ONE HYSTERIC AND "MANY PHYSICIANS,"

OR

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AS OTHERS SEE US.

[The following letter, the authenticity of which is vouched for by Dr Millais Culpin, was received by a lady in England from a friend in Canada. A few passages referring to private affairs have been deleted. What is here printed conveys a lesson to all who have to do with those patients who, more than any others, suffer much at the hands of many physicians. ED.]

Feb. 6th, 1921.

My dear

I came home from camp in August 1919, feeling that recovery was not far away. I am not sure what happened, but the news of Mr -'s death in September seemed to start a backward trend-not apparent perhaps to every one, but to me it seemed the very best thing in my life had suddenly gone. His letters kept up a living touch, and I just longed to get home and see him again. However, from then I had the most terrible time; in the November Dr H. said he could not bear to see me for three minutes, much less go through with it as I was, week after week. It was then we started to use chloroform for the attacks, and oh, the relief!-Here was something which acted instantly, whereas morphine took at least of an hour, besides which, knowing the tendency of morphine, I only dared take it when life itself was threatened.

From then on I could not get out of bed; excessive trembling, cramping, and heart thumping almost to suffocation; but comparatively easy in between if I remained in bed and just whiffed chloroform if I had to see folk. In March 1920 I had another terrific attack, so violent that I simply tore J.'s waistcoat etc., as the cramps twisted and turned me. Well, he thought I was going home, that time. And the nervous shock knocked him up; for three weeks he was in bed. Since then I have never been without chloroform and morphine at my bedside.

Then came the moving, through which I got fairly well, except that in going a few steps from the auto to the house I once more almost died. I had whisky in one pocket and chloroform in the other, and as J. was trying to carry me up the stairs, perfectly upright and stiff as a tree trunk, I could not breathe and tried to whisper "Whisky"; instead of which a spasm sent it out with a yell, "WHISKY," which, as we were then in a prohibition town, had its funny side.

However, I eventually got landed indoors and into bed, and have not been down the stairs since, except for an ambulance trip, to which I am leading up.

Now dear do not, for one moment, imagine me a poor suffering piece of humanity, but think of me very much as of yore; saying the most atrocious things and having a good deal of funny times, but with such a subconscious self always at work that I might make the most absurd joke, and go perfectly

rigid, and have chloroform, all within two or three seconds. Once, after a very bad attack, while J. and Dr X. were watching so anxiously (but I know the second the worst is over, by the relaxation) I said, "Doctor, what will you call this on the death certificate?" He looked startled, and said, "Why," so sympathetically anxious. "Well, because I have just read that Cromwell died from Tertian Bastard Ague, and I don't want anything like that." Well, in a second we were all laughing. "But," said Dr X., "No, I call it Decimated Sclerosis of the Spinal Cord"; so there you have it, up to Aug. 24th, 1920.

Then some of our doctors from overseas came back, and once more Dr X. got busy trying to find someone who might know more about it. First we had a germ specialist, and had a blood test everything negative. So there was no tuberculosis, or any trace of disease. He said, "Muscular, absolutely, will probably leave her as suddenly as it came." I forgot to tell him it had been a long time on the way.

He, in turn, was so much interested that he wanted another returned doctor, at present President of the - Medical Society, to see me. He came (Dr B.) and put me through all nervous tests, chloroforming whenever I was too bad. He was inclined to Dr X.'s view of the spinal cord, but would say nothing, as none of the nerves seemed worn out, even to the extremities of the toes they responded all right when I was lying down; but neither doctor attempted to stand me up, although I told them that I could, if they weren't there. Well, Dr B. had met XYZ. overseas, and had invited him to (Consultant Neurologist to. Practically the highest authority on nerves in the realm). He was sure XYZ. would be interested, as it was so extraordinary. In a few days I went to the hospital in the ambulance, just chloroforming all the way. I couldn't pretend to tell you the horror of the nurses at my daring to have chloroform, and they walked the bottle away, but how they came back on the double quick with it, and how all the doctors left me to it! They did not know who I was; at first I was entered as Dr B.'s patient, and when I tried to explain that I was not there for ordinary treatment, but was privileged as XYZ.'s patient, they all thought I was more than a little touched.

