D. TREATMENT AND RESULTS OF SHELL-SHOCK. (continued 2)

This man was neuropathic, having always been a rather strange, irritable and restless person, and given to nervous crises in anger, in which he lost consciousness entirely.

Re pseudo operations as forms of disguised persuasion, almost countless methods have been used. See Cases 514, 515, 518, 519, especially 521, 560, 561. Sham injections under ethyl chloride have been made (Goldstein). See also under Case 484, re continuous bath, and under Case 488, re lumbar puncture. Very close to these methods are the methods of torpillage of Vincent and the methods employed by Yealland in England and Kaufmann in Germany. See under Cases 574, 563, and 564, and 570.

Léri quotes Babinski as saying, “We cannot fight hysteria in trench warfare; manoeuvres are necessary.”

Re treatment of mutism, Chavigny remarks that the principle of treatment for mutism is quite different from the principles of treatment of paralysis. The reëducation of mutism is psychic. Chavigny claims probably absolute success in the treatment of mutism through faradism to the larynx region simultaneously with a signal given to the patient to make an effort to pronounce the letter A. Garel modifies the treatment (in case the faradic apparatus is not at hand), by a vigorous and sudden blow to the patient’s epigastrium simultaneously with the patient’s endeavor to imitate the movement of the doctor’s lips.

Shell-shock: Impairment of vision (even commanded men to fire on kindred troops!) Improvement by verbal suggestion, faradization, injections.

Case 517. (Mills, October, 1915.)

A sergeant-major, 29, in private life a bookkeeper, said that shrapnel struck the ground in front of him and burst as it struck. Unconscious for a moment, the sergeant-major thereafter saw everything imperfectly, led his men in the wrong direction, and even commanded them to fire in the direction of his own troops.

Seven days afterwards the eyes looked normal, fundi were normal, vision was reduced to the perception of hand movements; with a plus 10 sphere the right eye could count fingers at 5 c.m. and with a plus 8 sphere the left eye could count fingers at 3 c.m. There was a right frontal analgesia.

Treatment: Sweating; rest in bed for several weeks; assurance of complete recovery. There was a slow but constant improvement, aided by faradization and injections of strychnine sulphate into the temporal region, but the prospect of a return to the front retarded the improvement.

Re injections into the temple, see also Case 521 of Bruce. Re cure of blindness, Grasset has a case of a blind deafmute who was cured by a nurse. She put a pencil in his hand and guided the pencil while she wrote a question. The patient replied in very good MSS. In blind deafmutes sight is described as returning first, hearing next, and speech last.

For other cases of blindness, see especially under Section C, Cases 433 to 438, with discussions thereunder.

Re retardation of improvement by the prospect of further military service, Lewandowski has insisted upon the strong factor of the wish in all such functional conditions. Lewandowski wants all functional cases, however, to be sent to duty in the rear or to be discharged as unfit.

Aphonia: manipulation in larynx.

Case 518. (O’Malley, May, 1916.)

A corporal, 28, had a bullet pass through his neck from a point in the middle line at the upper border of the thyroid cartilage to a point behind the right sternomastoid muscle, two inches below the point of entry. The corporal lost his voice at the time of injury, spat up a teaspoonful of blood, and thereafter was able to whisper only. The laryngoscopic examination betrayed no intralaryngeal lesion. Treatment as described below enabled the patient to speak. O’Malley describes his technique as follows:

The patient is placed in the common position for the examination of the larynx, the tip of the tongue being seized in a piece of linen by the left hand fingers and the laryngeal mirror introduced with the right hand. The patient is then requested to say “e” or cough, and if the cords do not approximate, they can be made to do so by using moderate friction on the fauces and pharynx with the mirror to excite secretion. The latter begins to drop into the larynx, and acting as a foreign body, a protective reflex is at once excited which adducts the cords to prevent the secretion from entering the trachea. At the same time an involuntary cough is produced to expel the mucus, and if the friction and flow of secretion are maintained and the patient is urged to cough vigorously, voluntary coughing and a tendency to retching with forced laryngeal notes will rapidly follow. It is usually best to persist until retching occurs, as the cords are then forced together to protect the larynx and trachea from the possible entrance of regurgitated stomach contents. Involuntary laryngeal sounds are thus produced and the patient is conscious of laryngeal effort. Some of these cases are at the moment very shallow breathers, which can be demonstrated by X-ray screening, but the act of retching causes a wide excursion of the diaphragm with a more pronounced expiratory blast, to be rapidly followed by deeper inspirations. This method of treatment is best carried out just before a meal, as the stomach is then practically empty and the unpleasant effects of the sudden regurgitation of food are avoided. When the explosive sounds accompanying retching have occurred two or three times the mirror is withdrawn, the tongue released, and the patient is requested to swallow, take a deep breath, and cough, and then urged to count up to ten, directing his voice to a certain point on the ceiling. This method has given me uniformly good results, and was rapidly effective in all cases coming under treatment soon after the onset of the neurosis.

