=Case 494.= (BINSWANGER, October, 1917.)

A soldier (brother choreic, sister infantile palsy) had had measles

at 13 and in his fever climbed out of bed upon a couch, fell from

the couch and was found by his mother lying on the floor. He was of

moderate intellectual grade, of an emotional, passionate Saxon nature

and had now and then been intoxicated.

In September, 1914, he was wounded over the right eye. He did not lose

consciousness but concluded that he could not get back to his own lines

on account of the enemy fire. Using a knapsack to cover his head, he

lay down for twenty-four hours, until rescued by a passing body of the

sanitary corps who were about to leave him for dead when he called

loudly to them.

He was very weak in hospital and, towards the evening of the day after

receiving his injury, he must have fallen into some sort of psychotic

state lasting ten days. For this he remained quite amnestic, although

he was told by comrades that he had hallucinations and had scolded and

yelled, hearing voices. Apparently there were situation-deliria--the

call to go over the top. Temperature, which had run to 38.8, after ten

days sank to normal, and consciousness cleared up.

Was this a case of protracted febrile delirium? Or of psychosis due

to _commotio cerebri_, that is, an effect of heightened intracranial

pressure? Or was it exhaustion-delirium following loss of blood, sleep

and food?

But this was not the end. The wound suppurated, and in May, 1915,

eight months after the injury, operation was performed to relieve this

abscess. Temperature immediately rose to from 38.4 to 38.6, the fever

lasting three days, and a second psychotic phase with complete amnesia

entered. He went into this phase immediately after recovering from

the operative narcosis, looking wildly about and cursing the sister.

The patient was violently excited and was put in a straight jacket

on the second day. This phase may be regarded as one of epileptiform

excitement with delirium. The operation may have played a part in the

psychosis.

There were no further psychotic phenomena which could be attributed

in any way to _commotio_. There were, however, attacks of cortical

origin and emotional seizures. The patient became emotionally excitable

and lost all inhibitions against expression of emotion, such as

crying. Once he actually tried to suppress his emotion with a noose

about his throat. He became seclusive and withdrew within himself--a

victim of Kaplan’s explosive diathesis, or of Bonhoeffer’s emotional

hyperesthetic defect condition.

A second operation was performed in September, 1916, to loosen the

brain scar, and a large splinter of bone was removed. During the

operation, under local anesthesia, there was a severe cortical

seizure with complete disappearance of the reflexes. Ether was then

administered. Later, in the same day, there were several minor cortical

attacks.

After this operation the man’s emotional status changed; he was no

longer irritable or exclusive, but became slightly euphoric and

contented. He received during the next two weeks four tablets of

Sedobrol and for a long time thereafter two tablets daily. There were

never any phenomena of bromidism or any suggestive effects of the

bromides.

The first attack after the second operation came in November, 1916, and

was followed by slight dysarthria. Repeated attacks followed which were

attributed to contractions in the scar. Accordingly, a third operation

was performed and an attempt was made to bridge over a defect in the

right frontal bone. The man’s emotional status remained good after the

operation, but further attacks appeared six weeks later and there were

spells of dizziness. Occasionally, in process of thinking, he said

something stuck in between his thoughts. Sometimes thinking broke off

sharply as if he had cut through a wire with an electrical current in

it. There was a slight reduction in attention and a slightly increased

fatiguability.

Hard service; shell explosion with loss of teeth: Vomiting. Cure by

restoration of self-confidence.

=Case 495.= (MCDOWELL, January, 1917.)

A married reservist was called up at the outbreak of the war and went

through Mons, the Marne, and the Aisne and was finally blown up by a

shell at Ypres. Early in November, 1914, he lost his speech but got

it back in time to get home for Christmas. A number of teeth had been

lost in the injury. Vomiting began first in England. While on leave at

home he vomited at every meal. Asked whether it was his food or his

thoughts, he said, “You are quite correct, Sir, you know I have always

been with thinking.”

Under medical care, June, 1915, he was found suffering from hesitating

speech, general tremulousness and emotionality. He worried a great deal

on account of money matters at home. He lay awake thinking. A child

became ill and died, and all the while he got worse, “thinking all the

time.”

It was explained to him that the vomiting was a matter of emotions. The

lost teeth were replaced by false ones. As he began to get control of

his emotions, he vomited less and increased in weight. Finally he was

boarded for discharge and was sick again on the day of the meeting. A

fortnight later when sent to sign discharge papers he vomited once more.

According to McDowell, the vagus may possibly be incriminated as a

cause of these gastric disturbances. Practically, the vomiting is a

result of emotional stress. The cure is to produce insight on the

part of the patient, the removal of worry and the restoration of

self-confidence.

Michell Clarke cured such cases with milk diet.