""

However, Dr B. came in that afternoon, and I was left in peace until Dr X. brought in XYZ. next day. Well, all the morning I almost prayed Dr B. would be with them-but he was so afraid that I should be a little more at ease with him, and he wanted me at my worst, so he stayed away, for which I was very very thankful afterwards. Dr XYZ. shook hands, I put on my very nicest smile and said, "Good morning, doctor. It is very good of you to spare your valuable time to bother with me.' "Not at all, Mrs P., if I can do you any good." By this time my sweetest smile was gone, and I was panting like a dog on a summer's day, and jerking away up the bed. Dr B. had purposely refused to give Dr XYZ. any history, so that all his diagnosis would be quite unbiassed. "Tell me, Mrs P., how long have you been like this?" "Five years."-"Five years you have been like this, but not like this all the time?" "No, only if I see people, or if I attempt to do certain things; for instance, if I go to make a cake I can put all the ingredients together, but immediately I go to mix it I go perfectly rigid and cannot move; or perhaps for weeks I can walk about the bedroom, but if I go to step outside the bedroom (even though I count 20 steps across the bedroom and say, 'Well, if I can do 20 steps in the bedroom I can do it in the hall') I cannot; I go into these attacks. And this is nothing; as a rule I tighten so that life itself is threatened." (All this between gasps and spasms

at about a word a minute.) "Tell me the first time this happened-had you not some sort of serious illness or trouble? No?-now Dr B. this is brain storm. Tell me, Mrs P. just what happened." "Well, I was going down the road and passed, or rather saw, two men walking on the sidewalk; I went perfectly rigid and could not pass them. They saw I was ill and asked me into a store, but I said I thought it was just cramp. By that time I was better, and so walked on to the doctor's office. I told him what had happened, and he brought me home in his car. Since then I have never seen anyone without going perfectly stiff when up, and jerking and twisting like this when in bed." And do you mean to say that you were perfectly all right when this happened?" "Yes." Once more I went through every kind of nerve test. Then he turned to Dr C. and asked for a nurse. "Now Mrs P., do you think you could stand up?" "Perhaps I could, if I chloroform, and get this attack quiet." "No, we want to see you as you are. Nurse, take everything off Mrs P., put on just a triangular bandage....Now, Nurse." Well, it was a free fight for all to get me off the bed, but when I was partly raised he swung my feet to the floor, he taking one arm and the nurse trying to get the other.

I was knotted from head to foot; every muscle to its utmost. The head and trunk forwards, knees turned right in, knock-kneed and strained up, with only the two big toes touching the ground. As to move, it was impossible; I clutched his tie and waistcoat, and he forced me all along the private ward (this took about 20 minutes for 20 yards). "Dr B., this is absolutely the typical up-on-the-toes of shell-shock, you have seen the men like this,"pointing to muscles here and there. When we made no progress he would slip his foot behind my leg and try to kick it forward with his full strength It would advance about 2 inches. Then I began to scream-not me consciously but an unconscious shriek like a drunken woman.-"Reflex hysteria." Eventually I got back to bed. The relief was so great that I relaxed instantly, and looked up to say something, but I saw XYZ.'s face simply streaming, soaking wet, and his clothes all over the place (the water had been trickling all down my chest and back in streams from the exertion). He was patting my shoulder, so I forgave him and once more smiled. "Doctor, I am so sorry, it has made you as hot as it has me." "To be sure it has," he said...."Now, Mrs P. I must tell you you will get well. This is brain storm, exactly the same as shell shock. Not brain disease, mind you, in any shape or form." I told him about the lordosis (spinal curvature) making the doctors think it was sclerosis of the cord. "No, the curvature can't be helped, of course, but the cord is quite all right. Treatment along the line of suggestion, etc. Take her out there and treat her the same as the men; let her see hundreds of people, and she will be well in no time." (I don't know where there was.) "She is a sensible woman, it is not like treating an ordinary woman, she is extremely sensible and well controlled."

"Doctor, if you call this control"-"Yes, but Mrs P., all this is subconscious; you cannot help this. It is incredible that a woman like you should go under." I thanked him.

