Part 9

It seems that the man relied on the opinion of the two physicians and discounted that of the third. He thought himself the victim of an injustice, and not knowing how to get on, it occurred to him that he would abandon the regiment and get out of the difficulty. It was without resistance, however, that he gave himself up as a prisoner. This fugue was neither unconscious nor amnestic, nor was it due to an irresistible impulse; nor can we say that it was due to a genuine intellectual disorder. It was an emotional fugue, and partly due to the man’s long-standing depression. It seems that he had inherited this character from his father. He was below normal intelligence, had a very poor education, lost his wife, and grew more and more sombre. He married again, but this time a neuropath. He began to be preoccupied with his health and he had even some ideas of suicide. At the time of his leaving the regiment, he had passed through a phase of depression of about 6 months’ duration, and at this time had a number of hypochondriacal ideas with poor appetite and loss of weight.

Diagnostic dispute between regimental surgeon and alienist.

=Case 44.= (KASTAN, January, 1916.)

Julius Q. was sent on guard April 14, 1915, with orders to remain there. While on guard he made a noise and made a movement as if to take a knife from his pocket. Ordered to empty his pockets, he attacked the other guards. The witnesses said that he was drunk.

Upon examination, it appeared that he had recognized and called by name those present in the guardhouse, despite his supposed intoxication. There were red spots on the skin and a certain amount of analgesia. His powers of computation and reasoning were poor. He was unable to explain the meaning of a picture shown him. He maintained that he had an indomitable desire for drink. A diagnostic draught of alcohol yielded no reaction. Upon dismissal, he got drunk at once again, and had again to be imprisoned in a state of excitement. What the outcome in this case was is not stated by Kastan.

The previous history seems important. Julius Q. had been a state ward. He had escaped several times from the institution but had always to be brought back again because he could not be trained at home. He had once attacked a supervisor in the state institution with a knife. It seems that he had at this time been drunk, having been brought back drunk to the institution.

Two years before the war he had been taken to the Breslau Hospital for the Insane on account of fits of insanity. In 1913 he had been a patient in Wuhlgarten on similar grounds. The diagnosis there had been epileptoid degeneration, psychopathic constitution, imbecility, or epilepsy(?). He had been convicted of crimes a number of times and put to labor. He had been given to cruelty in childhood.

Despite this, he was _declared perfectly healthy in mind and body by the regimental surgeon_.

In 1914, Q. fell suddenly ill in prison (he was presumably in prison for a military offence), and smeared the cell with feces, saying that he was able to do that as he could pay for anything. He stared at the floor and failed to answer questions. He remarked, however, that he had frequently been convicted for breach of the peace and assault and battery, and he said his father had been a drunkard, and he acknowledged hallucinations to the extent of saying that he heard his name called when he was alone.

The story of this case warrants our inquiring why such a patient was kept in the army. He was kept there clearly on account of the report of the regimental surgeon, who could not have taken seriously the previous history of the case, or else thought the patient perfectly good cannon fodder.

The hypothesis of syphilis apparently need not be entertained. That of feeblemindedness is possibly the fundamental diagnosis, yet epilepsy was considered by the German diagnosticians, doubtless on account of the sudden violent attacks and breaches of peace on the part of the patient. There is clearly something behind mere alcoholism in the entire story of this state ward. On the whole, the periodicity of the attacks is equally consistent with the picture presented by numerous feeble-minded persons, and the institutions that had to deal with Q. regarded him rather as epileptoid. There seems to be evidence of actual intellectual defect. Accordingly it seems wiser to consider the case of Julius Q. one of feeblemindedness, possibly of the moron group. We should then consider the epileptoid features as part and parcel of the feeblemindedness. We should consider the intellectual defect a part of the process; and the uncontrollable impulse to drink, the sudden violent attacks, and the cruelty in childhood would then be regarded as merely symptomatic of the feeblemindedness. It seems clear that either mental tests by the regimental surgeon or an examination of the patient’s previous history would tend to exclude such a patient from the army.

How can a rifleman be an imbecile?

=Case 45.= (KASTAN, January, 1916.)

Anton K. was down in the list as “missing.” He was found at home. He said his feet had become sore from the marching. He had lain down and become unconscious. Coming to his senses, he was possessed only of trousers and a shirt but he got a civilian suit in a village. He had gone home part way by train, part way on foot. It seems that he did not tell his father any details about his coming back although he expressly denied deserting.

It seems no mental weakness had been noticed in the army. It had been observed, however, that after seeing the first corpses he was deeply impressed and did not want to see any more. On examination in the hospital he gave the impression of indifference and low spirits. He had to be urged to eat and work. No great amount of intelligence defect could be determined, though his knowledge and capacity were below the average. The physician examining him thought his depression was either caused by or increased by his imprisonment; but this examiner thought that the protection of Section 51 did not extend to the patient at the time of his desertion. The examiner thought that an examination by a psychiatrist was not necessary, though both judge and prosecutor urged it.

