Neurasthenia—Muscular Spasm, Catalepsy, etc.—Menstrual Cases —Insomnia—Sea-Sickness —Pruritus Vulvae and Eczema — Hyperhidrosis
No. 51. Mrs. --, aged 11; March 20th, 1892. Had always been more or less delicate. Obstinate constipation since infancy; this had been worse during the last twelve years, the ‘minimum interval between successive actions of the bowels being a week. Chronic dyspepsia, anwmia and emaciation. Severe dysmenorrhcea since commencement of menstruation. Married twenty years; no children, sexual desire absent, marked dyspareunia. Frequent attacks of depression since 1882; for two years the condition had practically been one of melancholia, and she had shunned all society, neglected her domestic duties, and frequently shut herself alone in her bedroom for hours and spent her time in crying. Insomnia since 1889. Sick-headache since childhood: for the last twelve years these attacks had been more frequent and severe, and latterly had averaged one a day—invariably followed by vomiting. As long as she could remember, she had been short-sighted; and reading or working, especially by artificial light, soon produced headache.
On December 9th, 1889, I sent her to see the late Mr. Bendelack Hewetson (ophthalmic surgeon to the Leeds Infirmary), who afterwards supplied me with the following notes:— “Mrs. - complained of distressing and almost constant headaches, with frequent nerve-storms of migraine. She had persistent pain over the eyes and at the back of the head, extending down the neck; the roots of the hair were tender. Ophthalmoscopic examination showed that she was hypermetropic, and that this condition was over-corrected by ciliary spasm, rendering her virtually myopic and necessitating a minus glass.
Mr. Hewetson prescribed atropine for a month, and afterwards a + glass for reading. The headaches ceased while the atropine was used, but the patient said the glasses hurt her, and would not persevere with them, and the headaches soon returned with increased violence.
She suffered greatly from her teeth, of which she had but twelve left, all decayed. She was anxious to have them extracted, but was afraid to face a dentist, and asked me to have the operation performed during hypnotic anaesthesia. I explained that patients who were suffering from hysteria rarely became hypnotised deeply enough for operative purposes, and tried to persuade her to take an ordinary anaesthetic. As she refused to do this, I consented to the experiment. To my surprise, before I had finished my usual preliminary explanations, profound hypnosis appeared. The patient had hypnotised herself. I then suggested that she should sleep well, be free from headache and depression; that her appetite and digestion should be good, the bowels regular, etc., etc. I also successfully suggested local and general anaesthesia. The curative suggestions were quickly responded to: she slept well, her headaches disappeared, the bowels acted regularly. Menstruation and connection became painless, digestion and appetite improved, and she rapidly gained in weight and strength.
The toothache entirely disappeared; and, owing to this and other reasons, she deferred the operation for some time. Meanwhile, I discovered that I could produce profound anaesthesia, or analgesia alone, by simple suggestion in the apparently normal waking state. On these occasions the patient recognised and talked with those around her, and afterwards remembered everything that had happened, except the sensations which had been specially inhibited.
The operation was performed on July 21st, 1892, at Mr. Bendelack Hewetson’s, Leeds, in the presence of a number of medical men, including Mr. H. Littlewood, F.R.C.S. The following account was given by Mr. Henderson Nicol, L.D.S. Eng., the numbers quoted showing the teeth extracted, according to Dr. Thompson’s “Approved Record Plate “:—
“Nos. 21, 22, 24, 25 and 26 were removed without any interval, and entirely-without pain, or any symptom of feeling on the part of the patient. After an interval of a few minutes for rinsing out her mouth, Nos. 27 and 1 were removed without interval, and with some slight indication of pain in the case of No. 1, but none in the case of No. 27, which, in common with Nos: 21 and 22, was very firmly attached to the jaw. After a further interval of a few seconds, No. 16 was removed; it was much broken down, and there were symptoms of some pain. All the teeth were much diseased, and the extractions, under ordinary conditions, would have caused acute pain. I think,*considering the circumstances under which the operation was done, it was a remarkable success, and I am pleased to, have seen it.” -
Remarks. — The patient was not prepared in any way for the operation, and the analgesia was not posthypnotic, i.e. it was not suggested to her during a previous hypnosis that pain should be absent on this particular occasion. Without the employment of any mechanical methods, or verbal suggestion of hypnosis, she was simply told in the waking state that the operation would be painless. This was regarded as an experiment which might possibly fail, and the patient made me promise that I would hypnotise her if she had pain. She lost much blood and felt faint, but this soon passed off, and she gave the following account of her sensations:—She had felt a little pain when. No. 1 was extracted, but this was nothing to what she had felt when she had had teeth drawn previously, and not sufficient to make her remind me of my promise to hypnotise her. She had had the fixed idea that this tooth would hurt her, a previous attempt to extract it having failed.
