Part 60

Once when a tooth was to be pulled a post-hypnotic suggestion that no more pain would be felt was given, nor was any pain felt. Headache persisted after the first two or three sittings. Accordingly, during hypnosis a pencil was pressed to the forehead with the suggestion that it would burn and that after waking there would be an itching pain for half an hour, followed by recovery from headache. Curiously enough, a distinct erythema of the skin was observed over the point of pressure. Toothache and headache vanished.

Shell-shock from air-craft bomb: Amnesia: Recovery under hypnosis (also removal of a headache dating from childhood).

=Case 542.= (BURMISTON, January, 1917.)

May 22, 1916, a stoker, 26, was found on shipboard in a workshop behind oil drums, refusing to come out, looking dazed, not recognizing messmates, suspicious and complaining of headache. He reached the Royal Naval Hospital at St. Malo, May 24, answering questions “Don’t know,” and physically normal except for diminished knee-jerks. At the end of two or three weeks he would answer questions about his stay at the hospital, but complained of headache or weight in the head. Wassermann reaction, negative.

Special examination on May 26, showed an amnesia for everything up to his arrival at St. Malo. For example, he did not know the name or use of a hammer or a pressure gauge, though he knew the pressure gauge was made of brass and glass, having seen brass and glass in the hospital wards. He had no idea of the nature of a ship. He was sent to the sick bay at the Royal Naval Barracks at Chatham, July 7, carrying a recommendation that he be retrained as a stoker.

He was put under hypnosis, induced by gazing at the brass knob of a paper weight. He went off easily, was told there was nothing to worry about, taken back to the beginning of his illness, and asked what happened. He told about a bomb explosion from aircraft, and how he had lost his memory after a nearby explosion. He told how he was married and had a child 21 months old. During the narrative about bombs falling, his worry was such that he was put in a deeper hypnotic sleep, and was told that he would remember all that had happened. Upon being ordered to wake up, he remained dazed for a few moments, and then said that he was all right. Asked about his marriage, he replied that of course he was married and had a child.

After four days leave, he returned, July 13, without trouble except a headache, from which it appeared that he had suffered ever since a fall when a child. He was again put into a hypnotic state and asked to remember the accident that caused the headache. He was conducted back through the years, and finally described a white house in India, his fall in the area, the black people in white clothes, the cut bleeding head. He was told that he would have no more of such headaches. On being wakened, he said that his headache was gone, and retold the story of the accident. August 2, he said he had never felt better in his life. September 1, he was drafted to a seagoing ship.

Shell-shock, unconsciousness: Convulsions (recollection of childhood convulsions): Cure by hypnosis.

=Case 543.= (HURST, March, 1917.)

A New Zealander was rendered unconscious for a few minutes following concussion from a high explosive shell. Convulsions developed, occurring at least once and often several times a day.

As to the origin of these convulsions, it appeared that the soldier had had a few convulsions after falling on his head at the age of 8. According to Hurst, recollection of these childhood convulsions probably led by a process of autosuggestion to the Shell-shock convulsions.

Captain Crabtree hypnotized the man, suggesting recovery. The fits immediately ceased and did not recur.

Recurrent hysterical mutism. Spontaneous recovery in (_a_) 18 months (antebellum incident). (_b_) Hypnotic recovery in a few minutes.

=Case 544.= (EDER, August, 1916.)

A soldier in a mine accident eight years before the war, lost his speech when his brother was killed, and then recovered his speech spontaneously after 18 months.

After a shell explosion in Gallipoli, he was again struck speechless and also deaf.

Six weeks later, he came to Dr. Eder and objected in writing to treatment, saying that he believed in nature’s methods. God had taken his voice away before and had restored it. Eder replied in writing “rather irreverently” that God had taken 18 months, but he could do it in a few minutes. The patient afterward consented to treatment, and speech and hearing were duly restored in the time promised, whereupon Dr. Eder told him that in point of fact his physician was merely the instrument of Providence.

Neurasthenic symptoms: Cured by repeated hypnosis.