When examined in the clinic, he seemed to be disoriented for time. He claimed to have been able to stand the shooting and the sight of the corpses. After becoming unconscious, he had wakened and eaten cucumbers and carrots in the fields, wandering on for a period of three or four weeks, until he came to a place where he had formerly worked. The reason he had thrown away his uniform was because Russians had been about. He had not known that it was his duty to report to the army again.

It was found that the patient’s father was poorly developed as to mind, that his brother was subject to periodic mental disturbance so that he had to be watched. It was found also that K. himself had had a similar mental disturbance, lasting a week, two years before. Moreover he was not considered mentally right in his home town. In fact, no one there wondered really at his desertion because he was so stupid. His school work had been poor and limited.

He himself said that his people were of sound mind; that during school days he had felt bad in his head, once running into the woods after being told something. He was able to give the names of his former superiors. His calculations were only partly correct. He was poor at reasoning and at simple distinctions; for example, asked the difference between a bird and a butterfly, he replied that a butterfly was a bird too. He did not know the difference between a river and a lake. He thought Russia, England, and Austria were the enemies of Germany.

He sat about or lay on the floor, motionless and indifferent, with a newspaper stuffed into his trousers, unoccupied although saying that he wanted to work, and even allowing his fingers to be burned by cigarettes he was smoking.

He was tried once more and the first medical expert still adhered to his former opinion, pointing out that K. was a rifleman and that _only an intelligent man could be a rifleman_. The court, however, accepted Kastan’s opinion and granted K. the protection of Section 51.

In comment upon this case, it seems clear that ever so slight a knowledge of K’s home town reputation would have naturally excluded him from the army. However, what is to be said “when doctors disagree,” as noted by Kastan in this very case? It seems impossible, also, that his comrades should not have noticed something odd about him (over and above the deep impression on seeing the first dead) which might have given occasion to the regimental surgeon for a special mental examination. However, to the military mind, mayhap the man seemed to be sufficiently “effective.”

_Re_ imbecility in a rifleman, the compiler has studied somewhat elaborately the brain of a feeble-minded murderer with some North American Indian blood in him. This man was a crack shot despite his subnormality. It would seem that the German regimental surgeons castigated by Kastan as above were very properly so castigated.

Hypomania in an imbecile.

=Case 46.= (HAURY, August, 1915.)

A brusque little man, of a somewhat bold and talkative disposition, though giving a good first impression, was evidently a bit feebleminded, though (as Haury says) of the active group. He had a sister like himself, whose children were taken care of by the State, and at home he had had a number of fugues, about which details were lacking. It was soon evident what sort of soldier he would make, and he was put in one of the Territorial regiments, but it was not noted that he had a genuine mental disorder, as he was thought to be just a peculiar person.

His new relations caused him to do a number of eccentric things. He shortly proved to be in a sort of rudimentary maniacal state; talkative, restless, scheming rather feebly to go back to his village. He said that he couldn’t walk on account of corns, and that these corns required a certain drug, which he wanted to get from home. He said that he had been struck by lightning twice; that he had fires in his body, etc. He wanted only to be retired on a pension of one or two hundred francs so he could take care of his farm, his hay and his fields. There was no need of trying to get land by means of bullets, he said, since he had enough.

The mental disorder of this man was much deeper than appeared, and in fact, he did a number of dangerous things compromising the security of the entire regiment.

_Re_ the dangerous tendencies of Case 46, see the remarks above drawn from Colin, under Case 37.

Insubordinate desire to remain at the front.

=Case 47.= (KASTAN, January, 1916.)

Friedrich L., on March 4, 1915, was ordered to go back to the baggage-train. He did not obey. He said to the non-commissioned officer who then came to him, “I am not going; you have nothing to say anyhow, you ox-tender!” He stood with his hands in his pockets, and, when the officer seized him angrily by the collar, L. struck the officer’s face.

