Part 58

He was able to converse very well and spontaneously (he remembers having lost consciousness at the explosion of the grenade and not coming to until after his arrival at the hospital at Cervignano); he read correctly both mentally and aloud, and answered by signs the questions put to him in writing. Being face to face with hysterical traumatic deafness, notwithstanding no other hysterical phenomena were noticed, a successful attempt was made with suggestive therapy, the patient being emphatically assured (always in writing) that the following Sunday his hearing would be restored without doubt. The following Sunday, in fact, during the visit of a lady (one of his friends), hearing in his left ear was suddenly and almost completely restored to the patient. He was in profound emotion on account of this, and upon the appearance of the physician he had a hard weeping spell. During the following day, he began slowly to hear with the right ear.

During the latter part of his stay at the clinic, however (until September 24, 1915), a slight hypo-acusia in the right ear persisted, along with severe headaches and pains in the left ear (which the patient compared to the suffering as a child with otitis).

At the otoscopic examination by a specialist, only residuals of the old catarrhal otitis with retraction of the tympanic membrane were found.

Shell-shock story reproduced in hypnosis. Recovery.

=Case 523.= (MYERS, January, 1916.)

A private had been found wandering in a village, in shirt and socks, unable to give name, regiment, or number. He was admitted at a field ambulance, and seen by Major Myers three days later. No Christian name seemed familiar to him. The past was a blank. He was depressed. There was numbness over the occiput. The legs, hands and tongue were tremulous. The left arm and leg and the left side of the face, chest and abdomen were hypalgesic. The knee-jerks were exaggerated; pseudo-clonus of left knee and right ankle. There had been a nightmare of bombs thrown into trenches--one thrown by a German hit him in the neck and woke him up in a cold sweat.

In hypnosis the dream was repeated, and points about his previous life were dragged out piecemeal. Next, the names of village and near-by town, and finally his own name, regiment and number were elicited. After the bomb-throwing, he said, “I must have gone off my head and run away. I must have taken off my clothes in a field. I spent the first night under a hedge. I spent the next two nights in a wood. I ate nothing. The next night I was walking along a road on the outskirts of a village and I was taken to a house by two men.” On waking, he proved unable to remember these things and was promptly rehypnotized, whereupon the memories became clearer and more ample. More powerful suggestion was given, and complete recovery of memory followed the second period of hypnotism. The pupils became larger. The despondency disappeared, together with the occipital numbness and the left-sided hypalgesia. He was transferred to a base hospital, and thence after three weeks to a hospital in England, made an uninterrupted recovery, and rejoined his regiment.

Shell-shock story reproduced in hypnosis. Recovery.

=Case 524.= (MYERS, January, 1916.)

Private, 29, seen by Major Myers in a base hospital the day after entrance, was in a stupor from which he had to be repeatedly roused to answer questions. He could recall neither name, regiment nor age, and was unable to write or read except a few letters in very large type. Twice he said the words _war_ and _comrade_, and made a gesture as if following. He agreed that a shell came and intimated that he had pains in the forehead. He could not hold his hands out for many seconds without dropping them. Knee-jerks brisk.

Four days later he was very little better, never having spoken voluntarily, but replying _yes_ to the utterance of his name, and was able with great effort to write his name. He still intimated his severe headache. The next day the names of his two children were given. He could not read aloud the figure 2 but held up two fingers. Next day, he gave syllable by syllable his wife’s name from her photograph.

A week from admission he was hypnotized and persuaded to talk about the events that preceded his disorder, breathing excitedly, gesturing, and evidently visualizing the scenes. He had been in the trenches, had been sent to draw water at a camp, and had been knocked down when two or three shells burst over him. He carried out post-hypnotic suggestions.

He was hypnotized again, two days later, and now described how, after shelling, he had lain on the ground, dazed; had risen, picked up the water bottle, returned to the trenches, and then lost all sense and reason. He recalled how his mates had told him he was silly, but had lost all intervening memories. But the full details were elicited by persuasion. Next day he complained that he still wrote with difficulty. Under hypnosis, his speech and writing were restored to normal. He was discharged two days later to an English hospital.

He was then passed for foreign service, being prevented from active service in the field by occasional severe headaches.

Burial after explosion of a “coal box”: Automatism, amnesia, deafmutism: Recovery by hypnosis.

=Case 525.= (MYERS, September, 1916.)

A sergeant, 18, with nineteen months service in the army, 11 months in France, was seen by Lt. Col. Myers at a clearing station to which he had been transferred after three days in another clearing station, with a note “Found in the streets of B----, asking his way to the fire trench; could not be got to speak on admission nor since; seems deaf, but now writes rationally.”

