II. Hypophrenoses (the Feeble-Minded Group)

Moron of use at front (alienist’s report).

Case 35. (Pruvost, 1915.)

Vigouroux reports concerning a tanner of 19 who could not read, write or calculate (3 plus 8 equals 14) and had been of the 1916 class in an infantry regiment at Brest, on the occasion of his asking to be sent to the front more speedily:

Mental weakness, with insufficient school and theoretical knowledge but with the ability to assimilate practical ideas, though not knowing how to read, write or calculate; seems to have earned his living in several lines. “As a soldier, he does not know the insignia of the different ranks but understands how to obey a superior officer. Understands a gun and can tell a chargeur from a Le Bel gun. Moreover he seems to be perfectly stable, fixed in his wishes, persistently and intelligently wants to go to the front and kill Boches. He appears to be well disciplined and educable. Although feebleminded, he appears to us able to be useful at the front, though he should not be employed in any undertaking requiring initiative or foresight.”

An imbecile, superbrave.

Case 36. (Pruvost, 1915.)

A loquacious, active fellow, 22, with very slight school knowledge and no idea of military ranks (treated his superiors like his comrades), was often punished in the barracks. He did not get on well with his instructors. His activities were never interrupted by any obstacles or by derision. He kept singing and talking enthusiastically during the mobilization. He was the butt of his section.

At Dinant he did very well; though his section was losing a good many men he remained calm. He was careless of danger and remained at his post firing ceaselessly at the enemy and giving a magnificent example to the few comrades who remained with him. In fact, he remained so long in his shelter that he was surrounded and taken prisoner. He escaped, swam the Meuse and got back to his regiment.

An imbecile of service in barracks work.

Case 37. (Pruvost, 1915.)

A farmer, 36 (father alcoholic, mother always sick, two brothers at the front; patient had typhoid at an unknown age; had gone to school at 13 but “learned nothing”; worked in fields with his brother who gave him some pennies on Sunday), was put into the auxiliary service by the Council at 20. Patient said he was not strong enough for this service. In 1914 the Council reconsidered the case and put him into a regiment of infantry. He could not be given military instruction or execute the most simple drilling manual. He said that 4 plus 2 equalled 7; 4 plus 3 equalled 5. He was of an excellent character, very docile and easily directed. He did all his comrades’ barracks work and was very proud because, as he said, “I do everything they tell me to do.” He was happy in working, everybody was good to him, but he had no comrades. He had no general knowledge and knew nothing about the war but that they were fighting the Boche.

Re imbeciles, Colin, Lautier and Magnac found amongst 1000 soldiers entering Villejuif, 53 imbeciles. Twenty-four of them had been either exempt or retired at the outset of the war, when military surgeons had reviewed them and considered them fit for service. Several of the 29 others also had shown previous evidence of imbecility.

Of course, French military surgeons may have felt that a number of these men would be of just such service in barracks and otherwise as Case 37 (Pruvost). But for one or two cases like Cases and of Pruvost, there are great numbers of other imbeciles who prove quite useless in the army. Two of the Villejuif cases had been volunteers: one volunteer declared that, if he had been intelligent, he never would have enlisted! Ten cases proved unable to use a gun; one turned his gun upon his mates. One regularly forgot the password. One (see Case 42 of Lautier) thought the war too long and tried to take command of the company in order to finish the war one way or the other. Three of the imbeciles had to be evacuated for desertion (unmotivated fugues); two of them cursed their officers. Some of the imbeciles had an emotional diarrhoea throughout their service.

Colin suggests that line officers and military surgeons ought to agree that these men are not fit for service, and that the civil authorities of the home towns should advise the review boards about known imbeciles and criminals. In point of fact, previous knowledge of imbecility could have been obtained quite readily in 27 of the 53 cases observed by Colin.

A feeble-minded inventor.

Case 38. (Laignel-Lavastine and Ballet, 1917.)

