Part 59

_Re_ Nonne’s enthusiasm for hypnosis, see under Case 526. Nonne, contrary to Babinski and Froment, would regard even the severe and obstinate vasomotor disturbances as purely functional and as not even “sub-organic.” The basis of this belief is that hypnosis cures these phenomena as well as various tics and pertinacious tremors. French observers consider that these tics and tremors may even be organic in their nature, basing their ideas upon the non-success of suggestion. (It may be noted [see under Case 528] that the French military authorities do not allow the use of hypnotism in the army.) With respect to the present case (530), of course, the French observers would not deny the power of hypnotism to produce the cure. Babinski and Froment’s Postscript to the English edition of their work on hysteria, remarks that, though Roussy and Lhermitte state that vasomotor symptoms may disappear along with the psychotherapeutic cure of paralyses and contractures, yet Roussy and Boisseau later admitted that improvement in thermal and vasomotor control is at best an exceedingly slow one.

More recent personal communications indicate that there is still room for some question as to the curability by suggestion of such disorders as tic, tremor, vasomotor imbalance, and the like. In short, the true scope of the “pithiatic” or suggestion-curable diseases is still somewhat a matter of controversy.

Shell-shock: “Doll’s head” anesthesia, mutism: Hypnosis.

=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.

A soldier is put in the Landsturm at 22 and later called “unfit” by reason of tremors after mine-explosion (history of tremors at 14 after a fall), but is cured by hypnosis.

=Case 532.= (GRÜNBAUM, November, 1916.)

A _Landsturm_ soldier, 22 (father excitable, family otherwise normal), had a history of being the best scholar in the class and well up to his fourteenth year. At 16 he fell from a tree and though he apparently sustained no injury his head and arm began to tremble. He became unable to learn and gave up his preparations to be a teacher. The tremor, however, disappeared in six months and he went into some technical work. At 16½ years he went as cabin-boy, but in a fortnight he was sent home by the physician. He then began to breed carrier pigeons and got first prizes at international exhibitions. He also went into foundry work and did well as an apprentice. He worked well at home and busied himself with setting up small electrical and other machines. He had never been interested in women and loved his pigeons best, and therefore was regarded by people who knew him as not quite right. He was also non-alcoholic.

After mobilization he was sent back twice but finally was put into a _Jäger_ Battalion. After reaching the front he had to have a hernia operation and on getting well went back to his place and a few days later a mine exploded near him. He was much frightened and fell down unconscious. On regaining consciousness he felt a “running” in the legs and tremors in the hands. The latter grew stronger and began to affect the arms.

After two months in hospital he went to garrison unrecovered, was placed in the _Landsturm_ and did four months station duty in Russia. The tremors persisted and when his comrades played a bad practical joke on him the tremors got so bad that he was sent back home as unfit for service.

He was a stocky looking, well-nourished man of middle height, without visceral disease or sign of organic nervous disorder. The shaking tremor grew much more powerful in any state of excitement but always paused sufficiently to permit the execution of any particular movement. The head movements were continuous, slight rotations. There were a few regions of anesthesia to touch, but these areas differed at different examinations. There was a general hyperesthesia. Conjunctival, corneal and pharyngeal reflexes were absent. The man was slightly excitable, apprehensive, depressed, complained of sleeping badly, did not want to sit or stand and felt as if he wanted to run away, no matter where. In dropping off to sleep he would fall out of bed and talked aloud in his sleep. He thought he was incurably sick. Intelligence and school knowledge were very good.

He was hypnotized eight times for periods of about five minutes each. Hypnosis was extremely easy to accomplish. At the second trial the manual tremor disappeared. After the third trial there was an essential improvement in the shaking tremor. Moreover, his emotional state had become happier. He began to sleep well. He was now free from disease and regained confidence and looked upon himself as well and fit for work. Undoubtedly without hypnotism this man would have been released from service after a few months of inconsequential hospital care without pension.

_Re_ tremors, see remarks under Case 308, concerning the possibly organic nature of many of the so-called Shell-shock tremors; an opinion apparently shared in by Meige and by Guillain. Babinski also found that these tremors were not influencible by psychotherapy. Yet here is an instance in which tremors are reported cured by hypnosis, and moreover, tremors that were recurrent from an ante-bellum attack at 14. See remarks under Case 530.

Shell-shock, slight injury, unconsciousness: Astasia-abasia: Recovery under hypnosis, two séances.

=Case 533.= (NONNE, December, 1915.)