Mute and very deaf at the second C. C. S., he regained a good deal of his hearing with encouraging talk and also became able to cough and utter P, B, F and S, finally whispering name, regimental number, and the like. At the same time he could write fluently. After being buried he had lost himself until he had asked his way of a military policeman at the crossroads in B----. There was amnesia again until he had been 48 hours in the clearing station at B----. The throat hurt as if it were pulled down when he tried to speak, and his head ached when he tried to remember. There was much tremor, especially of right arm. In a quiet room adjoining, the tremors increased and there was much agitation. Lt. Col. Myers suggested cure and encouraged the man, finally inducing a mild hypnotic state in which he spoke aloud, at first hesitatingly, later fluently.

The man eventually remembered what had happened after he had extricated himself. He had run, as he thought, towards the fire trench, taken a wrong direction, and met a Frenchman who gave him eggs and bread, allowed him to sleep on a couch, put him on a cart and drove him to B----. He was then very giddy and asked his way of the policeman. The shell by which he was “terribly shaken” was a “coal box.” Posthypnotic suggestion that the headache would not recur and that he would shake hands with the orderly was successful. He now talked in a proper voice, at first hesitatingly. He looked another man as his clay-colored face resumed a normal aspect. After a good night’s sleep he was evacuated to a base hospital, thence to an English hospital, whence he wrote six days later in gratitude for the successful treatment, stating that he was now nearly well and hoped to be fit for light duty.

Six weeks later he wrote that he was still dizzy. He also remembered certain further details of his experience; how he had wandered into a listening sap in front of the Huns’ barbed wire and had had a tussle with three Huns, after which he was buried during the heavy shelling.

This case belongs in the group termed by Myers “A Group,” namely, the physical group, in which the patient has been lifted, buried or knocked over by a shell or otherwise felt physical or chemical effects of an explosion (in contrast with the B Group, or psychical group, in which fear of the noise or emotional response to the mutilation of companions is the exciting cause). Predisposing affections occur as often in the physical group as in the psychical group. The average age of mutism cases seen by Lt. Col. Myers is twenty-five. Mutism is rare among commissioned officers. Lt. Col. Myers has heard of but one or two cases.

With respect to the technique of getting these men to utter sounds, Lt. Col. Myers states that he first assures the patient that he has already cured many cases of loss of speech by the method about to be employed. The patient is next asked to copy his teacher as the sounds (not the vowels) B, D, finally V, S and K are made. The patient is, as a rule, shortly induced to make the necessary movements of lips, tongue or throat. “You see you are beginning to talk. Now let me hear you cough.” The patient coughs. “You see you are able to make a noise. I want you next to cough out an A (Continental pronunciation).” After a time the patient adds this vowel to the cough. Other vowels are now taught him. Eventually a consonant is prefixed to the vowel instead of the cough. The patient is now delighted with his progress and can shortly repeat surname and regimental number.

Mutism: Recovery by hypnosis.

=Case 526.= (HURST, 1917.)

A transport driver, 31, was run over by a loaded wagon at Gallipoli in May, 1915, and fractured his pelvis. He remained perfectly conscious but unable to speak for three days. At the beginning of August, when he was admitted to the war hospital, he still spoke with great difficulty and with contortions of his face. Even when he did not speak, he had facial contortions and that mental condition characteristic of tic, namely: although he was able to control the contortions by will, he felt uncomfortable during the control and finally gave way to the irresistible impulse.

Under hypnotism, it was suggested to him that he would be able to speak without difficulty and would no longer have the contractions of the face. When he came out of hypnosis he was able to talk quite normally, sang next evening at a concert, and a few days later he took part in a play. The facial contortions persisted in hypnosis and even afterwards, but vanished after a second hypnosis.

_Re_ hypnosis as treatment of mutism, Ballard remarks that a genuine return of speech and a merely hypnotic speech must be distinguished.

Nonne is the great exponent of the use of hypnotism in treatment of the war hysterias. He got as good results from high as from lower classes of men. He remarks that the hypnosis does not protect against recurrence if the patient again falls under the original conditions that brought about the first attack. Hypnosis may be used also as a diagnostic measure between functional and organic cases. Even tics and tremors have been at times cured.

_Re_ employment of hypnotism, Hurst suggests that it may well be used, not only in mutism, but in hysterical deafness, blindness, and occasionally in psychasthenia. It is not a cure-all for the war hysterias, but is to be used as a not infrequent form of treatment. Nonne claims cures of 51 out of 63 cases of hysteria major (28 rapidly, 23 more gradually). Ten of his 63 proved refractory to hypnosis altogether.

Stammering: Cured by hypnosis.

=Case 527.= (HURST, 1917.)

