NEUROSES. 
BY 
MORTON PRINCE, M.D., 
BOSTON, MASS., 
Physician to Out-Patient Department, City Hospital (Nervous Diseases), Boston, Mass. 
Reprinted from “ The International System of Electro-Therapeutics.” Published by The 
F. A. Davis Co., Philadelphia. See announcement on last page of cover. NEUROSES. 
BY 
MORTON PRINCE, M.D., 
BOSTON, MASS., 
Physician to Out-Patient Department, City Hospital (Nervous Diseases), Boston, Mass, 
Reprinted from “ The International System of Electro-Therapeutics.” Published by The 
F. A. Davis Co., Philadelphia. See announcement on last page of cover. NEUROSES. 
By MORTON PRINCE, M.D., 
BOSTON, MASS. 
Mode of Action of Electricity in Neuroses. 
Neuroses are, par excellence, the kind of nervous disease in which 
favorable results are obtained from electrical treatment. More or less 
doubt may be entertained whether electricity alter for good or for 
evil such disease processes as cause organic change in the central nervous 
system, but any one who has had extensive experience in treating func- 
tional nervous affections with electricity must either bear witness to the 
favorable results observed or else lay himself open to the suspicion that 
he has not the skill and judgment necessary for its proper employment. 
Of course, in some kinds of neuroses and psychoses its effects are more 
marked than in others, while some may be absolutely rebellious to its in- 
fluence. But the same is true of all therapeutic agents. It is also true 
that some ph}-sicians are less successful than others in using electrization, 
—a difference which, it may be suspected, depends in part upon the judg- 
ment with which suitable cases are selected for treatment, and in part 
upon the skill with which electricity is applied. This general statement 
of the beneficial effect of electrization in this class of diseases is not a 
committal to any particular theory of its mode of action. It does not 
imply that electricity must have a specific influence as electricity on the 
nervous elements, or that its curative results are brought about in a way 
other than that of reflex stimulation of the skin and peripheral nerves; 
indeed, it is not incompatible with the belief that the therapeutic effects 
are due entirely to the mental effect or suggestion. Whatever its mode 
of action, the treatment of neuroses by electricity is often followed by 
beneficial results. 
At this point, then, it will be well, once for all, to consider the modes 
of action of electricity, in order to avoid repetition when, later, we dis- 
cuss the treatment of the different neuroses by themselves. It will then 
be understood that all that is necessary has been said in this matter. 
There are several ways in which electricity is capable of action on the 
nervous system so as to produce its therapeutic effect, although it is not 
always easy to determine the one that is active in individual cases. 
Considerable skepticism lias been awakened of late years regarding 
the possible specific action of electricity in curing disease. The exag- 
gerated claims of the earlier observers of the power of electricity to cure 
organic disease, such as cerebral haemorrhage, spinal sclerosis, etc., have 
led to a reaction which not only denies all curative influence in such NEUROSES. 
Affections, but attributes all the beneficial results which are obtained in 
functional diseases, and which are beyond question, not to the physical 
effects of the current, but to the psychological impression produced. 
The power of suggestion to modify functionally-diseased states has 
been brought into prominent notice of late by the study of hypnotism, 
and the therapeutic results obtained by hypnotic suggestion have offered 
a new explanation of many of the phenomena obtained in every depart- 
ment of therapeutics. The inference was natural that the effect of elec- 
tricity in functional disease might be due to suggestion pure and simple. 
That the electric battery, and especially a static machine, can be 
made to have a powerful suggestive influence on a patient’s mind is a 
fact that can be easily demonstrated. It is beyond question that the 
electric current, in many instances, acts in this way, and that some of the 
more brilliant cures are due to suggestion, and to suggestion alone. I 
have myself, again and again, made use of this suggestive influence, and 
obtained very striking results. In fact, whenever I wish to make use of 
suggestion for therapeutic purposes, it is my habit to employ the bat- 
tery 1 as an agent. Very pretty experiments may be made in this way, 
showing the power of suggestion in the waking state, even without hyp- 
notism. If any one doubts the suggestive power of many of our thera- 
peutic agents, he has only to make a few experiments of this sort. That 
the results in such cases are due to suggestion cannot be doubted. It is 
possible to play upon the nervous systems of some patients as readily as 
in the hypnotic state. Susceptible subjects will experience just such 
feelings and be relieved of others, as the operator “ suggests.” One has 
only to assert boldly that the patient will experience this or that sensa- 
tion, and, if the subject is a suitable one, the prediction will be fulfilled. 
If more evidence is wanted that these results are due to suggestion, 
it may be obtained by shutting off the current from a galvanic battery 
without the knowledge of the patient. 
These facts are very important, and must be borne in mind by him 
who would form a sound judgment on the action of electricity.2 The 
case of paraplegia cited on page K-46 may be referred to here. The 
cure, in this instance, effected by “ electric suggestion,” was literally so 
electrical as to seem to the patient to partake of the nature of a miracle. 
But though the electric battery may be made to produce results of 
this nature, the same may be said of almost every other therapeutic 
agent, medical or surgical. The physician who, believing implicitly in 
the efficacy of his treatment, never prescribes a dose or applies a blister 
without giving positive assurances of the beneficial results that will 
follow, will always count a higher percentage of cures, when dealing with 
functional diseases and minor ailments, than the skeptical and timid 
practitioner. The electric battery is particularly well adapted to pro- 
1 The static machine is most effective for this purpose. 
5 The same may be said of many other therapeutic agents, such as blisters. Compare, for 
example, Harkins’s cases, cured by blistering over the fourth and fifth cervical vertebrae. PRINCE 
duce a profound impression of this sort on the mind. But he is a rash 
generalize!’ who would infer from such facts that this is the only way in 
which electricity acts. A generalization of this kind rests on even less 
substantial evidence than that which attributes to the electric current the 
power to reorganize structures irreparably destroj’ed. One might as 
well infer that, because in given instances bromide could be shown to 
produce sleep by suggestion, it had no physical hypnotic effect. It may 
be said that electricity can act, and in manj' cases does act, by suggestion, 
but, with our present knowledge, more than this cannot be said. 
On the other hand, it has been found that electricity does produce 
certain physical reactions in the body, and there is good reason to infer 
that it is through the medium of these reactions that the beneficial 
therapeutic effects in psychoses are brought about. 
The physical facts, by means of one or more of which the thera- 
peutic effects of electricity may be brought about, may be briefly described 
as follows ;— 
1. The compound group of phenomena known as catalysis.1 
2. Changes in the circulation of the brain and spinal cord, which have been observed 
to follow electrical stimulation of the skin. (Nothnagel observed contraction of the cere- 
bral blood-vessels following electrization of the skin and of the sensory nerves. These 
results have been confirmed by Rumpf, who found that faradization of the skin of a limb 
caused transient anaemia, followed by congestion of the opposite hemisphere.) 
3. Changes in the circulation of the brain, shown by Lowenfeld to occur in rabbits 
when an electric current is passed in different directions through the head. According to 
this observer, when the positive pole was placed on the forehead and the negative pole on 
the nape of the neck a contraction of the blood-vessels of the brain occurred, but when the 
poles were reversed a dilatation of the vessels resulted. When the poles were placed on the 
side of the head a contraction of the vessels lying beneath the positive pole was produced, 
and a dilatation of the vessels on the side on which the negative pole was placed. 
4. More important than all, certain changes, as yet of an unknown nature, pro- 
duced in the central nervous elements by reflex stimulation independent of the circulatory 
changes. 
The effects included in this fourth class receive a certain explanation 
from what we know of the effect upon the body of reflex stimulation 
physical agencies other than electricity. The readiness with which the 
central nervous system may be affected for good or for evil by different 
kinds of peripheral stimulation is a fact too well known to need reitera- 
tion, but the intensity of the effect that may be produced by such stimu- 
lation, even on parts of the nervous system not directly connected with 
the particular centripetal nerves acted upon, is apt to be overlooked in 
1 Catalysis was introduced by Remak as a convenient term to designate a number of com- 
plex physical effects of the electric current. They are thus summed up by de Watteville :— 
1. Its property of conveying liquids from pole to pole (cataphoresis and osmosis) through 
the tissues, whether cell-walls or intercellular material. 
2. Its property of inducing chemical changes in solutions through which it circulates 
(electrolysis). 
3. Its effect on the circulation of lymph and blood through the tissues. This effect is (a) 
direct (by excitation of the vessels themselves); (6) indirect (of vasomotor or sympathetic 
nerves); (c) reflex (of sensory nerves). 
To which list we may add (4): Its possible excitation of the trophic influence of nerves on 
tissues; and of their constituent cells themselves. NEUROSES. 
individual instances. Counter-irritation is a classical instance of such 
action. Heat and cold are capable of producing very profound effects 
upon the nervous system, whether in the form of douches, ice and hot- 
water bags, hydrotherapy, or the atmosphere. The undoubted beneficial 
influences of hydrotherapy can only be attributed to the stimulation of 
the peripheral nerves. The tonic and depressing influence of the at- 
mosphere is a matter of such familiarity that it is apt to be overlooked ; 
yet, when one pauses to consider the profound effect on the well-being of 
the individual, at times produced in a very few minutes by sudden 
changes in the temperature of the atmosphere, one can hardly help being 
astonished. An instance of this, which has probably been experienced 
by every one, is the tonic, bracing effect almost instantly felt when, after 
a hot day in the city, one feels the cool sea-breeze on a harbor steamer. 
The physical depression caused by the cit}r’s heat and day’s work disap- 
pears as if by magic. The change is too sudden to be due to the cooling 
off of the body, but the feeling of well-being must be due to stimulation 
of the peripheral nerves. This is in line with what is known of the tonic, 
bracing effect on the nervous of the cold air of high altitudes. It 
is generally conceded by writers on Alpine health resorts that this is one 
of the principal factors which give these places their therapeutic value. 
The power of smelling-salts to relieve headache, remove faintness, 
etc., is too well attested to be doubted. 
These commonplace facts are referred to here because they are similar 
in character to many of the effects produced on the central nervous 
system by electricity, and throw a side-light on its mode of action. I 
have frequently noticed, as has, probabty, every observer, the same 
physiological phenomena after electrization. Patients often describe 
the same sensations of well-being, of increased energy, and of a sense of 
exhilaration wdiile being electrized as from a cold douche or a sea-breeze, 
etc. It seems to me that these effects are best explained by stimulation 
of the peripheral nerves. Further evidence of this mode of action is the 
unfavorable effects sometimes produced. It occasionally happens that 
patients do not bear electricity well. In such cases various unpleasant 
symptoms are produced; headache, vertigo, faintness, various parses- 
thesiae, pains, nervousness, and sleeplessness are experienced. These 
seem to be the direct result of the irritation of the nerves, 
Rockwell says he has repeatedly seen the pulse-rate (in a case of 
neurasthenia with rapid pulse) reduced 40, 50, and 60 beats. I have seen 
the pulse fall 20 beats under similar conditions. Przewaski observed 
the temperature of one side of the face reduced from 0.5° to 0.115° C. b}r 
subaural faradization. This, as well as the fall of temperature of the 
skin between the third and fourth fingers on faradization of the ulna, 
was, however, probably due to contraction of the vessels. Weir Mitchell 
has demonstrated the rise of the general temperature of the body after 
general faradization. PRINCE. 
Further direct evidence of the reflex influence of centripetal stimu- 
lation is the sweating sometimes observed following static electricity. 
The fact that peripheral irritations tend to diffuse themselves along other 
associated tracts that are in close connection with the nervous centres 
primarily stimulated may sometimes be observed in painful affections 
like neuritis. In a case of inflammation of some of the branches of the 
brachial plexus I frequently observed that the pain, after it had persisted 
for some time in an intense form in the original nerves, spread to the dis- 
tricts supplied by neighboring branches, then to the neck, side, and, finally, 
leg of the same side. This mode of propagation was very much like that 
of the discharge of an epileptic fit. 