She described the various steps of the operation, and asserted that all the extractions, except No. 1, were absolately painless. The analgesia was still further tested by a powerful application of the faradic brush.
A fewdays later, under the same conditions, I extracted her remaining four teeth, and, despite the fact that they were all firmlyattached to the jaw, this was accomplished without pain. Neither operation was followed by pain, and the gums healed rapidly; when the casts of the mouth were taken, all unpleasant sensations were prevented by suggestion.
It is to be noted that, in this case, analgesia alone was suggested, and that this appeared unaccompanied by anaesthesia.
Afterwards Mr. Bendelack Hewetson saw the patient several times, and gave me the following notes:—
“Dr. Bramwell brought Mrs. --- to see me in July, 1892. She stated that she had had no headache since being hypnotised on March 20th, 1892. She was a new creature mentally and physically—bright, healthy-looking and well-nourished; formerly she had been a burden to herself and her friends. On examination, I found her vision in every way as defective as on the first occasion I had seen her. Dr. Bramwell then suggested to her, in what was apparently the normal waking state, that she should be able to read the bottom line of Snellen’s unaided by glasses. This she did successfully, and immediately afterwards repeated the feat on a changed series of test types. Obviously Dr. Bramwell could induce his patient to relax her accommodation and produce the same improvement of vision as had resulted from a minus glass. Dr. Bramwell then suggested that the increased range of vision should be maintained, and that the patient should continue to be able to read Snellen’s 20/20 unaided.
“I saw her again on October 26th, 1892, when she stated that she had remained entirely free from headache, and that the increased range of vision had been maintained. I found that Dr. Bramwell, by suggestion in the apparently normal waking state, could enable the patient to reproduce the ciliary spasm and the original condition of vision, and again to relax the accommodation and gain the increased visual range.”
Mrs. --- had invariably suffered from sea-sickness, even on the shortest voyage and in the calmest weather. This had been a great disadvantage to her, as her husband was captain of a merchant steamer and often wished to take her with him. In April, 1892, I suggested during hypnosis that she should be free from sea-sickness. Before the end of the summer she made eight voyages between the Humber and London; her husband reported that on the first outward voyage there was a strong north-east swell. Returning, the weather was rough and the steamer, which was in ballast, rolled heavily. Bad weather was also encountered on some of the other trips, but the patient had not even the slightest feeling of nausea and ate hearty meals.
No. 52. Mr. —, aged 32; May, 1895. Although nervous and highly strung, he had been physically strong and athletic up to 1887, when he broke down, apparently from overwork and underfeeding. His appetite became capricious, and he suffered from constipation, dyspepsia, nervous trembling, and persistent feelings of lassitude and weariness. The slightest physical exertion, such as walking a quarter of a mile, produced feelings of collapse and utter exhaustion.
He was constantly depressed, and wished to end his life according to his own account, nothing but want of pluck prevented his committing suicide. He gave up smoking, dieted himself strictly, tried change of air, sea voyages, and prolonged medical hydropathic treatment, without benefit.
He was first treated in May, 1895: this was repeated almost daily for six weeks, when his morbid symptoms had disappeared. He had gained eight pounds in weight and enjoyed exercise. In September, 1900, he stated that he had practically perfect health, that he frequently bicycled over a hundred miles a day, without undue fatigue, and sometimes danced the greater part of the night and was fresh for his office next morning. There had been no return of any of the symptoms which had formerly troubled him. In December, 1902, Dr. Eric Pritchard, of Hampstead, who had sent the case to me, informed me that the patient was still in good health, although he had been living in the tropics for some considerable time. Later reports satisfactory.