A jockey of Nîmes, 31, entered the service May 15, 1917. He retired before the war. He was in the auxiliaries at the moment of mobilization. Nothing is known as to any pathological episodes in his past. He said he had been a poor scholar, had left the primary school at eleven hardly knowing how to write or spell, but he had a lively imagination and was a happy-go-lucky youth, playing many tricks on the trades people. He tried a variety of ideas in the industrial or commercial world with very varying success. He had a mechanical taste. The Colonial Exposition at Marseilles caused him to float a variety of projects, from that of having the visitors photographed on a camel to the sale of lemonade. He said he had been a jockey and then a trainer and had finally become a valet de jockey at Maisons Laffitte. He was a gambler and invented a “system.” He made various inventions in relation to horses. At the end of 1914 he had plans for a bomb thrower and placed his discovery at the service of the War Minister. He was not discouraged by the lack of success of the bomb thrower. He now made an aerial torpedo carrier. He had the idea of the tanks. However, he found the secret of his torpedo carrier printed in a magazine. There was a slight difference between the German apparatus and his own.

From this time he began to be mistrustful, and now he jealously avoided entering into any details about his inventions and he did not let his officers see his plans. The Commandant offered to give a place in the safe to his documents, but he could not embrace the offer. He now invented a counter-torpedo machine. He went on leave to Paris, asked an audience of the Minister of Marine, who put him in relation to the Committee on Inventions, who put him off, desiring that he should forward all his plans. He emerged from one of his interviews so excited that there was a scandal on the public street and the police commissary evacuated him to Val-de-Grâce, but the patient says he does not remember this incident. He came on service of Laignel-Lavastine May 15. He shortly wrote again to the Minister, who again referred him to the Committee on Inventions. He protested to the President of the Republic and wrote directly to the King of England, who referred him to the Military Administration. He is now occupied in creating a machine to destroy the first line trenches and continues to write to the Ministry. He has documents buried underground in a secret place. He still talks with great vivacity of his discoveries.

According to Laignel-Lavastine, we deal with a feeble-minded person who has for many years had a délire raisonnant of the inventing group.

Re feeblemindedness in the British Army, Shuttleworth found 70 who had joined from special schools for the feeble-minded in London, and 100 from Birmingham in the year 1915. The institutional “children” were in general good at drilling and obeying. One of them, given to lying and stealing, got into constant trouble in Flanders.

Sir George Savage stated that he had sometimes run the risk of allowing enlistment of men who had shown earlier in life a weakness for lying and pilfering, and remarked that such men might make good soldiers. A case like the above would run counter to this view. On this matter, see below Case 183 (Henderson), one of pathological lying.

An imbecile who walked lame.

Case 39. (Pruvost, 1915.)

A soldier, 20, eight days after being called to the colors, complained of pain in the knee and hip. He was observed for 18 days in hospital and then sent back to his company; but he continued to complain of the pains, and the regimental surgeon sent him to a neurological center where the joints were found to be normal and where no sensory, motor or reflex disorders were in evidence. The man continued to walk lame and insisted he could not get about without a cane. He also complained of his mouth and his belly and, though he was very ruddy, said he was á bout de forces.

It was a question of simulation. The man, however, was a feebleminded person who could not read, write or calculate. He was invalided as such.

Enlistment to improve character.

Case 40. (Briand, February, 1915.)

A village boy had passed for simple ever since typhoid fever at 8. He had learned to read and write, but had always been impulsive and subject to fugues, running to see his grandmother, or off as a truant. It was decided that he, at 19, should enlist to improve his character. But one fine day, even before the war, he deserted. He said, in explanation, that he had lost his way, and he was being examined mentally when mobilization began.

He looked ape-like, with spread ears; had a low forehead, a head flattened behind, an asymmetrical face, prognathous jaws, an arched palate, and defective teeth. He talked freely of homosexual relations, and said he wandered off because it occurred to him to do so. He was determined to be unfit for service.

An imbecile who may be sent to the front.

Case 41. (Pruvost, 1915.)