A curious though simple phenomenon of cutaneous irritation, and 
one which I have never before seen mentioned, is the following, which I 
have frequently produced on a certain subject: On scratching the skin 
on the outside of the thigh, a very intense, sharp, stinging pain on the 
same side of the bod}1- over the lower ribs has been felt. The pain is very 
sharply localized, and feels as if the skin were pricked acutely with a 
needle. It can only occasionally be excited, but on favorable occasions 
it is very easy to elicit it. This is evidently a reflex pain, due to slopping 
over of the stimulation to associated centres. 
The exact mode in which electrical stimulation—as well as that of 
other agents—acts upon the central nervous system is, of course, hypo- 
thetical or unknown. But its influence evidently extends beyond the 
centres directly connected with the centripetal nerves. It undoubtedly 
has an inhibitory influence on associated centres, as in the suppression of 
pain and headache, and it seems to have the power to restore the nervous 
equilibrium, so to speak, when disturbed. It also seems to have the 
power to arouse into activity nervous centres which temporarily, from 
functional causes, have been dormant. Deeper than this it is not to be 
expected that we can go. 
When, then, the effects of other forms of peripheral stimulation, a 
few of which have been mentioned above, are recalled, and when we bear 
in mind the immense number of cutaneous nerves that can be brought 
under the electrical influence, and the intensity of stimulation that can 
be obtained of the central nervous system, it is not so very surprising, 
after all, that electrization should be so effective a mode of stimulation. 
Psychoses. 
Arndt was the first to make a systematic and extensive study of the 
effect of electricity in mental affections. The results obtained bj’’ him 
were of an encouraging character. A number of other observers, for 
the most part in Germany (Schule, Morel, Emminghaus, Benedict, and 
others), have reported cases which were cured by electricity. On the 
whole, the results achieved thus far have given promise that in electricity 
we have an agent capable of influencing beneficially a certain class of PSYCHOSES, 
cases of this kind. The method has not, however, been as systematically 
pursued as it should be. Whether it is that the helplessness of attempt- 
ing to effect the graver forms of mental disease by such an agent has 
thrown a damper over the courage of the alienist, and produced a skep- 
ticism regarding the possible curative influence in the lighter cases, even 
in their earlier stages, or whether it is that alienists, as a general rule, 
have not that familiarity with the use of electricity which would stimu- 
late them to more systematic trials, while electrical therapeutists are not 
sufficiently often brought in contact with cases of psychoses,—whatever 
be the reason, the treatment of these affections by electricity has not 
been pursued as systematically as is desired. The observations thus far 
made, although there could be many of them of a favorable nature, have 
been comparatively scattered and limited. Erb wrote, in 1887: “We 
have been unduly backward with regard to the systematic and extensive 
employment of the electric current in one group, and that one of the 
most important of cerebral diseases. The psychical affections have, until 
now, been subjected to electrical treatment very seldom, and in a manner 
that has been quite insufficient.” The same statement is true to-day; in 
this country, at least. 
It may be said, however, that it is not in asylums that cases will be 
found suitable for this kind of treatment. Cases sufficiently grave to be 
committed to asylums are generally too far advanced or too serious to be 
affected by .electricity. It is rather in the lighter or border-land cases that 
favorable results are likely to be obtained by this mode of treatment. 
And yet quite a number of cases of a severe type have been reported in 
which the curative effect of electricity was quite marked. Referring here 
only to some of the later observations, mention may be made of a series 
of eleven cases (ten being of melancholia), carefully observed and re- 
ported by Wiggles worth,1 in three of which a cure resulted under treat- 
ment by galvanism, and two were thought to be benefited. Of the three 
cases discharged cured, one had existed over two years previous to treat- 
ment, and was convalescent in about forty days, after sixteen sittings. 
The author concludes, as a result of his experience, that the use of gal- 
vanism is followed by good results in selected cases, which might other- 
wise drift into hopeless chronicitju He believes that mental stupor, 
torpor, melancholia, and acute dementia are particularly benefited by gal- 
vanism. These cases by themselves, without additional corroborative 
testimony, are hardly sufficient in number, nor were the results suffi- 
ciently brilliant (judging the report) to justify the conclusion that 
galvanism was the active agent in bringing about the final result. There 
is, however, more testimony bearing on the point, which, though scattered, 
is of value. 
A very remarkable case is one reported by Robertson. It was a 
case of melancholia, with delusions of suspicion, for which the patient, 
* Journal of Mental Science, No. 33. PRINCE. 
a woman 50 years old, was committed to an asylum. Imaginary voices 
affected her very much, and in time she refused food so that she required 
feeding by the stomach-pump. In October, 1882, when galvanism was 
begun, her condition was worse than when she entered the asylum, fifteen 
months previously. Up to this time she had been insane seven years. 
After the third application she began to improve, and in the following 
March was discharged cured, but it was noted that she had been free 
from symptoms for two months. A current from 15 to 20 cells was 
used. The patient was so convinced of the benefit derived from the bat- 
tery that she asked to have her hair cut very short in order to get the 
full effect of the current. She attributed her recovery to the battery. 
Erb, in his hand-book of electro-therapeutics, has given a summary 
of the observations, mostly favorable, of Arndt, Benedict, Neftel, Franz 
Fischer, Tigges, and others, to which the reader is referred. It is folly, 
however, in spite of occasional brilliant results, to expect to find in the 
electric current an agent which can be relied upon in the severer psy- 
choses. We could hardly expect better results than those obtained by J. 
Morel1 in melancholia, mania, paranoia, and dementia. Electricity had 
but slight effect in these cases, excepting that in 15 out of 96 cases of 
melancholia the results were very good. In 16 others they were less 
gratifying, while in the remainder there was no, or only temporary, im- 
provement. As has already been said, it is only in the initial stages of 
the milder psychoses that electricity will have a favorable influence. 
More promising are those cases where various psychical disturbances are 
engrafted on other co-existing physical states, such as neurasthenia, 
hysteria, epilepsy, traumatic psychoses, etc. Cases of this kind are very 
numerous, and come under the observation of the general practitioner 
and the neurologist rather than the alienist. 
It is not possible, with our present limited experience, to define, ex- 
cept in a very general way, exactly what cases are benefited by electriza- 
tion. Examination of the literature shows a heterogeneous assortment 
thus far reported, and further systematic observation is necessary to de- 
termine what class is likely to be favorably influenced and what class not. 
Melancholia sometimes, even in a severe form, has been frequently cured, 
and some cases even of primary dementia have given favorable results, 
but the latter must be regarded as exceptional. Although all kinds of 
insanity have been treated, it is absurd to expect electricity to influence 
such diseases as mania, general paralysis, secondary dementia, paranoia, 
or melancholia in its severer forms. But milder psychoses, conditions 
which may be supposed to be dependent on neurasthenic conditions, va- 
rious functional disorders, such as impaired nutrition, derangements of 
circulation, or a morbid association of ideas may often be cured, even 
though hallucinations, delusions, etc., be present. The results of observa- 
1 “ L’electro-therapie dans Ics Maladies Mentales” ; Bull, de la Societe' de me'd. ment. de 
Belgique, 1889, Ma., Nos. 52, 27. PSYCHOSES, 
tions, thus far made, indicate that it is desirable that a more extensive 
trial should be made of the treatment by electricity of cases of this kind. 
The field is a promising one. As Erb says, “ A general survey of the 
observations, with regard to the electro-therapeutics of the psychoses, 
which have been made up to the present time, shows us that the ps}'- 
choses can, in certain cases, be favorably influenced and sometimes cured 
by the electric current, even in cases in which all other possible remedies 
have long been tried in vain.” 
The writer has made no attempt to treat with this agent the graver 
psychoses, such as are suitable for asylum care, but has had considerable 
experience with the lighter forms. The results have been satisfactory, 
particularly when the psychical symptoms were the manifestations of 
other physical conditions. Such patients, it is true, were not strictl}' 
insane, but the psychical symptoms were sufficiently prominent and 
persistent to create a distinct psychosis, for which the patient sought 
treatment. The following are examples of the class of psychoses likely 
to be benefited :— 
Personal Observation 1.—Mrs. D., aged about 42 years ; ill for two years. Fixed idea that 
certain persons have hypnotic influence over her, and that she influences others. Interprets 
every action of others, including strangers, through this idea. Cannot ride in horse-car or 
go to church in consequence of hallucinations of vision ; sees faces of certain individuals. 
Insomnia, general neurasthenia. Out of bed only three or four hours a day. Mental de- 
pression. Various perverted bodily sensations, such as pain, etc. Treatment: Static elec- 
tricity three times a week. Improvement immediate. Slept well; hallucinations gradually 
disappeared. Fixed ideas less insistent and less constant. At the end of about two months 
patient could work greater part of the day, and, though not strong, could do much. Insistent 
ideas present only when tired, and in mild form. [Patient discharged, partly because nearly 
well and partly because it was not practicable to continue treatment. She had heen sent to 
me by one who had had a large experience in asylums, with the prognosis of a hopeless 
case, and prophecy of early commitment to an asylum.] 
Personal Observation 2.—Mrs. W., aged about 40 years. As a result of experimenting 
with spiritualism and mediums, had developed a psychosis. Against medical advice she 
had tried to develop herself into a medium. Symptoms : Great mental depression (melan- 
cholia) ; hallucination of visions; insomnia; insistent ideas; local pain. Treatment: 
Static electricity. Improvement began at once and continued. Cured after about three 
weeks’ treatment. 
Personal Observation 3.—Mr. D., aged about 45 years. Subject to ambulatory epilepsy. 
Medical advice sought by his wife because of melancholia and suicidal impulses. Depres- 
sion marked. On first appearance he was the picture of misery. Although formerly an 
active business man and full of energy, he had become unable to perform any business, etc. 
Insomnia. Treatment: Static electricity. Improvement immediately after first sitting. 
After about ten sittings, well. 
Symptoms which have essentially a psychical origin, whether they 
be pain, partesthesia, insomnia, or many of those strange, “ queer feelings 
in the head” or elsewhere, which patients find great difficulty in de- 
scribing, are, as a rule, favorably influenced by electricity. 
The customary method is to apply the electricity to the head, 
although it is recommended by some to galvanize or faradize the spine 
TECHNIQUE OF TREATMENT. PRINCE. 
and “ sympathetic ” and peripheral nerves. Minute rules have been given 
by German writers governing the use of the different poles and the dura- 
tion of the current. For example, it is laid down by Arndt that when 
well-marked irritation is present the descending current should be em- 
ployed,—that is, the anode on the head, the cathode peripherally ; but if 
a state of depression or torpor exist, the ascending current should be 
used,—the cathode on the head, and the anode peripherally. In other 
words, if an exciting action is desired, the cathode is selected, and if a 
sedative the anode. Lowenfeld goes one step farther, claiming, as a result 
of his experiments on rabbits, that when the anode is placed on the nape 
of the neck and the cathode on the forehead,—the ascending current,— 
the vessels of the brain are dilated and the circulation accellerated, while, 
if the electrodes are reversed and the descending current used, the vessels 
are contracted and the circulation retarded. Therefore, when a state of 
hyperaemia is present, the anode should be placed on the forehead and the 
cathode on the nape of the neck, and vice versa. But granting the appli- 
cability to the human brain of results obtained in experimenting on rab- 
bits, an inference of which the questionabilit}- has been pointed out by 
Erb, we know too little of the condition of the circulation in psychoses 
to make these physical principles of any value. But even Erb, who per- 
ceives the flimsiness of the evidence on which rules of this sort are based, 
cannot quite free himself from the force of authority, and so his work on 
electro-therapeutics is in many places a painful exhibition of the struggle 
of a scientific mind to reconcile the traditionally accepted and pleasing, 
but imaginary electro-therapeutics of his predecessors with what is really 
known of the action of electricity on the body in health and disease. 
