Part 23

September 11, 1916, he had been admitted to Number 3 General Hospital, France, in a noisy, excited, insolent state: said he saw spirits of the dead; heard his sister urging him to lead a better life. Admitted to Netley early in October, 1916: now said he was a spiritualist, a Frenchman, had a quarrel with parents and enlisted in British Army, in army service; went to France August 12, 1914, was wounded at Loos, September, 1915, returned to front in February, 1916, “shell-shocked” June 1, 1916; lost consciousness after this--did not know where he was until July 22, 1916, when he had been arrested as deserter.

Admitted to Lord Derby Hospital October 14, 1916,--quiet, orderly, coöperative: desired to return to his regiment. He now gave a history: Enlisted British Army 1908, went to France, August, 1914, wounded February, 1915, at Neuve Chapelle; recovered; then attached to 45th Durham Light Infantry; blown up July 22, 1916, came to August 5, 1916, in hospital in Boulogne; then back to his regiment--but month later left without leave to pay off old score on a former comrade who had insulted his sister--arrested later by military police; put under observation in 65th Field Ambulance. No deterioration noted, school knowledge fairly well retained; no hallucinations or delusions (maintained he was a spiritualist, also that following shell-shock had suffered from insomnia and seemed to hear sister’s voice). Physically--small, well nourished, effeminate looking.

Oct. 23, 1916, he broke parole, but a month later returned to hospital under arrest. The police reported he had been masquerading as wounded French soldier attached to British army as interpreter; imposed on people; had two leaden types in his possession: “Interpreter R. le Auldere, attached to 1st Division.”

Story in hospital on return:--Born in France, did well in school, entered military academy at Paris. Quarreled with father--ran away to sea. Adopted by a French lady at Pembroke Dock. On account of drunken habits, quarreled again; joined army at Bristol, 1908. Went to France in August, 1914; January, 1915, invalided home because of “trench feet”--discharged as unfit. Reënlisted June, 1915, in Durham Light Infantry. January, 1916, again ordered to France. Blown up on Somme, July, 1916, by shell--remembered nothing until brought to No. 3 General Hospital. He remembers being accused of desertion but sentence was not passed, as he was held by the medical officer to have been irresponsible (as a matter of fact he was, at that time, considered to be a case of dementia praecox.)

Said that during twenty-five days, due to drunkenness, his friends had taken him to Manchester with them; arrested by police as he attempted to get back to hospital. He was now accused of wilfully lying and, confronted with his police record, at first denied it, but later gave following approximately true story:

Born, England, 1890; early life of a roving disposition, good at school, liked books of adventure. Drank early. Ran away at sixteen; was returned home. Ran away again--convicted of drunkenness. Three-year sentence to reformatory in 1910 for stealing: escaped. Rearrested for stealing in 1911: released in 1913, enlisted in army and deserted. Arrested in January, 1914, for stealing; sentenced to three years: released to rejoin army in June, 1915. Arrested as deserter: imprisoned but released in January, 1916; left for France. August, 1916, “shell-shocked,” sent to Field Ambulance No. 3, General Hospital, Netley, and Lord Derby War Hospital. Court-martialed for desertion: nothing came of it on account of medical evidence.

After breaking his hospital parole, he masqueraded in district as “R. le Auldere,” “Le Marchal” and imposed on various persons.

Psychopath almost Bolshevik.

=Case 184.= (HOVEN, 1917.)

A sergeant, accountant in civil life (father insane, mother pulmonary, grandfather alcoholic, cousin insane; patient himself anemic as a boy, victim of chronic gastritis and gonorrhea), was evacuated from the front to Chateaugiron in March, 1916. It appeared that instead of watching over his men as a sergeant should, he gave utterance to baroque theories of the divine right, the influence of the grace of God on man, and the end of the war. He went so far as to ask leave to transmit to the Inventions Bureau of the War Ministry an invention with respect to the problem of locomotion, and he sent to the King of Belgium a manuscript to the effect that he had received from heaven a mission to reëstablish the world’s balance. He was, in fact, the victim of delusions of a mystical nature with visual hallucinations. To explain his mission, he wrote, “It was my duty to take supreme command of war operations.… I have the power, the right and the duty to give the following order … general armistice … peace will be symbolized by the house undivided and will be constituted by general Christian religious unity … as a consequence of what we shall say they will give up our territory to us of their own accord.”