Roussy and Lhermitte find hysterical vomiting to be relatively common

and as a rule without difficulty in diagnosis; but they remark that

there is often some underlying organic condition to be sought for and

treated after the neuropathic element has vanished. They remark, also,

that there is no tendency to spontaneous cure of the disease. They

advocate a strict dietetic régime and psychotherapy.

Cure of self-accusatory (“started retreat from Mons”) and other

delusions by “autognosis.”

=Case 496.= (BROWN, January, 1916.)

Capt. William Brown, in the discussion at the Section of Psychiatry of

the Royal Society of Medicine, January 25, 1916, speaks of a method of

treatment which he calls _autognosis_--a method of giving the patient

self-knowledge, by revealing to the patient through his own confessions

the cause of mental change leading to his symptoms. One of Brown’s

examples is that of a sergeant in the firing-line during the retreat

from Mons. He was admitted to Maghull with the delusion that people

thought he had given the signal for the retreat from Mons on a silver

whistle, a shooting prize of his. German officers used silver whistles

that made a note like his own. In fact, he had other like delusions,

such as that people thought him responsible for an Edinburgh railroad

accident in connection with his troop-train. A German spy might have

heard this.

In the process of procuring autognosis, Capt. Brown found that at the

age of 12 this man had been falsely accused of stealing pork pies from

a shop, and had been brought before a magistrate. In point of fact, he

proved an alibi, but he was greatly worried by the charge. According to

Capt. Brown, this incident of the insistence of the false accusation

was the beginning of his tendency to delusions. In two months’ time

there was a remarkable improvement.

_Re_ psychoanalysis, autognosis and various modifications, Forsyth

remarks that when the acute stage is passed, the Shell-shock case

becomes an everyday neurosis in which war experiences are merely the

latest phases in the patient’s life, and that psychoanalysis may then

become necessary. Eder regards the “mechanisms” of what he terms “war

shock” as the Freudian mechanisms of hysteria, and has commended

psychoanalysis for a few cases, preferring hypnotism for acute

cases. Adrian and Yealland decry psychoanalysis on the score of time

limitations.

Deafmutism in three men shell-shocked at one time.

=Cases 497, 498, 499.= (ROUSSY, April, 1915.)

There were three Zouaves in a first-line trench north of Arras, January

14, 1915, who were blown up by a bomb thrown from the enemy trench

some hundreds of meters away, by a mortar, a _crapouillaud_. This

projectile burst with a great noise, louder than that of a bomb, and

made a very strong windage. A dozen men were blown under the trench

wall, just after entering the trench; two were killed; and the others,

most of whom had been buried to the neck, were pulled out and carried,

trembling, to the nearest relief post. Two of the three Zouaves were

bleeding at nose and ears, and all three were absolutely deaf and

mute. Evacuated to an ambulance, and thence to Paris, they arrived at

Val-de-Grâce, January 17, that is to say, three days after the shell

burst. They communicated with the attendants by signs; one got hold

of paper and wrote several hours in the day rapid notes about the

accident. However, hysteria or pure simulation was suspected in these

three Zouaves, and they were placed in small separate rooms. They

were informed through the physician’s remarks to his staff that these

were cases of nothing but simple nervous shock such as we had often

observed, and the claim was made that they would be completely well

either on the morrow or the day after.

On the morrow, two of them partially recovered hearing and got back

their voices. They became loquacious and began to tell about the

battle. The day after, the third patient began to speak. Two of them

showed traces of auricular hemorrhage, and in fact, actual ear lesions

were found in all three. One had a suppurative right middle ear, with

perforation; another had both drums perforated and a suppurative middle

ear, also on both sides. The third, who recovered his speech after the

others, had perforation of the left tympanum with a little suppuration

of the right ear tympanum and a slight tear of the right tympanum. In

April, 1915, the hearing was cured.

These men had been under fire several months, and had taken part in the

battle of the Marne. It was not a question of their first baptism of

fire, and in fact, each of them had been previously wounded. According

to Roussy, the story is, that the shell-burst produces by displacement

of air tympanic perforation, and at the same time a violent nerve

shock with loss of consciousness for a few minutes. The men come to,

but the ear lesion, probably exaggerated by the nervous status of its

bearer, creates a complete bilateral deafness. This deafness produces

an absolute hysterical mutism.

_Re_ case groups of war neurosis, several writers speak of dangers

of contagion, but also emphasize the values of contact of patients

with one another in the securing of therapeutic results. What

Mott has termed the _atmosphere of cure_ was no doubt present in

the three instances of Roussy just cited. The cure of one may act

heterosuggestively to produce the cure of a second, and so on.

Functional deafmutes are somewhat refractory as a rule. H. Campbell

states that there is some danger attached to allowing large numbers

of functional cases to consort together too closely. He suggests

making use of small wards and screens, and a process of sorting out

patients so that they shall not affect one another injuriously. Steiner

especially stresses the value of individual rooms in preventing psychic

infection, of which, he says, the danger is large in open dormitories.