=Case 545.= (TOMBLESON, September, 1917.)

A private, 24, was admitted to hospital with diagnosis neurasthenia, March 11, 1916. He suffered from vertical headache; general analgesia, more definite on the right side (patient left-handed); loss of smell and taste, also more definite on the right side; paresis of right leg, with dragging of foot (old trench foot); and sleeplessness.

The next day Tombleson put him in a hypnotic state, third stage, and again, March 13, but without results.

March 14, the somnambulistic stage was reached in hypnosis, and next day the man’s headache was much relieved as a result of the suggestion offered. He was again hypnotized and the following day, March 16, the headache had vanished and the man was in general much improved. In somnambulism the disappearance of the analgesia was suggested, and it proved possible to make the man walk about without limp and without dragging the right foot. Next day the analgesia was much relieved. In somnambulism the suggestions were repeated.

March 18, the man said he was quite well, and proved to be so on examination, except that he could not yet taste with absolute normality on the right side. In somnambulism it was further suggested that the cure was a perfect one and included the sense of taste. However, March 25, the expected improvement had not yet occurred in the taste, whereupon further suggestions were given in hypnotic somnambulism, _re_ taste. Next day taste had become normal.

_Re_ hypnosis, Tombleson says that the most successful cases of hypnosis are those of Shell-shock psychasthenia, but that he gets very good results with hyperthyroidism and with neurasthenia also. He goes so far as to say that practically all cases of war neurasthenia and psychasthenia can be cured and sent back to work if treatment by hypnotic suggestion is used in a reasonable time.

Neurotic symptoms: Improvement under repeated hypnosis.

=Case 546.= (TOMBLESON, September, 1917.)

A private, 32, was admitted, April 15, 1916, to Tombleson’s ward from the Cottonera Mental Ward with the diagnosis: psychasthenia with paresis of right arm. The man was very suspicious of the medical profession, melancholy, morose and prone to tears. He had been kicked by a horse four years before and showed a depressed and very tender scar in the right parietal region. The right side of the body since that injury had been getting weaker, but the arm was much weaker than the leg. Anesthesia was practically complete on the right side. There was a wasting of the muscles of the right arm and the skin of the hand and fingers was thin and shiny.

Before his transfer the man was placed in the somnambulistic state, with suggestions of happiness and confidence in the coming cure. He arrived at Valletta, April 16, in a cheerful frame of mind, stating that there was nothing now the matter but weakness. Under somnambulism the loss of symptoms was suggested and, April 17, the patient was well except for the loss of power in the arm and leg. Daily training under somnambulism was given for a period of seven days, with suggestions especially leveled at the paretic muscles. He was then so far recovered that hypnotic treatment was stopped. The patient went to England, May 12, 1916, well.

Convulsions, “Jacksonian,” and dysbasia: Cure by hypnosis.

=Case 547.= (TOMBLESON, September, 1917.)

A private, 18, was admitted to hospital, March 22, 1916, with the diagnosis Jacksonian epilepsy, with marked functional gait. He had just had several fits--two March 20, two March 21, and several earlier. He was tremulous and could not stand. Much pain. Knee-jerks brisk.

There was a history of a fall into a harbor at seven, followed by bleeding from nose and ears and unconsciousness for a week. Convulsions, involving the face, arm and leg, and attended by unconsciousness, kept recurring until twelve. Five months before admission there had been cerebrospinal meningitis. In February at Salonica he had had pneumonia.

March 23-24 the soldier was hypnotized to the third stage, but he had two fits. A “funny feeling in the right big toe” was brought out and suggested away. March 26-27 the patient was able to walk with a typical functional disorder. Under somnambulism the suggestions were repeated, but on the evening of March 27 two more convulsions appeared. In somnambulism he explained that he “had got round” the inhibition of the aura.