This case of paranoia apparently took its coloring in part from the war situation itself.

Hysterical mutism: Persistent delusional psychosis.

=Case 185.= (DUMESNIL, 1915.)

A sergeant, aged 23, evacuated from the front to a hospital for the insane, had been mute, though not deaf, since February 28, 1915. If asked to cry out he grew black in the face and could utter only a raucous scream which made everyone jump. He wrote very frequently, stating in February that as he was still a sergeant and had no hope of advancement, he cared nothing more for life. “The idea of death got anchored in my head.” In this state of mind, on the afternoon of the 27th two bombs came. “I saw the first one coming and cried out a warning. Coming back I saw the second one. The bombs were coming rather softly. From this moment on and up to the time when they burst, I thought I had gone, that I had been carried off and crushed. I was quite astounded at finding myself covered with earth and stones … but I could not talk any more, I could just say in a low voice ‘Papa,’ and the next day in an ambulance I could not talk at all.”

There was complete pharyngeal anesthesia. The man had been a foundling and was clearly a degenerate. He had always been of a depressed disposition and given to thoughts about his misfortunes. Over and above the mutism gradually ideas of persecution and revindication developed (such as that he merited adjutant’s rank and was being mocked and treated as a simulator). He drew up a long letter to the War Ministry in which he stated his desire to be sent back to the front. He complained to the police about a hospital sergeant and offered a duel in an elaborate and inflammatory style, “with whatever weapons shall please you, either sabre of 1845, revolver of 1902 or bayonet of 1886 or the _chassepot_. One of us two must disappear.” He had become dangerous enough to be interned and in hospital remained mute with the same ideas of persecution and revindication, the same alternate phases of calmness and excitation. According to Dumesnil: hysterical mutism with persecutory delusional psychosis.

A peasant’s psychopathic inferiority brought out by the war.

=Case 186.= (BENNATI, October, 1916.)

An Italian peasant began to feel sick on being called to arms. Antebellum he had been an even-tempered, good-natured man, according to his own story, satisfied even with stale food, and always enjoying his sleep. He had been in the war about a month, doing construction work, sentry duty, and chores. Though he lived in the trenches under damp conditions, there had really not been much excessive war strain. He shortly developed migraine and war-weariness, as well as middle-ear disease.

A number of times he heard shooting nearby, and was subject in his sentry duty to a good deal of anxiety and painful associations. On sentry duty he had digestive disorder, vomited, and became intolerably weary; in point of fact, a fever, regarded as malarial, then developed, together with diarrhea.

Upon hospital observation, he was found fatigued, given to terrible dreams, tremulous in the fingers, with skin reflexes a little excessive, and the Moebius phenomenon. The thyroid was somewhat swollen. The pulse stood at 80. The Mannkopf sign was well marked, as well as that of Thomayer (80-120), and Erben (120-87). The oculocardiac reflex was prominent.

Psychopathic episodes.

=Case 187.= (PELLACANI, April, 1917.)

A Neapolitan, 26 (neuropathic stock: mother epileptic, brother psychopathic; patient had previous criminal record; married and then appeared to behave himself for several years; had always been excitable and of violent temper), after but one severe day in the trenches, woke and found his night clothes soaked in urine. Another time, his comrade had awakened him because he was gnashing his teeth in his sleep. Again, his grief became very violent at learning of his wife’s infidelity, and during the night he bit his finger. He thereafter suffered from severe headaches, dizziness and vertigo though without falling. He was granted a furlough, but the condition was aggravated on account of his wife’s abandonment of him, and one day, finding her with her lover, he threw himself at them, wounding her severely in the face: he did not remember this impulse later. Many hours later, on awakening in prison with his wounded hand, he recalled the entire episode. He showed a confused and excited condition, which, however, quickly diminished. He became lucid and tranquil, though easily aroused. He cried at the thought of his daughter, whom he wanted to save. Insomnia, instability of reaction, habitual migraine, and dizziness. Tremors of the fingers and of the eyelids. Exaggerated reflexes. Very striking cutaneous analgesia.