Re methods for curing aphonia, Muck has a method called the “ball” method. A ball is put into the larynx to cause a temporary suffocation, which produces a reflex that starts the adductors. He would apply the method as soon as the man was well over the shock that produced aphonia. Muck states that he has applied the ball method, not only to cases of aphonia, but to cases of mutism and deafness, with success.

Tilly mentions a case in which the patient refused to open his mouth, so the device was adopted of passing an electrode through the left nostril so that it finally reached the larynx. A spasm was produced, which was carried to the point of considerable cyanosis, but the aphonia was relieved and for the first time in three months the man spoke. Incidentally he began to hear also.

Re treatment of aphonia, Schultz has used the electric current externally over the larynx, all the while carrying on a laryngoscopy. Schultz remarks upon the fatigue that may come during the first few sittings. Roussy and Lhermitte remark that, although aphonia sometimes exists from the outset of shock, it is often a phase in recovery from mutism.

Liébault notes that, not only cases of true nervous aphonia but cases of laryngitis, apparently of infectious origin, and cases of true voice strain, may also turn up for treatment. Some men have been improperly discharged from the army for aphonia actually due to voice strain.

Hysterical aphonia in a mechanician (war time contributory?). Cure by suggestive manipulation of larynx.

Case 519. (Vlasto, January, 1917.)

A mechanician was refitting an engine valve, when steam was suddenly put on and the drains were opened out. Some of the steam entered the throat of the mechanician, who rushed up, gasping, unable to speak. Oedema of the larynx was thought of; but there was no complaint except the inability to speak.

A month later he was discharged to the hospital ship at Plassy, where he got faradic treatment, the effect of which was to cause him pain without recovery of voice. The man could whisper well enough and cough fairly loudly. The vocal cords of the larynx appeared normal on laryngoscopic examination, but adduction of the cords was not be properly effected. He was now given rest and constant assurances that he would get well.

Ten days later, another laryngoscopic examination was made, with mild mechanical stimulation of the air passage. The patient remarked that he had never been so near being able to speak since his dumbness came on. The patient was now informed that his muscle of talking was going to be replaced and that the success of the operation depended upon his help, so that he was to shout out as soon as he became conscious of the physician’s working inside his throat. The patient was given ether lightly, into the second stage. When consciousness was about to return, the laryngeal mirror was placed lightly on the larynx. The patient was commanded and encouraged to count out loud and shout. Speech returned permanently.

It is to be noted that there was no specific war effect underlying the phenomena, unless we regard the fact of its being war time as contributory to the shock produced by an incident in every day engine room duties.

Gradual onset of mutism and amnesia without special occasion. Faradism. Dream.

Case 520. (Smyly, April, 1917.)

A soldier was slightly wounded in the arm and returned to the trenches. Later he found himself in hospital at Boulogne, unable to speak and unable to remember what had happened to him from the time he was in the trenches. It appears that his voice and memory had gradually disappeared, according to what was told him by his comrades.

A month afterward, in a London hospital, the patient was roused suddenly from sleep, and then proved able to speak, although there was great difficulty in getting each word out. Two months later, he went to bed, feeling indisposed, in the night had a kind of fit, and remained unconscious until the following night; the next morning, his voice was again lost. The aphonia persisted for a fortnight, and the patient could hear only loud shouting when close to his ear. He was anxious to get well and requested electricity from the physician, Dr. Smyly, having heard probably of another case cured thereby. Dr. Smyly applied faradic current to the larynx externally, instructing the patient to blow at the same time. At first the patient spoke so low that he could not hear himself speak, but on suggestion succeeded in speaking up loudly enough. He was shortly able to speak and hearing improved. The climax arrived with a bad dream one night, from which the patient awoke in a fright and found himself able to hear and speak perfectly.

