Vibratory massage was given to the laryngeal region. He was gradually got to emit a few sounds in a low voice. He was sent, April 26, to Prés-à-goutrière. He was now somewhat vocal, but at times would become completely aphonic once more. The voice during the first few weeks of treatment became better, and the respiratory capacity was increased from 450 the first week to 460 and 500 in the next two weeks.
May 12, he suddenly lost his voice again and wanted to commit suicide. However, in three more days he was able to speak normally again and has had no relapse. He was then put under auditory reëducation and at the time of report his hearing had slightly improved.