No. 53. Mr. --, aged 29, was sent to me by Dr. Risien Russell, on May 21st, 1908. Four years previously the patient had begun to sleep badly and to have frequent attacks of depression. His condition became progressively worse, and, when I saw him, he was very emotional and wept while he told me his troubles. He had been engaged to be married, but had broken this off, as the idea of making any change in his life filled him with terror. He was always profoundly depressed, and constantly talking about his troubles and symptoms. He had lost interest in everything and felt that he must commit suicide. He recovered, and later reports are entirely satisfactory. In February, 1909, he wrote to say that he was “perfectly well and happy and keenly interested in everything and everybody.” His engagement has been resumed, and he is looking forward to being married.
No. 54. Mrs. --, aged 51; September 30th, 1903. For two years she had been profoundly depressed, had lest allinterest in life, and felt that death would be a relief. Indigestion, marked emaciation, etc. Since early childhood she had suffered from muscular tremor in the arms and hands. She was unable to pass things at table, and, when in company, was often unable to lift a cup or glass to her lips., Owing to this, she would often do without wine, tea or coffee. Eight months previously she began to have noises in the head. These soon became constant, frequently caused insomnia, and were associated with great mental distress.
The patient had been married twice and had recently lost her second husband. She began to have the delusion that her first husband’s name appeared on her visiting cards. She tried to reason herself out of this, but the obsession returned every time she made a call. She would draw a card out of her case without looking at it, hand it to the servant, and then shake with terror. She had consulted various physicians and surgeons, more especially in reference to the noises in the head, but had obtained no relief and was finally told that the condition was incurable. After the first treatment by suggestion, the tinnitus aurium ceased
it returned slightly at the periods, but disappeared completely two months later. The muscular tremor and the obsession disappeared after the third treatment. The patient rapidly put on flesh, gained in strength, and all the other nervous symptoms quickly-passed away. Since then, up to the present date (May, 1909), there has been no relapse. The patient is well mentally and physically, and enjoys life keenly.
During treatment the patient never passed into any condition even superficially resembling sleep.
No. 55. Miss aged 26; July 3rd,11900. Although always nervous and never very strong, she had fair health up to 1897, when, after a severe mental shock—her brother was accidentally killed before her eyes—she began to have muscular spasms in the arms. These soon spread to the legs, and, a few weeks later, practically all the voluntary muscles of the body became affected, the movements hardly ceasing a minute while the patient was awake. The attacks were very irregular in character at one moment the flexors and extensors of the arm were affected, when the patient struck out with startling rapidity, hitting those near her, or any inanimate object that happened to be within reach of the blow. A moment afterwards the legs would be similarly affected; the head violently jerked, or the muscles of the face convulsively twitched. She was cut and bruised from her involuntary violence, complained greatly of headache, and was anmnic and feeble. She could not walk without assistance, and was unable to dress or feed herself. Attacks of muscular spasm frequently occurred during sleep and invariably woke her.
The patient was sent to me by Dr. Bold Williams, of Llandudno, on the date mentioned. Hypnosis was induced at the first attempt, and she began to improve; but a week later, although the hypnosis had become profound, the attacks still continued. or a few minutes she would rest quietly as if asleep, and then convulsive movements appeared: slight ones did not arouse her, but if they were severe she came out of the hypnotic state with a start and looked confused. When this happened I re-hypnotised her, repeating the process until she had had at least half an hour’s continuous rest. At the end of three weeks the attacks ceased and treatment was abandoned. She walked and slept well, had no difficulty in-dressing or feeding herself, and her general health had greatly improved. On May 18th, 1909, Miss -- wrote to say that another brother had been killed accidentally. She was the first to receive the tragic news, and had to break it to her mother, who died shortly afterwards. Despite this, “her health was splendid, and she had had no return of the spasms.”
No. 66. Mr. —, aged 39; May, 1902. Had done twelve years’ service in the Royal Navy. All entries “very good,” no bad marks; good servicemedal. In June, 1893, he was ship’s corporal on H.M.S. Victoria, under Admiral Tryon, when she was rammed by the Camperclown. When the ship was sinking it became his duty to go below and release the prisoners. This he did, then went down to the battery-deck to see if the ports were closed; while there, the ship sank and carried him with her, and he believed the subsequent explosion blew him to the surface. He was picked up unconscious by one of the boats and taken on board H.M.S. Nile. After prolonged artificial respiration he had an attack of noisy delirium, followed by seventeen hours’ further unconsciousness. Immediately afterwards violent generalised muscular tremor appeared. This was constant, except during sleep, and was aggravated if anyone approached him. He could do nothing for himself, and had to be fed through a bent tube which was passed from the back of his head to his mouth. The attendant, who had to stand behind so as not to be seen, poured liquid nourishment into one end of the tube, while the patient, with much difficulty, took it from the other end.