An Australian, 22, wrote the following, August 21, 1916:

“You may be a little surprised to hear that I am in the Hos. suffering from shell-shock, which has taken away my speech and hearing. It is some sixteen days now since it happened.… We were in the trenches and going for dear life, when two of us spotted a German machine gunner in a hole, so we made up our minds to have him. We made a charge at him, and I just remember getting to him when a high-explosive shell burst at my head; it seemed as if it burst inside my head; everything went black. I tried to call out and couldn’t, and I could not hear my mates--only just a terrible bursting in my head all the time. I never remembered anything more until I came to on the boat. The Drs. have told me that I will get alright in time. I saw a good deal of France.… There is not a young man there who is not in the Army. The girls and women work in the fie----”

The abrupt ending of the letter was due to the entrance of Major Hurst. The patient had been hypnotized but his deafness had persisted during the hypnotic sleep, so that suggestions could not be effectively taken. He heard nothing whatever during a very heavy thunderstorm, was unable to make any sign whatever, and could not even cough.

He was now told in writing that his speech and hearing would be restored when ether was given. After a few whiffs, he struggled and before he was under began to repeat the word “Mother.” Etherization was discontinued before his limbs had even become relaxed. As he was coming to, he was requested to repeat various words, and when the anesthetic had passed, he was talking normally and had completely recovered hearing.

Now, however, his memory had become a complete blank. From a short time before his shell-shock up to the moment of his regaining consciousness after etherization, he remembered nothing of his loss of speech or hearing, nothing about the events in his letter, and nothing about Major Hurst, whom he felt he had not previously seen. According to Hurst, this patient had become (_a_) speechless from fright at the time of the shell explosion, (_b_) deaf from the noise of the explosion, and (_c_) unconscious from the windage. After he came to at the time of the explosion, an autosuggestion to the effect that he had lost his power of speech and hearing occurred. Ether broke down this inhibition of speech and hearing by interfering with the control of the high over lower cerebral centers.

_Re_ emotional stammering, Chavigny treats by voice gymnastics, rhythmical breathing movements, sounds spoken by metronome with simultaneous movements of arms or trunk, and by singing. _Re_ hysterical stuttering, Roussy and Lhermitte remark that the symptoms are always very pronounced, come on suddenly, and cease just as suddenly under the influence of electrical treatment. The history will differentiate hysterical stuttering. The effects of treatment will also help. Genuine non-hysterical stammering may, of course, be increased through emotion or shock. Dundas Grant aids the stutterer by having him twist a button or carry out some other muscular movement simultaneously with the attempt to speak. He also has the patient endeavor to expand the lower part of his chest during the effort.

MacMahon notes that Shell-shock stammering is chiefly a difficulty with vowel sounds and voiced consonants, and amounts to a speech inhibition, accompanied sometimes by amnesia for words and suggesting a form of aphasia. Mild cases of such stammering are cured simultaneously. MacMahon relies in part upon especially regulated breathing movements and the attendant sense of repose. The cases of old cured stammering that have come back under Shell-shock are harder to treat.

Two burials; shell-shock: Mutism and amnesia. Recovery aided by hypnosis.

=Case 528.= (MYERS, January, 1916.)

Major C. S. Myers recites hypnotic cure in a case of mutism. He remarks that malingering is sometimes suspected in these cases. There was, however, in this case a severe constipation which lasted five days from the shock, and a retention of urine with catheterization during the same period. This private, 32 years, came to a base hospital, mute but able to read and write as follows:

“I was buried alive on ---- and again on ---- [5 months and 4½ months respectively before admission], and then I had the misfortune to have two shells burst over me on ---- [four days before admission]. There was shelling for about 20 minutes and then two bursted over my head. I did not remember any more until you came to see me, but I am still living in hopes to regain my speech back.”

It seems that he had wandered off with a lance-corporal for three days after the first burial, and neither he nor his comrade were able to find their regiment.

Understanding was slow and look vacant. There were jerky movements of the arms and a snoring sound from the nasopharynx. Voluntary movements were restricted, weak, slowly executed, jerky, and incoördinated, but not tremulous. Station was unsteady; failure in finger-to-nose test. He could imitate the sound _ah_, and the consonants _s_ and _p_.

Knee-jerks exaggerated; plantars flexor; abdominal reflexes absent; pupils reacted; eye movements normal; moderate restriction of visual fields on temporal side; watch not heard even in contact with ear; heard better by air than by bone conduction.

In the next two days, the patient became brighter and movements became better. On the seventh day stupor and ataxia had disappeared. Familiar names could be repeated and the next day could be given on request. The patient would sweat profusely in giving replies. There was no spontaneous speech. A week later speech had improved.

Under hypnosis he spoke more fluently though feebly, and became emotional upon being questioned as to trench life, waking up suddenly from hypnosis and wiping the sweat from his chest.