Maniacal and hysterical delinquent.

=Case 188.= (BUSCAINO AND COPPOLA, January, 1916.)

An Italian soldier, 25, a foundling, was always off and on in a military prison. At a tavern one night the man unsheathed his sword and threw three bottles at the host. Bystanders overpowered him and carried him to the local police station. Handcuffs were put on to stop the mania. His pupils were dilated and he was sweating profusely. Alcohol could absolutely be excluded from the history of this incident.

Observed in clinic, the patient was rather silent, but on the whole normal and without delusions or hallucinations. It seems that he had committed a number of crimes in the army that were always excused on account of his mental state. He had been strongly alcoholic, although not at the time of the incident mentioned. He was covered with tattooings of an obscene and violent nature.

He showed pharyngeal and conjunctival anesthesia and concentric limitation of the visual fields of unusual degree, and a remarkable hypalgesia. The knee-jerks were lively. The man was, in point of fact, sent back to military service, with, however, the suggestion of reform school.

Psychopathic delinquent.

=Case 189.= (BUSCAINO AND COPPOLA, January, 1916.)

An Italian, 20 (family history negative), was described by officers as of an odd disposition, at times thoughtful and again chattering and presumptuous, and often very vulgar in talk and manner. He had tried several trades, with little success.

While in the army he discharged his gun three times, claiming to have heard noises in a nearby field. On account of the inopportune repeated discharges, he was condemned to the barracks for ten days. The following day, instead of returning to the barracks, he abandoned his musket, cartridge box and uniform, and, returning to town, left for Leghorn. Being sent to prison, he began to scream that he was thirsty. He tore his jacket into strips with his teeth, and making a noose of it, attempted to hang himself.

On being transferred to the military hospital, he was often very restless, screaming and making a great uproar. On being questioned, he answered indifferently and had a vacant stare. During his stay at the clinic, patient was always quiet. Once, however, he had a spell of intense psycho-motor agitation, brought on without any known cause and followed by a short period of bewilderment, lasting altogether half an hour.

Patient had insomnia and his visual fields showed concentric contraction for white. He was sent to a military convalescent hospital.

Psychopathic excitement.

=Case 190.= (BUSCAINO AND COPPOLA, January, 1916.)

An Italian soldier, 22 (father and brother both committed to insane asylums), since his enlistment had been conducting himself strangely, being impulsive, undisciplined and unbalanced. He had been in Libia from January to August, 1913, and was returned to Italy on account of persistent severe headaches. A month later he was returned to a regiment in camp.

September 23, 1914, the patient, who had been reproved by a superior officer to whom he had given a disrespectful answer, began to be excitable. He was calm during the day, but acted in a sullen and gloomy way and kept entirely to himself, avoiding even his most intimate friends. When, however, he suddenly recalled his punishment of the morning, he began to race around the yard and finally threw himself upon the ground, remaining there in a cowering and squatting position. At the beginning of the attack he was possessed of a paroxysm of fury, which made a great impression upon those present: eyes agape, face swollen and distorted. He resisted being transferred to the hospital and a furious struggle followed. He tried to bite and scratch everyone. It required ten persons to carry him by his hands and feet safely to the hospital, where he arrived in a state of great excitement and rage.

At the clinic, during the period of observation, he was always tranquil, rather silent, gloomy, somewhat hostile; said he did not remember why he was brought there. Often he was not able to sleep, especially during the first few days of his stay. Has had painful headaches and feeling of dizziness. Several times he showed a tendency to be untruthful. Bodily examination revealed the absence of conjunctival and pharyngeal reflexes. W. R. of serum was negative.