Now, supposing a condition of anaemia or hyperaemia to be present 
in melancholia or dementia, have we any means of determining what 
relation this supposed condition of the circulation bears to the disease 
itself, whether that of cause or effect, or whether influencing the circula- 
tion would influence the disease? Similar questions may be raised as to 
the use of the anode and descending currents to produce sedative effects, 
and vice versa. I do not question the fact that the physiological reac- 
tions of the tAvo poles in some respects differ, and that occasionally results 
are obtained with one pole that the other pole fails to give; but the physi- 
ological reactions furnish no basis, and the therapeutic results a very 
slender one, for any system of treatment of this kind. In the great ma- 
jority of instances one pole is probably as effective as the other, and 
where there is a difference it may, perhaps, be explained by a difference 
in the intensity of the action. With a feAv exceptions, with a current of 
the same strength, the cathode has more intense action than the anode; 
but if the current be decreased while the cathode is the active pole, the 
intensity of the action will diminish till it equals that obtained with the 
anode with the original current. The supposed sedative action of the 
anode may be due to its quantitative and not qualitative effects. In PSYCHOSES. 
peripheral electrization the reason for this becomes plain when it is 
remembered that it is probable that the principal mode by which elec- 
tricit}r acts on the central nervous system is reflex through the afferent 
nerves. It is the excitation of the nerves which brings about the central 
changes ; this means that it is neural molecular motion, and not that form 
of molecular motion which is known as the electric current. Now, 
obviously, we should a priori expect that it would be a slight matter 
whether this neural motion (current) were excited by a positive or a 
negative anode, or an ascending or a descending electrical current. When 
Rumpf found that faradization of the skin produced contraction of the 
cerebral vessels, the immediate agent was the neural current in the 
afferent nerves, and not the electrical current. 
Turning from these theoretical considerations to practical experi- 
ence, it seems to me that these views find ample confirmation in the 
equally successful results obtained by different and opposing methods. 
One hesitates to throw overboard the experience of other observers with- 
out weighty evidence, but I must confess that, allowing for this difference 
in the intensity of action of the two poles, my own experience has failed 
to convince me of a difference in the quality of their therapeutic effect. 
Erb speaks with great caution in the matter, and, although believing in 
a difference in the polar action, admits that our use of them must be 
largely empirical; and de Watteville, whose discussion of the subject is 
by far the most scientific and sensible that has yet appeared, is still more 
skeptical. Until, however, the matter has been settled one way or the 
other, many physicians will prefer, as de Watteville advises, “ to observe 
up to a certain point the polar dictum,” and use the positive pole when a 
sedative effect is desired, and the negative when a more exciting one. 
The pathogenesis of many psychical affections is too obscure to 
allow ourselves to be governed b}r theoretical principles in 
using electricity. The formulae of electro-therapeutics rest only on 
empirical data, and the best methods are those which experience shows 
give the best results. While different observers have their preferences, 
equally good results seem to be obtained irrespective of the direction 
of the current or the pole used. As de Watteville expresses it, “ The 
position of the pole in therapeutic applications is to be governed chiefly 
by physical principles; it must be such as to secure the most complete 
permeation of the organ or tissues to be influenced by the current.” 
In applying galvanism to the head, my own method is to try and 
saturate, so to speak, the whole brain with the current, unless there is a 
specific reason for localizing it on a special region. With this end in 
view, it is passed longitudinally from forehead to nape of neck, and 
longitudinally through the temples or parietal regions. I use a current 
as strong as can be borne without producing vertigo, beginning with 0 
and gradually increasing to this limit without removing the electrode 
from the skin. Before removing the electrode the current is gradually PRINCE. 
diminished. Shock must be avoided. A sitting should last about ten 
minutes.1 An electrode covering the head in the form of a cap may be 
used, the other electrode being applied to some other part of the bod}r. 
When th e far a die current is used it is not necessary to use the same pre- 
cautions in regard to increasing or decreasing the current when applied 
to the head. This current is considered by some to be more stimulating 
and more efficient in cases of stupor or depression. 
Galvanization and faradization of the peripheral nerves are strongly 
recommended by Arndt, who used this method principally in his earlier 
observations. For this purpose general electrization, after the method 
of Beard and Rockwell, may be used as described on page K-59. This 
should be particularly serviceable when neurasthenia exists. It is ver3r 
refreshing and stimulating when properly done. 
To obtain the best results with electrization considerable judgment 
and skill are essential, especially with the class of cases we are consider- 
ing. It seems to be a very simple matter, but experience, in this as in 
everything else, is a great advantage, and he who possesses it will obtain 
results which another will strive for in vain. Some persons—neurotic 
subjects—are very sensitive to electrization, and when it is carelessly 
done unpleasant consequences are likely to ensue. I have seen this 
illustrated in more than one individual, who, though affected most favor- 
ably by electrization, developed most disagreeable symptoms if I became 
careless in applying it. I have used static electricity in the mild psjr- 
choses with marked success. This form has the advantage that it can be 
applied to the head and the body without the inconvenience of removing 
the clothing. For the head the static douche, or breeze, is most advan- 
tageous. Many unpleasant symptoms are readily dissipated by it. 
Mental depression and insomnia often yield after a few applications. 
Local symptoms in different parts of the body, but of a psychical origin 
(pain, paraesthesia, etc.), can sometimes be suppressed at once. For this 
latter purpose a mild spark is best. It is not necessary to have sparks 
stronger than can be borne without effort, but when the local distress is 
severe it is often surprising to see how strong shocks a patient can bear, 
and even court, without flinching. A well person will rarely endure so 
much. For methods of using static see article on that subject 
(A-84) in this work. For mental depression and other psychical 
toms, I would recommend allowing treatment with head douches for a rela- 
tively prolonged sitting,—say, twenty minutes to half an hour. Finally, 
it may be said that individual s3rmptoms in the psychoses, when suitable 
for electrical treatment, are to be treated as in other diseases. 
1 The rules given hy some writers are absurdly cautious. One or two minutes and 2 or 3 
milliamperes are stated to be the limits of time and strength. Excepting in individual cases, 
which exhibit great sensitiveness, these are unnecessarily small. Rockwell speaks of having 
given 33 milliamperes. The best guide is the sensation of the patient. A current less than that 
which will produce vertigo is safe. I have never seen any reason to think ten minutes too long, 
nor that this time might not be prolonged, but it is true that over 4 or 5 milliamperes will 
USuaUy, not always, produce vertigo or other disagreeable symptoms. HYSTERIA 
Regarding the choice of the different varieties of electricity, static 
electricity certainly has more suggestive influence than other varieties, 
but whether it is more effective in other wa}rs may be doubted. I am 
inclined to think, though, that a static spark is most effective in psychoses 
in relieving pain located in distant parts of the body, but of a psychical 
origin. Still, sometimes one variety is most effective and sometimes 
another, and it cannot always be determined without trial which will 
prove the most suitable in a given case. But for application to the head 
experience seems to have shown that galvanism or faradism is most efli- 
cient in the great majority of cases. It is -well to begin with one of these, 
and then, if the results are not satisfactory, to shift to one of the others. 
It is even well, during the course of prolonged treatment, to change from 
one to another, as we would change in medicinal treatment from one tonic 
to another. For electrization of the peripheral nerves for purposes of 
stimulation, faradism is usually the more effective. It is particularly 
important, when using general faradization, not to use a strong current. 
A general stimulation of large surfaces and many nerves produces much 
more favorable effects. To relieve local pain, such as a painful spine, 
galvanization or faradization should be selected. 
Hysteria. 
The results of the electrical treatment of hysteria are very uncertain. 
Sometimes very brilliant cures are met with; at others, hysteria is as 
rebellions to electricity as to everything else. This difference depends 
in part upon the varied character of hysterical affections, and in part 
upon wholly unknown factors. Some writers claim that electricity has a 
specifically favorable influence in hysteria ; others, like Erb and de 
Watteville, that it is very unreliable. This diversity of opinion depends 
largely upon the difference of view as to what shall be classed as hysteria. 
In cases where the may be properly classed as hysterical and 
symptomatic of, or a complication of, some other disease, electricitjr may 
justly be said to have a beneficial influence. It is well known that even 
in organic disease many symptoms of a functional (hysterical) nature 
may be superimposed upon those due to the primary disease. In neuritis, 
for example, or cerebral haemorrhage, an amesthesia may be added of a 
purely functional nature. In other cases, a localized paralysis may be- 
come widely distributed over other parts from the same reason. In 
neurasthenia many of the symptoms may be purely hysterical, and may 
be so marked as to mislead us as to the true character of the disease. 
Anaemia may present a variety of hysterical symptoms, which may over- 
shadow the true pathological conditions present. 
Sometimes it happens that an organic disease, such as a neuritis or 
an arthritis, turns into an hysterical affection of the same parts, in which 
case the transition is often overlooked until a sudden cure takes place to 
the surprise of the physician. For example, I recall a severe case of in- PRINCE. 
flarnmation of the brachial plexus, causing paralysis and atrophy of the 
muscles supplied by the nerves. At the end of about eight months there 
was no improvement of the paralysis, but loss of power appeared in the 
other arm. One day, in a fit of emotional excitement, the patient threw 
up her arms, and she was cured. All the symptoms of neuritis (pain, 
glossy skin, atrophy, etc.) had been present in the arm originally affected. 
The neuritis had healed without the fact being suspected. A student 
received an injury to the knee from a fall while playing foot-ball. There 
was no abatement of the symptoms during several months, until one 
day he threw away his crutches and walked off well. 
Organic injuries of one part are apt to induce functional disturbances 
of other parts. Hysterical neuralgias are very common accompaniments 
of various diseases. A mild neuritis of the arm was accompanied not 
only by excruciating pains of the same limb, but also by pains in the 
neck, side, and corresponding leg. The course of events showed all 
these secondary pains to be functional. Whether such conditions should 
properly be classed as hysterical may be questioned, though, as a matter 
of fact, in practice it is usual to find them so considered. The same is 
true of a great many minor functional disabilities, some of which, at least, 
I must consider as more properly belonging to habit neuroses, association 
neuroses, auto-suggestion, and what not, while others are hysterical 
psychoses. 
Now, I think, it is within the limits of moderation to say that such 
minor affections as these, as well as the hysterical factor complicating 
other diseases, are, as a rule, readily cured by electrization. Hysterical 
neuralgias complicating other affections are often dissipated as if by 
magic. They often return, it is true, as long as the primary disease per- 
sists, but they are easily held in check by repeating the treatment. Nar- 
cotics and other drugs are thus dispensed with. It would seem that cases 
of this kind are very different in their pathology from those in which the 
physical defects present are but manifestations of what may, for want of 
a better name, be termed the hysterical diathesis. When this is present, 
underlying the paralysis, or anaesthesia, or convulsive seizures, there 
seems to be a morbid condition of the nervous system, of which these 
stigmata are the symptoms. 
Given a case of hysteria of this kind, it is pretty safe to count 
upon its being rebellious to all electrical treatment. By this I mean 
cases of monoplegia or hemiplegia of the Charcot type, with implication 
of the special senses; cases of hystero-epilepsy, ataxia, hysterical con- 
tractures, joint disease, and of hysterical hemiamesthesia. In each of 
these diseases the type is well and sharply defined, so that it may be 
classified as specifically and distinctly as pneumonia or typhoid fever. 
