Course in hospital of an oniric delirium.
An Italian gun-maker, 27 (father neurotic; grandmother and mother, alcoholic; patient excessive onanist), was called to arms June 14, 1915, and went into artillery service in the Tolmino, early in September. Some time later, a shell burst about 30 meters away and killed his lieutenant. The patient, however, was not hurt and did not even fall. He became mute and inaccessible, and was sent to a military hospital, and thence to an asylum in Udine, where he was restless and hallucinatory. October 2, he was sent to Florence on two months’ leave for convalescence. He was still hallucinated, always seeing his dead lieutenant. He spoke rarely, slept little, and his conduct became more and more queer. Now and again, he would act exactly as if he were at the front. November 5, he started off to find his brother, but was met by a hospital attendant, who promptly took him to a clinic. Here he was inaccessible and lived in a hallucinatory way a soldier’s life at the front: in continual movement, shielding his eyes with his hands as if looking far into the distance, bending down to turn an imaginary lever, apparently taking part of his aim, crouching in a corner, clapping his ears with his palms, and obeying hallucinatory commands: “Ready,” “Fire,” and the like. As to his interpretation of the actual surroundings, he would give a military salute at the entrance of the physician, as if he were the lieutenant. Another patient near by was interpreted as a spy. Hypodermic injections, November 6, were interpreted as military antityphoid injections. On succeeding days he piled dry horse-chestnut leaves for a parapet, which became the scene of battle. November 12 he had become a little more lucid. November 14, he evidently heard whistling and made the leaves ready as a bed for horses. November 15, he rolled up his blanket in a military fashion and hid in a cell corner. He explained, November 16, that he was a sentinel and had not been relieved by the corporal. He had saved everybody’s lives by signaling from a tree the presence of four airplanes. He could not be convinced he was in an institution for the insane. November 20, he was virtually recovered but amnestic for what he had done since commitment. Headaches and dizziness. November 21, he remembered some of his dreams, especially one of being blinded and another of being tied by a German to a tree. By November 29 he had become lucid and oriented, but there was an amnestic gap for his stay at the clinic. Early in December the fields of vision were contracted; polyopia and a glaring and burning sensation before the eyes (after each test conjunctival and tear duct inflammation).
December 21, discharged well.
Re the nature of oniric delirium, see discussion under Cases 333 and 450, Chavigny had but two cases out of 260 in which a rapid curability was noted (90 per cent finally curable). Chavigny’s treatment consists of rest in bed, quiet, purgation if necessary, and warm or cold shower baths. Chavigny remarks upon the extraordinary transformation from apathy to lucidity in the course of a few minutes, brought about by arranging a slight but definite emotional shock to the patient, namely, by mentioning in his presence something about home or family. One bit of technic was to get the patient to write or dictate a letter home.
Régis remarks that battle dreams of this nature occasionally affect alcoholics in garrison or at home. The victim ought not to be hastily committed to an asylum, but should be treated in a military neuropsychiatric service with isolation chambers and open wards. Régis organized early in the war at Bordeaux a central psychiatric service along these modern lines. He remarks that the central service ought to receive not only patients from the military hospitals, but also patients from the temporary auxiliary hospitals of the city and district round about. A pooling of the military and civilian issue upon rational lines is here indicated.
Régis and others have remarked upon the necessity of differentiating these battle deliria from toxic and infectious psychoses.