A Parisian sandwichman, 25, of unknown parentage and a state ward, placed out with a farmer at 12, escaping with a friend to Bordeaux at 14, thence leading a wild, improvident life at Lyons, Marseilles and Paris, sleeping in fields and hedges, earning 22 sous a day but in no case mixing with the police, was examined for physical inefficiency at 20 years. He wanted to enlist but was refused. He insisted and was very proud of the fact that he got in as the Major said to them, “Let him go in.” He could hardly read, write or calculate but was by reason of his adventurous life full of practical resources. He was irascible and frequently crimed, whereupon he would cry under the Captain’s window, “Robber band, idiots, I shall write to the Minister.” He was passionately fond of military life, though he had but the vaguest notions about the commands, the names of generals and the like. He wanted to drill. His comrades played practical jokes upon him asking him to look for a trajectory, for the squad’s umbrella and the key to the drill ground. They also told him he had been proposed to be corporal, whereupon he was greatly overjoyed and immediately sewed stripes on his sleeve and began to give commands. He said if they put him among the auxiliaries he would throw the adjutant in the water. He sang and swung his gun with joy when he went to the front. He thought there were stripes hanging to the barbed wire and wanted to pick as many as possible. Such a man may be safely sent to the front although he will bear watching. At the date of report this man had been at the front two months doing very well.

Re the comparative success of the Germans in the matter of excluding imbeciles, Meyer found that 8 per cent of the mental cases in the army were cases of mental defect.

Imbecile with sudden initiative.

Case 42. (Lautier, 1915.)

A soldier, 41, a farmer, from the Department of the Marne, married, childless, was called to the colors August 31, 1914. He was on guard duty until May, 1915, watched prisoners until October and was finally sent to the front, February, 1916, where he fell sick.

“He was tired in his head.” “His commanding officer made him drill without rhyme or reason; he would have been able himself to have commanded with greater intelligence.” He once attempted to put himself at the head of the company to lead them against the Boche; this idea arrived to him all of a sudden in a phase of perfect confidence and sang froid. He thought his comrades would follow him and that the officers would do likewise. He hoped thus to be able to end the war one way or the other. He was getting tired of the war and regretted his family life and kept saying that this was no existence for family men. “We ought to attack or ask for peace.” No one followed him and his comrades said he was un peu fou but he did not share this opinion.

In point of fact he hardly knew how to read or write and at home lived with his relatives, submitting himself entirely to their guidance. He was much afraid of being punished and often feared that he had done badly as he had trop de conscience. He was non-alcoholic and without hereditary or acquired neuropathic taint. He had no pronounced stigmata of degeneration. He was rather reticent about certain mystical ideas of a political tinge. At Villejuif, whither he was brought February 17, 1916, he received a diagnosis of imbecility.

Emotional fugue in a subnormal subject.

Case 43. (Briand, February, 1915.)

A soldier in the Territorial Army, 40, appeared before the examining board in a depressed, dejected-looking state, speaking slowly but collectedly and lucidly. Mobilized the second day, this man was much afraid that he could not get through the marches, and asked for a special examination to determine whether his feet did not make him unsuitable for fatigue. Two physicians thought he was unsuitable for marching, and another thought he put it on. A trial march was not executed well. He was kept in barracks but jumped the wall, put on civilian clothes, and made off for Paris. But a relative, warned by his wife, finally got him to go to the authorities. He was told that he ought to return in the afternoon, when suddenly he was arrested.

It seems that the man relied on the opinion of the two physicians and discounted that of the third. He thought himself the victim of an injustice, and not knowing how to get on, it occurred to him that he would abandon the regiment and get out of the difficulty. It was without resistance, however, that he gave himself up as a prisoner. This fugue was neither unconscious nor amnestic, nor was it due to an irresistible impulse; nor can we say that it was due to a genuine intellectual disorder. It was an emotional fugue, and partly due to the man’s long-standing depression. It seems that he had inherited this character from his father. He was below normal intelligence, had a very poor education, lost his wife, and grew more and more sombre. He married again, but this time a neuropath. He began to be preoccupied with his health and he had even some ideas of suicide. At the time of his leaving the regiment, he had passed through a phase of depression of about 6 months’ duration, and at this time had a number of hypochondriacal ideas with poor appetite and loss of weight.

Diagnostic dispute between regimental surgeon and alienist.

Case 44. (Kastan, January, 1916.)

Julius Q. was sent on guard April 14, 1915, with orders to remain there. While on guard he made a noise and made a movement as if to take a knife from his pocket. Ordered to empty his pockets, he attacked the other guards. The witnesses said that he was drunk.