Three days later he entered Malta Hospital, where he stayed a month. He was then sent to the Naval Hospital at Haslar, and remained there until October 3rd, 1893, when he was invalided and sent home. During the first year after his accident he was stated to have had four “epileptic fits,” but, from -the description I have been able to obtain, it seems probable that these were attacks of catalepsy. Marked muscular tremor continued for a year, then gradually became less violent, and, finally, almost ceased. The most striking and persistent feature in the case was the difficulty in walking. This showed itself from he beginning: at first the patient could walk a step or two alone, but, if anyone came near him, he suddenly fell on his back. After his dismissal from the hospital this symptom became more pronounced, and he only left his bed to be helped into a chair. He could stand, however, and move about a little by holding the chair arid pushing it in front of him. After being kept on as invalided from year to year for four years, he was finally pensioned off as incurable.
On May 8th, 1902, he was sent to me by Dr. Roome, of Southsea. The patient told me that he bad never known what sickness was until his accident. He now complained of nothing but his inability to walk: his general health was excellent and he never felt ill or depressed. He was powerfully built and strong in the arms, but the muscles of the lower extremities were.markedly wasted and flabby, and the pulse weak. Reflexes much exaggerated: the slightest touch over the patella produced a violent convulsive kick. Further, any muscular stimulus, particularly if unexpected, produced an immediate response. For ex-ample, if his foot touched an inequality in the bedclothes, he would be almost thrown out of bed by the violence of the muscular start.
His walking was still limited to moving a little about his room, with the aid of a chair; if he tried anything beyond this he fell. At first the exciting cause was mainly emotional, such as anyone coming near him. Later, he fell if he attempted to walk with the help of another person if he encountered the slightest inequality in the ground he tumbled and dragged his companion with him. This did not occur because his legs failed him, but always seemed due to a distorted or exaggerated reflex. The slightest unexpected stimulus to the soles of the feet was followed by a convulsive response which threw him rigidly and violently on the back of his head. Beyond this I could discover nothing abnormal. There was neither paralysis nor loss of consciousness, nor were there alterations in sensation other than those just described.
I began treatment at once, and continued it five times a week until July 24th, when the patient returned to Portsmouth. Nothing was done beyond making “curative suggestions” while he rested quietly in an armchair; he never even became drowsy. Despite this, the result was striking. In a week, he could cross his room; and, after the first month, he spent hours at a time walking about the streets and parks. He even went into crowds without fear or tremor, and was present at the various military reviews, etc. hich were held at that time.
It is of interest to note that, although the patient responded to suggestion in this instance, ordinary medical treatment associated with self-suggestionhad entirely failed. He had had the fixed idea that a certain medical man could cure him, and, as soon as he left the hospital, had placed himself under his care, but, despite his faith, had received no benefit. From that date he had been almost invariably under treatment, and had consulted in all nineteen different medical men.
No. 57. Miss --, aged 28, dressmaker, was admitted to the National Hospital, Queen Square, August 6th, 1896 (Sir William Gowers’ wards), and I am indebted to Dr. Stewart, House Physician, for the following notes:—
“For the last ten years the patient had suffered from sickness after food, and pain in the abdomen. Used to spit up blood in small quantities; but no cough, wasting, or night sweats. Said she had coffee-grounds vomit followed by tarry motions. Since January, 1896, she had also had pain in back and attacks of stiffness.