The psychic contagion is as a rule that of hysterical seizures and

tremors; but complaints about faulty hospital arrangements are also

readily spread. Steiner advocates never questioning a nervous patient

concerning his troubles in the presence of other soldiers. To reach 60

to 70 patients, Steiner had one examining and treatment room. Roussy’s

institution at Salins in 1917 had a service limited to traumatic

hysteria, from which, in three months’ time, 200 subjects had been

discharged cured (see Boschi).

Dysentery: Milk diet persisted in: Vomiting, incontinence, inability to

walk. Cure by persuasion.

=Case 500.= (MCDOWELL, December, 1916.)

A soldier, 25, a low menial when war broke out, developed “dysentery

and gastritis” at the Dardanelles, although even before the dysentery

his nerves had gone bad. He had diarrhoea and vomiting, was sick every

day, found himself unable to walk, and found himself always wet with

urine dribbling day and night. Arriving in England and treated in a

hospital, he still had vomiting. He had lived on milk and custard and

been kept in bed.

Capt. McDowell convinced the patient that his legs were not as weak as

he supposed. He was encouraged to walk, put upon light diet and then

upon ordinary diet. He became an active worker in the ward, later going

for five-mile route marches. Two months later he went back to duty

in good health, weighing seven pounds more than before. This man was

weakminded and, when his dysentery was cured, did not dare to start

eating ordinary food. He was a victim of hospital régime. Individual

attention would have obviated much of the subsequent state.

_Re_ vomiting, see remarks under another case of McDowell (Case 495).

_Re_ incontinence, see Case 384, of Guillain and Barré.

Officer dies in convulsions: Servant develops hysterical convulsions,

which vanish on being explained as such.

=Case 501.= (HURST, March, 1917.)

An officer and his servant were blown up by a shell. The servant ran to

fetch a stretcher for the officer, to whom he was much attached, but

on his return the officer made a few convulsive movements and died.

Immediately after, the servant had a fit. During the next two months he

had eleven more. Hurst made a diagnosis of hysterical fits resulting

from emotion, explained his idea of their origin and nature to the

servant, and the convulsions then ceased completely.

_Re_ hysterical convulsions, see remarks under Case 443.

Course of a case with crises of trembling.

=Case 502.= (ROUSSY, April, 1915.)

A soldier in the artillery, who had been in the lines from August

as a kitchenman, looking after the food of the first line trenches,

with which his shelter was connected by communication trenches, 800

meters away, was on January 17, 1915, with three other men placed in

the shelter kitchen of the trenches but a short distance away from

the French artillery. The firing passed over the heads of these men

but they could feel the windage, which obliged them to lie down each

time. The evening of that day, several hours after firing had ceased,

the kitchenman had a shivering spell, with trembling that lasted all

night; after which these crises came on every day. He had finally to be

evacuated to the rear.

According to Roussy, such patients always have neuropathic taint and

a history of previous crises. Such a patient ought to be handled

with rather severe discipline. In this way, according to Roussy, the

reappearance of a severe attack of convulsions can be prevented. But

these patients cannot go back to the front.

_Re_ tremors, see Cases 224 and 225.

Two cases of lameness cured by persuasion: Russel.

=Case 503.= (RUSSEL, August, 1917.)

A man on crutches, paralyzed completely in the right leg, partially

in the left, developed paralysis in the right arm from the use of the

crutch. There were marked vasomotor changes in the right leg and arm

together with anesthesia to pinprick. Assured that he could move the

legs perfectly he said that he had tried and failed. After a persuasive

talk in private he began to use the arm, and to walk perfectly. It

seems that in the trenches he had a sharp pain in the right knee, after

which he did not use the leg and it gradually became more and more

useless. It had been paralyzed for three months. The reason he did not

use this leg was not on his own account, but on account of his mother

at home. He seemed really grateful for the cure.

=Case 504.= (RUSSEL, August, 1917.)

A sergeant in hospital for a year for shell-shock still had a marked

shaking of the right leg whenever he raised it from the ground. He

walked in leaning on a silver headed cane. The functional nature of

his shaking was explained to him by Russel, whereupon he walked out

normally saying he could do without his cane. Russel suggested that

crutches and sticks thus given up were often donated to the shrine. The

sergeant whose cane must have cost at least three pounds beat a hasty

retreat carrying the cane in front of him.

_Re_ Russel’s general point of view concerning malingerers and

psychogenic cases, see under Case 458.

Hard patrol work: Delirium; head tremor augmented by excitement:

Virtual recovery on bandaging neck, isolation, open air, to-and-fro

transfers to mental and nervous wards.