The night of April 2 occurred two convulsions. April 5, the man was placed in the somnambulistic stage to last three days. During the night of April 6 he was observed to be restless for an hour, with some twitching of the right face, yet no fit followed. The morning of April 8 the patient woke feeling well. He was again placed in somnambulism to last two days. Two hours later, however, a fit started. It was stopped at once by suggestion, but the patient woke. He was left awake the rest of the day. April 9, somnambulism: suggestions repeated; sleep to last for two days. That evening there was a slight beginning of a fit, which was stopped at once by suggestion, the patient waking April 11 in another beginning of a fit, stopped by suggestion.

Thereafter no more fits recurred at all. May 12, 1916, well.

Agoraphobia: Cure by hypnosis.

=Case 548.= (HURST, 1917.)

A captain was (with one lieutenant) the sole survivor among his battalion officers at Ypres. The captain received the D. S. O. for his gallant conduct in saving the remnant of his battalion. He now felt he could never face responsibility again and that he would disgrace himself if he ever got into danger. He developed a terrible dread of open places and became more and more depressed. When he heard that there was going to be an attack at Neuve Chapelle, he broke down but managed to get through the first day of the battle. He was worse off than ever in the evening, felt that he could not face another day’s fighting, was invalided home, and arrived in a condition of exhaustion and feeling of disgrace. He had bad dreams at night. Rest was insufficient to restore confidence. Hypnosis was followed by rapid improvement, and the man was soon able to get back to duty.

_Re_ agoraphobia, see Section A, XI, Psychopathoses, and also Steiner’s case (182) of claustrophobia, in which shells were preferred to safety in a tunnel.

Stress on Eastern front; cardiac seizures; cellulitis: In convalescence, manual tremors. Treatment eventually by forcing and isolation.

=Case 549.= (BINSWANGER, July, 1915.)

A subaltern officer, 24, in civil life a student of mathematics, had serious hereditary taint on both sides (father, alcoholic; maternal grandfather, victim of “severe nervous disease”). As a boy he developed normally, and was a good student. He served as volunteer in 1911 to 1912, but in drill in 1913 he had had to be released from service on account of nervous heart and difficulty with respiration.

However, he was called to the colors at the outbreak of the war, and was subjected to tremendous strain in the eastern campaign; and he was put in the pack train at the end of November for cardiac seizures. He had a cellulitis with furunculosis following, and at the beginning of December there was suppuration of the whole right tibia. He was treated in hospital and slowly recovered.

At the beginning of March, 1915, without obvious external cause, while sitting in a café, the convalescent officer felt a cramp in his right hand, and strong movements of the hand to right and left followed. He was treated with bromides, but unsuccessfully. The tremors became more marked and then again from time to time grew weaker. Electric treatment increased the shaking to a maximal degree. April 27, the patient was brought to the nerve hospital at Jena.

The patient was a fat and muscular man, of average size, with very small ears and poorly-developed, adherent lobules, and syndactylism of the second and third toes of both feet; reflexes increased; marked dermatographia; a static fine tremor with rapid oscillations. The tremor became a positive tonus if the arm and hand were stretched out horizontally. Face and chest reddened easily.

Whenever any other voluntary movement was carried out (even slight finger movements of the left hand or of the right or left foot while lying in bed) this right-sided convulsive tremor immediately disappeared. The movements could also be made to disappear by slight turning movements of the head or of the tongue. Moreover, when the mind was diverted, as in reading, the tremors ceased. When the patient thought intensely of some mathematical problem, he could bring his shaking to a stop. The left grip was stronger than the right. In the Romberg position there was a marked swaying to the left and backwards.

Subjectively, the patient complained of nothing but a circumscribed headache in the left parietal region and of sleep interrupted by frightful dreams. At first the condition remained unchanged. There was much insomnia, and the slightest noise caused fright. Headaches in the daytime also were produced by any noise, and these headaches were localized in the left parietal region. The tremors of the right hand persisted except as he caused them to stop as above mentioned. He could write well with his left hand. He would drum with his left hand on the table until the tremor of his right hand disappeared. He could play on the piano, playing first with the left hand until the right had become quiet. He was a very irritable man, passing into anger and extreme profanity at the slightest occasion, and it was very difficult to bring him to any kind of orderly activity or persistence in therapeutic measures. These consisted of baths, massage, and gymnastics, but they proved quite unavailing.