Patient was sent to an interior hospital for convalescence.

Desertion: Dromomania.

=Case 191.= (CONSIGLIO, 1917.)

An Italian private, 19, came up for desertion in the face of the enemy. He had had a good record during a year of military service and his army conduct in the war was regarded as very good.

He felt sad and preoccupied for a number of days, but all of a sudden “some indomitable force” thrust the idea into him to go out into the country a distance of some 20 kilometers from the front, with the definite object of praying in a certain church. It seems that this same impulse had occurred to him several times before but not so forcibly. These prayers were to be said in memory of some sad events in his life.

Upon examination he was found in a sad and self-accusatory state, much discouraged with ideas of his guilt, unworthiness, and ruin. He had a variety of gloomy fears and obsessions, all of which contributed to the dromomania that culminated in desertion.

As to his previous history, he had had a depressive psychosis two years before, but the delusions at that time were of persecution. He had also suffered from typhoid fever a few weeks thereafter.

Suppressed homosexuality.

=Case 192.= (R. P. SMITH, October, 1916.)

A man, 32 years, of high intellectual attainments and unblemished moral character--a teacher--enlisted as a private. He apparently found his associates in camp very uncongenial and undesirable. He grew physically tired, then mentally tired and unable to concentrate attention. He began to neglect his uniform, could not keep his equipment in order, became introspective and depressed. The drums he heard seemed to point to his funeral. There was but one thing to do in his opinion: that was to humiliate himself by committing sodomy. He thought of committing suicide.

Upon discharge from military duty, he began to show improvement. Smith regards this case as one of suppressed homosexuality.

Of the cases in which change or excessive work is the precipitating cause, four out of six of Smith’s cases were men.

_Re_ homosexuality in the Italian army, Lattes has made a special study. The effeminate homosexual is decidedly unfit for the army, being unable to stand the war stress. Homosexuals diminish army morale. The cases of functional effeminacy with normal physique are likewise unfortunate for the morale of active units, though they may be employed in garrison duty and office work. The medical decision in these cases may prove difficult unless a broad interpretation of the concept “psychopathic” is allowed to prevail.

Psychopathic: suicidal, then self-mutilative.

=Case 193.= (MACCURDY, July, 1917.)

An English soldier as a child had night terrors and fear of the dark; as a youth wanted to throw himself down from heights; took delight in seeing animals killed; was shy with both sexes; was never able to run great distances; was taken from school at the age of fifteen for weakness, and had always been subject to headaches, somewhat improved by lenses.

During training sharp pains appeared in the left groin that grew better when the man lay down. These pains were regarded as hysterical. Thereafter began shortness of breath, pain above the heart, with palpitations and occasional attacks of dizziness. After a short sick leave he insisted upon going to the front, though his superior officer thought it unwise, and, after a period of seventeen months training, was finally sent to France in September, 1916.

He was at first somewhat afraid of shells and, though he soon got used to the shells, the horror of the war grew on him, with pity for the Germans as much as for the British. He became depressed over his weakness and when his commanding officer committed suicide got obsessed with the idea of committing suicide himself. He went so far as to drive a knife into his upper lip and to smash a looking-glass to avoid seeing himself. After a long spell of trench duty he had to be sent home incapacitated.

In hospital in England he was depressed and suicidal. He began to want to mutilate himself, yet found that a slight pain and the drawing of blood was all that he really craved. Of course, he had been a failure, but now he rationalized the failure by a comfortable conviction that he should never have been sent to the front. He complained of memory and attention disorder, insisted that he was physically incapable of outdoor exercise, complained of headache if he stayed indoors. He said he wanted to go back to the front; knew, however, that he could not, and even refused to consider the possibility of getting well to work at home. At the time of report he argued there was nothing left but suicide.

Bombardment: Psychasthenia?

=Case 194.= (LAIGNEL-LAVASTINE AND COURBON, July, 1917.)