Re nocturnal spontaneous cures, see observations by Mott under Case 473. Note also in this case the presence of what Mott has termed “the atmosphere of cure.”

Re relapses, see Case 476 as well as remarks under Case 474. Re special cases of mutism, Goldstein has insisted upon a greater individualization of treatment for functional mutes than even for other neurotics, and advocates the establishment of schools within the hospitals and aftercare institutions. He thinks the problem very serious.

Shell-shock blindness: Cure by a course of injections in the temple.

Case 521. (Bruce, May, 1916.)

A soldier from Gallipoli was admitted to the Royal Victoria Hospital at Edinburgh, blind. He had been at Gallipoli from May 1, 1915, until August 12, when a shell explosion blew in his trench and buried him. He was dug out nervous and tremulous. Shortly afterwards there was the bright flash of a second shell, and amnesia set in until he found himself in hospital. He could not see at all with the left eye and the sight of the other was poor. He arrived in Scotland, October 9. He was nervous, excitable and now somewhat depressed, complaining of blindness and pain in the left eye, and headache. The left eyelid drooped. The fundus was normal. He had not been given an anesthetic.

It was explained to him that the eye had not been injured; that it had become weak from the explosion; that he would be given a series of injections into the left temple of a strong drug which would restore the sight of the eye.

Gradually increasing quantities of normal saline solution were given every morning. After four days he said that the treatment was doing him good. A week later he said that the eye was much stronger. After the fifteenth injection he could not sleep. The headache was worse, and there was “moving about inside his head.” Early in the morning he went to sleep after a period of restlessness. He awoke at eight o’clock able to see perfectly, and was overjoyed at the result. There was some blurring and four days later he said he was becoming blind again. More normal saline was injected, causing pain. After that there was no relapse, and the man was sent back to his unit.

Re Shell-shock blindness, Ormond and Hurst recommend a light hypnosis; taking the functionally blind man into a dark room and requesting him to make his mind a blank. Some cases are refractory. An anesthetic may be used with suggestion in the semi-conscious stage.

Deafness, cured by suggestion in writing.

Case 522. (Buscaino and Coppola, 1916.)

L. G., 20 years old; fusileer. (Mother of neuropathic constitution. Father died in 50th year of heart disease. One brother had hemiparesis from infantile cerebropathia.) The patient suffered from infantile otitis media bilateralis, which was followed by abundant chronic otorrhea from his fifteenth year. He relates that for a long time he was obliged to wear a very large handkerchief on his shoulders to receive the pus, which came from an ear. No sex disease. Nothing of importance in the physical anamnesis.

Patient entered the army, Jan. 15, 1915. In May, he was sent to the front (Basso Isonzo). Towards the end of July, while he was in the trench, a grenade exploded a short distance from him, causing slight abrasions at the nape of the neck and in the fleshy part of the left calf. He was picked up in an unconscious state, and taken to the hospital at Cervignano, where he was admitted as a deafmute and was given electric treatments. After 18 days or so, first stammering and then pronouncing with difficulty a few words, he finally regained his speech entirely. Deafness continued, however.

Being transported to a special hospital in Florence, he was in a state of psychic excitement for several days, showing also visual hallucinations—saw “many soldiers,” saw “many soldiers all about him.” He was treated with chloral and bromide. The suspicions of several physicians were aroused by the obstinate declaration by the patient that he was incurably deaf.

On being admitted to the clinic on August 22, he showed complete deafness in addition to a slight degree of stupor; he remained impassive to the glance of his questioner without showing signs of worry about his condition, nor did he make any effort to make himself understood by making lip-movements (which is in contrast to another patient affected by organic deafness, who on the contrary made great efforts to understand anything said to him, clearly showing his great grief over his incapacity).

