Case 321. (Lattes and Goria, March, 1917.)
Project Gutenberg EPUB3 edition
Southard, Elmer Ernest
An Italian soldier of the Class of ’95, a mechanic (mother cardiac; as a boy, pains in joints and heart; since boyhood, no illness), had a big Austrian shell pitch near him, July 23, 1915. The shell failed to explode and injured no one. The patient, however, fell to the ground, unconscious, and remained in the camp hospital for two days, quite immobile. This event followed an advance by his company under very fatiguing circumstances without sleep for a period of four days.
July 26, the patient was observed in profound stupor, non-reactive, constantly and monotonously repeating the phrase, Mama mia!, with fixed gaze and smiling as if at visions. He swallowed food. The pupils reacted poorly to light, and the cornea and nasal mucosa seemed anesthetic. The tendon and skin reflexes were lively. The muscles were hypotonic; bradycardia, 56; no control over feces or urine.
July 27-28, restlessness at night, gasping movements, and poses of terror.
July 29, he called for his mother, who had been dead for several years. He was still stuporous and insensible.
From August 1 to 10, he improved slowly and became able to carry bread to his mouth after it had been put in his hands. He still did not speak and made signs when he wished to urinate or defecate. Pulse 50-60.
August 12, the patient began to react to intense light and to pain stimuli, as well as to pressure. He ate voraciously.
August 15, visual stimuli were responded to, the pulse had risen to 80, the skin reflexes were no less lively. There began to be terrifying dreams at night, with motor reactions.
August 17, the patient looked about more alertly, promptly seeing bread when placed in the center of the field of vision and saying words to the man who might try to remove the bread. He did not yet react to acoustic stimuli, nor was there any other change up to August 21.
August 22 a notable improvement set in. The hearing was now slightly diminished, questions were answered after a brief refractory period. After a few questions, however, a state of exhaustion would ensue, which would disappear only after a short rest. There was amnesia for the entire period following the day of his departure for the front, May, 1915. At this time, instead of eating voraciously, he showed anorexia. The skin and tendon reflexes, instead of being lively, were now dull. There still were battle dreams of enemies trying to kill him.
August 25, there was an area of hypesthesia on the inner aspect of the right thigh, but otherwise no disorder of sensation. The pulse stood at 80 and there were no other neurological phenomena.
August 31, the patch of hypesthesia of the thigh and the retrograde amnesia disappeared. There was still a slight diminution of hearing. The accident of the non-exploding bomb could now be recalled, but there was a memory gap for all facts up to the latter part of August.
September 2, dreamless sleep; no signs of abnormality except a slight diminution of hearing. Discharged, well.