An Investigation of Selective Deafness Produced by Direct Suggestion under Hypnosis.

TETANUS BEnIJO been found by Adriani and Kerr (1955) to be the most effective drug. First used in neonates, we have used it with success in the last seven older children. In three children treated with paraldehyde, phenobarbitone, and tracheotomy who were having such severe spasms that I.P.P.R. was contemplated, a change from paraldehyde to mephenesin resulted in satisfactory control. In adults it has been used intravenously rather than by mouth, but in children it has proved effective when given by stomach tube. Because of its local anaesthetic action this is preferable to oral administration, which may lead to depression of pharyngeal protective reflexes. It has shown none of the recognized complications of fall in blood-pressure, haemoglobinuria, or thrombophlebitis. It cannot be too strongly stressed that tetanus is a preventable disease and that active immunization with tetanus toxoid is a safe procedure that should be carried out in all communities. The use of antitetanic serum in prophylaxis is far less satisfactory as it carries a considerable hazard from serum reactions. It has also been shown recently to be ineffective if the recipient has had horse serum or has an anaphylactic reaction (Godfrey et al., 1960). Furthermore, severe and fatal tetanus can follow upon the most trivial injury for which the patient is unlikely to receive any prophylactic antitetanic serum. Summary In a series of 55 children with tetanus in which routine tracheotomy was not done, 27 (49%) died, while in a comparable group of 27 children in which tracheotomy was done in 14 severe cases and I.P.P.R. was used in 4, there were 3 deaths (11 %). Apart from the use of mephenesin in some of the latter group, treatment was essentially the same. Reasons are given why tracheotomy should be part of the routine treatment of severe tetanus. The indications for and the technique and subsequent care of the tracheotomy in patients with tetanus are described. Many aspects of psychogenic deafness as encountered clinically in association with psychopathology have already been demonstrated in deafness produced in normal persons by direct suggestion under hypnosis (Erickson, 1938; Pattie, 1950). Such work to date has dealt only witlh deafness extending over the whole aural spectrum (total deafness). We have reported, in a preliminary communication, on the production of frequency selective deafness in this way (Black and Wigan, 1960), and we have now carried out further interpretation of our data and have performed …