He failed to respond to auditory stimuli either by air or by bone conduction. It was possible from the beginning to exclude suspicion of simulation; during the day, indeed, it was not possible by any of the repeated attempts to awaken surprise in the patient by means of an acoustic stimulus. At night, while the patient slept, it was possible, however, to awaken him by calling his name, or by making a fairly loud sound; the patient would then open his eyes but was quite unable to hear. Neither confusion nor hallucinations were in evidence.

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.

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.”

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.

But the next morning he was again stone deaf in the left ear. Blistering and electricity failed to produce benefit. He was, however, puzzled about himself.

After a fortnight he was again given ether and a little chloroform was added. The yes-no test was again positive. He was allowed to recover gradually from the chloroform, but he had now lost recollection of what had happened. The left ear remained deaf. Ether was again given. He was asked to close his right ear with his finger. While answering questions addressed to his left ear, he was suddenly awakened and immediately said that his hearing had come back. This return proved permanent. He returned to his dépôt. In the conversations under ether there was no stuttering. He had been totally deaf in the left ear for five months.

Blow in neck by rifle butt: aphasia, right hemiplegia and hemianesthesia, and especially (here MEDICAL suggestion) trismus: Recovery by anesthetic and suggestion.

Case 554. (Arinstein, September, 1915.)

A Russian soldier was struck in the head and neck by a rifle butt, and developed paralysis of right arm and leg with loss of speech. After the excitement experienced by the patient when exhibited to the students by the late Prof. M. N. Szukowsky in the neurological clinic of the Military Medical Academy, trismus developed.

The patient spent a year in various hospitals, the most diverse methods of treatment by drug therapy, electricity, and suggestion yielding no results. The patient had to be fed chiefly by nose and rectum, though small quantities of fluids were fed through the mouth through an opening formed by the falling out of one tooth in the upper jaw. The patient became greatly emaciated and weak and was, October 29, 1915, brought into the nervous wards of the hospital.

He showed flaccid paralysis of left arm and leg, together with anesthesia, analgesia and thermanesthesia over the whole left side of the head, extreme general atrophy of muscles, somewhat more marked on the palsied side. The temperature of the paralyzed half of the body was not lowered. No knee or Achilles reflex obtained upon either the affected or the healthy side (general exhaustion?). Abdominal and testicular reflexes lively. The pupils responded well to light. Corneal reflexes lively. The neck was held awry to the left, and the head was inclined somewhat downwards and leftwards; hearing on left side impaired. The jaws could not be opened even with the greatest effort. Wassermann reaction negative.

Patient thought himself incurable. Purves Stewart’s case, in which chloroform and oxide of nitrogen were used, was the basis of Arinstein’s treatment. It was suggested to the patient that he submit to narcosis with the proviso that he would not be operated upon. His consent was secured; with the coöperation of others, the chloroform was administered November 6. The stage of excitability was not well marked. 8 gr. of chloroform was used altogether, by the drop system. Nevertheless, even with the weak initial excitability, the patient became capable of some movements with paralyzed hand and foot. On opening mouth, the patient yawned yet uttered no sound. Between the jaws was put a rubber insertion and upon awakening the patient was let see with his own eyes that his jaws were open and that therefore food might be introduced through the mouth. Upon repetition of the narcosis, 5 gr. of chloroform was used altogether, and the stage of excitability was this time better marked. To strengthen movements in the paralyzed extremities, the device of pricking the patient with a pin on the unaffected half of the body, with the unaffected hand and leg held horizontal by assistants, was adopted. The patient then made reflex defensive movements in the paralyzed extremities, especially the hand. At this point the narcosis was suspended, and the irritation with the pin was continued until consciousness returned. At this moment, the patient’s attention was called to the disappearance of the paralysis and his restored ability to move the paralyzed extremities.

From that time on, the patient’s condition underwent a sharp transition. Artificial feeding became unnecessary. The patient ate by mouth; the mouth was opened by the leverage of a small stick held by the patient between his teeth. Speech returned gradually. In reading aloud the patient aided the movements of his lips with his hands. At the time of report the patient spoke well, ate normally, had gained in weight, and with some effort could sit down and even stand and walk. All this was attained in a relatively short time after a whole year of paralysis.

The author felt that the success attained in this case gave him the right to use the same method where the cause was not a contusion.