Such cases are difficult to cure by any mode of treatment. This is par- 
ticularly true of paralysis, etc., due to traumatism, especially when liti- 
gation is in progress. And yet it sometimes happens that individual HYSTERIA. 
cases rapidly improve under electrization, while others quite obstinately 
resist. 
In illustration of this last statement the case of a young girl who 
was paralyzed in consequence of a blow on the top of the head by a 
piece of shafting may be cited. An hysterical paralysis, with anaesthesia 
of the left leg, of moderate intensity, developed. The left hand was also 
weaker than its fellow. The special senses on the left side were affected, 
and the field of vision was also much contracted for colors, as well as for 
white light. Under electrization the patient improved, and in a short 
time was practically well. Another case of hysterical paralysis of 
the muscles of the back following a fall was much improved after a few 
sittings, though she returned to her home in the country before the cure 
was complete. But in contrast with these favorable results other cases 
might be given where no benefit whatever was derived. 
It almost seems as if some cases of hysteria, especially monoplegia 
of the Charcot type, waited until they were ready to get well, and then 
got well of themselves. Such kinds of hysterical paralysis may persist 
for years. I have known three cases to persist for twenty-five years with 
little change.1 Because of the suddenness with which cure sometimes 
takes place in hysteria the impression is current that this is to be 
expected ordinarily. This is a mistake. As a rule,—at least, this is 
the writer’s experience,—hysteria yields gradually to treatment like 
other affections. The general physical condition needs to be treated as 
much as, if not more than, the motor and sensory phenomena. The 
strongest moral influence must be brought to bear, and unhealthy mental 
surroundings removed. Isolation from home and friends, in most cases, 
is all-important. As an adjunct, electricity is often of service, and some- 
times its effects in dispelling local stigmata are striking. In applying 
electricity for the cure of hysteria, it is important to use it so as to 
obtain a powerful moral effect; that is, suggestion plays an important, if 
not the principal, role in producing the cure; as witness the well-attested 
cures effected by metallo-therapy, as well as many of the phenomena pro- 
duced in hysteria by magnets. A wooden magnet is just as effective as 
a real one. Some curious experiments illustrating the force of suggestion 
were made by Babinski2:— 
Two hystero-epileptic girls, each of whom presented hemianjesthesia, were seated 
back to back, and then a magnet was placed upon the arm of one of them. In a short time 
one of the girls was entirely wanting in sensibility, while the other recovered it. Afterward 
the conditions were reversed, and there followed a series of oscillations. The hemianies- 
thesia quickly returned to both girls upon their being separated. The transfer from one to 
the other took place more quickly if the backs of the patients touched, but also took place 
when there was a distance between the two. A paralysis, induced by suggestion, in one 
of the hysterical patients could be transferred to the other by the method above described. 
The same was found to be true of coxalgia, dumbness, and a somnambulistic condition, 
When patients who had come to the hospital with an hysterical paralysis not arising from 
* Amer. Journal of the Med. Sci., 1892. 1 Progress Me'd., xiv, 47, p. 1010, 1886. PRINCE. 
suggestion were seated back to back with one of the hysterical individuals just mentioned, 
who was in a somnambulistic condition, and the magnet was applied, the corresponding 
paralysis of the former appeared in the latter, even although the former remained 
paralyzed. 
It would be easy to multiply the evidence of the suggestive power 
of electricity in hysteria, if it were necessary. It is not entirely, how- 
ever, by suggestion, that electricity acts. The local shock, or peripheral 
stimulation by itself, is equally capable of removing hysterical manifesta- 
tions. For instance, in one case I accidentally, and contrary to my pur- 
pose, caused complete anaesthesia of the hand to disappear by means of 
the electric needle. I was experimenting for another purpose, and was 
not myself prepared for the unexpected result, nor was the patient. The 
consequence was, the experiments could not be carried out. It is well 
known that a local shock from other means—as, for example, the actual 
cautery, a cold douch, emetics, etc.—will sometimes cure hysterical symp- 
toms. Just as powerful irritations will cause listeria, so they may cure 
it. A wise physician will, therefore, take advantage of all the therapeutic 
aid which electrical treatment offers in hysteria—of the mental as well as 
the physical impression; neither should be neglected. It is justifiable, 
as well as desirable, to attempt to arouse an expectant condition of mind 
in the patient as to the results that will follow. For this purpose it is 
imperative that positive assurance should be given of the result that will 
follow. The patient should be encouraged to regain the dormant will- 
power. The physician who is timid or hesitates is lost. It is well to 
persist at each sitting until some degree of improvement is manifested. 
Strong currents or shocks are, as a rule, more efficient than mild ones; it 
is therefore important to use as strong a current as can be comfortably 
borne, but it is not necessary or desirable to be severe. 
Regarding the choice of kind of electricity, it will be found that 
sometimes one kind is more effective and sometimes another. Probably, 
as a rule, faradism is more efficient in curing motor defects and static 
in relieving sensory symptoms, although I am not aware that any sys- 
tematic observations have been made to determine this matter. It is 
only possible to state a general impression, which has been derived from 
experience. The powerful muscular contractions that may be evoked by 
faradism render it particularly serviceable in paralysis. On the other 
hand, pain, partesthesia, and anaesthesia are often more readil}’ dissipated 
by static electricity. The awe-inspiring nature of a powerful static ma- 
chine make it especially suitable for producing a profound effect on the 
mind of the patient. 
Static electricity often gives successful results in the treatment of 
motor as well as sensory S3'inptoms. Of late years this variety has been 
much used, and in a great measure has superseded the galvanic and 
faradic currents in the treatment of neuroses, largely because of the con- 
venience with which it can be applied, and its adaptability to a variety of HYSTERIA, 
different conditions. By means of Morton’s electrode and method, it 
can be converted into the dynamic variety, and made to produce all the 
effects of faradism. In large hospitals, where many patients have to be 
treated, several may be placed on the same insulated platform and be 
treated at the same time, as is done in La Salpetriere. 
Some interesting observations, showing the effects of static elec- 
tricity, have been published by Blanc-Fontenelle. Ten cases in all were 
treated, three or four being placed on the insulated stool at once. In 
four cases of anaesthesia (three of hemiansesthesia and one of complete 
anaesthesia) electrization quickly restored the sensibility, which, however, 
tended to disappear again. In the case of complete anaesthesia sensibility 
only returned to one side. After each sitting the anaesthesia in three 
cases disappeared, and then returned again after various intervals. The 
same phenomenon occurred after each sitting, and finally the sensibility 
was completely restored. Of two cases of amyosthenia (paresis) one 
sitting was sufficient to restore the strength of the affected hand, as meas- 
ured by the dynamometer. Of four cases exhibiting hy stero-genetic zones, 
pressure upon which readily produced convulsive attacks, in all but one 
these zones disappeared under static electrization, so that pressure failed 
to cause an attack. The author states that static electrization diminishes 
the disposition to contracture and sometimes makes it disappear. On the 
other hand, Eulenburg, in his table of cases1 (embracing a variety of 
affections treated by static electricity) records seven cases of hysteria, 
none of which were cured. 
This is a fair illustration of the varying results obtained in the 
treatment of hysteria by electricity, as well as by every other method. 
Even the rest-and-seclusion treatment of Weir Mitchell must testify to a 
similar record. The fact is—and it is a fact that must be recognized— 
that in no disease does the personal equation of the phj'sician play so 
important a part as in hysteria. Some physicians, men of character and 
strong personality, will succeed with a given mode of treatment where 
others fail. No greater compliment can be paid to the force of character 
of certain physicians than that they have been able to apply with success 
the Weir-Mitchell treatment of hysteria and neurasthenia where others 
have tried it in vain. They are probably unconscious how much their 
own personality has to do with their success, rather than the treatment 
per se. The rest-and-seclusion cure is not a method that will succeed in 
any one’s hand as a drug or the surgeon’s knife will succeed in other 
diseases. It is a method that is peculiarly fitted for him who has natural 
gifts which will enable him to make use of it. In a great measure it is 
likewise with electrization. Certain persons will obtain successful results 
by electrization for hysteria, while others will not. The proneness of 
hysterics to respond to suggestion, conscious or unconscious, makes this 
easily intelligible. Unconscious suggestion on the part of a physician 
1 Deut. med. Wochenschrift, March 1,.1889. PRINCE. 
is as important an element as that which may be given deliberately, and 
must be guarded against. The elfeet of electricit3r, tonics, rest, and 
everything else may be undone by thoughtlessness on the part of the 
physician, as well as of the nurse and friends. Many a patient has been 
kept an invalid for mouths, if not years, by this subtle influence. The 
mere tacit assumption of the physician that nothing can be done to im- 
prove the patient’s condition, or the sympathy of friends who bewail the 
patient’s sufferings, may be sufficient. In some cases nothing has a more 
injurious effect than forbidding the patient to do certain things for fear of 
increasing the symptoms. Acts which bring on discomfort are apt to be 
interdicted, instead of the patient being encouraged to persist in them 
until their ill-effect disappears. In this way hysterical-habit neuroses are 
created which are difficult to break up. The power of the will to control 
the body, as well as all automatic processes of inhibition, become lost. 
The patient must then gradually learn to regain this. 
On the other hand, in hysteria unconscious suggestion may work for 
good, as when the physician, believing firmly in some simple remedy, un- 
wittingly gives a powerful suggestion of cure. The already-cited examples 
of metallo-therapy and magnets, to which may be added such quackery as 
Perkins’s points, are illustrations. Care, then, must be taken not to undo 
the good gained with electrization by injudicious management of the 
patient. The patient must be encouraged to hold every little that is 
gained, and must be convinced that she can if she will. I do not speak 
of adjuvant treatment, such as rest, seclusion, and forced feeding, as the}r 
are not germane to this subject, and it is to be understood that they will 
be employed when necessary. 
Electrization may be applied generally or locally. It is usually 
desirable to tone up the general system, with the view of removing the 
general hysteric “ diathesis,” upon which, in many cases, the local mani- 
festations depend. As long as this continues, there will be relapses, or 
the local outburst is liable to take on some other form. Besides the usual 
therapeutic methods for this purpose, general electrization, either in the 
form of faradization or franklinism, is of service. Before and after the 
local application the patient may be given a thorough treatment of this 
kind. If static electricity is used, the head douche, followed by mild 
sparks or the breeze, to the remainder of the body should be given for 
twenty minutes to half an hour. This will usually be found to have a 
refreshing and invigorating effect. 
Locally, electrization is applied to remove individual symptoms. The 
paralyzed, anaesthetic, or painful part is then treated directly. When 
cerebral symptoms are present, they are to be treated as described under 
“ Psychoses.” When the hysteria is strictly local, whether as a paralysis 
or a sensoi’y neurosis, a few applications of electricity to the seat of the 
trouble oftentimes dispel it entirely. In such cases the hysterical affec- 
tion is apt to be merely the residue of some other foregoing affection, or HYSTERIA. 
a complication of another co-existent but distinct disease. Where, how- 
ever, there is present a deep hysterical diathesis which is the basis of the 
local defects, the latter have a tendency to return after they have been 
removed, as has just been pointed out, or else the hysteria shows itself in 
some other form. Therefore a cure cannot be established without the 
restoration of mind and body, as a whole, to a normal, healthy condition. 
Meanwhile, it is advisable to remove, if possible, the local stigmata, as 
thereby the cure of the general diathesis is facilitated. The complete 
cure of grand hysteria is pronounced by some to be impossible. This is 
unquestionably going too far, though it may be difficult to effect a com- 
plete cure, for, as Gowers says, many hysterics have been restored suffi- 
ciently to health to lead useful lives. 
The manifestations of hysteria are so numerous that it is impracti- 
cable and hardly necessary to consider the treatment of each. A few 
only of the more important will be here referred to. 
