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EXAMINATION OF THE SUBCONSCIOUS
To test whether the case was of an organic, neuropathic, or psychopathic character, the method of guessing was used. The method of guessing consists in the making of impressions on the anęsthetic organ, and the subject, not perceiving any of the applied stimuli, is asked to guess as to the nature and number of them by telling anything that happens immediately to enter the mind. The patient was placed before the perimeter and objects were introduced midway between her field and the normal field. These objects were outside the patient's field of vision, but if asked to guess what they were, stopping a few moments to think and naming the first object which came to her mind, her answers were correct. Letters were introduced into the perimeter, of the same size as the disc used for determining the field; she could often guess the correct letter, although she could not see it, but when it was near the limits of her field she often had a perception of white without being able to see the letter.
Under hypnosis it was suggested to her that her field would enlarge, that her vision would improve, and that she would be able to use her eyes better for reading and sewing. On awaking from the hypnotic state, tests with the perimeter showed a markedly increased visual field, and there was some improvement in her ability to use her eyes, but not as much as would have been expected from the increased size of the field of vision. The fields of vision taken immediately after this hypnotic state showed a marked tendency to change continually―dilating and contracting along certain angles from 5° to 15°, and finally lapsing into the original state. We may add here that the contracted field of vision which constitutes the central symptom of this case could only be transiently affected by hypnotic suggestion. In spite of the fact that suggestions given during the hypnotic state were most emphatic, the field of vision could not be permanently enlarged.
The subject manifested a tendency to fall into deep somnambulism with complete amnesia in the waking state. She was unable to open her eyes when told that she could not, and equally unable to prevent the arm from rising to a level with the shoulder when told it would. If she was told that she could not lower the arm when in this position, it remained there indefinitely, and all her efforts to lower it were futile. Rotation of the hands about one another, if started, was continued, and if they were held a moment, they immediately flew apart when released and continued the motion. Complete anęsthesia could be produced by suggestion, and the patient was completely unconscious of any movements communicated to the anęsthetic limb, and could not tell where it was without the aid of vision. If now one arm only was made anęsthetic and both arms were raised to a level with the shoulder, the patient meanwhile having her eyes closed, the anęsthetic arm trembled less, sank more slowly to the side, and when it finally dropped, after having remained up longer than the other, it did so in a heavier, more lifeless manner. If all the limbs were made anęsthetic and the subject with her eyes closed was directed to rise and take two steps forward, she did so, but in answer to inquiries said that she was not aware of having moved.
Both positive and negative visual hallucinations of persons and things could be given by suggestion. If a person rendered invisible to her was placed in her path while walking, she ran directly into him and tried to walk on, pushing by him, and appearing entirely unconscious of his presence. She could not explain when questioned what had interfered with her progress. This negative hallucination did not extend to objects handled by the invisible person. They seemed to her as if suspended in mid-air, and she could give no explanation of this incongruous appearance. On one occasion she was told that an empty chair opposite contained Dr. E., that he was speaking to her, and she was expected to answer him. She said that she saw Dr. E., but did not converse with him as she did not hear him address her. She would see imaginary columns of figures on blank paper, read them, and add them all, or any combination of them; but the number of figures in each instance which she saw never exceeded four. In the same way she saw photographs on blank paper, and when asked whose pictures she saw she usually gave the names of the nurses. If a letter of the alphabet was eliminated from her mind by telling her she could neither see, pronounce, nor write it, she repeated the alphabet promptly, omitting the letter, and copied passages from books leaving the letter out wherever it occurred.
While in a hypnotic state, a nurse was introduced to her, whom she had never seen and whose name she did not know, and after telling her the name she was told that when she awoke she would ask me for pencil and paper and write the name. On awaking, she had no knowledge of ever having seen the nurse, who still was in the room, and made no spontaneous effort to carry out the suggestion. When asked if she did not feel as though there was something which she should do, she tried to think, but failed to recall anything. Finally she had to be assisted by telling her that she was to ask for something, whereupon, after a few moments' thought, she asked for pencil and paper and promptly wrote the name.