=Case 505.= (BINSWANGER, July, 1915.)

A metal moulder in civil life, 29, in military service 1907 to 1909 (no

hereditary taint, moderately good scholar), became unconscious for a

half hour after taking a cold drink following a somewhat long practice

march, at some time during his first year of military service.

He was in several skirmishes in Belgium and Northern France early in

the war, being once surrounded in patrol work (November 11) by Turcoes

and Zouaves. There was a lively exchange of shots, in the course of

which five of the eight men on patrol fell. The three survivors hid

themselves for three days in a quarry, and on the fourth were found by

the advancing troops, and immediately went into battle.

But during a pause while on the point of taking coffee, the man

suddenly fell sick, tried to carry on, but lost consciousness and

apparently remained unconscious for about three-quarters of an hour. It

seems that he raved and shouted and tried to bite his fingers, being

held with great difficulty by several comrades. He was removed to a

dressing-station three km. distant.

At the dressing-station, his head began to shake, although he was

unaware of this until his attention was called to it by his comrades.

He said that he felt restless and that his head ached almost

continually. He was carried to the reserve hospital, and from thence,

December 9, 1914, to the nerve hospital at Jena, where he was unaware

of the shaking of his head (which had now lasted for three weeks),

and said that he felt a thick fog in his head (to say nothing of

headaches), and was only free and clear in his head while standing in

the open air.

His sleep was restless and poor; there were war dreams almost every

night. In the process of getting to sleep, his arms and legs frequently

twitched. He would soon tire and feel weak. Also since his dangerous

experience, he had noticed a change in his speech: always fluent

before, it was now hard for him to speak because one had to exert one’s

head so much in speaking.

This head tremor was in fact the most marked symptom of his illness. It

would increase on every active motion of the head, but ceased almost

entirely when attention was diverted. The head would then be held bent

to the right.

During emotional excitement, the shaking spasm would spread over the

entire upper part of the body, but would remain more severe upon the

right than upon the left side. The forearms would fall into a lively

shaking movement of pronation and supination. The hands and fingers

would be attacked by a less marked tremor. After calm had set in,

a fine tremor of the right hand would remain plainly noticeable.

The musculature of facial expression would frequently fall into

spasmodic movement, the left corner of the mouth twitching, the lips

set for whistling, or the upper lip making movements as if snuffing

spasmodically.

Physically the man was of medium height, strongly built, with adherent

lobules, and a somewhat pointed skull. The teeth were defective and

irregularly placed. Both deep and skin reflexes were increased. Marked

dermatographia and mechanical excitability of the muscles: periosteal

reflexes strongly developed; numerous pressure points in the head.

The right temple and back of the head were painful on percussion.

The patient showed no disturbance in touch and pain sensibility.

Outstretched tongue showed marked fibrillary twitching; speech was

difficult, being slow, awkward, stumbling, and sometimes hesitating

(suggesting the speech of general paresis). At other times, the speech

was of a peculiar sighing, tremulous nature, reminding one of the

speech of children complaining or asking for pity. Rest was secured

by injections of salt solution. A few days later, the treatment was

continued by a bandage about the neck. After this the tremor grew

slighter and would even remain absent for some hours. The patient

was told to rest in bed and not to speak much; being “seriously ill,”

he was kept alone. He was often irritated, querulous, and subject to

outbursts of profanity. He took food well and slept well, receiving

sodium bicarbonate.

The bandage was changed after five days. The tremor was very marked.

The patient was furious because visitors were refused to him. He

was especially angry with his nearest relatives and his betrothed,

and wrote defiant letters to all of them. He became one of the most

troublesome patients in the psychiatric division of the hospital. He

complained sometimes of anxiety and feelings of unrest. He received

treatment by pantopon. He continued to be a very disagreeable patient,

feeling himself opposed and not properly considered. He thought himself

seriously ill, behaved much like a spoiled child, and was of the

opinion that he would not get well in the hospital because they were

grieving him so. His appetite became bad; he complained of pains in the

loins and of rheumatism in the legs. A cord was found hidden in the

bed. The patient expressed suicidal thoughts at various times.

At the beginning of January there was marked improvement. The

headshaking ceased almost entirely; the patient walked in the garden

some hours daily. However, in the middle of January, on refusal of

furlough, the head-shaking began again markedly. At his request

a bandage was placed on the head again for a few days. He seemed

emotionally very tender; his head would shake at the sight of a dead

rabbit.

He was transferred to the nerve division of the psychiatric clinic at

the end of January. He had recently begun to complain of flickering

before the eyes. The ophthalmologists established an existence of a

choroiditis disseminata. The eye examination had a markedly depressing

effect upon the patient, and the shaking spasm of the head appeared

again. Upon being told that he would have to be sent back to the

psychiatric section of the clinic, the shaking immediately disappeared

(24 hours after it had begun).