Hystero-Epilepsy.—It is stated that faradism will cut short and pre- 
vent an attack. One electrode may be placed on the spine, the other to 
the sole of the feet, or one on the back of the neck and the other on the 
epigastrium, as recommended by Didier, who considers faradism one of 
the best means at our disposal. Charcot recommends galvanism to the 
head for the same purpose. The current may be made and broken several 
times, due care being used. Richet and Roux succeeded in cutting short 
attacks by this method. Trouve used a strong galvanic current (40 to 
50 cells), with sudden reversals, with similar effect. Static electrization 
is used at La Salpetriere for the purpose of curing this form of hysteria. 
Several patients are placed upon the insulated stool at once, and charged 
simultaneously. The effects are said to be favorable, and to influence 
the general habit, as well as to cut short an attack. Charcot states that, 
after static electrization, pressure on the hystero-genetic zones ceases to 
produce an attack. The results of Blanc-Fontenelle have just been men- 
tioned. He found that, whereas, in certain cases, the lightest touch to 
these zones produced a convulsive attack, after the application of static 
electricity the strongest pressure failed to do so. When electrization 
fails, resort must be had to one of the other numerous methods of treat- 
ment. 
Anaesthesia.—The faradic and static forms are the most serviceable. 
There are several ways of using faradism. The wire brush is the most 
effective electrode, as it causes the most intense stimulation. The whole 
anaesthetic area may be brought under its influence, according to the 
method of Rumpff, who has advocated the electrization of large surfaces, 
with the idea of acting on the central circulation, which, as he has shown, is 
modified by such peripheral stimulation. (Page K-28.) Another method 
is to concentrate the stimulation on a circumscribed region, according to 
the method advocated by Vulpian, who found that faradization of the 
skin of the forearm on the anaesthetic side caused a return of the sensi- PRINCE. 
bility not only to the part faradized, but over the whole corresponding 
part of the body. There is no reason to suppose, however, that there is 
any specific relation between this portion of the skin and the sensory 
centres, as faradization of other regions, and even of sound portions of 
the body, will accomplish the same result. 
It is an interesting fact, however, that strong, localized faradization 
will remove not only anaesthesia of the part, but of distant portions of 
the body. How much of this effect is due to changes in the central 
circulation, how much to reflex nervous processes independent of the 
circulation, and how much to psychical influences, it is impossible to say. 
Probably it is due at one time to one of these factors, and at one time to 
another, or to all three. 
Static electricity is probably equally successful in restoring sensi- 
bility. It is to be applied in the usual way. In France franklinism is 
applied as a powerful aesthesio-genetic agent. Charcot, who was among 
the first to study its action, found that anaesthesia could be transferred 
from one side of the body to the other, and finally dispersed for good. 
Vigouroux has also had favorable results. Although there is a tendency 
for the anaesthesia to return, yet, even when this is the case, a patient can 
be kept nearly free from anaesthesia by repeated applications,—not an 
inconsiderable aid to a final cure. 
Galvanism is also not without influence. Whatever form of electri- 
zation is adopted, it is, as a rule, more effective when powerful currents 
or strong sparks are used. 
As has already been said, there is a strong tendency for hysterical 
anaesthesias to return. In such cases the general “ diathesis ” must be 
treated on commonly•-accepted principles. Electrization should, however, 
be persisted in, and the anaesthesia removed as often as it returns. In 
many cases it will be found that, after a number of sittings, it will dis- 
appear for good. The practitioner must always be prepared to meet ob- 
stinate cases, upon which the effect of electrization will be absolutely nil. 
Among them will be many traumatic cases, which will positively refuse 
to get well as long as litigation and other sources of auto-suggestion 
persist. 
Paralysis.—The behavior of paralysis to electrization varies greatly 
in individual cases, as has already been said, and it is difficult to predict 
beforehand the result. Some cases are cured rapidly; some slowly, after 
repeated sittings ; some are uninfluenced. It is always worth trying. 
Aphonia may often be removed at a single sitting. On the other 
hand, as is likewise the case when a cure is effected by other means, 
there is a tendency for it to return. One reason for this is that it is 
really but the expression of an hysterical state, and as long as this latter 
persists the aphonia is liable to appear. In one sense it is not a true 
paralysis, but is rather an to use the laryngeal muscles for a 
particular purpose,—phonation,—while the acts of coughing, and some- HYSTERIA, 
times singing, which equally depend on the action of the altiicted mus- 
cles, can be performed. In other words, the power of contraction per se 
is not lost. The affection more properly belongs to or approximates 
another type,—that of ideational paralysis,—which will be presently 
spoken of. 
For the treatment of this paralysis faradization is the usual method. 
Both poles may be placed externally on the larynx, or, if this is not 
sufficient, a laryngeal electrode should be inserted within the larynx and 
the other placed externally. More technical skill is required for this. 
Weir Mitchell recommends instructing the patient to take a deep inspira- 
tion before speaking, when there is a lack of co-ordination between the 
laryngeal and respiratory muscles. By this means the patient is helped 
to once more resume volitional control over the necessary co-ordinated 
movements. 
There is another form of paralysis, which was first described by 
Russell Reynolds,1 and which, although not identical with, is allied to 
that due to hysteria; it may be designated as 
Ideational Paralysis.—Paralysis is not the only form in which 
this neurosis appears. Other disorders, such as spasm, pain, paraesthesia, 
and various sensory disturbances often occur. Sometimes various minor 
psychical symptoms are met with, and give the impression of hypochon- 
driasis or some form of hysteria. The pathology is always the same, 
and what is true of paralj'sis is true of the other forms of this disorder. 
Properly speaking, a paralysis of this kind is not true hysteria ; but it is 
allied to it, and in practice it usually is diagnosed as of this nature. It 
will, therefore, not be out of place to consider it here. It is fairly common, 
but ordinarily its real nature is overlooked, so that its existence is not 
as well recognized as it should be. It requires some acumen on the part 
of the physician to distinguish it from true hysteria. The practical im- 
portance of doing so is that, unlike hysteria, it is readily curable, and 
electrical treatment is one of the most effective methods. If not recog- 
nized, it may persist for years. Its pathology seems to consist in the 
idea taking possession of the patient’s mind that a given set of muscles 
cannot be used. All volitional control over these muscles has been given 
up by the patient. This surrender seems as if made voluntarily, instead 
of involuntarily, as in the case of hysteria, and often has its origin in 
some antecedent condition, such as traumatism. In such cases the pa- 
tient’s idea is a logical deduction from such real conditions, or has origi- 
nated in some way by auto-suggestion. In every other respect the 
subject may be without a trace of hysteria,—in fact, may be perfectly 
normal in every way. Careful examination will fail to reveal other 
of hysteria, such as implication of the special senses, anaes- 
thesia, emotionability, contractions, etc. Nor is there a tendency for a 
paralysis of this nature to return, unless the exciting cause persists, or 
1 British Medical Journal, November 6,1869. PRINCE. 
unless it occurs in a person who has the hysterical diathesis. In the 
latter case it may he impossible to distinguish it from true hysteria. Rus- 
sell Reynolds, in his original description of the affection, in summing up 
its chief characteristics, says “ (1) that some of the most serious disor- 
ders of the nervous system, such as paralysis, spasm, pain, and otherwise 
allied sensations, may depend upon a morbid condition of emotion, of 
idea and emotion, or of idea alone; (2) that such symptoms often exist 
for a long time, appearing as complicated diseases of the brain and spinal 
cord; (3) that they resist many different kinds of treatment, being alike 
unmoved by sedatives or irritants, by attention or neglect, but that the3r 
disappear on the removal of the erroneous idea; (4) that they occur in- 
dependently of anything that can be called either insanity of mind, lis- 
teria, hypochondriasis, or malingering; (5) that they are often, but not 
constantly, associated with some bodily weakness or general debility; 
(6) that they sometimes associate themselves wdth distinct and definite 
diseases of the nervous centres, so that it becomes very important to 
know how much of a given case is due to organic lesion and how much 
to morbid ideation; (7) that it is possible to make a diagnosis in regard 
to them in many instances ; and (8) that the principles upon which their 
treatment should be conducted are simple and their application marvel- 
ously successful. 
One peculiarity of this paralysis from idea is, that the subject can 
often iise the affected muscles for one purpose, though not for another. 
There is a paralysis of movements, rather than of the muscles themselves. 
These movements are those involved in the particular idea that is at 
fault. For example, a subject while lying down may be able to move his 
legs in all directions, or to rise to a sitting position, although he may 
not be able to stand or to walk. The reason for this is apparent. This 
peculiarity was present in the following observation, which is a good 
illustration of the affection, particularly as the paralysis occurred under 
circumstances which gave ever}r reason to suppose that we had to do 
with an uncomplicated focal injury to the spinal cord :— 
Observation 1.—P. G. was originally admitted to the Boston City Hospital with 
fracture of the spine, causing paraplegia. After his discharge he was admitted to the 
department for nervous diseases. At this time his condition was as follows : He was only 
able to walk by the aid of crutches. He stood with difficulty, with his feet wide apart, and 
walked with hesitation and uncertainty unless supported. He stood with his knees slightly 
bent and his back thrown back, in a position difficult to describe. He complained of great 
pain in the lower part of his spine and buttock on sitting down, and therefore refused to sit 
while waiting his turn to be examined. There was apparently great weakness of the glutei 
muscles and of the extensors of the leg, for he had difficulty in raising himself to an erect 
posture after being made to bend over, and he carried himself with the centre of gravity 
thrown backward, so as to relieve these muscles. There was also difficulty in extending 
his lower leg. 
The details of the examination of the reflexes, sensations, muscles, etc., are omitted 
here for brevity. At first the diagnosis was paralysis of the extensors of the leg and of the 
glutei muscles from injury to the cauda equina. This at first seemed clear, but when the 
patient was made io lie down, and the muscles were tested in that position, it was a matter HYSTERIA 
bf surprise to find that he had complete control of both the extensor and flexor muscles of 
the thigh, as well as of the lower leg. The case was a puzzling one, and it was difficult to 
come to a conclusion in regard to the distribution of the paralysis. 
He was examined twice with great care, with a view to studying the subject of spinal 
localization in the light of this case. As there was also marked toe- and foot- drop on both 
sides, with atrophy and loss of electrical reaction of the corresponding muscles, it was cer- 
tain that there was present some serious injury to the nerves or cord ; but it was difficult to 
localize it, or account for the peculiar distribution of the paralysis. 
At his next visit it was not possible to examine him, owing to lack of time ; but that 
he might not be disappointed at what might appear to be neglect, I directed that he should 
be given static electricity, and instructed to return for further examination. 
After a few moments I went into the adjoining room, where he was being treated, and 
watched the process. Then, of a sudden, a sort of inspiration came to me, and in a com- 
manding tone I ordered him to get off the chair and walk, assuring him that he was 
perfectly well and could do so. He looked at me incredulously, as if I were not in earnest. 
After some hesitation he obeyed. To his surprise, as well as ours,—for till this moment we 
had not suspected the true nature of his malady,—he got off the chair and walked around 
the room, incommoded only by a certain amount of foot-drop which he did not notice. 
Nothing was more ludicrous than to see him, as he walked about, staring at us in astonish- 
ment, his eyes as “ big as saucers.” 
Owing to the foot-drop, he raised his feet high in walking. He was told to leave his 
crutches and go home. He did so, and walked all the way to his residence,—a distance 
of several miles. At his next visit, two days later, he still retained command of the 
formerly paralyzed muscles. He, naturally, seemed to think a miracle had been performed. 