He stated at his hearing that no one had the right to send him back. At that time even he conveyed the impression of being not quite normal and was let off with his arrest only. Later he refused again to go on guard duty, saying, “You have nothing to say at all. Perhaps you will find out that we shall meet each other again in hell tomorrow morning.” He was taken before the physician, who considered him mentally inferior and not entirely appreciative of the nature of his acts. He was told that the death penalty would meet such behavior, whereupon he remarked, “I am not afraid of the death penalty,” staring excitedly at the officer and trembling throughout his body. It seems that he had already made an impression of mental inferiority in the troop, and had once before said to an officer who wanted to send him to the front, that he would not go; this had been regarded as almost a breach of discipline. He had been in the habit of not reacting to the calls of his superiors, and had smiled at their reproaches. He seemed to hold the opinion that not even a company commander had power to order him to go back. Examined in the clinic he held to the same opinion, that there was no need of his going back; that they took volunteers; and that he wanted to remain at the front. On the day of the deed, he had drunk a rye whiskey. He had shaken off the non-commissioned officer because the leader had seized him by the throat. In the clinic he often smiled and wrinkled his forehead. He gave evasive and inadequate answers. Asked about oaths and perjury, he remarked, “I prefer to remain silent.”

He said that one of his sisters was a little stupid. Study of his previous history indicates that Friedrich L. had formerly been a quiet and steady man, although he often had attacks of rage, breaking out upon sudden excitements. As to his capacity in school, nothing could be learned, since the Russians had taken the school registers away.

The analysis of this case seems to reduce to the question of feeblemindedness and schizophrenia, unless some form of inborn qualitative inferiority of mind be preferred as the diagnosis. On the whole, possibly, the diagnosis of feeblemindedness seems preferable. The entire symptom picture seems to relate to the patient’s one mental attitude about sticking at the front, _ruat coelum_.

A French soldier who admired Germans.

=Case 48.= (LAUTIER, 1915.)

A man with the extraordinary first name of _Agapithe_ (Laurent insists on the frequency of strange first names in degenerate families) came from Val-de-Grâce to Villejuif June 5, 1916, with the diagnosis of mental weakness, interpretative ideas of persecution, mental excitement, recrimination, logorrhoea, and a tendency to revengeful reactions.

On arrival the patient said he must be in an insane asylum because he heard _spiritiques_ talking together. He, however, was “not insane” and began expounding his plans for revenge with the words “Kill,” “Cut-throat.”

This man had been placed in the auxiliary service by the Council, called to the colors December 13, 1914, and finally sent to the front in May, 1915. In July he was made prisoner in a brush. He said, “I cried out, ‘Comrades, what difference does it make to me whether I am German or French? My officers are imbeciles that drink the blood of us unlucky ones!’” He was interned in some camp whose name he could not exactly give and reported that the Germans were very gentle with him, that his real enemies were the French, for the French were against him night and day. “As a matter of fact, among Germans the French are nothing but _cochons malades_. The Germans are fine types.”

He was repatriated in May, 1916. He kept making verbose and neologistic eulogia of the Germans. He had been a farm boy in Brittany, where he had had headaches. He had been at Quimper Asylum in 1910. In fact, he said his parents had tried to poison him and to have him assassinated; they had charged him with setting fire to their house. His mother was an imbecile, he said, who believed she was the Queen of France. His recriminations did not stop short of himself. He had been accused of kissing a girl and stealing apples; as a matter of fact he knew what to do with girls.

He had a coarse face and a number of stigmata besides his name _Agapithe_. He was kept at Villejuif as an imbecile.

Unfit for service: Question of feeblemindedness.

=Case 49.= (KASTAN, January, 1916.)

Walter N. was declared unfit for military service in 1912, on the ground of mental incapacity. He had shown this clearly during his period of training. He committed a number of slight offences secretly, but not so secretly but that they were immediately discovered and punishment meted out therefor. He could do nothing without aid. It appears that his mental weakness had not been noticed in school, but that his employers had thought him both feebleminded and irresponsible. Nevertheless he always executed orders properly. While in hospital in 1912, he had occupied himself very little, sitting indifferently, quiet and dreaming. At that time, he had shown poor calculating ability and decreased power of perception. It also appears that he did not grasp the nature of simple orders, the requisite associations being disturbed.

Despite this history, on September 11, 1914, he found himself being transported. He claimed to be very tired. Upon reaching the city, he picked up a large stone and raised his arm as if to strike the transport leader. While N. was being bound by the transport leader in consequence, he kicked at his leader’s shins.

In the clinic he resisted examination, moving his legs without speaking, staring at the floor, moaning frequently, sitting motionless with head hanging, answering monotonously repeated questions, but turning his head at a loud noise. He felt ill. It appeared that he was oriented and that his knowledge was well preserved although his calculation ability was poor.

It would seem that psychiatric examination, possibly with the aid of psychological work, would have excluded Walter N. from the army.

Oniric delirium (Régis) in a somewhat feebleminded Esthonian.

=Case 50.= (SOUKHANOFF, November, 1915.)

An Esthonian, 21, a soldier in a reserve regiment, came to a psychiatric section towards the close of 1914. He was negativistic, mumbling, restless, fugacious; later more tranquil. One day he entered the physician’s office, walking up and down, mute, looking at articles and attempting to take them away.