Thereafter slow improvement followed. He stayed in the open a great

deal and walked. March 2, he showed a vehement outburst of anger,

quarreling and using violence with a comrade. He was brought back to

the psychiatric section, and in transit had a severe hysterical attack

with unconsciousness, crying fits, and stepping movements of the

extremities. He was promptly taken to a section for those seriously

ill. The next day, upon his assurance that he could control himself, he

was put in a more quiet division. He began to take part in gymnastic

exercises, worked as a coachman, and then as an experiment was sent to

a gentleman’s estate for recreation. At last accounts he was feeling

well except that he occasionally had headaches during work. He could

not work so hard as before on account of the rapid onset of fatigue,

especially when working in the sun. The head-shaking recurred but

seldom and lasted for a few hours only when the patient became angry or

when there was much noise about.

Rationalization of war memories: Returned to duty.

=Case 506.= (RIVERS, February, 1918.)

A young English officer was wounded just as he was extricating himself

from burial in a mass of earth. He became nervous and sleepless and

lost his appetite. After the wound had healed, he was sent home on

leave, which had to be extended as he got worse. An out-patient in

London for a time, he was finally sent to a convalescent home, still

troubled with insomnia, battle dreams and concern about his recovery.

He made light of his condition and was on the point of being returned

to duty by the medical board, when his sleeplessness led to his being

sent to Craighlochart War Hospital.

He could not sleep without a light in the room, else every sound

attracted his attention. He tried hard all day long to banish all

unpleasant and disturbing thoughts, but at night it took him a long

time to get to sleep and then came vivid dreams of warfare. He did not,

himself, feel that he could ever forget the war scenes.

Rivers, in general believing that the attempt to banish such

experiences absolutely from the mind is poor psychotherapy, narrated

his views to the patient. Rivers advised him no longer to try to

banish the memories, but to try to transform them into tolerable,

if not pleasant, companions. The war experiences and anxieties were

talked over. That night the man had the best night he had had for five

months, and during the following week the sleeplessness was no longer

so painful and distressing. If unpleasant thoughts came, they had to

do rather with home life than with the war. General health improved;

insomnia diminished. He was at last able to return to duty.

Rationalization of war memories.

=Case 507.= (RIVERS, February, 1918.)

An English officer was buried by shell explosion and developed severe

headache, vomiting and disorder of micturition, yet remained on duty

for more than two months. Collapse came when he went out to seek a

fellow officer and found the body blown to pieces, with head and limbs

severed from the trunk. This vision haunted him in dreams. Sometimes

the officer appeared as on the battlefield; again as leprous. The

officer would come nearer and nearer in the dream, until the patient

woke pouring with sweat and in utmost terror. Accordingly, he was

afraid to go to sleep, and spent all day thinking painfully about the

night to come. Advice to keep all thoughts of war out of mind merely

brought the memories in sleep upon him with redoubled force and horror.

Rivers’ therapy was to draw attention to the fact that the terrible

mangling proved conclusively that the officer had been killed outright

and without pain. The officer said he would now no longer attempt to

banish the thoughts and memories of his friend, but would concentrate

on the pain and suffering his friend had been spared. No dreams at all

came for several nights, but one night in his dream he went out into

No-Man’s-Land and saw the mangled body, but without horror. He knelt

down, as he had in the original experience, and woke as he was taking

off the Sam Browne belt to send to the relatives. A few nights later

came another dream in which he talked with his friend. There was but

one more dream in which horror occurred.

Rationalization of war memories: Eventually unfitted for military

service.

=Case 508.= (RIVERS, February, 1918.)

A young English officer, after doing well for a period, was rendered

unconscious by shell explosion. The first thing he remembered was being

led by his servant towards his base, thoroughly broken down. He had

headaches, sleeplessness, war dreams and spells of terrible depression

appearing with absolute suddenness, unlike ordinary “blues.” For ten

days in hospital no such attack appeared, but one evening he came to

Rivers pale and anxious. A few minutes before, he had been writing

a letter in his usual mood, when this causeless depression came on.

In the afternoon he had walked about on some neighboring hills. The

letter dealt with no depressing matter. In ten minutes the depression

vanished. Nine days later another came as he was standing idly looking

out of a window. The attack lasted for several hours, as no physician

was present to meet the issue. If he had had a revolver he would have

shot himself.

Rivers was inclined to interpret these gusts of depression as due to a

forgotten but active experience. As there was no definite tendency to

dissociation, Rivers hesitated to plunge in with the hypnotic method,

nothing short of which, however, served to recall the incident. The man

was gravely apprehensive about fitness for further service, and was

repressing his fear, as he thought it either was cowardice or would

be called cowardice. The patient, by his discussions with Rivers, had

already become familiar with the idea that the gusts of depression

might be due to a submerged experience. Perhaps, however, there had

been no experience, and the patient was advised that possibly the thing

repressed was the idea about fitness for service. Accordingly, the

patient agreed to face the situation. One transient attack of morbid

depression occurred, after an operation. Then the man fell into a state

of anxiety neurosis such that he was passed by a medical board as unfit

for military service.