In this case, then, there had been a combination of paralysis of the feet and toes, from 
organic injury to the cauda equina, with a large amount of functional paralysis involving 
the trunk- and thigh- muscles. The latter was dependent on idea. Tbe origin of this ide- 
ational paralysis could be traced to a true, but temporary, paralysis of the same muscles fol- 
lowing fracture of the spine, but which had cleared up. He was left, however, by the acci- 
dent, under the dominant idea that he could not use his legs for certain purposes, and as 
long as this idea persisted he could not do so. 
The following observation may also be cited :— 
A lady was attacked with an ulnar neuritis while convalescing from the “ grip.” She 
suffered from intense pain, which had nearly subsided when she came under my personal 
observation, about six months from the beginning of the attack. At that time there was 
marked paralysis of the hand, the use of which she had for the most part given up. She 
could not flex the fingers into the palm of the hand. There was tenderness of the nerves 
and skin, pain, and slight glossy skin, but there was no atrophy of the muscles or alteration 
In the electrical reaction. The diagnosis was mild neuritis, complicated by ideational 
paralysis. The latter was concluded as the result of cross-examination and a critical analy- 
sis of her history, which would be too lengthy to detail here. She was assured that the 
paralysis could be cured, but no opinion given regarding the pain, which was due to the 
neuritis. After the first electrization there was an immediate return of power to her hand. 
After a few sittings there was only a slight weakness, if any, left. The exact amount of 
strength could not be measured, on account of the tenderness which persisted. This also 
greatly improved under treatment, so that, when discharged, her disability was only slight 
from pain. 
The course of events in this case was evidently as follows : In consequence of neuritis 
the patient suffers great pain, possibly some muscular weakness, and gives up all use of the 
hand. At first the patient cannot use the hand ; later, without her being aware of it, the 
neuritis disappears, but the patient remains still under thqimpression that she cannot use it. 
She cannot will to use it, because of the strength of this idea. It requires a strong stimulus 
to enable her to regain power of the muscles. This was afforded by the treatment. 
In the experience of the writer, most cases of ideational paralysis PRINCE, 
have their origin either in some injury to a part suspending function or 
in some previous acute disease having the same effect. More rarely, in 
impressionable subjects, the affection can be traced to mimicry, or the 
effect of suggestion inspired by the presence of another person afflicted 
with a real disease. If litigation is in progress, no treatment will have 
any effect. 
There are other methods besides electrization for curing this affec- 
tion ; for example, gradual education of the patient to resume control 
of the paralyzed muscles. It is not necessary, however, to go into these 
here. The method of using electricity is the same as for other forms of 
paralysis. The muscles must be made to contract energetically power- 
ful currents. It is often serviceable to induce the patient to make efforts 
to contract the muscles voluntarily in unison with the electrical contrac- 
tions. All the muscles of the paralyzed part should be treated. Faradism 
is the most effective, but galvanism and franklinism can be used. 
Hysterical paraplegia is generally regarded as very obstinate to 
electrical treatment. Monoplegia and hemiplegia, in the writer’s experi- 
ence, are also apt to be rebellious, but sometimes the result is satisfac- 
tory. 
Contractures are not, as a rule, benefited by electricity. Cases of 
cure are, however, reported. 
Neuralgia is more readily controlled by electricity than any of the 
hysterical stigmata. In fact, there is no method of treating this sjunp- 
tom that compares with electricity. Often pain will disappear like magic 
during a sitting. It is true that frequently it will return, but this is no 
valid argument against its usefulness. Pain, in itself, unlike anaesthesia 
and paralysis, is so great a source of suffering that anything that will 
suppress it even temporarily will be welcomed. In cases of some chron- 
icity, especially when the hysterical symptoms are a complication of 
some other disease, the patient may be kept comfortable for months by 
daily electrization, when otherwise resort must be had to drugs, with all 
the attendant disadvantages. In a case, for example, of traumatic neu- 
ritis, with marked histerical neuralgia as an accompaniment, the suffering 
was made endurable for a 3rear, pending the settlement of the litigation. 
This relief was given not only to the hysterical neuralgia, but to that 
from the neuritis. In this case the pain was at times excruciating. 
In a case of neurasthenic hysteria now under treatment, in which 
the principal suffering was produced by neuralgiform sensations in the 
head of great intensity, which had practically disabled the patient for 
five years, and confined her to her bed for three years, the patient has 
been kept fairly comfortable while she is undergoing the Weir-Mitchell 
treatment, and has been enabled to make efforts which otherwise would 
have culminated in severe attacks of pain and prostration. The result 
bids fair to be a success. 
Spinal tenderness is often completely controlled by electrization, as NEURASTHENIA. 
well as many of those pains in the back and legs supposed to be due to 
uterine difficulty. Static electricity is, on the whole, the most efficient 
form, as it is the most convenient. In the absence of an influence ma- 
chine, the galvanic or faradic currents may be used. Sometimes oue of 
these is the more efficient, and sometimes the other. Care must be taken, 
with sensitive subjects, not to use too strong currents at first. With 
each sitting the current may be increased, until finally a strong one can 
be borne. A strong current is more effective than a mild one, when the 
pain is intense. With timid subjects the galvanic current has the advan- 
tage of being less alarming. Whichever variety be used, the current or 
sparks, should be applied directly to the seat of the pain, and at each 
sitting electrization should be persevered in until some degree of relief 
is experienced. It will be very rare that the patient does not admit at 
least a diminution of the pain, if not total cessation. If the pain return 
the interval of freedom will probably be prolonged, and the pain will be 
rendered less intense by each subsequent sitting. 
When using the faradic and galvanic currents one electrode should 
be allowed to rest on an indifferent part of the bod}q while the otlier is 
gently rubbed over the painful part without being removed from the skin. 
The current, at first mild, should be gradually increased until it becomes 
as strong as can be borne. With the galvanic current it is generally con- 
sidered that the positive pole has a more anodyne effect than the negative. 
There is no harm in following this rule, though there is some reason to 
doubt the fact on which it is based. It is well to let the active electrode 
rest for a few moments over painful spots, until the current becomes un- 
bearable. 
Neurasthenia. 
(Pseudo-Neurasthenia.) 
The opinion is generally entertained, by those who have had a large 
experience with electro-therapeutics, that many cases of neurasthenia are 
ATery favorably influenced by electrization (Beard, Rockwell, Erb, 
Rumpf, Fischer, Mobius, Arndt, Eulenberg, and others). On the other 
hand, the general practitioner, who is less familiar with this mode of 
treatment, either completely ignores these claims or exhibits an ex- 
tremely skeptical attitude of mind regarding them. There must be some 
truth—perhaps some exaggeration—in each of these conflicting views. 
Between the extremes of confirmed faith and utter indifference there 
must be a safe middle ground on which we can stand. It may be stated 
at the outset that the effect of electrical treatment on that large group 
of diseases known as neurasthenia gives very varying results. For this 
reason it is impossible to make a general statement of its value which is 
applicable to individual cases. To appreciate this fact, it will be well to 
consider in a brief way the nature of the disease with which we have to 
deal. PRINCE. 
The pathology of neurasthenia is obscure, but whatever be its 
nature, whether it be an autocthonous poisoning of the nervous system, 
as some would have us believe, or whether it be exhaustion of the nerve- 
elements, after the manner of the changes which have been shown by 
Hodge, in his experiments on birds and bees, to follow prolonged use, 
or other molecular changes such as would be produced by inanition, its 
symptoms and the laws of their development must be studied b}7 them- 
selves as clinical phenomena for purposes of intelligent treatment; just 
as in physical science the laws of electricity must be studied and formu- 
lated in the absence of an exact knowledge of the nature of electricity 
itself. And just as the fluid hypothesis of electricity was convenient 
for the time being for practical purposes, so it is desirable to have a 
working hypothesis of the nature of neurasthenia, as a basis for clinical 
study and treatment. That of exhaustion is the most convenient, as it 
contains no assumption of the nature of the finer changes that may be 
involved in the morbid process. 
Adopting, then, this hypothesis for the purposes of this discussion, 
we should expect, on theoretical grounds, that in the practical handling 
of this disease we should have to do with a great variety of symptom- 
pictures, many of which wTould present very little external resemblance 
to one another. As the nervous system is made up of segments, each 
of which, though connected with the rest, is yet more or less isolated 
and capable of acting as an independent automatic centre, we should 
expect that any one of these segments might become exhausted by 
disease without the implication of distant or neighboring parts. It 
might be anticipated that, in this way, a variety of symptom-pictures 
would be produced which would have little external resemblance to one 
another, notwithstanding the fact that nerve exhaustion would be the 
physical basis of each. And, in truth, practical experience has shown 
that what is thus at first sight presumabl}7 true, is, in reality, the case. 
Clinical experience teaches that neurasthenia, at one time, may be ex- 
pressed by a variety of more or less compact, localized s37mptoms, indica- 
tive of exhaustion of comparatively limited portions of the cerebro-spinal 
system, while at other times the exhaustion may be more disseminated, 
and include a very large part, if not the whole, of this same system. 
Neurasthenia may be expressed, for example, by any one, or by a combi- 
nation of several or all of the following groups of symptoms, according 
to the part affected: Cerebral symptoms, indicative of mental weakness, 
fixed ideas, incapacity for work, etc.; headache, vertigo, nausea, asthe- 
nopia; cardiac disturbances ; vasomotor changes ; localized pains in the 
spine, limbs, abdomen, loins, sacrum, etc.; gastric disturbances, such as 
dyspepsia, flatulence, etc. ; uterine and ovarian pains and other symp- 
toms referable to the reproductive organs; muscular weakness, espe- 
cially of the legs ; disturbances of the sensibility (such as formication), 
subjective numbness, faintness and sense of exhaustion produced by NEURASTHENIA, 
slight exertion ; inanition and physical degeneration, and so on. This, 
of course, is only an incomplete classification of the possible symptoms. 
When neurasthenia is more or less generalized, all these disturbances of 
function may be included in the picture, in which case, of course, the 
exhaustion will be more profound. The degree of localization, on the 
other hand, may be from an almost isolated phenomenon, due to the 
limitation of the process to one or more nervous segments, up to almost 
general exhaustion. Where, however, the nervous exhaustion is limited 
in its extent, it nevertheless almost always happens that symptoms 
indicative of the implication of other parts, distant or neighboring, are 
included in the clinical picture, because of the physiological association 
between all parts of the nervous system. Experience shows that, even 
when exhaustion, as a pathological process, is limited to special segments 
of the brain or spinal cord, the disturbances of function observed point 
to the implication of more remote centres by an abnormal diffusion of 
normal nervous stimuli; or, if the term be preferred, by reflex influence. 
From this it will be understood that disturbances of function do not 
always indicate exhaustion of the nerve-centres as a physical basis; or, 
putting this truth in more general language, the hypothetical anatomical 
exhaustion of the nerve-centres is not co-extensive with the disturbances 
of function (distribution of symptoms). In fact, the disturbances of 
function have a much wider distribution than the exhaustive process, and 
the phenomena presented by the disturbances of associated, but healthy, 
centres may be so extensive as to overweigh and obscure that of the 
primarily diseased centres. In such cases the disability will be occa- 
sioned almost entirely by the secondary disturbances of associated parts 
of the cerebro-spinal axis, while the diseased and exhausted focus will be 
of secondary consequence. 