The next day, forgotten events of the second burial were recalled together with what followed. Post-hypnotic suggestion of the performance of eccentric actions was successful.

Next day his memory had returned save in reference to the two days’ wandering after the first burial; and under hypnosis the events of those two days were recalled. He was then transferred to an English hospital.

_Re_ hypnosis for “war shock,” Eder remarks that the usual objections to hypnosis cannot apply because the majority of cases have no neuropathic antecedents. Eder, as psychoanalyst, endeavors to level hypnotic suggestion against the so-called “complexes.” Elliot Smith and Pear commend Lt.-Col. Myers’ results, but regard the results of hypnotic treatment as brilliant but erratic. Colin Russel, regarding hypnotism as an induced hysteria, remarks that a true hysteria can hardly be cured by adding more, although he has sometimes used the treatment with apparent success. Podiapolsky notes that some 17 per cent of his functional cases will, at a word, drop off into an artificial deep slumber. He thinks chloroform should not be given to these subjects without an attempt to secure this artificial deep slumber first. Chavigny, highly commending suggestion, notes that the use of hypnotism is prohibited in military hospitals in France. A remark of Smirnow indicates that the Russian authorities also look with disfavor upon hypnosis, but he notes certain patients whom he cured by hypnosis, so that apparently Russia did not absolutely forbid the use of hypnosis in war cases. Another Russian, Arinstein, prefers the Dubois method to hypnosis.

Roussy and Lhermitte definitely state that the psychotherapy of Dejerine, Dubois, and Babinski beneficially replaces hypnotic suggestion, “which ought definitely to be rejected.” However, if the conclusions of Bernheim are sound, there can be no theoretical claim of distinction between hypnosis and other forms of suggestion.

Fifteen bayonet wounds; recommendation for Victoria Cross: Hysterical contracture of hand, revealed by hypnosis as the bayonet clutch.

=Case 529.= (EDER, August, 1916.)

A left-handed Irishman, 23, on December 22, 1915, got 15 bayonet wounds, 14 of which were on the right side of the body. He was in the trenches with 23 men, when they were attacked by about 200 Turks. He and a sergeant leaped out of the trench into a bayonet attack with Turks.

He was admitted to the hospital January 26, 1916, for a hysterical contracture of the right hand. The fingers were semi-flexed and could not be passively extended. Col. Purves Stewart noted that there was an anesthesia and analgesia to pin-pricks and cotton wool on the whole of the right arm. “At the beginning of the examination, the patient felt pin-pricks at the wrist; as examination continued, the boundary of anesthesia steadily increased until it reached the shoulder, by which time the previously sensitive spots were now anesthetic.” Later there was a complete right hemianesthesia.

In telling his story, this soldier repeatedly emphasized that “You must clutch your rifle very firmly and never let it up, guarding yourself all the time.” This was the explanation of the contracture. According to Eder, in the unconscious, he was still clutching the rifle, fighting the good fight, and symbolizing the desire by the grasping hand. In hypnosis, suggestion was made that the fight was over and the rifle could be let go, whereupon the hand was immediately relaxed.

The analgesia, thinks Eder, was present during the fight and passed away subsequently. In fact, the soldier said that he felt no pain during the fight and did not know that he was wounded until his attention was called to the fact that blood was flowing from him. According to Eder, the unconscious mind refused to feel pain. At Col. Stewart’s first prick or two “the unconscious took no notice, but as the pricks continued, the former memory was revived and the unconscious became on guard.” He had been recommended for the V. C.

Gunshot of forearm: Hysterical contracture, wrist and fingers: Cure by hypnosis, “indecently quick.”

=Case 530.= (NONNE, December, 1915.)

An infantryman, without special hereditary taint and previously well, was shot September, 1914, in the right forearm. A paralysis of the hand and fingers persisted after the wound had healed. Several reserve hospitals failed to cure the paralysis.

Eight months after the injury he arrived at Nonne’s clinic at Eppendorf, with a flexor contracture of the right wrist joint as well as of the fingers (exclusive of thumb). The finger tips were deeply sunk in the flesh of the palm. Extension could only be brought about against strong resistance. There was a total anesthesia for all sensations in the hand and fingers. No contraction of visual fields.

The patient, upon suggestion, fell immediately into hypnosis. At first the contracture was released with some difficulty; then, with greater ease, and then without any resistance whatever. During the same hypnotic séance the patient finally became able to extend actively both fingers and wrist; and next day, after the patient had convinced himself of his cure, he was able voluntarily to stretch the hand and fingers with normal amplitude and power. The disturbance of sensibility had spontaneously disappeared.

This cure was, from the patient’s point of view, indecently quick. He said everybody must feel he was a malingerer, and in fact he felt so himself. He went back into service, where he had been for several months at the date of Nonne’s report.