Upon examination, it appeared that he had recognized and called by name those present in the guardhouse, despite his supposed intoxication. There were red spots on the skin and a certain amount of analgesia. His powers of computation and reasoning were poor. He was unable to explain the meaning of a picture shown him. He maintained that he had an indomitable desire for drink. A diagnostic draught of alcohol yielded no reaction. Upon dismissal, he got drunk at once again, and had again to be imprisoned in a state of excitement. What the outcome in this case was is not stated by Kastan.

The previous history seems important. Julius Q. had been a state ward. He had escaped several times from the institution but had always to be brought back again because he could not be trained at home. He had once attacked a supervisor in the state institution with a knife. It seems that he had at this time been drunk, having been brought back drunk to the institution.

Two years before the war he had been taken to the Breslau Hospital for the Insane on account of fits of insanity. In 1913 he had been a patient in Wuhlgarten on similar grounds. The diagnosis there had been epileptoid degeneration, psychopathic constitution, imbecility, or epilepsy(?). He had been convicted of crimes a number of times and put to labor. He had been given to cruelty in childhood.

Despite this, he was declared perfectly healthy in mind and body by the regimental surgeon.

In 1914, Q. fell suddenly ill in prison (he was presumably in prison for a military offence), and smeared the cell with feces, saying that he was able to do that as he could pay for anything. He stared at the floor and failed to answer questions. He remarked, however, that he had frequently been convicted for breach of the peace and assault and battery, and he said his father had been a drunkard, and he acknowledged hallucinations to the extent of saying that he heard his name called when he was alone.

The story of this case warrants our inquiring why such a patient was kept in the army. He was kept there clearly on account of the report of the regimental surgeon, who could not have taken seriously the previous history of the case, or else thought the patient perfectly good cannon fodder.

The hypothesis of syphilis apparently need not be entertained. That of feeblemindedness is possibly the fundamental diagnosis, yet epilepsy was considered by the German diagnosticians, doubtless on account of the sudden violent attacks and breaches of peace on the part of the patient. There is clearly something behind mere alcoholism in the entire story of this state ward. On the whole, the periodicity of the attacks is equally consistent with the picture presented by numerous feeble-minded persons, and the institutions that had to deal with Q. regarded him rather as epileptoid. There seems to be evidence of actual intellectual defect. Accordingly it seems wiser to consider the case of Julius Q. one of feeblemindedness, possibly of the moron group. We should then consider the epileptoid features as part and parcel of the feeblemindedness. We should consider the intellectual defect a part of the process; and the uncontrollable impulse to drink, the sudden violent attacks, and the cruelty in childhood would then be regarded as merely symptomatic of the feeblemindedness. It seems clear that either mental tests by the regimental surgeon or an examination of the patient’s previous history would tend to exclude such a patient from the army.

How can a rifleman be an imbecile?

Case 45. (Kastan, January, 1916.)

Anton K. was down in the list as “missing.” He was found at home. He said his feet had become sore from the marching. He had lain down and become unconscious. Coming to his senses, he was possessed only of trousers and a shirt but he got a civilian suit in a village. He had gone home part way by train, part way on foot. It seems that he did not tell his father any details about his coming back although he expressly denied deserting.

It seems no mental weakness had been noticed in the army. It had been observed, however, that after seeing the first corpses he was deeply impressed and did not want to see any more. On examination in the hospital he gave the impression of indifference and low spirits. He had to be urged to eat and work. No great amount of intelligence defect could be determined, though his knowledge and capacity were below the average. The physician examining him thought his depression was either caused by or increased by his imprisonment; but this examiner thought that the protection of Section 51 did not extend to the patient at the time of his desertion. The examiner thought that an examination by a psychiatrist was not necessary, though both judge and prosecutor urged it.

When examined in the clinic, he seemed to be disoriented for time. He claimed to have been able to stand the shooting and the sight of the corpses. After becoming unconscious, he had wakened and eaten cucumbers and carrots in the fields, wandering on for a period of three or four weeks, until he came to a place where he had formerly worked. The reason he had thrown away his uniform was because Russians had been about. He had not known that it was his duty to report to the army again.