Rationalization of war memories: Commission relinquished.

=Case 509.= (RIVERS, February, 1918.)

An oldish English officer lost consciousness while looking at the havoc

wrought by shell explosion. Probably there was a second shell that sent

him off. He was eventually admitted to an English hospital with paresis

and anesthesia of legs, severe headache, sleeplessness and terrifying

dreams. Hypnotic drugs and advice neither to read nor to talk about

the war were the measures adopted and after two months in hospital he

was given three months leave. He buried himself in the heart of the

country, away from relatives, with aspirin and bromides. He began to

sleep better and had less headache. When the president of the medical

board asked a question about trenches at the end of his period of

leave, however, he broke down and wept. He again repaired to the

country for two months’ leave, for the chosen treatment by isolation

and repression.

An order was then given that all officers must be either in hospital or

on duty. He was sent to an inland watering place and treated by baths,

electricity and massage, whereupon he rapidly became worse, especially

as to sleep. He was transferred to Craiglochart in an emaciated state,

with an expression of anxiety and dread, paresis of legs, sleeplessness

and war dreams.

He was now advised to give up repressing, to read and talk a little

about the war, and to accustom himself to thinking about war

experiences. He did this but half-heartedly, as he thought the ideal

treatment was what he had so long followed. Nevertheless, he got

distinctly better and the content of the war dreams was altered to home

scenes. He was still loath to acknowledge his improvement and thought

that he would have recovered if he had not been taken from his retreat

and sent to hospital. As it was obvious that he would be of no further

use in the army, he was allowed to relinquish his commission.

Rationalization of war memories, without redeeming feature as nucleus.

=Case 510.= (RIVERS, February, 1918.)

An English officer was flung by shell explosion so that his face struck

the ruptured and distended abdomen of a dead German. The officer

did not immediately lose consciousness and got distinct impressions

of taste and smell and an idea of their source. After a period of

unconsciousness he came to, vomiting and much shaken. He carried on

several days, still troubled by vomiting and haunted by taste and

smell images. Several months later he was observed by Rivers suffering

from horrible dreams, in which the battle experience was faithfully

reproduced. He got no relief except when he went into the country,

far from every suggestion of war. Rivers’ psychotherapeutic plan of

finding a redeeming feature in the experience, upon which the patient

might concentrate, failed because there was no redeeming feature.

Accordingly, it was thought best that the man should leave the army and

seek the conditions that had given him slight relief.

_Re_ psychoanalysis and its modifications, see remarks under Case

496, under which several favorable opinions were mentioned. Boschi

in his report on French conditions gives no reference concerning

psychoanalysis or hypnosis. Bruce has found blended with the war dreams

many episodes quite alien to the war, and considers that the patient’s

ante-bellum history is of importance, since ante-bellum emotions may

be revivified by the war. Craig states that he has not been impressed

favorably by the results of psychoanalytic treatment. Arinstein from

Russian experience gives preference to Dubois’ psychotherapy over

hypnosis and psychoanalysis. Nonne states that the data of the war

prove that hysteria is neither a degenerative disease according to

classical theory, nor a disease based upon Freudian principles.

Post rheumatic “paraplegia” (or abulia?) cured by removal of crutches,

after question of discharge “unfit” had been raised.

=Case 511.= (VEALE, November, 1917.)

A soldier, 23, had fever with swelling of several joints and

temperature in 1915, and was furloughed to England. He complained of

pains in the limbs and shortness of breath, and was put in hospital.

As he did not improve, he was sent to a special hospital for baths and

electricity. There he remained from August, 1915, to March, 1916, with

D’Arsonval baths, cataphoresis, electric treatment and massage.

He was now sent to the second Northern General Hospital to see whether

he should be discharged permanently unfit. Here he shuffled along

on two crutches, very tremulous, and sweating, and suffering from

palpitation on exertion. He wanted to take poison if he could not be

cured.

The crutches were taken away. He was asked to walk up and down. He had

to be supported at first and fell several times. The exercises were

continued. Massage and drugging were stopped. The next day he was able

to stand alone. In twenty-four hours he walked by himself. The other

patients in the ward encouraged him on account of the genuine exertions

he was making to get well. April 7, he returned to duty, smart and well

set up.

