- A divorced Negro woman of about 40,
complaining of violent spasms of sneezing and a
compression sensation in the chest, was referred
me for diagnosis and to determine whether a
causal relationship existed between her
condition and the substances with which she
worked.
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- The claimant stated that she began sneezing
on the first day that she worked with a
gunpowder mixture. Occasionally the attacks were
interrupted by yawning. Her condition became
gradually worse, and by the third day the
attacks became so violent and continuous that
she required emergency care by the company
doctor. The physician administered a general
anaesthesia (chloroform) and the patient was
relieved of her symptoms for about three hours,
after which the attacks recurred. The next day
she was seen by her private doctor, who advised
her to give up her job since he was of the
opinion that her symptoms were caused by the
inhalation of the dusts of the gunpowder. She
was under his care for a period of about three
weeks, receiving vasoconstrictor and local
anaesthetic drugs to her nose and throat. This
was discontinued because it failed to relieve
the patient.
-
- The patient's job was to weigh the
gunpowder. Her first contact with this powder
was on the day she began working in the factory.
Prior to this job she worked as a pantry girl,
where she came in of contact with flour and
other food substances. There was no history of
allergy in the family. She had had three
children with the husband from whom she was
divorced many years ago and she had given birth
to an illegitimate child eight months ago. She
denied having had any serious illness before the
present attacks began. Because of economic
pressure, she decided to take the job in the
gunpowder factory and place her infant under the
care of her older sister upon whom she was
dependent since the death of her mother twenty
years ago. The claimant admitted that her sister
had been like a mother to her since their
mother's 'death. On the day that she began
working with the gunpowder mixture the claimant
remembered saving had a feeling of complete
frustration because she had received word that
her sister was accutely and seriously ill and
had become upset over the thought that there was
no one else with whom she could leave the
child.
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- On her first visit to my office, the
claimant sneezed almost constantly, "about
fifteen times per minute," which was interrupted
occasionally by spells of yawning lasting only
for a few minutes. She complained that she had
been suffering with her condition from the time
she began working with the gunpowder, that the
attacks had persisted for the past three months,
and that she was free of her symptoms only
during her sleeping hours.
-
- On examination of the patient the following
significant findings were observed. There was no
evidence of conjunctivitis, but there was a
profuse watery discharge from the eyes. The
nasal mucosa was normal in appearance with a
moderate amount of engorgement of the turbinates
and no nasal discharge was present. Examination
of the lungs, heart, and abdomen were
essentially negative. The blood Wassermann was
negative, urinalysis and complete blood counts
were normal, and only per cent eosinophiles were
found in the blood smear. A nasal smear showed a
normal amount of polymorphonuclear leucocytes
with occasional eosinophiles. Complete
intradermal tests, including the extracts of the
common inhalants and foods, produced no marked
skin reactions. The gunpowder mixture which the
claimant handled consists of the following
ingredients: zinc dust, hexachtoroethane,
ammonium chloride, calcium chloride (anhydrous),
calcium carbonate, and ammonium perchlorate, all
of which are powders, and hexachlorabutadeine, a
solution. Each of these were applied locally to
the nasal mucosa and produced no local allergic
reactions in the tissues. Inhalation tests with
these materials also failed to produce local
allergic changes in the nasal mucosa or symptoms
of sneezing and yawning.
-
- Fluroscopic examination of the chest showed
no evidence of pathology in the lungs and the
heart shadow was within normal limits as to size
and shape. Electrocardiographs showed no
evidence of myocardial damage or disease of the
coronary vessels.
-
- It was the impression of her physician that
the claimant was troubled with an allergic
coryza which was caused by inhalation of the
gunpowder dust at the factory. However, since
the condition occurred on her first contact with
the gun powder, it seemed apparent that a strong
psychogenic factor played a role in this
case.