It was found that the patient’s father was poorly developed as to mind, that his brother was subject to periodic mental disturbance so that he had to be watched. It was found also that K. himself had had a similar mental disturbance, lasting a week, two years before. Moreover he was not considered mentally right in his home town. In fact, no one there wondered really at his desertion because he was so stupid. His school work had been poor and limited.

He himself said that his people were of sound mind; that during school days he had felt bad in his head, once running into the woods after being told something. He was able to give the names of his former superiors. His calculations were only partly correct. He was poor at reasoning and at simple distinctions; for example, asked the difference between a bird and a butterfly, he replied that a butterfly was a bird too. He did not know the difference between a river and a lake. He thought Russia, England, and Austria were the enemies of Germany.

He sat about or lay on the floor, motionless and indifferent, with a newspaper stuffed into his trousers, unoccupied although saying that he wanted to work, and even allowing his fingers to be burned by cigarettes he was smoking.

He was tried once more and the first medical expert still adhered to his former opinion, pointing out that K. was a rifleman and that only an intelligent man could be a rifleman. The court, however, accepted Kastan’s opinion and granted K. the protection of Section 51.

In comment upon this case, it seems clear that ever so slight a knowledge of K’s home town reputation would have naturally excluded him from the army. However, what is to be said “when doctors disagree,” as noted by Kastan in this very case? It seems impossible, also, that his comrades should not have noticed something odd about him (over and above the deep impression on seeing the first dead) which might have given occasion to the regimental surgeon for a special mental examination. However, to the military mind, mayhap the man seemed to be sufficiently “effective.”

Re imbecility in a rifleman, the compiler has studied somewhat elaborately the brain of a feeble-minded murderer with some North American Indian blood in him. This man was a crack shot despite his subnormality. It would seem that the German regimental surgeons castigated by Kastan as above were very properly so castigated.

Hypomania in an imbecile.

Case 46. (Haury, August, 1915.)

A brusque little man, of a somewhat bold and talkative disposition, though giving a good first impression, was evidently a bit feebleminded, though (as Haury says) of the active group. He had a sister like himself, whose children were taken care of by the State, and at home he had had a number of fugues, about which details were lacking. It was soon evident what sort of soldier he would make, and he was put in one of the Territorial regiments, but it was not noted that he had a genuine mental disorder, as he was thought to be just a peculiar person.

His new relations caused him to do a number of eccentric things. He shortly proved to be in a sort of rudimentary maniacal state; talkative, restless, scheming rather feebly to go back to his village. He said that he couldn’t walk on account of corns, and that these corns required a certain drug, which he wanted to get from home. He said that he had been struck by lightning twice; that he had fires in his body, etc. He wanted only to be retired on a pension of one or two hundred francs so he could take care of his farm, his hay and his fields. There was no need of trying to get land by means of bullets, he said, since he had enough.

The mental disorder of this man was much deeper than appeared, and in fact, he did a number of dangerous things compromising the security of the entire regiment.

Re the dangerous tendencies of Case 46, see the remarks above drawn from Colin, under Case 37.

Insubordinate desire to remain at the front.

Case 47. (Kastan, January, 1916.)

Friedrich L., on March 4, 1915, was ordered to go back to the baggage-train. He did not obey. He said to the non-commissioned officer who then came to him, “I am not going; you have nothing to say anyhow, you ox-tender!” He stood with his hands in his pockets, and, when the officer seized him angrily by the collar, L. struck the officer’s face.

He stated at his hearing that no one had the right to send him back. At that time even he conveyed the impression of being not quite normal and was let off with his arrest only. Later he refused again to go on guard duty, saying, “You have nothing to say at all. Perhaps you will find out that we shall meet each other again in hell tomorrow morning.” He was taken before the physician, who considered him mentally inferior and not entirely appreciative of the nature of his acts. He was told that the death penalty would meet such behavior, whereupon he remarked, “I am not afraid of the death penalty,” staring excitedly at the officer and trembling throughout his body. It seems that he had already made an impression of mental inferiority in the troop, and had once before said to an officer who wanted to send him to the front, that he would not go; this had been regarded as almost a breach of discipline. He had been in the habit of not reacting to the calls of his superiors, and had smiled at their reproaches. He seemed to hold the opinion that not even a company commander had power to order him to go back. Examined in the clinic he held to the same opinion, that there was no need of his going back; that they took volunteers; and that he wanted to remain at the front. On the day of the deed, he had drunk a rye whiskey. He had shaken off the non-commissioned officer because the leader had seized him by the throat. In the clinic he often smiled and wrinkled his forehead. He gave evasive and inadequate answers. Asked about oaths and perjury, he remarked, “I prefer to remain silent.”

