Case 302. (Rogues de Fursac, July, 1915.)

A man, 36 (boat painter to 30 and thereafter a wine seller; paternal grandmother insane, father alcoholic and suicide; gonorrhea, 20; two attacks of lead colic, 25 to 30; purulent pleurisy, 31; phlegmon of mouth, 34; also a chronic alcoholic), at the time of examination showed arteriosclerosis and slightly hypertrophic liver; unequal pupils, slightly contracted and sluggish to light. He complained of frequent headaches, possibly due to a combination of plumbism and alcoholism. He was not in any respect demented, and had an excellent memory. He had always been emotional, being unable to go to a funeral without many tears, or remain in a house where there was a corpse without threatening to faint. He was always overcome if he saw a fight going on; and even in his wine shop he would escape when there was a fight and get a neighbor to bring the police.

He was mobilized on the fifth day, sent first to a territorial regiment and then, in October, put into the reserve of an active regiment and sent to the front. He reached the first line trenches in the night, greatly affected by ruins he saw on the road. He slept poorly and had nightmares. At daybreak he woke up to see a pile of corpses near by, and felt an indescribable terror on account of the corpses and the noise of bullets, machine guns, and shells. By superhuman efforts—according to the man—he mastered his emotions and took his turn at the observation post. Another sleepless night. Next day he got such tremors that his sergeant sent him to the hospital where he was at first thought to be suffering from a fever. But his temperature was found normal, and he was sent back to the trenches.

He passed another night without sleep, and next day he could not hold his gun for trembling. The Captain sent him back to be a kitchen man in the rear, and here he remained six weeks—restless, trembling, eating very little. He would have anxious spells. In the morning, as he was carrying coffee to the men in his company, on seeing a pile of corpses, he dropped his pot and ran back to the kitchen declaring that whoever wanted to carry coffee might, but he would not go back. He spilled a pot of soup on his left foot. The Captain had him evacuated, saying: “Go! when you come back, I hope the war will be over!”

He was sent back to a hospital near Paris, where he was all right for a few days, happy as a prince. The burn got well, and as the time approached when he would probably have to go back to the front, the terror returned. He had visions of corpses, and imagined bullets whistling, machine guns popping, and shells bursting. He wept, lost appetite, hid in corners, made three suicidal attempts by poisoning,—though the sincerity of these attempts was doubtful (zinc oxide ointment; rose laurel leaves; verdigris). Sent back to a dépôt before getting leave, he had crises of tremor with anxiety, and was then sent to Val-de-Grâce on the mental service, and finally to Ville-Évrard. He unhesitatingly confessed his terror, becoming more and more anxious and tremulous, and almost losing his pulse while describing his experiences. He said he would commit suicide rather than return to the front. He stayed at the Hospital, working in the garden rather calmly, but when it was a question of leaving, even on convalescence, his terror and anxiety returned. Every time he was examined there was an emotional explosion, with expressions of anguish, generalized tremors and crises of clonic convulsions with respiratory disturbance even of threatening suffocation, depression of pulse. It is this latter which is the most important element in the proof that such a case is not a case of simulation.

Re war cases, Bennati remarks upon the great number that do not fall into known categories. There is, he thinks, an anaphylactic group in which the trauma acts as the secondary toxic agent; and there is another group in which exhaustion works after the manner suggested by Edinger: that is, by a physiological overwork of certain structures.