A twenty-year old engineering student of high grade and without hereditary taint, a scientific and non-introspective man of a brilliant and gay disposition, not very religious, without special sexual abnormality, was mobilized in class 1914, was put into the artillery, and was soon appointed _maréchal des logis_. He left for the front April, 1915, yet had to be evacuated in November. One afternoon, at the end of a bombardment, he rose from a recumbent attitude and immediately felt a dreamy, bizarre feeling, as if a fog lay between him and his surroundings. Next day, after a good night, he woke in the same state. Everything was bizarre and novel despite the fact that he recognized men and things. A physician ordered rest and after a few days evacuated him.

He was cared for in various hospitals, but the psychasthenia increased. He felt a terrible and causeless anguish, with precordial constriction. He felt as if he were about to be executed. His fears appeared after seeing some turning object, such as a wheel or a cane twirling. Gradually this fear was transformed into a genital excitation, though lascivious pictures did not excite him. Seeing anything turning gave him a voluptuous feeling in proportion to the speed of the rotation. It seems that all sexual interest had been at a standstill for several months in the early part of his disease, when suddenly this new aberration appeared. It seems that a portion of the man’s work in the artillery caused him to use screws and cogwheels every day. Attacks of vertigo occurred, with the appearance of an infinity of small, colorless spheres turning over one another, the whole forming a sort of animated system of rotation. In the night this system was luminous and somewhat like what one feels on compressing the globes of the eye. There was a retraction of the visual field. The man would be found in the dream state, especially after waking in the morning or when some novel kind of act was being performed. He got somewhat better and did not wish to go on leave, because he feared the recurrence of these psychasthenic paroxysms. However, he took a leave July 14th. In the first part of his journey he had some vertigo and some of the voluptuous sensations, but in the next two days he was much better. He returned to hospital without trouble.

The authors somewhat doubtfully term this case one of a quiet psychasthenia, but in discussion still further talk arose as to the diagnosis.

_Re_ psychasthenics, Lépine notes that the lack of any out-standing symptoms in many psychasthenics allows them to stay in the army longer than would epileptics or hysterics of the same degree of disease. The line officers tend to consider them exaggerators or simulators. The fact that they besiege the line officers and the physicians with their troubles may add to the impression of falsification. The basis of the psychasthenia is often also, genuinely enough, a fear. Lépine divides the military cases into anxiety neuroses and hypochondrias. The anxiety cases are hypotensive and given to tachycardia. They have very labile vasomotors. When it comes to the necessary exclusion of malingering, it is the history, with its hereditary and collateral taint, that tells the tale. A history in the patient himself of alcoholism, typhoid fever, syphilis, or especially cranial trauma may play a part. An agoraphobic may actually be in general a courageous man except for his crises of anxiety about open spaces.

As to the hypochondriacs, fear of syphilis must be noted. Akin to the syphilophobics are a group of pseudo genitourinary cases that fear effects of an old gonorrhoea. See Case 195 (Colin and Lautier) below.

Gonorrhoea: NOSOPHOBIA, depression, suicidal attempt. Recovery, thirteen months.

=Case 195.= (COLIN and LAUTIER, July, 1917.)

A munition worker came to Villejuif, December 6, 1915, with cord marks on his neck and conjunctival ecchymoses. He had tried to hang himself.

Non-alcoholic, he had, however, long since shown signs of imbalance; his father had died insane, in an institution. When the man came in, he wept and groaned and made vague complaints of having contracted a venereal disease, insisting that his genital organs were purple.

After a few days, he grew less anxious and told how he was married and how his wife had made life a hell for him, giving herself up to drink and becoming a sloven; how several months since he had contracted gonorrhoea; how though told that the condition was cured, he had found filaments in the urine and had tried a variety of drugs, spending most of his money; how he found more and more filaments, thought himself incurable and unable to live with his wife; how at last, desperate, he had tried to hang himself.

He got well quickly, though his convalescence was interrupted by several periods of depression a few days in duration, with anxiety and tears. February, 1916, he was discharged well.