He said that one of his sisters was a little stupid. Study of his previous history indicates that Friedrich L. had formerly been a quiet and steady man, although he often had attacks of rage, breaking out upon sudden excitements. As to his capacity in school, nothing could be learned, since the Russians had taken the school registers away.

The analysis of this case seems to reduce to the question of feeblemindedness and schizophrenia, unless some form of inborn qualitative inferiority of mind be preferred as the diagnosis. On the whole, possibly, the diagnosis of feeblemindedness seems preferable. The entire symptom picture seems to relate to the patient’s one mental attitude about sticking at the front, ruat coelum.

A French soldier who admired Germans.

Case 48. (Lautier, 1915.)

A man with the extraordinary first name of Agapithe (Laurent insists on the frequency of strange first names in degenerate families) came from Val-de-Grâce to Villejuif June 5, 1916, with the diagnosis of mental weakness, interpretative ideas of persecution, mental excitement, recrimination, logorrhoea, and a tendency to revengeful reactions.

On arrival the patient said he must be in an insane asylum because he heard spiritiques talking together. He, however, was “not insane” and began expounding his plans for revenge with the words “Kill,” “Cut-throat.”

This man had been placed in the auxiliary service by the Council, called to the colors December 13, 1914, and finally sent to the front in May, 1915. In July he was made prisoner in a brush. He said, “I cried out, ‘Comrades, what difference does it make to me whether I am German or French? My officers are imbeciles that drink the blood of us unlucky ones!’” He was interned in some camp whose name he could not exactly give and reported that the Germans were very gentle with him, that his real enemies were the French, for the French were against him night and day. “As a matter of fact, among Germans the French are nothing but cochons malades. The Germans are fine types.”

He was repatriated in May, 1916. He kept making verbose and neologistic eulogia of the Germans. He had been a farm boy in Brittany, where he had had headaches. He had been at Quimper Asylum in 1910. In fact, he said his parents had tried to poison him and to have him assassinated; they had charged him with setting fire to their house. His mother was an imbecile, he said, who believed she was the Queen of France. His recriminations did not stop short of himself. He had been accused of kissing a girl and stealing apples; as a matter of fact he knew what to do with girls.

He had a coarse face and a number of stigmata besides his name Agapithe. He was kept at Villejuif as an imbecile.

Unfit for service: Question of feeblemindedness.

Case 49. (Kastan, January, 1916.)

Walter N. was declared unfit for military service in 1912, on the ground of mental incapacity. He had shown this clearly during his period of training. He committed a number of slight offences secretly, but not so secretly but that they were immediately discovered and punishment meted out therefor. He could do nothing without aid. It appears that his mental weakness had not been noticed in school, but that his employers had thought him both feebleminded and irresponsible. Nevertheless he always executed orders properly. While in hospital in 1912, he had occupied himself very little, sitting indifferently, quiet and dreaming. At that time, he had shown poor calculating ability and decreased power of perception. It also appears that he did not grasp the nature of simple orders, the requisite associations being disturbed.

Despite this history, on September 11, 1914, he found himself being transported. He claimed to be very tired. Upon reaching the city, he picked up a large stone and raised his arm as if to strike the transport leader. While N. was being bound by the transport leader in consequence, he kicked at his leader’s shins.

In the clinic he resisted examination, moving his legs without speaking, staring at the floor, moaning frequently, sitting motionless with head hanging, answering monotonously repeated questions, but turning his head at a loud noise. He felt ill. It appeared that he was oriented and that his knowledge was well preserved although his calculation ability was poor.

It would seem that psychiatric examination, possibly with the aid of psychological work, would have excluded Walter N. from the army.

Oniric delirium (Régis) in a somewhat feebleminded Esthonian.

