Hysterical aphonia in a mechanician (war time contributory?). Cure by suggestive manipulation of larynx.
Case 519. (Vlasto, January, 1917.)
A mechanician was refitting an engine valve, when steam was suddenly put on and the drains were opened out. Some of the steam entered the throat of the mechanician, who rushed up, gasping, unable to speak. Oedema of the larynx was thought of; but there was no complaint except the inability to speak.
A month later he was discharged to the hospital ship at Plassy, where he got faradic treatment, the effect of which was to cause him pain without recovery of voice. The man could whisper well enough and cough fairly loudly. The vocal cords of the larynx appeared normal on laryngoscopic examination, but adduction of the cords was not be properly effected. He was now given rest and constant assurances that he would get well.
Ten days later, another laryngoscopic examination was made, with mild mechanical stimulation of the air passage. The patient remarked that he had never been so near being able to speak since his dumbness came on. The patient was now informed that his muscle of talking was going to be replaced and that the success of the operation depended upon his help, so that he was to shout out as soon as he became conscious of the physician’s working inside his throat. The patient was given ether lightly, into the second stage. When consciousness was about to return, the laryngeal mirror was placed lightly on the larynx. The patient was commanded and encouraged to count out loud and shout. Speech returned permanently.
It is to be noted that there was no specific war effect underlying the phenomena, unless we regard the fact of its being war time as contributory to the shock produced by an incident in every day engine room duties.