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."

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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."

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.

CRITICAL NOTICE.

First Report of the Miners' Nystagmus Committee. London: published by His Majesty's Stationery Office. pp. 64. Price 1s. 6d. net.

A survey of the facts collected by the Miners' Nystagmus Committee leaves one in no doubt as to the wisdom of including amongst the members of the Committee some one versed in psychological investigation. The possibility of a psycho-neurotic factor in the disease had been suspected by many observers, and Dr H. W. Eddison was appointed to enquire into this aspect. The desirability of doing so becomes abundantly clear when the data collected from many sources are examined, and the compilers of the Report are to be congratulated upon placing before the public so clear a picture of a widespread and costly industrial disablement.

The facts are remarkable. What is to be considered of such an array as the following? Nearly 1,000,000 men are employed as miners in the United Kingdom. In 1908 the total number of cases of nystagmus was 460; in 1920, 7028. In 1908 the cost of all industrial diseases was £13,000; in 1920, £343,000, ninety per cent. of these sums being due to miners' nystagmus. Yet the number of men employed had risen only from 783,000 to 978,000, whilst it is noteworthy that in the same period the output in tons per man per year fell from 334 to 235. In a typical Yorkshire pit employing 2000 men, 25-38 per cent. (according to the grade of employment) of all men over the age of twentyone working underground showed oscillation of the eyes, and every one of these men could obtain a certifying surgeon's certificate and be legally disabled. In the north of France, Dransart estimated the frequency as 15 per cent., but 99 per cent. of these were unaware of the condition and were not incapacitated. The disease varies greatly in different districts and in different pits of the same district. It is more prevalent in the dark winter months, and among the night shift workers. Slack trade causes an immediate increase of cases certified as disabled. When a lump sum is paid in settlement as compensation, the men are more likely to resume work. A man with nystagmus can always allege that he is unable to work even on the surface, and to ask an employer to prove a man's fitness is simply asking an employer to attempt the impossible." Although every class of worker is affected, 81.5 per cent. of all cases come from the coal face. The direction of the gaze is not an essential factor in the production of the disease. The skilled workmen are the most affected.

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It is possible to 'infect' a pit, hitherto free from certified cases of nystagmus, by the introduction of a few bad (nystagmus) cases. Alcohol in large doses lessens and even arrests the oscillations of the eyes, but the prognosis in an alcoholic is not so good as in an ordinary individual. The average age at the time of failure is forty-two. An accident to a man's eye tends to precipitate the disease. There is a tendency for several members of one family to be affected. There is a great difference of opinion as to the influence of a purely ocular condition such as an error of refraction. Compensation has reduced the rate of return to work. A hopeful attitude on the part of the doctor increases the chances of cure. Finally, according to Dr W. H. R. Rivers, "it may now be accepted with confidence that the affection is primarily due to defective illumination."

The recital has a familiar ring to those who have come into contact with the psycho-neuroses produced by the recent war, and it is clear that Rivers' experience therein was of service in dealing with the information obtained by Dr Eddison. A critical examination of the above summary leads inevitably to

the opinion that the study of miners' nystagmus requires a broad view of the worker and his reaction to his environment, and one reads Rivers' personal report with a sense of relief that a beginning has been made, and a feeling of disappointment that the investigation of the psychological aspect has not gone very far. This implies no reproach to the Committee or Dr Eddison. The field for research is enormous; every one of the facts extracted from the Report fills one with wonder as to its significance in the life of the miner. Before speculating on this, it is worth while to see how far the psycho-neurotic miner resembles other sufferers.

After some years of work in the pit, the miner begins to feel eye-strain, followed by a difficulty of concentration of the sight on the object looked at, and a fear of harming, or being harmed by, his fellow workmen. Then follow loss of self confidence, and a fear of light. Such a history can be obtained every day from dozens of out-patients in every ophthalmic department in the country. Unfortunately the out-patients limit their spontaneous complaints to the 'straining.' For reasons unknown to themselves they omit all reference to other symptoms with the sole exception of headache, and, unless the oculist has the perspicacity of Dr Eddison, he is content to attribute the symptoms to the error of refraction which is almost invariably present, and to prescribe glasses. Specialism rarely stops to distinguish between post hoc and propter hoc.

Following the photophobia come blepharospasm, headache and giddiness. Turning again to ordinary hospital experience, 80 per cent. of ophthalmic outpatients who seek relief from other than inflammatory conditions suffer from headache and 60 per cent. from giddiness. The types still correspond closely. As the miner's disease progresses, disordered action of the heart, excessive sweating and dilated pupils may be noted; corresponding disturbances of the sympathetic nervous system are found among the out-patients. Depression and insomnia and fearful dreams are common in miners; they are also very common in the ordinary run of hospital out-patients.

Taking a broad view of all these facts, the necessity for further psychological investigation becomes apparent. What is the peculiarity associated with the miner's occupation which distinguishes it from practically all others? He is an average kind of man working far down in the bowels of the earth, in very poor light (the illumination of the coal face is sometimes reduced to foot candle), in considerable danger (in 1913 there were 195,000 accidents recorded), and it is found that he tends to become affected with a disease almost as easily as a child becomes afraid of the dark. Increase the illumination and the disease lessens much in the same way as a child's terrors diminish in the comfort and assurance of a night light. Even the fact that he is on a night shift affects him adversely, and like so many nervous children he becomes photophobic. Introduce to the small apparently healthy herd a few bad examples, and a small stampede occurs with startling ease. Encourage the man to give way to his difficulties by granting compensation, and the incidence increases still more. With cheerful confidence encourage the sufferer to get well, and he improves. Diminish the healthy man's sight still further, if only temporarily, by an accident to his eye, and he gets a definite percentage of increase in the risk of becoming nystagmic. Make him forget his troubles by large doses of alcohol, and the nystagmus may disappear, whilst the man who has made it a habit to drown his troubles in drink and failed, cannot be cured. Let him go on working until he begins to get on the down grade in vitality at the age of about fortytwo, and he throws in his hand. Bring him back to safety and sunlight, and the sufferer has a reasonable chance of pulling himself together, especially with J. of Psych. (Med. Sect.) III

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