“On admission—a well-nourished but pale, anaemic girl. Intelligent. No motor or sensory paralysis. No anaesthesia. Organic reflexes normal—plantars present, erector spinae increased; jaw, biceps, and wrist jerks present; on ankle clonus. Cranial nerves normal. Some ovarian and epigastric tenderness. Chest normal. Visual fields, pupils and discs normal Has had attacks of rigidity; several a day, sometimes lasting twelve hours. These come on suddenly, painlessly, and without warning. Spasm first affects legs and feet. Legs become stiff, knees extended”; ankles extended and toes stiffly flexed. Spasm is most marked in extensor and adductor muscles of leg; but all muscles are rigid. Pulling on one foot pulls the other over too, as if glued to it. When trunk becomes rigid, the whole body is like a bar of iron and can be lifted up by .one foot. Abdominal muscles hard; respiration shallow, and back muscles rigid. When the arms are affected, they are stiffly extended parallel to the body; the fingers flexed at metacarpo-phalangeal joints, but extended at others; the thumbs adducted and wrists stiffly flexed. Face sometimes stiff, jaws firmly clenched and unable to be separated; speech impossible; no risus sardonicus, expression impassive. Eyes not affected. Neck stiff and extended.
“November 23rd, 1896. Numerous observations have shown that there are two hysterogenetic spots—(1) interscapular region of spine; (2) lumbar spine: pressure on these induces an attack. Attacks can be relieved by application of faradic brush to external malleoli in turn; first one leg and then the other becoming relaxed. The duration of the attack varies from a few minutes to several hours; af terwards the patient perspires a great deal about the hands and feet, and feels tired. After a severe attack, when the face has been involved, she usually vomits also.
“December 8th, 1896. Patient has had several attacks of urgent vomiting, apparently causeless, with severe pain, necessitating rectal feeding by peptonised enemata.
“January 20th, 1897. Patient has been getting steadily worse; attacks have increased in frequency and severity; she is rigid nearly all day and occasionally wakes up rigid during the night.
“Yesterday, I [Dr. Stewart] induced stiffness of legs experimentally by rubbing lumbar region, and stiffness of shoulders and arms by rubbing interscapular region. Patient lay with trunk, legs and thighs rigidly extended; toes pointed and arms parallel to body. She could be lifted by head and heels like a log. The face was rigid; and she could neither speak, smile, protrude her tongue, nor move her facial muscles. The eyes, however, could be moved freely in all directions, and the eyelids could be opened and closed. Temperature before, during and after this attack was 98-2°. Rigidity of arms, neck and face passed off when hands were rubbed, but that of the trunk and lower extremities required application of faradic brush to external malleoli one after the other.
“On January 26th Dr. Bramwell saw the patient and commenced hypnotic treatment.”
On March 4th Dr. Stewart, in forwarding me the above notes, congratulated me on the result, which he said had been very satisfactory.
Remarks.—Isaw the patient on sixteen occasions from January 26th to March 4th, 1897. At first I visited her at the hospital: she was suspicious and evidently dreaded some disagreeable experiment, and I failed to influence her; despite the fact that, on several occasions, suggestions were made during chloroform narcosis. Later, she was brought regularly to my house, where I showed her other patients who had been treated by suggestion, and thus gained her confidence. From that time she improved rapidly, and, before the treatment ceased, the attacks had disappeared. Her recovery was confirmed by a later report.
No. 5S. Mrs. —, aged 25; February, 1891. Had always been nervous and emotional; when a child, any excitement caused vomiting. Attack of migraine since the age of 8; latterly, these had been very frequent, and accompanied by feelings of giddiness and confusion. Catamenia appeared at 15; slight dysmenorrhma. Married at 19; the succeeding period, an exceedingly painful one, was followed by pregnancy. After the periods recommenced they were regular, but invariably preceded by much uneasiness, and accompanied by attacks of severe spasmodic pain in the lower part of the body and back. These lasted from one to three days, and the patient, who kept her bed was unable to lie down during the paroxysms, and had to get on her hands and knees; maintaining this position almost continuously for the first twenty-four hours. There was constant nausea with occasional vomiting. Discharge scanty. Uterus retroflexed; slight leucorrhcea. Depression, frequent attacks of hysterical weeping. Dyspareunia; no sexual desire.
After drugging, pessaries and other local treatment had been tried without result, the patient was sent to me by Mrs. Dickinson Berry, M.D.
She was treated twenty-nine times up to May 5th, 1894, when the morbid symptoms had disappeared. In April, 1895, she reported that the periods were free from pain, lasted three days, instead of five as formerly, and that the discharge was more abundant. The interval was now four weeks instead of three. Marital relations were normal. About a year later, the patient wrote to say that she had again become pregnant and that the periods had been normal up to then.
