Shell-shock and burial; labyrinthine disease on one side: DEAFMUTISM. Cures, relapses and eventual cure by general anesthesia, more than four months after shock.
Case 552. (Dawson, February, 1916.)
A private, 30, had been 12 years in the service. July 8, 1915, he was partially buried by a shell which killed two companions.
On admission to hospital he spoke a few sentences but was deaf, and next morning could neither speak nor read, nor did he take food for 36 hours thereafter.
Admitted to the King George Hospital, July 18, he was found stuporous, but started violently if touched, made signs indicating his wants, took no interest in surroundings, and resisted efforts to arouse him. He was without signs of organic disease. It seems that he had been a nervous child, with nightmares and fits.
July 24, he was given gas for dental extraction, partly in the hope that he would recover speech; but though he struggled violently, he made no sound. He had by this time become rather intelligent in a childlike manner, being pleased to see his small boy, but taking no notice of his wife. It transpired afterward that he did not recognize her.
Phonation in whisper now began. There was then a relapse, and for a week or more no food was taken. Such relapses with irritation and hypobulia and an obstinate constipation recurred; but improvement came on slowly. He became able to read short printed words, and later handwriting.
For another month there was no improvement and he lost heart and the will to get well, brightening up only when offered a motor drive or something else pleasant. He was transferred to an auxiliary hospital, against his will, September 18.
November 1, he was brought back to the King George Hospital, excited, shouting, struggling and evidently drunk. On a day’s leave from the convalescent hospital he had come up to London, and in alcoholic elation began to laugh and talk. Morphia did not reduce his violence. He insisted on seeing the physician, to tell him the good news. Hearing was still diminished, though if attention were diverted, direct answers were given to some questions. Sleep followed.
The next day he spoke perfectly but could hear nothing. There was no further progress for three weeks, though he occasionally caught sounds. He now became bright and pleasant and had lost all irritability and sulkiness. Galvanic and faradic current had no effect on the ears.
November 27, after elaborate preparation to heighten the suggestive effect, the patient was kept in bed and given gas and ether up to the abolition of the corneal reflex. As he was coming round, the doctor shouted that he could now hear well. He was overcome with joy and had hysterical convulsions. He could hear, but with the right ear only. In point of fact, the left ear on examination showed signs of labyrinthine deafness. He was placed on home service.
Re etherization for functional deafness and mutism, Ninian Bruce maintains that ether is more satisfactory than chloroform. The loss of consciousness in cases of deafness and mutism ought to be a relatively slight one, and the patient should be suddenly roused to the realization that he is speaking. Recovery from chloroform anesthesia is, according to Ninian Bruce, too slow to allow the patient to catch the point that he is now speaking and hearing when he was formerly dumb or deaf. A failure with the method is a bad thing for the patient, as he loses confidence in the method, whereupon some other method must be resorted to.
Re etherization for deafmutism, see technic of Ninian Bruce under Case 553. Penhallow has a case in which during primary etherization the patient reviewed in a loud voice the whole story of his speech loss. He was found to have recovered speech and hearing after coming out of ether.
Re anesthesia by gas, Abrahams has used nitrous oxide for cure of hysterical paraplegia. Proctor also reports the use of light ether anesthesia for bringing out the voice of functional mutes.