Another element, at least, in the production of these secondary 
disturbances, and one which profoundly affects the symptom-picture, is 
the deficient inhibition of lower centres by higher centres. When the 
higher centres are exhausted, they cease to hold the lower centres 
in check. The latter go on working of their own will, without heed 
to the proper regulation of the nervous household. “ When the cat’s 
away, the mice will play.” Hughlings-Jackson, in his able article on 
the evolution and involution of the nervous system, has maintained 
with great force the division of the nervous system into three levels of 
evolution,—the lowest (spinal cord and medulla), middle (mid-brain), 
and highest (frontal lobes.) All parts of the body are represented at 
each level. In disease, according to the views of this author, there is a 
dissolution of the nervous s}rstem in a reverse order,—from the highest 
to the lowest centres. In disease—and this is a point of great practical 
importance, and one which has been frequently pointed out by Hughlings- 
Jackson—there are two sets of symptoms,—one positive and one nega- 
tive. The negative symptoms are those due to the destructive action of PRINCE. 
disease. The positive are those due to the normal working of the 
remaining unimpaired centres, usually of lower levels. When an 
aphasic swears, for example, his profanity is due to the normal physio- 
logical working of the only remaining uninjured portion of his speech- 
centre; the deliriums of fever or hallucinations of insanity are the 
expressions of the physiological workings of the remaining levels of 
consciousness, etc. This law, which Hughlings-Jackson has fortified with 
great force of argument and example, has special value in explaining 
many of the clinical phenomena of neurasthenia. The exhaustion of the 
highest centres gives rise to an inability on the part of the subject to 
perform certain mental and physical acts. But the lower and unex- 
hausted centres act normally and physiologically, and give rise to phe- 
nomena which, because unusual, are regarded as pathological. The lower 
centres react in place of the higher or highest centres. If the latter were 
not exhausted, the lower would be inhibited, or quiescent. From this 
point of view, many of the symptoms of neurasthenia are really the 
expression of the normal or healthy centres, either from lack of inhibition 
or because of the exhaustion of the higher levels. They alone can func- 
tionate. Such functionating centres are not diseased, and the phenomena 
presented by their functionating are not to be taken as indicative of 
pathological processes located therein. 
It is not the writer’s intention to enter into a discussion of the 
of neurasthenia; the object here is only to indicate the mech- 
anism of the pathological process so far as is necessary to understand the 
conditions that must be met for purposes of treatment. The treatment 
cannot be intelligently undertaken unless the make-up of the symptom- 
picture of neurasthenia be understood. If these views be true, it becomes 
evident how impossible it is to make general statements of the efficacy 
of electricity, or any other agent or system of treatment that shall be 
applicable to all cases. We might predict from a priori considerations 
—in fact, we find it true—that electricity produces results in one class 
of cases of neurasthenia which are not obtained in another. When, for 
example, symptoms indicative of lack of inhibition or reflex irritation of 
associated centres predominate with only local exhaustion, the effect of 
electricity is likely to be more curative than when the opposite extreme 
is present, and when all the S}rmptoms are due to a general exhaustion 
of the whole cerebro-spinal system, with imperfect nutrition and other 
forms of physical degeneration. In the latter case you could not expect 
to obtain curative results without first building up the body with food 
and improving the nutrition and increasing the amount of blood. In 
fact, it is in this last class of cases—in which inanition and anaemia 
exist, with their own train of symptoms—that the rest-cure of Weir 
Mitchell, with overfeeding, becomes necessaiy. But in these cases elec- 
tricity is of use as a palliative. Many of the more distressing S3Tmp- 
toms can be relieved and kept in abeyance by electrical treatment. NEURASTHENIA, 
Insomnia and painful spine, headache, and similar disturbances are 
often kept under by means of electricity, and constant drugging is 
dispensed with. 
The effect of electricity in neurasthenia, then, may be said to be (a) 
palliative and (6) curative. In most cases the palliative effect is obtained 
rather than the curative, but, nevertheless, there is a certain class of 
neurasthenics who may be said to be cured with electricity. And here 
another element may be referred to as influencing the effect of the treat- 
ment,—namely, the hysterical element. Hysteria, in one form or another, 
is very often associated with neurasthenia, just as, in hysteria, neuras- 
thenia is superadded frequently as an additional factor. It is not often 
that we obtain a pure type of nervous debility. From a practical point 
of view, we may almost make a third group of cases, classified as hystero- 
neurasthenia or neurasthenic hysteria, according as the hysterical or 
neurasthenic symptoms predominate. Electrical treatment of these cases 
effects results which cannot always be obtained in the pure types. It may 
be that the hysterical symptoms will disappear, leaving a pure neuras- 
thenia, or the asthenic symptoms may clear up, leaving the hysterical 
only behind. 
The great difficulty in practice is to determine what class of cases is 
most likely to be benefited and what class not. Speaking generally, it 
may be said that the most favorable cases are those in which the nervous 
exhaustion is well localized and the symptoms are for the most part due 
either to defective inhibition or to secondary reflex processes. The effect 
of treatment is also likely to be more favorable when the case has been 
of short duration, the physical condition of the body is good, and the 
nutrition is not impaired. The least favorable cases are those with 
neurotic antecedents of long duration, and in which, from the long con- 
tinuance of the neurasthenic conditions, the nutrition of the body has 
become impaired and the disturbances of function have existed for so 
long a time that they have become engrafted almost as automatic, inde- 
pendent processes. There are neurasthenics who may almost be said to 
be born neurasthenic, to live neurasthenic, and die neurasthenic. Such 
may be improved by this or that treatment, or they may have their lives 
made fairly tolerable by careful regulation of habits, and be relieved 
from time to time of any prominent symptom. Electricity will help 
these from time to time, it may relieve them from this or that thing 
from which they suffer, but it will not cure them. Such persons may be 
said to go through life like an old doctor’s rickety buggy,—always worn 
out, always rattling and creaking, but never completely breaking down 
so as not to go at all. Another less severe type of cases may be decid- 
edly benefited, if not cured, by electricity. This agent is a great help 
in their treatment; it palliates; it will relieve many of the distressing 
symptoms, and thus ward off the effect which constant suffering has in 
retarding recovery; while good food, fresh air, and exercise do the rest PRINCE. 
and effect a cure. In the more local forms of neurasthenia electricity 
often produces the most brilliant results. Sometimes even a few sittings 
will not only dissipate most distressing s} mptoms seemingly like magic, 
but will do so permanently, and enable the patient to be discharged 
cured. Such cases every one who has had a large experience in electrical 
treatment has seen and can testify to. Although there is much difference 
of opinion regarding the efficacy of electricity in the treatment of affec- 
tions of this kind, this difference depends very largely on the difference 
in the views entertained regarding the pathology and the consequent 
diagnosis of such cases. 
Probably no two persons would agree exactly as to what shall be 
included under and what shall be excluded from neurasthenia. With 
many neurasthenia is a general cloak to cover almost functional dis- 
turbance ; with others it is limited to a comparatively small class of cases. 
The tendency at present is to expand the term and make of it a sort of 
general omnibus, into which everything that is not organic, or does not 
belong to a special type, shall be damped. It seems as if, like an omni- 
bus, there is always room for one more disease. This tendency, it is 
needless to say, has already gone too far. It is time that a serious at- 
tempt should be made to differentiate the various types of functional 
diseases of this sort from one another, and to classify them according to 
their pathology. The writer’s views regarding what class of cases are 
likety to be benefited and what are not will, perhaps, be best explained 
by a few illustrative cases :— 
Cases Not Benefited. Observation 1.—Woman, about 50 years of age ; in opulent cir- 
cumstances. Descended from neurotic family, has always been neurotic from childhood ; 
never has been strong; as a girl was subjected to a great deal of nervous strain, and, being 
of almost a morbidly conscientious temperament, has always found it difficult to reconcile 
her actions with her ideas of duty. Great tendency to dwell on the moral side of any con- 
templated act. Nutrition is poor ; underfed; rather anaemic. Breaks down under almost 
any strain ; suffers from sick-headache ; tender spine ; nausea ; functional ataxia; vaso- 
motor phenomena; heat and flushes; cold hands and feet; palpitation; general muscular 
weakness; hemiparaesthesia and anaesthesia (subjective only) of left side. Any psychical 
shock, such as a rude word or personal controversy, will bring on a whole series of these 
symptoms. Cannot walk without becoming greatly exhausted and other symptoms follow- 
ing. Auto-suggestion marked and easily recognized. This can be taken advantage of for 
treatment. Patient is intellectual, unusually intelligent, and cultured. As soon as her 
condition is improved she breaks down under some strain which would not affect another 
person. Attempt was made to treat her by electricity, but, although a very slight charge 
of the static electricity was used, a series of symptoms developed which, it was later ascer- 
tained, were identical with those supposed to be caused in her by a thunder-storm. Patient 
confessed she had prejudices against electricity and expected just such symptoms would 
come on. 
Observation 2.—Woman, about 30 years of age ; in well-to-do circumstances. Neurotic 
from her childhood. Had quite frequently fallen into hysterical trances. Symptoms : 
General lack of strength, palpitation, headache, dyspepsia, vasomotor disturbances, poor 
nutrition. Physical exertion causes great prostration, vasomotor and other disturbances. 
Treated by the rest-cure with great gain in weight; nutrition improved, and she was much 
better generally. Broke down again immediately after attempting to return to ordinary NEURASTHENIA, 
life. Electricity not only failed to relieve the symptoms, but, as in Observation 1, pro- 
duced symptoms said to be similar to those produced by a thunder-storm. The reflex irri- 
tability was extreme : almost any form of irritation, whether physical or mental, produced 
distressing symptoms. 
Obsei-vation 3.—Young woman, married, 22 or 23 years of age, with neurotic antece- 
dents. Health poor generally ; dyspepsia ; unable to eat more than the slightest quantity 
of food ; irritability and torpid action of the bowels alternating with each other; great 
physical fatigue ; very marked symptoms of pseudo-angina pectoris, which always caused 
much alarm. The fright from these attacks induced, in turn, numerous association symp- 
toms. The cardiac attacks were brought on by physical exhaustion, mental irritation, and 
indigestion. In consequence of last, patient even refused to put water into her stomach. 
Under the Weir-Mltchell treatment patient was taught to take and digest large quantities 
of food, and her physical condition improved generally ; but she did not regain strength, 
and immediately broke down again on her restoration to her former habits of life. Elec- 
trical treatment in this case failed to accomplish any beneficial results. 
Cases Curable by Electricity. Observation 1.—Mrs. E., about 35 years old; naturally a 
strong, healthy woman. Well up to one year ago. Has led a fast life. Previous to break- 
ing down, one year ago, had been drinking hard for two years. Finding herself becoming 
used up, broke off drinking entirely. About that time began to suffer from the same set 
of symptoms she has now; has been better off and on. Patient, when first seen, was in 
bed, where she had been for about ten days. Complained of palpitation, which she de- 
scribed as due to some supposed trouble of the heart, for which she had been treated. 
Also had “nervous feelings,” the latter said to resemble the feeling from a faradic battery 
“that went all over her.” These symptoms were very disagreeable, and alarmed her. 
Complained also of muscular weakness, “goneness,” marked sleeplessness, general numb- 
ness, and dizziness; unable to walk but a very short distance, because of prostration. 
Physical tire brought on attacks of the above symptoms. Patient was up late at night and 
obtained very little rest and sleep. Had been treated during the past year by various doc- 
tors. One had treated her for a long while for heart disease. Physical examination 
showed her to be a strong, healthy-looking woman, good color, heart normal, no objective 
signs. Told to get up next day and come to the office in a carriage for electricity. Patient 
considered her condition so serious that she was arranging to break up her household and 
go into the country. Next day, treated by static electricity. The effect of the first sitting 
was beneficial. She at once felt better, refreshed, and relieved of various symptoms. 
Two days later patient reported herself as greatly improved; symptoms had largely 
disappeared, and she slept well. Static electricity was re-applied with same beneficial 
effect. After this, patient so well that treatment was discontinued, and she gave up her 
plan of going into the country. 