No. 59. Miss —, aged 19; November, 1889. Was markedly anaemic, and had suffered from attacks of frontal headache since the age of 7; these averaged two a week and were invariably followed by vomiting. Menstruation, always painful, commenced at 13. Early in 1887 the periods began to be scanty, with prolonged but irregular intervals, and ceased in May, 1888. After a short hypnotic treatment in November, 1889, somnambulism with anaesthesia was induced. In February, 1890, her health was remarkably good, with the exception that the amenorrhoea still persisted. I re-hypnotised her, and suggested that on March 13th, 1890, she should experience all the symptoms which had formerly preceded menstruation—pain in the back and thighs, sensation of weight and dragging in the abdomen, etc.; that these should last two hours; that the catamenia were then to appear and all pain cease. During the six weeks which preceded the date fixed, I hypnotised the patient two or three times a week, and repeated the above suggestions. On the morning of March 13th the symptoms indicated appeared, continued for two hours, and were followed by menstruation, which lasted five days. During the next fortnight I hypnotised her on three occasions, and suggested that menstruation should appear on April 7th, and on this and subsequent occasions be free from pain. After this, menstruation was normal for over two years; the patient then married and becamepregnant. She had no return of the headache and her general health remained good.
This patient was operated on for double strabismus by Mr. Bendelack Hewetson, of Leeds, November 4th, 1889; hypnotic suggestion being .the only anaesthetic employed. She Obeyed .all his commands; kept her eyes in the required position, or turned them Bo as to put the muscular fibres on the stretch. Anaesthesia was perfect; when awakened she would not believe that the operation had been performed, until shown her eyes in a looking-glass. There was no subsequent pain.
No. 60. Mrs. --, aged 34; December, 1901. Nervous temperament. Amenorrhaea since, the birth of her last child, two years previously. She was only able to suckle the child two days, owing to the scanty secretion of milk. Later it increased, but was never enough for nursing purposes; it. persisted, however, despite both external and internal treatment. In September, 1901, she had an attack of inflammation of the breast with threatened abscess; a month later there was a similar one; and again, a month after, another attack.
The patient was sent to me by Dr. Swan, of Devonport Street, W., on December, 31st, 1901, and Was treated on fifteen occasions -from that date until March: 6th, .1902; The secretion of milk ceased and there was no return of the mammary inflammation. Menstruation appeared on January 21st, 1902, and was regular from then until pregnancy occurred some months later.
No. 61. Miss --, aged 24; December, 1892. Weak and anaemic, miserable and depressed. Weight 8st. 7lbs. Menstruation commenced at 14 and was always very painful. Pain, sometimes started a week before and lasted three or four days after the commencement of the period; always three or four days in bed. Frequent vomiting. Insomnia for the last three years; worse the last year—average amount of sleep three hours. Very frequent headaches, sometimes accompanied by sickness. Patient had a good night after the first treatment. At the end of five weeks she was well and had gained 7lbs. in weight. Headaches had disappeared. Periods became normal, with exactly four weeks interval between them, instead of about a fortnight. After treatment there was no warning before the appearance of the period. Recovery confirmed by later reports.
No. 62. Miss --, aged 33; April 15th, 1893. Was sent to me by Dr. Roe, of Penryn. She was feeble, badly nourished and markedly neurotic., She had never been strong and had had frequent attacks of eczema. Six years previously she had herpes zoster, and since then had suffered from interrcostal neuralgia and rheumatism. Constipation during the last four years. Very nervous, irritable arid, intolerant of noise. She had, always slept. badly, and since a severe attack of influenza in January, 1892, the insomnia had been much worse. To relieve this she took bromides and other drugs for six months without benefit. She often remained awake until 5 a.m, and then only slept for an hour or two. Menstruation began at 13, and since then she had always suffered from dysmenorrhcea and menerrhagia. Severe pain started just before the patina and lasted all the time, usually six days. Frequent attacks of vomiting during the period, and loss of appetite.
After the first treatment on April 15th the patient slept that night, from the moment she laid her head upon the pillow until she was called in the morning; this had never happened before in her whole life. Treatment was repeated on April 17th and 18th, but not again.
The patient called to report herself a year later: she had gained greatly in weight, slept well, was free from rheumatism and constipation. Menstruation had been normal in amount and painless, and all morbid nervous symptoms had disappeared. Her recovery is confirmed by a recent report—March, 1909.