February 21, 1915, he was evacuated to the Notre Dame Hospital for the insane at Petrograd,--a tall, healthy, agitated-looking youth with a rapid pulse. He explained in poor Russian how he was now among Germans and feared that they were going to hurt him. At first in the hospital he was seclusive and morose. March 9 he became excited, and tried to break through the door. He was placed in the bath, agitated and yelling. An Esthonian interpreter did not quiet him. The Germans were going to make a martyr of him. After an hour of this he grew quieter, and next day complained only of head weakness and malaise, was in good humour, smiling, and reading an Esthonian paper, and well behaved in church, though tired and pale.

He now got better, began to work and wrote letters. It seemed as if he had waked up from a painful dream. He explained how he thought he had been in captivity; that he was going to be hanged. He had thought that the Germans could talk Russian. He had had hard work in his regiment, as he did not understand Russian and had never before left his little village in Livonia. His mental disorder had started in the autumn, but all that was now like a dream. He said that he had had a mental disorder of short duration following some bodily disease, at the age of thirteen. According to Soukhanoff, this is a case of Meynert’s amentia, in a somewhat feebleminded person. The twilight state might well receive (according to Soukhanoff) the term “oniric delirium” invented by Régis.

Shell-shock; burial: Incapacity to rationalize the situation.

=Case 51.= (DUPRAT, October, 1917.)

A soldier, 39, a herdsman, was shell-shocked at Hill 304 May 23, 1916, buried twice, slightly wounded in right eye, and carried unconscious to Bar-le-Duc. He was then forty days in a semi-confusional state with headaches and dreams of the Boches wanting to behead him. Some of these dreams came in the waking state, in which state he could recognize them as imaginary. In April, 1917, he said he had always been afraid, even in daytime, that he would be hurt and had been especially troubled by the fear of shells. He was also bothered by nocturnal enuresis which might become an incurable disease and bring impairment of memory and attention. Although not feebleminded the man was of but moderate intelligence, and his emotions, according to Duprat, were such as to defeat any complete resolution of his plight by the intellect.

An affective complex, passing from the surprise of the shell-shock over to a fright based on clear though wrong ideas of what might happen to him, had left him without sufficient power of _autocritique_.

Weakling, twice buried by shell explosions in one day: Change of character; fear; three fugues (“It is stronger than I am”).

=Case 52.= (PACTET and BONHOMME, July, 1917.)

An infantryman, Class of 1913, at the front from September, 1914, had a somewhat infantile build physically but was intellectually of average powers, having been a type-setter (three years in a job). However, the confined life had borne hard upon him and his father put him on a farm. He passed through his military service successfully, though he was given two weeks in the guardhouse for overstaying Easter leave. He was suggestible enough at this time to think that he would not be punished very severely, since there were other men whose leaves did not expire at the same time as his own.

He was buried twice in the same morning, March, 1915, at Bois Le Prêtre, spent four or five days in hospital, and went back to his battalion. But now there was a change in his character. Formerly indifferent to danger, he was now apprehensive every time he went to the line and felt an almost irresistible impulse to make for the rear. He was condemned to five years in prison, June, 1915, but was finally sent back to the front.

However, in July he left his company a second time as it was going into the trenches, and this time the captain simply asked him to do better. A third fugue, a few weeks later, sent him back to court-martial, and thence to be examined by alienists. He was perfectly conscious at the time of the fugues and understood his duties and possible punishments. All he would say was, “_It is stronger than I am._” Fear outweighed every consideration after the episode of the shell burials.

The man may be regarded as a hypobulic, somewhat feebleminded person, able to get on in civil life but thrown out of gear by war. Of course, the concept of fear as a disease can easily be overdone; however, here was a case in which three desertions occurred; the third after severe punishment. In the differential diagnosis, epilepsy, alcoholism, impulsive poriomania, must be considered, as well as feeblemindedness.

III. EPILEPTOSES

(THE EPILEPTIC GROUP)

Diagnosis “epilepsy” revised to neurosyphilis.

=Case 53.= (HEWAT, March, 1917.)

A Scotch soldier, in the Royal Navy, 43, was admitted to the Royal Victoria Hospital at Netley, as major epilepsy. He had been 12 years a stoker, and 16 years before admission had suffered from syphilis, a chancre locally treated with black wash, without secondary rash.

After leaving the Navy, he had worked in a fire-brigade and as dock laborer. He had been very alcoholic when funds permitted, although never “primed.” His first convulsive seizures came at 40, while working at the docks, following a night on which he had drunk a bottle of whiskey. He thought he had been about half an hour in the fit.

He joined the A. S. C., January, 1915; served in France; later at Salonica. He had eight convulsive seizures, some in France, and others at Salonica, always after much rum.