Later, Dr B. came, and when I told him he laughed and laughed. He imagined a typical high-brow, and thought Dr C. would have all the fuss, and XYZ. look on and comment. "What did Dr X. do?" "He just stood with his hands behind him, against the wall; so did Dr A."

Well, that night there was to be a clinic of seven patients, two hundred doctors and nurses. I was to be one. Can't you imagine what I thought, and

every now and then the nurse would come in to know if I had had word. It came at last; they thought I had been through enough for one day: I need not go to the clinic-the Te Deum.

Now, what was gained? Well, just that the danger to the spinal cord being eliminated I could force myself to do things, and having the chloroform at hand, even if a severe attack was induced, I could soon get it under. So I made a little headway, getting round the house.

Next for suggestion. A very typical French doctor was doing splendid work at the hospital, so Dr B. interested Dr F.

He came-imagine the pictures in the comic press! Pinched suit, violet hued tie, shirt and socks perfumed, marble glazed forehead and French beard.

"Now, Mrs P., you know what is the 'Heepnosis'-I shall send you to sleep, but you must give yourself to me entirement you must be willing to do just what I say, you must make your mind a perfect blank and follow only what I say are you willing to do this?

With some idea that I was getting married over again I nearly said "I will." I caught J.'s eye twinkling and pulled myself together in time to get in a few questions; then J. was ordered out of the room.

"Look at me, keep your eyes fixed on me, don't think of anything, let your mind be a blank, look at me, you are going to sleep a deep sleep, you are getting drowsy, so drowsy, you are going to sleep, sleep, sleep, sleep, a sweet sleep, a deep sleep."

Twenty minutes of it, and he never once blinked an eyelash-Nor did I. "A hard case, a very hard case": J. came in. "She is a very hard case, but I will come again. Next time she will be more prepared; she is like the publeek, she is what you call him"-he meant incredulous. J. got the twinkle in my eye this time and volunteered the word-frivolous.' Yes, she is the frivol, but I shall conquer."

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Again he came. "I shall use the other methods if you do not give yourself in abandonment this time." "On my dignity Doctor, I am not fooling or incredulous. I should not ask you to come if that were all." (I had no idea but that it might be 50 dollars or so a time, so you can guess I wasn't fooling.)

"Sleep, sleep, you're sleeping so quietly, so peacefully. You are going to sleep." Twice he tried it fast and slow, persuasive, compelling. Nothing doing.

Once more he came. "Sleep, sleep." (In between he had met Dr B. and told him that I was a very hard case-a fine but hard intellect, and Dr B. has joked me on this hard intellect ever since.)

Sleep, sleep but sleep slept on, nor would she come at his bidding. Then I suggested I should have some chloroform to quiet the jerks, and that he should try to catch me just as I emerged from the chloroform; I woke clean up. I had taken 15 grains of sodium bromide in the morning, and so I looked up and said: "I was feeling awfully sleepy Doctor, until you came, I think if you had not come I should have gone to sleep." That finished him.

He told Dr B. he was fitting an office in the city with crystal glasses, batteries and so on, and would try me down there. But Dr B. says I scared him; he won't come back.

Now I could fill you sheets more of the funniest happenings: Christian Science visitors; Apostolic Faith; Auto-suggestion; the Presbyterian minister who asked if he could read to me, and started off on 'the fig-tree that was cursed'; the Church of England woman who advised cold cream for the nerves

and said whenever she heard a nonconformist minister pray it sent cold shivers all up and down her spine; the woman who sent me tracts on 'The menace of the movies.' Oh dear, what a life it is!...

Yours

P.S. I really dare not write a bit tense or emotional, or I shake from head to foot and can't write at all.

You will understand no blame can be attached to my doctor as not one of the hospital doctors or nurses had ever seen or heard anything like it. As to seeing hundreds of people, in the general struggle to say anything at all I forgot to tell XYZ. that I had persevered for a couple of years going to town etc., and seeing people, which is what really made the curvature. So much straining of the muscles. But I was privileged to have an hour of his time and a private examination when he was only a day in and saw only those at the clinic. This is well on in the seventh year-perhaps the seventh will end it.