The following case presents many points of interest. The patient, who describes his own condition, is a trained observer, well known by his contributions to more than one department of natural science. He was originally sent to me by Dr. Boulting, of Hampstead. The results obtained by the patient’s self-suggestion are worthy of note, particularly considering the slight amount of treatment he had. It is to be noted too that I did not teach him to practise self-suggestion.
No. 63. “A professional man, aged 51; subject to migraine, heavy smoker, very abstemious in use of alcohol. “Having suffered from sleeplessness and other nervous symptoms, I sought Dr. Bramwell’s aid at Easter, 1900.
“I had tried various systems of counting myself to sleep, and each in turn, as it became familiar and easy, had lost its effect. Dr. Bramwell asked me to sit down and compose myself to sleep in my usual way, and to pay as little attention as possible to him. His procedure was that which I understand he usually adopts; and during the sittings I tried to get drowsy by using my most recent method of counting (synchronous with respiration). I had three sittings, and during the second alone was I at all somnolent, and that very litt1e. The following has been the result of the treatment:—
“My sleeplessness has been completely removed, and my sleep has been more continuous and more restful than before. I have even slept when new business cares of a most acute kind presented themselves suddenly a quarter of an hour before bedtime.
“Farther, I have been able to influence myself in various ways by suggestion, which I employ in the following manner. I count, as I formerly did, when, trying to get to sleep, and alternate this with self-suggestions. What I aim at is to produce a stage in which I am sleepy enough to be suggestible, and yet sufficiently awake to make suggestions to myself.
“The method is least efficacious when I go to bed sleepy. I then find it difficult to count, sometimes even impossible, a drowsy state intervening. A vigorous effort, however, to wake up completely and count afresh is usually successful.
“I have been able to induce analgesia and sleep during toothache, whether the latter arose from periostitis or from inflamed pulp: in these cases the pain goes a few minutes before sleep. I suggest that ‘I shall sleep well and without pain. Sometimes the pain comes on again and wakes me, but a few more suggestions will induce fresh analgesia and sleep. Similarly, being subject to sea-sickness, I send myself to sleep on embarkation without much difficulty, and sleep usually very lightly, quite free from qualms: on awaking, even in rough water, I feel no tendency to sickness. I have had two failures to send myself to sleep on the boat, by suggestion, out of some twenty passages: the one was due to flies which kept alighting on my. face; the other instance was when I was convalescent from influenza, and I attribute it to my own lack of power as operator.
“Post-hypnotic suggestion has on the whole failed. I think that have sometimes succeeded in relieving constipation: I know that I have sometimes been unable to do so. I have failed, by suggestions going on every night for three weeks, to. escape sea-sickness without going to sleep. I have not succeeded in curing migraine. I have, however, stopped or prevented the simple congestive headache of coryza. I have been also much less irritable during migraine fits, etc:
“I attribute my difficulty of post-hypnotic suggestion to the fact that here the operator is the subject, and that the former is less efficient at the time when the latter should be most impressionable.
“I am usually able next morning to remember at what stage of my ‘count ‘I lost consciousness. This is generally almost sudden. However, the approach of sleep is usually preceded by hallucinations or idiotic questions which I all but hear, or by twitchings, or by a combination of these. My thought is almost verbal, auditive: I am a poor visualist. A moment of intense wakefulness now comes on, in which I know, from recollection of past experience, that I shall sleep very soon, improbable as it feels. Much more rare is the drowsy condition referred to above, which recalls the state of insomniac people; who have heard the clock strike every hour in the night, but not a child wailing for half an hour in an adjoining room.”
No. 61. Master —, aged 16; April 24th, 1890. Had not had a good night’s sleep since birth. There had been no break the insomnia, but it had varied in intensity and had been worse since January, 1890. While in bed .the patient recalled all the events of the day; he did not feel excited, ill or tired, but his brain remained abnormally active, and he lay awake till 4 or 5 a.m., when he would perhaps get two or three hours’ sleep. Physical fatigue did not influence the insomnia, nor had this been relieved by various forms of medical treatment and prolonged travel. His education had been almost entirely aural, but one term at school had been tried, with disastrous results: he became absolutely sleepless and prostrate.