Ten months’ field service; severe FEBRILE DISEASE: Afterward hysterical TRIPLEGIA, MUTISM, “JUMPING-JACK” reactions to stimulation of feet. Cure by anesthesia, verbal suggestion, faradism to palate.

Case 555. (Arinstein, September, 1915.)

A Russian private, 30, brought to a field reserve hospital, June 20, 1915, was in a grave condition diagnosed typhoid. By the end of June the general condition had improved and the temperature had fallen.

July 9, worse; happening to be in the company of a sanitary in a privy, he was observed suddenly to fall unconscious, with both feet and left arm paralyzed. Soon afterward he lost the power of speech. From September 30 to October 19, he lay in field hospital; but was then transferred to the nerve hospital with diagnosis: convulsive paralysis and aphasia. At entrance, complete paralysis of both legs and left hand; loss of speech and aphonia (speech understood). Upon touching a foot, strong convulsions developed with legs rapidly drawn apart and drawn together much in the manner of dancing toys. The mouth was twisted to the left. Though he silently opened his mouth and made rapid movements with the lower jaw, he could not utter a single sound, either vowel or consonant. Left hypalgesia. Hypesthesia of skin of hand and mucosa of tongue. Knee-jerks absent because of the strain of the muscles of the legs. Wassermann negative.

The history showed that the speech of the patient had been incorrect and indistinct from childhood. Moreover, in 1908, in chopping wood in the forest he had fallen under a sleigh and hurt his left hand, which had not since fully recovered. He had volunteered for the war.

The psychogenic character of the disease seemed clear. Suggestion was followed by ether narcosis, during which, on pricks of the healthy side with a pin, the patient made defensive movements with the paralyzed hands, and also moved both legs. Speech was not regained either during or immediately after the narcosis, although the patient gave forth indefinite sounds. Speech was restored on the same day, September 7, with verbal suggestion and faradic brush applied to palate. The patient at once began to speak clearly and distinctly, read his prayer book, and described distinctly and in detail how he went to war. From that moment the convulsive movements in the feet disappeared, the region of anesthesia on the left side narrowed, speech was permanently reëstablished, and the patient began to move with his feet and finally began to walk after six months of paralysis. Before that time no medical treatment had had the slightest effect. The effort to stop mechanically the jerks even temporarily by means of plaster casts had been unsuccessful. In sleep the twitches ceased, but upon reawakening, even before full consciousness returned, the jerkings would resume. It is curious to note that upon falling asleep under the anesthetic the patient would issue always one and same kind of yells—“Help, there goes the German! They are shooting! Russians, do not yield!”

Re chloroform anesthesia, Milligan remarks that the treatment should be carried out in a quiet, single room, with the chloroform slowly administered and the suggestions made by the anesthetist during the optimal phase for suggestion,—just before the stage of involuntary struggling.

Shell-shock; unconsciousness: Mutism and musical alexia. Cure by anesthesia.

Case 556. (Proctor, October, 1915.)

A private, 23, was admitted to the Duchess of Connaught’s Hospital at Taplow from Gallipoli, September 10, 1915. A shell had exploded behind this man. He had been picked up, unconscious, and remained so about a day. He recovered without the power of speech. Cerebration was slow at first but improved steadily.

The man had been a professional musician. Curiously enough, though his ability to read ordinary print was as good as ever, his reading of music was lost with the speech.

September 20, he was etherized, but being of a phlegmatic type, he was not readily excited and took the anesthesia very quietly. After perseverance, however, he was induced to talk. The ability to read music returned with the voice. He was discharged, October 4, 1915.

Re the use of anesthetics for curing deafmutism, Colin Russel rather disapproves of this method on the ground that no attempt is made to get at the genuine pathogenesis of the case and that accordingly there may be a tendency to recurrence.

Re the peculiar musical alexia, see discussion under Cases 353 and 450 of confusion and amnesia. The most highly selective amnesias have been found in confusional cases. However, Case 556 had been a professional musician and the effect may have been a highly specialized suggestion. See also Case 369 of Feiling for differentiated musical disorder. Mott has used the retained knowledge of tones as an avenue of approach in certain mute cases.

Shell-shock; burial (24 hours?); unconsciousness, 13 days: Deafmutism. Chloroform narcosis cured the deafness (!), not the mutism.