Babinski and Froment always give the suspected subject the benefit

of the doubt, never uttering the word simulation in the presence

of the soldier, and proceed to psychotherapy; for psychotherapy

will act to cure simulation or exaggeration just as it acts to cure

hysteria. They say that in their experience, all these disorders of

doubtful nature--that is, that lie diagnostically between hysteria,

exaggeration, and simulation--are as a rule cured by resort to

psychotherapy provided that the due amount of energy, tact, and

perseverance is employed. See also remarks under Case 453. Veale’s case

(511) never showed _mauvaise volonté_, and nothing more than aboulia.

“Trench foot,” “neuritis,” a year of astasia-abasia or at least of

complaint of inability to stand or walk. Treatment by a “cruel though

justifiable” process.

=Case 512.= (VEALE, November, 1917.)

A regular army man, 38, well built and muscular, in Flanders the

first winter, returned to England in January, 1915, with “trench

foot.” “Neuritis” then developed, with loss of power to walk. Baths,

electricity, massage, sympathetic wheeling about in a chair by women,

all failed.

January 11, 1916, he still complained of inability to walk or stand.

The reflexes were exaggerated. He was able to get into a wheel chair

from bed by jerks, associated with palpitation, tremors, flushing and

sweating.

He was told that he had now recovered from the neuritis. Crutches,

sticks and wheelchair were removed. He flopped about and then lay on

the bed exhausted. In a few days he began to shuffle about and was

put on the stationary bicycle. January 29, he left the hospital well,

remarking that though the treatment at first seemed cruel, it was fully

justified.

_Re_ genuine polyneuritis, Mann gives German experience regarding

neuritis as somewhat frequent and affecting a special form which

he terms polyneuritis neurasthenica. He states that the commonest

instances of mononeuritis developing in the war are the sciatic and

trigeminal. The neuritis often outlasts the other symptoms. The

treatment was rest, tepid baths, and electricity. Naturally, alcohol

and syphilis must be excluded in the diagnosis.

Nonne also described non-alcoholic, non-syphilitic, and non-infectious

polyneuritis in neurasthenics, which he, however, finds most common in

the ulnar, median, radial, anterior crural and posterior tibial nerves.

_Re_ “spa” treatment, Turner thinks there may be easily too much

massage, electricity, bathing. He prefers segregation in special

hospitals to “spa” measures in general hospitals, prefers occupation to

rest, and calls attention to the stimulating value of the gratuity to

be paid on leaving the hospital.

Shell-shock paraplegia: Treatment by bed, cigarettes and chocolates

altered to isolation, no tobacco, no visitors, faradization. Recovery.

=Case 513.= (BUZZARD, December, 1916.)

Early in the war, a lad, 19, was blown up by a shell. He was sent home

paralyzed from waist down, and was seen by Capt. Buzzard after he had

spent ten months in various hospitals, “carefully nursed, on the water

bed, constantly using a bed urinal, smoking innumerable cigarettes,

and eating countless chocolates.” He could not move his legs. They

were wasted and flaccid. The knee-jerks could be got with difficulty.

Plantar reflexes flexor. Complete anesthesia from umbilicus downwards,

but preservation of abdominal reflexes. The navel did not shift

downwards when the patient attempted to sit up. The incontinence was

not real; urine was passed into the urinal at appropriate intervals.

Buzzard directed treatment “not to his spinal cord but to his mind;

isolation; the stoppage of tobacco and all visits; the assurance that

he would rapidly get well, together with some suggestive faradization

of his legs.” This brought about a cure in a very short period. The

atrophied legs eventually grew strong enough to walk.

_Re_ cigarettes in Shell-shock, Mott decries the over-liberal gifts of

cigarettes that induced cigarette habits in both officers and men. Of

course, the cigarettes are still more detrimental to cases of soldier’s

heart than to other cases of neurosis. Mott remarks how over-frequent

are the social tea-parties, joy rides and drives given by well-meaning

ladies for the “poor dears,” actually perpetuating neuroses.

_Re_ atrophy, Babinski and Froment again bring up the question whether

muscular atrophy can be brought about by a hysterical motor disorder.

In point of fact, Charcot and Babinski were the first to describe

the true hysterical amyotrophy, but this hysterical amyotrophy is

exceptional in hysterical paralysis, and is slight when it occurs.

Shell-shock blindness, mutism, deafness: Blindness spontaneously

vanished, 24 hours. Mutism, 2-3 months. Deafness cured by “small

operation.”

=Case 514.= (HURST, September, 1917.)

A lance corporal, 26, became blind, deaf and dumb, though without

losing consciousness, when blown up by a shell, August 29, 1916. His

sight returned next day. On reaching England he talked in his sleep.

Encouragement, electricity, etherization failed to effect improvement.

One night in November he woke up and asked the sister for a drink;

thereafter he talked normally.