As the fellow got more and more intolerable, and as upon May 27 at about 9 o’clock in the evening, he disturbed the quiet of the entire hospital by a severe paroxysm of scolding, he was placed in a single room in the psychiatric department. He was placed in bed, cut off from all communication with others, and forced to carry out his exercises.

For two days he was surly, crabbed and obstinate, but then changed his demeanor completely; he became friendly and obedient. The tremor completely disappeared.

Five days later he was able to carry out all active gymnastic exercises with great energy and without the slightest disturbance in the right arm. At date of report he was busy in the garden.

Five weeks’ field service: Loss of speech. Cure by verbal and electric suggestion in three weeks.

=Case 550.= (SCHOLZ, December, 1916.)

A grenadier, 21, of healthy stock, physique, and habits, lost his speech, April 15, 1916, five weeks after going into the field. May 5, examination showed him a well-nourished healthy man (lively reflexes and slight dermatographia), able to communicate only by signs and writing. The laryngoscope showed almost complete immobility of the two vocal cords, which lay in the cadaveric position, as in paralysis of the recurrent nerves. In endeavoring to pronounce the vowels ā and ee the cords trembled but failed to move toward each other. The patient’s effort to speak was such that his head soon got deep red and sweat streamed from the forehead.

Speech exercises were started by passing the electric current through the larynx during the processes of laryngoscopy. The patient was meantime assured that his larynx was healthy and that he would soon learn to speak again. At the first sitting, the patient felt himself able to cough aloud.

After a few days, the patient was able to speak the separate vowels tolerably well, and was then made to go on with such words as Anna, Otto, Hurrah. The vocal cords began to move better. Fatigue was a feature of the first treatments, of such a degree that words that could be pronounced during the first part of the sitting were lost toward the close.

The grenadier assiduously set himself to say over and over again the words that he had learned, and would come to the sister radiant with joy at his success. In ten days he was able to speak again perfectly, though giving the impression of a slight stuttering. After three weeks hospital stay he was discharged cured and fit for service.

Struck by a rifle butt on right side of head; old wound of right thigh: Hysterical right hemiplegia and deafmutism. Treatment by faradization: Return of speech and improvement of hearing. Full recovery by suggestion. Hysterical CONVULSIONS developed BY HETEROSUGGESTION from convulsive neighbor.

=Case 551.= (ARINSTEIN, 1915.)

A Russian corporal, 21, was knocked unconscious, September 13, 1915, by a butt of a rifle which struck the right side of his head. He came to in a short time. He was examined in hospital, early in October, and besides a small skin wound of the head, there was evidence of a wound on the anterior aspect of the thigh. There was paralysis of both right arm and right leg, and anesthesia of the entire right side of the body, face and even of the tongue. There were also pains over the whole right side of the body. The abdominal reflexes were present on both sides; the tendon reflexes were in excess on the hemiplegic side; there were no pathological reflexes of any sort. The patient’s hearing was diminished, and he could not speak at all although he could understand the speech of others perfectly.

Speech returned after a single séance of suggestion with faradism to the throat. Hearing began to improve. The patient’s suggestibility was a favorable factor in his cure, but there were some unfavorable features. One day, he saw a neighbor go into convulsions and proceeded to develop convulsions himself. These hysterical convulsions continued. According to Arinstein, such undesirable complications appear under conditions of extreme crowding of hospital patients suffering from shell-shock. Progressive séances of psychotherapy caused the disappearance of all the signs of paralysis, and at the time of the report, there was no disability, except that the full use of the hand had not yet been regained.

Shell-shock and burial; labyrinthine disease on one side: DEAFMUTISM. Cures, relapses and eventual cure by general anesthesia, more than four months after shock.

=Case 552.= (DAWSON, February, 1916.)

