Case 531. (Nonne, December, 1915.)

An officer, mute for five months following shell-shock, had been for four months treated in a succession of hospitals—field hospital, war hospital, two reserve hospitals.

He had no acquired or hereditary neuropathic taint, but even in the period before the critical shock he had been under tremendous physical and mental strain. The explosion produced a total anesthesia of the skin of the head, face, neck and shoulder region—in short, what Charcot called the “doll’s head” form of sensory disorder. Moreover, there was a marked contraction of the visual fields.

The patient, when treatment was given, fell at once into a deep hypnosis and began to intone, and then to speak isolated words, and finally to speak complete sentences. All that was left of his mutism was a slight over-fatiguability of the speech organs. This also cleared up in the next few days. He was discharged well, and had already been—December, 1915—some months in the field.

Case 531, though an officer, responded to hypnosis well, and Nonne remarks that hypnotizability is independent of the presence of any neuropathic tendencies, or of any loss of resistance through exhaustion. One trouble with the hypnotic method, according to Nonne, is the fatigue of the hypnotizer and his inability to rely upon assistants.

Re Charcot, Nonne remarks that the work of Charcot on hysteria is not sufficiently well-known, especially as civilian practitioners in peace times had few cases. Re taint, Nonne found such tendencies absent in more than half of his cases with careful anamneses. The absence of adequate psychogenic cause is a not uncommon experience according to Nonne. Nonne, finding 26 cases of pure neurosis amongst 1800 cases of war injury, had a considerable number of odd erroneous diagnoses in the group. Not only were cerebrospinal paralyses wrongly diagnosticated, but ischemic paralysis, plexus paralysis, arthritis deformans and synovitis.