Seven months after the shell explosion he was transferred to the

neurological section at Netley, March 21, 1917. Deaf to air and bone

conduction, a loud noise behind him caused a slight tremor of hands,

with blinking and dilatation of pupils; but further stimuli of the same

sort failed to produce such reactions. Normal nystagmus and giddiness

on functional tests of vestibular nerve and canals. The internal ear

was then probably free from organic changes. Since shell-shock mutism

is always hysterical, it was probable that the deafness was hysterical.

Under hypnosis (staring at lines for fifteen seconds) he showed no

change. During natural sleep, also, a shout of “Fire” and metallic

noises failed to wake the patient or to produce contraction of eyelids.

Electric suggestion (despite the patient’s belief in electricity) and

reëducation failed.

April 16, he was told that a small operation would have to be done

April 20. To this he readily consented. Two small incisions were made

behind the ear under light ether and suture was inserted. A loud noise

was made during the “operation”; he heard this noise and jumped from

the table. To his intense delight normal hearing returned in a few

minutes. Next day hearing was tested and found normal to air and bone

conduction. He was discharged to duty three weeks later and on his way

to France, June 29, demonstrated his normal hearing to the physicians.

Deafness: cure by stimulating vestibular apparatus.

=Case 515.= (O’MALLEY, May, 1916.)

A private, 20 years of age, lost speech and hearing after the battle

of Neuve Chapelle. Eight days later he came under the care of the

laryngologist in a very excited state, pointing to lips and ears and

carrying a note with information concerning his deafmutism.

Dr. O’Malley wrote on a piece of paper that he would restore the

patient’s speech and hearing. Dr. O’Malley then used the mirror until

the point of retching, and wrote, “You can speak now; count up to ten

loudly.” He did.

Dr. O’Malley next used the cold water douche to the right ear to

the point of giddiness, then shouting through a speaking-tube (see

description below). The patient then found he could hear and the tears

streamed down his face. Thereafter he was able to converse freely. Dr.

O’Malley writes:

The treatment of functional deafness consists in exciting the

vestibular apparatus as follows. Cold or hot water is allowed

to flow in a steady stream into and out of the external

auditory meatus by means of a tube attached to a receptacle

placed about one and a half to two feet above the patient’s

head and continued until he becomes very giddy and an active

nystagmus is produced. A speaking-tube three feet long is then

used by placing the ear-piece in the ear so treated, and the

surgeon shouts into the mouth-piece the assertion, “You hear

now,” and the answer, “Yes” comes promptly. The tube is now

dropped and a conversation held as if no deafness ever existed.

So far I have found the treatment of one ear sufficient. The

patient is usually very emotional, as the disturbed vestibular

function, which in these cases responds easily and markedly,

causes him to feel as uncomfortable as a bad sailor on a

stormy voyage. This feeling, however, rapidly gives way to one

of pleasure at the return of his hearing. Where functional

deafness and mutism co-exist it does not appear to be material

which is treated first. In two cases of this kind under my care

I treated the loss of voice first.

Bullet through mouth; Hysterical mutism. Treatment by operative

manipulation.

=Case 516.= (MORESTIN, January, 1915.)

A Colonial infantryman, 32, was wounded December 17, 1914, at the

Boisselle, being struck by a bullet which entered on the right side in

the upper part of the neck and came out behind the left side of the

mouth, having traversed the tongue, broken two teeth, and caused a

good deal of hemorrhage by mouth. The patient felt his tongue swell,

and from this time on he could not pronounce a word. He was sent to

the ambulance, then to Mien, then to Saint Germain, and finally to

Morestin’s surgical service. With wounds by this time healed, the

patient found it hard to open his mouth. There was no trace of fracture

of the lower jaw. The tongue could be only incompletely examined. The

man swallowed liquids easily but could take no solid food. He tried

hard to speak, made pantomime movements, grew emotional and lachrymose.

On the whole, however, it seemed that his inability to articulate

sound could not be due directly to the lesion. There must be either

simulation or hysteria. For four days he was attentively watched, and

not once did he pronounce a word. He grew more and more stricken and

humiliated by his plight. Rigorous diet did not cause his mutism to

cease. Isolation and ennui did not decide him to talk. Accordingly,

it was announced, in the man’s hearing, that an operation was to be

done to restore speech. January 9, 1915, his face was copiously washed

with alcohol and ether. Cocaine was injected to secure anesthesia and

resolution of the muscles of mastication. Six c.c. of a 1-100 solution

on each side. Shortly the surgeon began to open the jaws, against

decreasing resistance. The tongue, which was not spastic, was seized

with a tractor and rhythmic movements were executed with it. After a

few of these movements, joy was painted on the features of the patient.

He said that he wanted to speak and that he was about to speak. He

shook the surgeon’s hands effusively and said, “_Merci_.” Although

the first words came hard, little by little speech became free and a

perfectly sincere elation at having recovered speech set in.

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.