A musketeer, without neuropathic taint and without nervous symptoms before the war (parents both dead of tuberculosis, eleven brothers and sisters died young), saw four comrades killed by a shell October 27, 1914. The musketeer himself was slightly injured superficially in the back. He remained unconscious for three hours and on coming out showed general tremor of the body, felt pressure in the head, was lachrymose and unable to walk or stand. He was subject to insomnia. He was in four different hospitals, finally reaching Eppendorf. Diagnosis rendered at the first hospital and carried on through the others was hemorrhage into the spinal canal.

For two months at Eppendorf he lay in extension. He was then examined by Nonne, who found general neuropathic habitus, pronounced “cramp neurosis” in the lower extremities, psychogenic astasia-abasia, hyperidrosis of the lower extremities, marked cyanosis of feet and lower legs, increased tendon and skin reflexes, pseudoclonus, no Babinski or Oppenheim reflexes. The man complained of pressure in the head, sleeplessness, a feeling of depression and hopelessness. Pulse 120-130.

Hypnosis proved easy. After the first treatment the man stood and walked and showed no tremor. The next day the hypnosis was repeated and the cyanosis of the legs disappeared. Sleep on the second night was good. Appetite returned and the man fell into a good emotional state. Thereafter the patient was intentionally ignored by the physicians and could soon not be distinguished in any respect from the other non-nervous convalescents.

This case is expressly stated by Nonne to resemble in all respects those formerly described by Oppenheim as “traumatic neurosis.”

Crural monoplegia: Cured by hypnosis.

=Case 534.= (HURST, 1917.)

A Belgian soldier fell into mud on the collapse of a roof from which he was observing the enemy. It was an hour before he got his left leg out of the mud, and found it fixed in extension. He was sent to England, where for three months the leg remained stiff. The spastic paralysis did not seem organic as the leg was dragged behind. The knee and ankle could be bent only by using much force. The entire leg was in all ways anesthetic. Babinski sign gave additional proof that the condition was hysterical: when the patient lay with arms folded and legs apart and then tried to sit up, the normal leg was lifted and the paralyzed leg remained flat.

According to Hurst, the paralysis and stiffness were due to an autosuggestion from the legs being embedded in mud. The anesthesia was probably a matter of medical suggestion produced in the course of examination during the three months of disability. According to Hurst, Babinski is right in supposing that hysterical anesthesia is almost invariably produced by the observer.

Accordingly a strong faradic current was passed through the leg, and he was assured that sensation and power would be restored. However, he could still walk only with difficulty.

Hypnosis was therefore resorted to and repeated on several occasions. He went back to duty in three weeks, although he still held the leg somewhat stiff when he walked.

_Re_ recurrences after hypnotism, see remarks of Nonne under Case 530. Howland also notes that cases treated by hypnotism must be followed up to prevent relapse. In the above case of Hurst’s, it will be noted that the hypnotic treatment was several times repeated.

Shell-shock, emotional (slight trauma): Tremors and sensory impairment: Cure by hypnosis, thrice repeated.

=Case 535.= (NONNE, December, 1915.)

A reservist, always well, not neuropathic (mother had had seizures, possibly epileptic, for many years) was wounded in the left calf by a shell fragment, about the middle of December, 1914. He was at the same time, as a result of the shell explosions near by, afflicted with a tremor of the whole body; this tremor gradually increased and proved refractory to all treatment for nine months.

At the beginning of September, 1915, the patient reached Nonne’s wards, showing tremor of head, arms and legs, with pronounced hypalgesia of the whole body, abolition of frontal and conjunctival reflexes, and contraction of the visual fields.

The tremor of the head was completely removed at the first hypnotic treatment. There was a slight recurrence of this tremor two days later, and traces of it could be observed for nine days. A third hypnotic treatment swept away this tremor, which did not return.

The patient was discharged after about four weeks, suitable for garrison duty.

_Re_ traumatic neurosis, Nonne dislikes this term of Oppenheim, because such a term rather tends to connote unfavorable prognosis. As quoted under Case 530, Nonne holds that the war data show that hysteria is neither a form of degeneration nor an affair built on the Freudian schema.

Nonne in fact maintains that the hysterical syndrome may occasionally occur with much greater ease in a normal person than ever has been known before. It is precisely in these cases of normals getting hysterical that Nonne gets especially good results with hypnosis. If the development of the hysterical syndrome had extended over days or weeks, then the hypnotic cure was a slower one. The above reservist developed his Shell-shock gradually and required three hypnotic treatments. But although the number of doses of hypnotism required may be said roughly to depend upon the time which the condition took to come to a head, yet there is no similar rule _re_ duration. A miracle cure may be brought about even in cases that have lasted over a year. This result, if confirmed, would signify that the hysterical condition once fixated did not especially increase in its tenacity.