He was treated on April 24th, 1890, and slept well the following night. Treatment was repeated about forty times during the next two months, after which he started active mental and physical work. Since then there has been no relapse; and in 1900, Dr. Oliver, of Harrogate, who had originally sent the patient to me, reported that he was then leading a useful, active and successful life.
No. 65. Miss —, aged 19; September, 1891. Had good health, but the shortest voyage produced violent and even dangerous sea-sickness. She was easily influenced at the first attempt, and curative suggestions were given. During the following year the patient crossed the Channel several times without being sick. The treatment was then repeated, as she wished to go to India. During the voyage a cyclone was encountered, and she alone amongst the passengers remained well. The return journey was equally successful, and further voyages to and from India were also free from sickness.
No. 66. Dr. --- consulted me forsea-sickness on May 5th, 1908, and had only three treatments. He was a very bad sailor and had been sick on every voyage he had taken, no matter how short. Shortly after treatment he went to Canada, and sent me the following account of his voyage:— ”The result of the suggestive treatment for seasickness in my case has been excellent. The first three days of the voyage were rough, the third day very rough; fiddles on all the tables. I was not sick, and felt very well all the time, except once after lunch on the third day. I then lay down in the smoking-room, gave myself sleep suggestions and anti-sea-sickness suggestions: I was soon asleep, and woke in a couple of hours feeling quite well; had no discomfort again during the voyage put in an appearance at every meal during the voyage, with appetite. There were many people ill on board; at breakfast on the third day very few were present.”
No. 67. Pruritus vulvae and eczema.—Mrs. --- aged 49; August, 1889. Had always been nervous and emotional. Three of her children had died of infantile convulsions; one suffered from epilepsy and two from hysteria. At an earlier date the patient had had several attacks of pelvic inflammation, associated with endometritis and menorrhagia: the latter diseases, after lasting five years, yielded to treatment in 1883. The menopause soon followed, and the patient had good health for two years. In 1885 she began to suffer from pruritus vulvae, and eczema of the hips and thighs. Irritation was always present, but at night it became intolerable and produced insomnia. She had long suffered from constipation: the bowels never acted without medicine, and rarely oftener than once a week. The uterus was retroflexed, and bound down by adhesions resulting from the former pelvic inflammation.
For four years I treated the patient with drugs and local applications under the supervision of a skin specialist, but without improvement. I then sent her to Mr. Mayo Robson, who thought the uterine displacement and chronic constipation interfered with the rectal circulation, and played an important part in the origin and maintenance of the disease. He stretched the sphincter ani under ether, but this neither cured the constipation nor relieved the other symptoms.
In August, 1889, I tried to hypnotise the patient, other treatment being abandoned. The attempt failed, and was repeated unsuccessfully on sixty-six occasions during the next four months, her condition meanwhile growing steadily worse. At the sixty-eighth sitting, somnambulism was induced. All irritation vanished immediately, and she slept soundly on that and the following nights. The bowels acted daily. In a fortnight all trace of eczema disappeared and treatment was abandoned. At the last report, three years later, there had been no return of any of the symptoms, and she had not required to take even a simple aperient. Case seen after recovery by Dr. Churton, of Leeds, and others.
No. 6S. Hyperhidrosis.—Miss --, aged 15, consulted me in January, 1890, on account of frequent attacks ofmigraine, accompanied by vomiting, from which she bad suffered for three years. Menstruation normal. I noticed that on the back of the left forearm a patch of skin, about 2i inches long by 11 broad, was the seat of constant perspiration. This condition, which had existed from infancy, was always excessive, and invariably rendered more so by emotion or exertion. The forearm was always enveloped in bandages, but these rapidly became saturated, and then the perspiration dripped upon the floor. The patient was frequently punished at school because she soiled her needlework, and her condition distressed her greatly, as she wished to become a dressmaker.
On January 10th the patient was hypnotised for the first time, somnambulism induced, and suggestions given as to the headaches and hyperhidrosis. The following day the perspiration had markedly diminished, and it ceased entirely after the reinduction of hypnosis. Treatment was then aband6ned. The case was shown at the International Congress of Experimental Psychology, London, August, 1892, and neither up to that date nor since, as far as I have been able to learn, had there been any return of either hyperhidrosis or migraine, and the patient was following the occupation of her choice.
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