HYPNOSIS IN HYSTERIA.

433 I will conclude by quoting Sir Patrick Manson once more : "If a supposed ague resist ...... quinine ...... the diagnosis should be revised."—I am, Sir, yours faithfully, WILLIAM FLETCHER, Captain, R.A.M.C.; Pathologist, Institute for The Laboratory,

Medical Research, Kuala Lumpur, F.M.S. University War Hospital, Southampton, Aug. 1st.

HYPNOSIS IN HYSTERIA. Editor ot’ THE LANCET. take the opportunity afforded me by to SIR,-I glad Captain J. R. O’Brien’s courteous letter in your issue of Sept. 21st to enlarge somewhat upon the question of the relation between hypnosis and hysteria, although a really To

the

am

of this relation would fill volumes. It is well known that Charcot failed therapeutically through his excessive enthusiasm for hypnosis. His methods were so vigorous, and he applied them so frequently upon the same subjects, that these subjects became more and more dissociated, more and more suggestible, more and more hysterical. Hence the grande hystérie, the attitude passionnelles, &c. , which are now so seldom met with. In other words, he "cultivated"hysteria at the Salpêtrière But in doing so he made great additions to our theoretical knowledge of both hypnosis and hysteria. His failure as a physician and his success as a scientist are both summed up in his statement, "Hypnotism is an artificial hysteria." I consider this statement, as far as it goes, to be absolutely true. The more one sees of hysteria and the more one sees of the results of hypnotism the more convinced one becomes of the intimate relation between the two. That is why hypnotism is such a dangerous method to use in the hands of operators whose enthusiasm outruns their psychological knowledge and skill. Safeguards are necessary, and in my article in THE LANCET of August 17th I have indicated the modifications of ordinary hypnotic procedure which I have found practically satisfactory in dealing with hysterical soldiers in the field shortly after their exposure to shell fire. Shell concussion, or the mental strain of being under shell fire, had already hypnotised them and produced a certain amount of mental dissociation in the form of amnesia, loss of motor or sensory functions, &c., without demonstrable organic nerve lesions, and by means of my method of light hypnosis I was able to remove the underlying cause of this dissociation and neutralise it by subsequent re-association. No doubt there are other forms of dissociation besides that of hysteria. But the point is that the dissociation of hysteria and the dissociation of hypnosis are identical in nature. Captain O’Brien writes : I I Thousands of healthy men absolutely devoid of any trace of hysteria have been hypnotised, while hysteria itself, instead of favouring the induction of hypnosis renders it more difficult." With the second half of this statement I entirely disagree. My experience has been that the more hysterical a patient is the easier it is to hypnotise him. I also believe that when an apparently normal person is hypnotised he is rendered temporarily hysterical by the very process of hypnosis, the vigorous emotional appeal of the operator producing a dissociation of a hysterical nature. Such a person will be more hysterical thereafter, and will be more susceptible to hypnotism, unless steps are taken to counteract this effect. I, of course, recognise how large a proportion of apparently normal people can be hypnotised by one means or another-although in many cases the degree of hypnosis is slight-but then most people, if not all, have some hysterical flaw, some dissociation following upon mental conflict, in their mental make-up. I I Jedermann ist ein bisschen hysterisch,"said Moebius, and this slight degree of hysteria is what ensures the success of the resolute hypnotist. The mild methods which I myself use have no effect upon apparently normal persons, although they are invariably successful with hysterical soldiers hot from the firing line. In my opinion, more impressive methods are to be deprecated, as their dissociative effects are difficult to neutralise afterwards. When Captain O’Brien writes as follows : 11 Pierre Janet’s theory that only hysterical patients can be hypnotised rests on the assumption that the presence of the secondary self is unable to follow always a symptom of hysteria," I am again him. Pierre Janet has no dealings with a " secondary self." He prefers to avoid hypothesis as far as possible, and to speak simply of dissociated ideas. When these ideas are sufficiently numerous and linked up with one another, they

adequate discussion

5 Loc. cit., p. 120.

I

produce the appearance of an alternating or dual personality. The essential psychological characteristic of the hysteric is, in Janet’s view, a weakness of mental synthesis. I can only repeat that my personal experience with cases in France agrees closely with the views of Janet, but is at may

It variance with much that has been written elsewhere. seems to me that only by the aid of hypnosis and other forms of mental analysis will the problem of hysteria be I am, Sir, yours faithfully, finally solved.