_Re_ hypnosis in Germany, it should be noted that Nonne is the chief protagonist for hypnosis, at least among the well-known neurologists. Psychoelectric cures, which the Germans term Kaufmann’s cure, are also greatly in vogue in German clinics. Despite the well-based claims of Lt.-Col. Myers and of Eder, some English observers appear to condemn hypnosis as inadequate, or even as dangerous.

A series of relatively successful cases like those here mentioned might yield a wrong impression of the value of hypnosis (see Feiling’s unsuccessful case 369).

Hysterical paraplegia of gradual development: recovery only under repeated hypnosis.

=Case 536.= (NONNE, December, 1915.)

A volunteer, of nervous parents, had for four years suffered from attacks of uncertain (hysterical or epileptic) nature. These attacks came on again after strenuous marching in the campaign in Belgium and France. Released from service at the front and detailed for guide duty, he proved unsuitable for this work, too, and was sent back to a hospital at home. Here there gradually developed a paralysis of the lower extremities. Treatment proved ineffective.

At the end of January, 1915, he came to Nonne’s wards at Eppendorf with a paralysis that had lasted six months. There was a total paraplegia inferior, with anesthesia for all sensation from the knees downward. The lower legs and feet were cyanotic and cold. The tendon and skin reflexes were lively. There was a moderate contraction of the visual fields on both sides.

Under hypnosis, the patient proved able to move both joints somewhat, but very weakly and slowly. The patient was hypnotized daily for a week, and made slow progress. Only after another week did it prove possible to get him to stand. After four weeks, his gait had so improved as to look like that of a tired old man. Three weeks more of treatment permitted the patient to walk, run and hop normally. Repeated _waking_ suggestion had failed to accomplish anything in this case. The improvement followed only hypnosis. It seems to be a general principle that in cases of gradual development, the recovery by hypnosis will also be gradual.

_Re_ repeated hypnosis for cases of gradual development, see remarks under the preceding case (535).

Struck by rifle butt: blindness of an eye already poor. Shell-shock: dysbasia. Hypnosis.

=Case 537.= (ORMOND, May, 1915.)

A lieutenant, 20 years, managed to get into the army despite the fact that he had never been able to use his left eye, owing to hypermetropia and amblyopia. He was hit on the left side of the head by a rifle butt, and knocked unconscious, in June. On recovering, he found he could not see at all with his left eye, which he had never been in the habit of using. August 10, he was wounded slightly in the left thigh. August 23, while still on duty, with the wound not completely healed, he was blown up by a shell. He regained consciousness on a stretcher. Feeling the pain in his old wound, he thought he should be unable to walk.

On shipboard, he found that he actually could not walk. He kept his left eye covered by a shade on account of headache that would follow exposure to light. He was much excited and had bad nightmares.

After the journey home from the Dardanelles, it was found that the left eye was normal except for the hypermetropia, despite the fact that he was quite unable to see with the eye.

He was hypnotized four times, losing the nightmares and much of the headache after the first treatment; the eye pain on exposure to light, after the second treatment; and the blindness, after the third treatment. He was now able to see with his left eye as well as before he was struck. He was still unable to walk without crutches. Hypnotized the fourth time, he was told he could walk, and did so.

For hypnotic treatment of blindness, see under Case 521. _Re_ blindness of eye already poor, see Cases 294-301 (296 and 297 eye cases). Ormond states that in the treatment of Shell-shock blindness, he first tried rest, tonics, cutting off tobacco, confinement in bed, isolation, persuasion, encouragement, counter-irritation; but that all these measures failed. Suggestion and hypnosis succeeded.

Shell explosion; concussion; retinal hemorrhage: Blindness. Cure by hypnosis.

=Case 538.= (HURST, November, 1916.)

An English private, 22, was looking over a parapet, July 18, 1915. He afterward remembered sand thrown in his eyes and a fall backward, hitting his head, after a shell had struck the sandbags in front of him. He was unconscious 24 hours. Upon recovery, he found himself completely blind, save that he could just tell light from darkness with the left eye. His eyes were sore and eyelids blackened; there was also severe headache and partial deafness.

Hearing returned and the headache improved shortly; but the condition of the eye seemed more permanent. On forcibly opening the eyes, September 14, they were turned far upwards so that the iris could scarcely be seen. Some sand grains were buried in the conjunctiva, not in the cornea. There was no inflammation about the sand grains.

