Liébault remarks that during the time when the patient could not speak his jaw muscles were contracted and his tongue could not mobilize well. He could think words but could not articulate them. It was accordingly important to cultivate the normal functioning of these muscles.
Gassing; tracheitis; crash from airplane; unconsciousness: mutism; stammering. Reëducation; hypnosis.
Case 586. (MacCurdy, July, 1917.)
A lieutenant in the Royal Flying Corps, 23, described as “unusually normal,” a successful business man, athletic, socially popular, had been for a year in the Infantry. He was caught suddenly in a gas attack, and, though he recovered after a few days in bed, had a severe tracheitis and laryngitis. The lieutenant had been very proud of his voice and its carrying power. He went to a laryngologist in London, who said that he would never be able to sing again—a matter of some worry.
He soon became an expert airman. In the spring of 1917 he was shot at by antiaircraft guns in a trip over the enemy’s lines. One of the wings was hit and so weakened that in landing the lieutenant crashed to the ground. He was unconscious for three hours and on coming to tried to shout to his servant in the distance, who, on arrival, found the lieutenant quite unable to speak.
According to MacCurdy, there was here a conversion hysteria with regression to the tracheitis that followed the gassing. The mutism MacCurdy regards as a pathological degree of an effort of protection for his voice. In hospital three weeks later he learned to whisper a few words, though with great mental effort. He regained the voiced sounds by coughing and then saying “ah.” Stammering now developed. Not more than one or two words could be said at a breath. Training to say two, three, four and then five letters in one expiration yielded improvement in the stammering. Under mild hypnosis, to the degree merely of distraction, normal speech was re-attained. There was no relapse. Singing was then practiced and in a period of six weeks the singing voice was virtually as good as it ever had been.
Shell-shock: Loss of consciousness, possibly hemorrhage from head: Spontaneous gradual recovery from anesthesias in three months: Recovery from paralysis by reëducation in a few more weeks.