WILLIAM BROWN, Major, R.A.M.C. Craiglockhart War Hospital, Edinburgh, Sept. 21st, 1918.

DRIED V. CONDENSED MILK : A CORRECTION. To the Editor of THE LANCET. CHER MONSIEUR,-Je me permets de recourir à votre haute impartialite pour vous demander de bien vouloir rectifier dans le prochain numero du’’LANCET " 1’erreur de traduction qui s’est gliss6e a l’occasion de ma precedente lettre sur le lait condense. Cela vous apparaitra d’autant plus nécessaire que cette erreur denature complètement ma pens6e et le sens de ma lettre. En effet, je disais : "Mes dernières recherches me permettent de conclure que les laits condenses non sucres sont inferteuro aux laits condensés sucrés et j’affirme que les laits écrémés constituent des produits dangereux pour les jeunes enfants."

Or votre traducteur

a

ecrit :

Unsweetened condensed milk he considers

positively dangerous."

Itt une interpretation qui me fait dire le contraire de ce que je pense : Ce sont’les laits condenses prives de leur creme qui je considere comme dangereux pour les enfants, mais si j’estime aussi que le lait condense sucr6 est le meilleur aliment de la 1ere enfance je reconnais apres une longue experience et je 1’ai declare dans de nombreuses publications, que les laits condenses non sucres (mais contenant leur creme), sont neanmoins excellents et bien pr6ferables à tous les autres laits en usage dans l’alimentation de la lere enfance. Votre souci de la vérité scientifique, m’assure que vous voudrez bien, cher Monsieur, corriger la fausse impression qu’ont pu avoir vos lecteurs. Recevez avec mes remerciements 1’hommage de ma haute P. LASSABLIÈRE. et sympathique consideration. 11 y

a

Sept.l7th.l918.

Chef de Laboratoire à la Faculté de Médecine de Paris.

METHODS OF CONTROL OF FRAGMENTS IN GUNSHOT WOUNDS OF THE JAW. To ’&M

Editor

Of THE lJANUET.

SIR,-May I be allowed to make a few remarks on an interesting article under the above heading that appeared in your issue of Sept. 7th by Major H. P. Pickerill. I appreciate much that Major Pickerill has written, and was particularly gratified to find him adopting as a routine methods and principles that I and my colleague, Mr. Percival P. Cole, at the King George Hospital, have consistently advocated and practised since the early days of the I refer in particular to : (1) The importance he war. attaches to the control of the posterior fragment; (2) the preservation of comminuted fragment of bone; (3) his condemnation of the needless extraction of teeth in the vicinity of the fracture ; and (4) his preference for the immediate as opposed to the gradual reduction of malocclusion. As regards (1), it is irteresting to note that as recently as March, 1918, at a meeting of the Odontological Section of the Royal Society of Medicine, Major Pickerill expressed doubt whether we (Mr. Cole and myself) "can control the posterior fragment at any rate by the methods shown." In view of this pronouncement it is interesting to find that, with the exception of the zygomatic screw method, his procedure of controlling the posterior fragment, when the ascending ramus is fractured above the level of the alveolar border, is identical in principle with the one I have always employed-the impression of the fragment being taken with the upper splint in situ and a saddle adapted to the model thus obtained and secured to the upper splint. (2), (3), and (4) were dealt with by me in a paper read at the same meeting, and published later in the Transactions, reference to which will prove the identity of Major Pickerill’s method with those therein advocated. Major Pickerill in his article refers to ’’ the four-tailed bandage,""screw lever splint," and a "submandibular 1

THE LANCET, August

24th, 1918 (p. 245).