A private, 30, had been 12 years in the service. July 8, 1915, he was partially buried by a shell which killed two companions.

On admission to hospital he spoke a few sentences but was deaf, and next morning could neither speak nor read, nor did he take food for 36 hours thereafter.

Admitted to the King George Hospital, July 18, he was found stuporous, but started violently if touched, made signs indicating his wants, took no interest in surroundings, and resisted efforts to arouse him. He was without signs of organic disease. It seems that he had been a nervous child, with nightmares and fits.

July 24, he was given gas for dental extraction, partly in the hope that he would recover speech; but though he struggled violently, he made no sound. He had by this time become rather intelligent in a childlike manner, being pleased to see his small boy, but taking no notice of his wife. It transpired afterward that he did not recognize her.

Phonation in whisper now began. There was then a relapse, and for a week or more no food was taken. Such relapses with irritation and hypobulia and an obstinate constipation recurred; but improvement came on slowly. He became able to read short printed words, and later handwriting.

For another month there was no improvement and he lost heart and the will to get well, brightening up only when offered a motor drive or something else pleasant. He was transferred to an auxiliary hospital, against his will, September 18.

November 1, he was brought back to the King George Hospital, excited, shouting, struggling and evidently drunk. On a day’s leave from the convalescent hospital he had come up to London, and in alcoholic elation began to laugh and talk. Morphia did not reduce his violence. He insisted on seeing the physician, to tell him the good news. Hearing was still diminished, though if attention were diverted, direct answers were given to some questions. Sleep followed.

The next day he spoke perfectly but could hear nothing. There was no further progress for three weeks, though he occasionally caught sounds. He now became bright and pleasant and had lost all irritability and sulkiness. Galvanic and faradic current had no effect on the ears.

November 27, after elaborate preparation to heighten the suggestive effect, the patient was kept in bed and given gas and ether up to the abolition of the corneal reflex. As he was coming round, the doctor shouted that he could now hear well. He was overcome with joy and had hysterical convulsions. He could hear, but with the right ear only. In point of fact, the left ear on examination showed signs of labyrinthine deafness. He was placed on home service.

_Re_ etherization for functional deafness and mutism, Ninian Bruce maintains that ether is more satisfactory than chloroform. The loss of consciousness in cases of deafness and mutism ought to be a relatively slight one, and the patient should be suddenly roused to the realization that he is speaking. Recovery from chloroform anesthesia is, according to Ninian Bruce, too slow to allow the patient to catch the point that he is now speaking and hearing when he was formerly dumb or deaf. A failure with the method is a bad thing for the patient, as he loses confidence in the method, whereupon some other method must be resorted to.

_Re_ etherization for deafmutism, see technic of Ninian Bruce under Case 553. Penhallow has a case in which during primary etherization the patient reviewed in a loud voice the whole story of his speech loss. He was found to have recovered speech and hearing after coming out of ether.

_Re_ anesthesia by gas, Abrahams has used nitrous oxide for cure of hysterical paraplegia. Proctor also reports the use of light ether anesthesia for bringing out the voice of functional mutes.

Shell-shock functional deafness (five months). Yes-No test. Cure by suggestion on emerging from ether anesthesia.

=Case 553.= (BRUCE, May, 1916.)

A soldier was admitted to the Royal Victoria Hospital, Edinburgh, completely deaf in the left ear. He had been under shell fire a number of times in France and was eventually thrown down and made unconscious by a shell explosion on his left. He did not remember the noise of the explosion or anything until he found himself in hospital. After the explosion he had begun to stutter, and the stuttering had grown worse. Examination of the ear indicated that the deafness was functional. He was given ether and when just under was asked if he could hear anything spoken in his right ear. He said, “Yes.” With the right ear closed he was asked if he could hear when his left ear was spoken into. He said, “No.” This test was repeated several times. After covering his right ear, he gave his name, regiment, etc., in reply to questions whispered into his left (previously deaf) ear. The incongruity was pointed out. He was now suddenly wakened. He laughed hysterically with joy over his recovery.