In hypnosis, he was told that he would see on waking. The moment he woke, this suggestion was repeated forcibly and his eyes were held open. He cried out that he could see; tears ran down his cheeks; he fell on his knees in gratitude. Three days later, he said he was able to see as well as he had ever seen. There was, however, an opacity of the vitreous of the left eye, the result of a retinal hemorrhage: doubtless the result of injury at the time of the explosion. September 30, he had perfect vision in the right eye and 6/36 in his left.

_Re_ results of hypnotic treatment, Lt.-Col. Myers, summarizing 23 cases of Shell-shock, got apparently complete cures in 26 per cent, and distinct improvement in another 26 per cent. He failed to hypnotize 35 per cent, and got no improvement after hypnosis in 13 per cent. Is the recovery after hypnosis complete and permanent? Lt.-Col. Myers believes that it may be, but others remark the tendency to relapse (see Case 534). Similar objections may be made to the psychoelectric treatment as used by Vincent, Yealland, or Kaufmann. See under Case 535.

Appendix operation: Post-operative retention of urine. Relief by hypnosis.

=Case 539.= (PODIAPOLSKY, August, 1917.)

A soldier, 32, operated for appendicitis, had a post-operative retention of urine. Hypnotic suggestion was requested to reëstablish excretion of urine before resort should be had to the catheter.

Somnambulistic amnesia was obtained at once and without questioning him P. suggested to him directly that he must feel the need of micturition. The suggestion was unsuccessful. However, bearing in mind psychogenic obstacles of an unknown nature, P. questioned the patient as to sensations and learned that in the operation the skin had been burned about the urinary passage and that the patient feared micturition. Besides this, micturition was painful on account of the wound above the appendix. The patient also feared that the sutures would yield.

Accordingly assurance was given that the burned parts would be insensible and that the bladder could be emptied without effort and without endangering the sutures. Analgesia was produced by a few passages of the hand upon the bed clothes. Complying with post-hypnotic suggestion the patient urinated after a quarter of an hour of sleep, and in thirty-six hours retention was relieved.

With respect to frequency of immediate somnambulism for the first trial, P. states that, although authorities set the percentage of successful immediate somnambulisms at 17-20 per cent, war conditions yield three or four times as high a percentage. The war has produced a suitable soil for hypnotism. Hypnosis is impossible in from 1½ to 2 per cent of cases.

Wound of sciatic nerve: Pains after operation. Relief by hypnosis.

=Case 540.= (PODIAPOLSKY, August, 1917.)

A German prisoner, 33, was admitted to a Russian Hospital, November 11, 1916, with “a bad wound of upper right thigh, marked pains in right sciatic nerve especially affecting feet.” Morphine and pantopon did not abolish the pain. Insomnia. November 13, the sciatic nerve was surgically freed from a scar and laid in the midst of the femoral biceps. Every evening pantopon was injected; but the pains and insomnia persisted nevertheless.

November 19, he was hypnotized. The pain stopped. He had an excellent night, and the next day felt only a slight pain in the toes.

Curiously enough, while giving him suggestion in the German language, P. had said fingers instead of toes (inadvertently, since the Russian language uses the same term for both). He slept well to November 29 but still felt a slight pain in the toes. On November 29 another hypnotic sitting was given, and the toes this time were named correctly. The next day the patient said, “You have relieved me of all the rest of my pain.” He had no pain thereafter and the morphine and pantopon were dispensed with. Sleep returned.

Incidentally, this patient had his hair grow white in a few months of war.

Ship blown up by mine: Stereotyped explosion dream by survivor: Cure by hypnosis (also of antebellum habitual headache).

=Case 541.= (RIGGALL, April, 1917.)

A survivor of H.M.S. T.B. II, blown up by a mine off Harwich, was admitted to the naval hospital at Chatham, March 3, 1916, a well-nourished, nervous looking lad, aged 20. After the accident, he began to dream, always the same dream, of the explosion, waking up with the cry of the ship mates, and then unable to sleep the rest of the night. The knee and ankle-jerks were somewhat exaggerated.

April 15, when there had been no improvement, he was hypnotized. The patient was told to lie back in an arm chair, make himself comfortable and allow muscles to relax. He was told to fix his eyes and concentrate his attention on an electric lamp. The suggestion of sleep was made, and he was repeatedly told in a monotonous voice that he was becoming more and more sleepy. Then in an emphatic voice he was told that the treatment would completely cure him. He had no more dreams after this first sitting.

Hypnosis was continued every other day until April 20, when he was discharged cured. After the first sitting hypnosis was induced by simply telling the patient to go to sleep, which he would immediately do on entering the room, while still standing up. At subsequent sittings, he was made to write twenty times such phrases as: “I feel much better”; “I shall have no more bad dreams.”