-
- On her second visit to the office, although
the claimant had been absent from her work for
nearly three months, she came in sneezing
violently and I decided to try some form of
suggestion therapy. I told the patient to look
at an incandescent light and after repeating
several times, "Now you will not sneeze, you
can't sneeze," within ten seconds the sneezing
stopped and the patient remained symptom free
for the rest of the session (a halfhr.). Before
leaving, I advised the patient to look at an
incandescent light whenever she felt inclined
towards sneezing. When she returned a few days
later she was enthusiastic over the treatment I
suggested, since she had only occasional attacks
of sneezing which she had been able to control
by this method. On this day and on subsequent
visits I tried further experiments with
suggestion. In general, I found that I was able
to stop or start her sneezing and yawning spells
at will. By pressing with my index finger
beneath the left angle of the jaw and telling
her that the sneezing would start, she
immediately would begin sneezing most violently
about ten times per minute. On pressing on the
opposite side and telling her that she would
sneeze in double time, she immediately began
sneezing about twenty times per minute. On
twisting her left wrist, and telling her she
would begin yawning, she immediately began
yawning, and by directing her to look at an
incandescent lamp, all symptoms ceased by
suggestion.
-
- On later visits, my nurse and other persons
were able to produce and stop the symptoms by
applying the pressure points as described above
without speaking to the patient or making any
suggestions. The patient was also conditioned to
start and stop her symptoms with suggestions
from me that pressing with her left middle
finger beneath the left angle of the jaw would
start her sneezing, the left thumb would produce
yawning, and pressure with her left index finger
would stop all symptoms.
-
- Then inhalation tests were performed with
the materials with which she came in contact at
her work. The patient was blindfolded; I started
her sneezing spells by pressing the "trigger
areas" and told her that I was going to apply
soothing medication to her nose. Instead I
applied the various ingredients which made up
the gunpowder substance to the nasal mucosa. She
stopped sneezing and had no recurrence after
each ingredient was applied. This was followed
by shaking a bottle containing tap water in
front of the patient (a rubber stopper was used
to prevent any of the water from spilling) and
after telling her that it contained a solution
of the gunpowder mixture, she soon went into
violent sneezing spells whith occasionally were
interrupted by short spasms of yawning. She
pleaded with me to get her out of her misery and
by using the incandescent light method of
treatment she was relieved of all her symptoms
in a few seconds.
-
- It is interesting to note that the claimant
was relatively symptom free from the time I
began using suggestion therapy until about two
months later, when she made her appearance at a
Compensation Board Hearing. On that occasion she
had a recurrence of her symptoms and the attack
was so violent that the hearing had to be
postponed. After this session was over, her
symptoms disappeared. About two months later she
returned with no complaints but quite indignant
because compensation was denied her on the basis
that had I had concluded that there was no
causal relationship between the patient's
condition and her work. When I gave her the
reason for my decision: that I was able to
produce and stop her symptoms by suggestion, she
challenged my ability to start her sneezing
again. At this time I tried suggestion ther
again and I failed to produce a recurrence of
claimant's former symptoms.
-
- This case was under my observation for over
period of two years, and the patient when last
se was working as a domestic and has had no
recurrence of her symptoms.
-
- Conclusion
-
- 1. A case is presented of a woman suffering
with violent and almost continuous sneezing
spells which occasionally was interrupted by
short spells of yawning. These symptoms were
alleged to have occurred by contact with a
"gunpower smoke".
-
- 2. The standard methods of testing allergic
patients were used and gave no evidence that we
were dealing with an allergic individual. These
included complete intradermal testing with the
common extracts of inhalants and foods as well
as "snuff," inhalation tests with the various
mixture of "gunpowder smoke," and materials with
witch the patient came in contact at her
work.
-
- 3. Psychotherapeutic measures (suggestion)
were used and caused disappearance and
recurrence of the patient's symptoms at
will.
-
- 4. It can be reasonably assumed that the
patient's symptoms in this case were purely
psychogenic in origin.
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