Shell-shock and burial: Mutism. Cure by work in a vineyard with wine to drink.
Case 481. (Anon, May, 1916.)
A correspondent of the British Medical Journal reports a case of cure of emotional mutism. This robust young soldier at Verdun was buried by the explosion of a shell and was thereafter found unable to speak. A week later he arrived at the ambulance in the interior, and was still mute. He could understand what was said to him without difficulty, and was able to reply by signs. He did not even move the lips when requested to pronounce such words as mamma and papa, but was eventually induced to whisper these words.
The laryngoscope showed complete paralysis of the vocal cords, which were in extreme abduction (it was possible to see several tracheal rings). There was no reaction on the part of the pharyngeal mucosa upon stimulation.
A fortnight passed without restoration of speech, though at one time, not having bolted the closet door, the patient was startled when a nurse rushed in, and he said, “Oh, pardon, Madam.” The mutism persisted. He was then given work in the vineyard, plenty of wine to drink, and hard work. After a time (not specified) speech suddenly returned. According to this correspondent, “this indeed is a universal experience, namely, that hard manual work is the best remedy for such functional incapacities of traumatic origin.”
Re Cases 480 and 481, compare cures by anesthesia with chloroform, nitrous oxide, and the like.
Re gradual cures as opposed to sudden ones, Dundas Grant deprecates violent measures in the treatment of mutism during the period of exhaustion after Shell-shock. However, Dundas Grant does not advocate an expectant treatment, but employs a gradual reëducation of the voice through imitation of the teacher. The voice is sometimes restored at a sitting, sometimes gradually; see, for example, Case 578 of Briand and Philippe, and Case 586 of MacCurdy.