Case 50. (Soukhanoff, November, 1915.)

An Esthonian, 21, a soldier in a reserve regiment, came to a psychiatric section towards the close of 1914. He was negativistic, mumbling, restless, fugacious; later more tranquil. One day he entered the physician’s office, walking up and down, mute, looking at articles and attempting to take them away.

February 21, 1915, he was evacuated to the Notre Dame Hospital for the insane at Petrograd,—a tall, healthy, agitated-looking youth with a rapid pulse. He explained in poor Russian how he was now among Germans and feared that they were going to hurt him. At first in the hospital he was seclusive and morose. March 9 he became excited, and tried to break through the door. He was placed in the bath, agitated and yelling. An Esthonian interpreter did not quiet him. The Germans were going to make a martyr of him. After an hour of this he grew quieter, and next day complained only of head weakness and malaise, was in good humour, smiling, and reading an Esthonian paper, and well behaved in church, though tired and pale.

He now got better, began to work and wrote letters. It seemed as if he had waked up from a painful dream. He explained how he thought he had been in captivity; that he was going to be hanged. He had thought that the Germans could talk Russian. He had had hard work in his regiment, as he did not understand Russian and had never before left his little village in Livonia. His mental disorder had started in the autumn, but all that was now like a dream. He said that he had had a mental disorder of short duration following some bodily disease, at the age of thirteen. According to Soukhanoff, this is a case of Meynert’s amentia, in a somewhat feebleminded person. The twilight state might well receive (according to Soukhanoff) the term “oniric delirium” invented by Régis.

Shell-shock; burial: Incapacity to rationalize the situation.

Case 51. (Duprat, October, 1917.)

A soldier, 39, a herdsman, was shell-shocked at Hill 304 May 23, 1916, buried twice, slightly wounded in right eye, and carried unconscious to Bar-le-Duc. He was then forty days in a semi-confusional state with headaches and dreams of the Boches wanting to behead him. Some of these dreams came in the waking state, in which state he could recognize them as imaginary. In April, 1917, he said he had always been afraid, even in daytime, that he would be hurt and had been especially troubled by the fear of shells. He was also bothered by nocturnal enuresis which might become an incurable disease and bring impairment of memory and attention. Although not feebleminded the man was of but moderate intelligence, and his emotions, according to Duprat, were such as to defeat any complete resolution of his plight by the intellect.

An affective complex, passing from the surprise of the shell-shock over to a fright based on clear though wrong ideas of what might happen to him, had left him without sufficient power of autocritique.

Weakling, twice buried by shell explosions in one day: Change of character; fear; three fugues (“It is stronger than I am”).

Case 52. (Pactet and Bonhomme, July, 1917.)

An infantryman, Class of 1913, at the front from September, 1914, had a somewhat infantile build physically but was intellectually of average powers, having been a type-setter (three years in a job). However, the confined life had borne hard upon him and his father put him on a farm. He passed through his military service successfully, though he was given two weeks in the guardhouse for overstaying Easter leave. He was suggestible enough at this time to think that he would not be punished very severely, since there were other men whose leaves did not expire at the same time as his own.

He was buried twice in the same morning, March, 1915, at Bois Le Prêtre, spent four or five days in hospital, and went back to his battalion. But now there was a change in his character. Formerly indifferent to danger, he was now apprehensive every time he went to the line and felt an almost irresistible impulse to make for the rear. He was condemned to five years in prison, June, 1915, but was finally sent back to the front.

However, in July he left his company a second time as it was going into the trenches, and this time the captain simply asked him to do better. A third fugue, a few weeks later, sent him back to court-martial, and thence to be examined by alienists. He was perfectly conscious at the time of the fugues and understood his duties and possible punishments. All he would say was, “It is stronger than I am.” Fear outweighed every consideration after the episode of the shell burials.

The man may be regarded as a hypobulic, somewhat feebleminded person, able to get on in civil life but thrown out of gear by war. Of course, the concept of fear as a disease can easily be overdone; however, here was a case in which three desertions occurred; the third after severe punishment. In the differential diagnosis, epilepsy, alcoholism, impulsive poriomania, must be considered, as well as feeblemindedness.