In every instance where she was given a suggestion to be carried out in the waking state, it was found necessary to assist to this extent, but when once the act was initiated it was completed accurately. Afterwards, however, this assistance became no longer necessary. The many experimentations seemed to have cultivated in her the spirit of obedience to suggestions.
On another occasion she was given, during hypnosis, a blank piece of paper upon which she was told there was a column of figures. When asked to read the figures, she read four numbers, giving a different order on a second interrogation, but maintaining this second order throughout the experiment. She was told that on awaking she would see these numbers and add them. With similar assistance to that described in the foregoing experiment, she took a pencil, drew a line as if under a column of figures, and wrote down the correct sum―21. When questioned, she said she had seen no figures, but had drawn the line to add and written 21 simply because that was the first number that came to her mind. Finally, when asked what she had added, she repeated the figures seen during hypnosis, and gave them as a reason for the sum 21, but she could not account for the particular numbers. They appeared to her as if they had accidentally occurred to her mind.
Anęsthesia of the right arm was produced during hypnosis, and it was suggested that this condition would continue in the waking state, which it did. The anęsthetic arm was insensible to pin-pricks, and with the eyes closed she could not locate it. The arm was carried in a limp, helpless way, but she was able to use it in grasping objects, playing cards, etc., and in holding a heavy book between thumb and fingers even with closed eyes.
On one or two occasions, however, while she was playing cards and holding the cards in the anęsthetic hand, on looking away from the hand the cards dropped to the floor.
With her eyes tightly closed, the fingers and arm were moved several times in the same direction. When left alone, these movements were continued automatically and without her knowledge. In the same way, if a pencil was placed in the fingers and the hand started writing a figure, letter, or simple word, it completed the movement, although she did not even know that she held a pencil.
If, with eyes closed, she was asked to think of a number, and the hand was pricked several times, although no sensation resulted she invariably thought of a number corresponding to the number of pricks made.
All these experiments were conducted with the same results during hypnosis. This anęsthesia was allowed to remain about three hours, and, as it seemed to worry her somewhat, was removed by hypnotic suggestion.
The subject in her normal state was given a book; she was directed to read aloud to some one in the room, in a slow, clear tone, taking pains meanwhile to understand clearly what she was reading. While she was reading, Dr. W. approached her from behind and spoke to her in a low tone of voice, directing her to raise her right hand to the table; the hand obeyed; Dr. W. placed a pencil in the hand, and the hand grasped it. Now any question that was propounded to her was answered in writing while she continued to read aloud. If a suggestion of a visual hallucination was given to her, the hand wrote, in reply to a question, that she saw the thing suggested. It was noticeable, however, that the two processes interfered with one another, and that while one was carried on at its best the other was interrupted and hesitating. When she stopped reading, she had no recollection of anything said or suggested, and her remembrance of what she had read was rather indistinct. If, however, she was hypnotized after one of these experiments, she remembered everything said and what her written replies had been. When questioned once during this period of distraction about a hallucination of a rose which had been given her in a former hypnotic state, and asked if she remembered it, the hand wrote "Yes"; asked what she did with it, the hand wrote "I gave it to Mrs. S.," which was a correct answer and showed complete recollection of the hallucination. Questioned after she finished reading, she had no recollection either of the hypnotic state or of the answers her hand had written.
If in her normal state she was placed at a table with pencil and paper in the attitude of writing and with closed eyes asked to think intently of a name, the hand soon began automatically and without her knowledge to write this name. This experiment has been duplicated with the hand made anęsthetic by suggestion both during hypnosis and post-hypnotically.
All these experiments were made without in any way suggesting to the patient, or indicating in her presence, what were the expected results, and a careful observation of her since admission has failed to detect any evidence of simulation.
Since her admission, she had no further nervous crises, except those described above, until the afternoon and night of June 12th and 13th. This attack was convulsive in nature and accompanied by marked spasms and dyspna.