Observation 2.—Mrs. E., 35 years old ; married; has the appearance of being a strong, 
healthy person, with good color, but states that she never had been strong and was always 
easily tired. Eleven years ago, while going down front steps, slipped and fell, striking her 
back ; fainted. Ever since has had a pain in the middle of her spine. This pain has in- 
creased of late, until now it is difficult for her to do any work. Is wearing a spinal corset 
for this, and is supposed to have some sort of lateral curvature. Has had numbness of the 
whole left side, off and on, for eleven years. These symptoms antedate the fall. Feels tired all 
the time ; lack of energy; little things worry her; has sleepy spells during the day-time, when 
she lies down and sleeps soundly; almost impossible to keep awake at such times; walking, 
housework, and driving tire her and make her back ache. This pain is “ terrible ” ; feels 
dizzy at times, as if falling backward ; certain positions in bed make her feel as if turning 
a somersault backward; nausea at times; has “gone,” faint feelings. Patient says that 
sometimes, on waking from these sleepy spells, she knows what is going on around her, but 
cannot speak. Mother and maternal grandfather are said to have had “ fits ” (?) (no spasms). 
Number of others died of consumption. Physical examination : No objective symptoms, 
except great tenderness of the spine. Treatment: Patient ordered to take off the spinal 
corset, and static electricity given, at first every other day, then at longer intervals. 
Eight sittings were given in all. The effect of electricity at each sitting was to dispel PRINCE. 
any unpleasant symptoms present, such as tenderness of the spine, headache, and numb- 
ness, and patient declared herself as feeling better and stronger after each application. 
At first symptoms returned after a number of hours, but in less intense degree. After 
eight sittings patient reported herself as well; able to walk long distances, and feeling in 
good health. 
There was evidently a strong hysterical element in this case ; patient 
was plainly amenable to suggestion, auto- and extrinsic. The brilliant 
effect of the treatment in this case is enhanced when it is remembered 
that for several years the patient had been an invalid, practically unfit 
for any duties in life; coidd do little without great suffering, and had 
been under constant treatment. It should be said, though, that the 
effect of electrical treatment was supplemented by strong moral lectures 
and a hygienic regulation of her life. 
Observation 8.—Mild neurasthenia following the “ grip.” Lady, 51 years of age; in 
affluent circumstances ; of a neurotic temperament. Symptoms : General malaise ; slight 
prostration and subjective numbness of left side, or hemiparaesthesia. Treatment: Gal- 
vanization of the spine ; after each sitting patient felt much refreshed and symptoms were 
dissipated. Patient expressed herself as being greatly relieved by electricity ; after a few 
sittings patient discharged, cured. This patient previously had suffered at different times 
from a similar group of symptoms, and has always been benefited by electricity. Besides 
dispelling the symptoms, electricity acted as a general tonic. 
It may be objected that cases in which striking curative results of 
this kind are obtained by electrical treatment are not really true cases 
of neurasthenia ; that they are some form of neurosis simulating, but not 
identical with, neurasthenia. The writer has himself often pondered 
over this question, and has often asked himself whether such cases 
should not rather be called pseudo-, or false, neurasthenia, and has fre- 
quently been tempted to make a separate classification of neuroses 
under this head. But the attempt to do so has been thwarted the 
difficulty of precisely defining what should be called true neurasthenia. 
The symptom-pictures of many are so similar that they cannot be dis- 
tinguished except by the results of treatment, and, therefore, the differ- 
ential diagnosis would have to rest upon the therapeutic results. This, 
in itself, for obvious reasons, is a very dangerous ground upon which to 
base pathological distinctions. Many cases which have promptly 
responded to a special treatment other than electrization have persisted 
for years in a neurotic condition under continuous and varied treatment 
improperly applied. A counter-objection might also be raised to limiting 
the term “ neurasthenia” to the severe forms, on the ground that many of 
them, such as those that have been described above as well-nigh incurable, 
are themselves not true neurasthenia, but are dependent upon some pro- 
found pathological processes in the nervous s}'stem, of the exact nature 
of which we are yet ignorant. Some of them are certainly due to develop- 
mental effects and to hereditary influences. The careful study of many 
cases seems to indicate that in certain individuals the normal evolution- 
ary process in the nervous system ceases at an earty age, and the process NEURASTHENIA. 
of dissolution sets in. This dissolution process thus gives rise to posi- 
tive and negative symptoms generally classed as neurasthenic. The 
pathology of such cases must be regarded as very distinct from those 
which, in the midst of robust, active health, temporarily break down, as 
the result of overwork and mental and physical strain. Furthermore, 
the separation of a distinct class of neuroses as pseudo-neurasthenia 
does not give us any deeper insight into the pathological processes, and 
we should remain just as ignorant as before of their true nature. As 
long as the pathology of both true and false neurasthenia is unknown, 
it is impossible to say how much there may or may not be that is 
common to the pathological processes underlying each. For the present, 
it would seem better to regard pseudo-, or mimetic, neurasthenia as a 
true neurasthenia of limited intensity and extent, but on which have 
become engrafted various associated processes, of which it is principally 
made up. These associated processes are not in themselves the expres- 
sion of disease of their own centres, but rather of the physiological 
activity of nervous segments which have ceased to be controlled by the 
normal inhibitory inferences of higher centres. It is for this reason 
that the electrical treatment in such cases seems to present such magical 
results. 
Special Modes of Treatment.—Speaking now more specifically of 
special modes of treatment by electricity, it may be laid down as a 
general rule that our aim must be, in all cases, to fight the individual 
symptoms. Headache, insomnia, spinal pain and tenderness, muscular 
weakness, each must be attacked by itself. Headache and insomnia are 
often overcome by the galvanization of the head, or by the static douche. 
Sometimes the one form of electricity is the more efficacious, and some- 
times the other. Tenderness of the spine is, as a rule, relieved or dis- 
pelled by one or another of the different forms of electricity. It is not 
uncommon to see the symptoms disappear immediately, under the influ- 
ence of electrization, and remain absent for hours. In this way the 
patient may obtain prolonged relief from constant suffering. The same 
may be said of lumbar, abdominal, and other pains. These symptoms, 
however, do tend to return, after intervals of greater or less extent,— 
as a rule, after some hours,—but on their return they will generally be 
found to be less severe, and, if the patient is improving, they will be 
observed, after each sitting, to be of less and less intensity, until finally 
they disappear altogether. 
Mental symptoms, such as melancholia or depression, vertigo, in- 
ability to apply the mind, etc., are also frequently benefited. The hemi- 
parsesthesia, as a rule, of the left side, so commonly met with in neuras- 
thenics, is readily dissipated by electricity. As a general tonic, electricity 
at times acts in a very striking manner, and patients declare themselves 
feeling refreshed and invigorated. They walk better and seem to have 
more vigor. PRINCE. 
Regarding the choice of electricity, it is impossible to lay down 
rules that shall govern us in all cases. Sometimes all three forms—gal- 
vanism, faradism, and franklinism—act equally well. Sometimes one 
form produces distinctly superior results. For cerebral symptoms, gal- 
vanization of the head is strongly recommended by some writers, the 
current being passed longitudinally, transversely, or diagonally. Lowen- 
feld advises that, when symptoms of congestion are present, the anode 
should be placed on the forehead and the cathode on the back of the 
neck. He bases these rules on experimental results that he obtained on 
rabbits.1 Even, however, if the same electrical effects are produced in 
diseased conditions in man (and it is very doubtful if this is the case), 
our knowledge of congestion and anaemia of the brain is too chimerical 
to allow us to base treatment upon rules of this kind with any degree 
of confidence. It seems to the writer that the results of electrical treat- 
ment do not bear out the statements made by various German authors, 
who lay down minute rules regarding the direction of the current and 
the poles to be used to overcome this or that pathological condition 
supposed to be present. 1 have not been able to satisf}r myself that the 
effects obtained depend on the direction of the current or the character 
of the exciting pole. It is true that different physiological subjective 
symptoms are produced, according as the current is passed transversely 
through the temples, or longitudinally from the forehead to the nape of 
the neck. But these symptoms are mostly only subjective, and there is 
not sufficient evidence that the influence upon pathological processes 
similarly varies. Our knowledge of the therapeutic effect of electricity, 
as of drugs, is entirely empirical, and we must be governed in our use 
of it by the clinical results obtained. Certain it is, however, that the 
application of the poles of a galvanic battery to the head is often fol- 
lowed a relief of many mental symptoms. Patients say, after each 
application, that their heads feel clearer, that the depression has vanished, 
and the feeling of weight and pressure on the top of the head gone; and 
they look forward with pleasure to each application. 
The strength of the galvanic current should be such that it can be 
borne without great discomfort. Many writers caution veiy strongly 
against the use of any but very mild currents to the brain. It seems to 
the writer that rather overcaution has been exhibited in this respect. It 
is true that patients have sometimes, under very strong currents, experi- 
enced very disagreeable symptoms, and have even fainted; but such 
symptoms are not in themselves dangerous, and, if the current is main- 
tained within the limits of strength that will produce such symptoms, no 
danger need be apprehended. Some writers say that not more than 1 or 2 
milliamperes should be used; but a better rule is to be guided by the 
physiological effect experienced. It would seem best to increase the 
current gradually until the first signs of vertigo are experienced, and 
1 Vide p. K-34. NEURASTHENIA. 
then decrease the current at once if the vertigo increase or persist in 
a disagreeable form. It is, however, true that few patients can take 
more than 4 or 5 milliampfcres without extremely disagreeable sensations, 
but, if more can be borne, it is well to take advantage of the fact. 
Five or ten minutes are usually sufficient for a sitting. The applica- 
tion should be made daily, if the circumstances are such that it is possi- 
ble ; or, at least, this is desirable for the first week or two; later, three 
or four times a week would be ample. Excepting when very weak cur- 
rents are employed to the head, it should be a cardinal rule never to 
break the current, or make it, while the electrodes are in situ. Shocks 
of this kind are liable to produce very disagreeable symptoms. The 
best method is gradually to increase the current after the electrodes have 
been placed upon the head at the spot desired, and then to move them 
about without removing them from contact with the skin. In galvaniz- 
ing the spine it is best to place one electrode at the lumbar extremity 
and the other ou the neck, and then, wdiile holding one stead}', to pass 
the other up and down the whole length of the spine, allowing it to 
dwell for a longer or shorter time upon tender points, according as the 
patient is able to bear it. A good plan is to keep one electrode on one 
of these points, and to persist in the spinal galvanization of the spine 
until the patient expresses feeling relieved of his symptoms. In fact, it 
is always well, in applying electricity, whether to the head or to the 
body, to persist until some degree of improvement, even if slight, is felt 
by the patient. Sometimes, when a distinctly stimulating effect is de- 
sired, it is beneficial to make and break the current while the electrodes 
are over the spine. The strength of the current should be as strong as 
can be borne without discomfort. It is not desirable to make the current 
painful or disagreeable. When spots are present particularly sensitive 
to the current, the electrodes need not be allowed to remain on them 
longer than can well be borne, but the current should be repeatedly ap- 
plied to them until relief is felt. 
Arndt recommends general galvanization in neurasthenia. He ad- 
vises that, when it is desired to obtain a quieting effect, as in the first 
stage of neurasthenia, the positive pole should be applied centrally and 
the cathode peripherally. When the opposite, or stimulating, effect is 
desired, as in the second stage of the disease, the poles should be re- 
versed,—i.e., the negative should be placed centrally and the anode 
peripherally. Unfortunately, little confidence can be placed in a system 
based on supposed differences in the therapeutic action of the two poles 
or of direction of the current, and equally good results are obtained by 
those who disregard niles of this kind. Sufficient has already been said 
on this point. Eulenberg, Erb, and others also recommend galvanism, 
either general or local, in this disease. 
General galvanism, which was brought into prominence by Beard 
and Rockwell, is done as follows : One electrode is placed upon the feet. PRINCE. 
It should be large, so that it can be retained in situ, during the sitting, 
without discomfort. The other electrode is then passed successively 
over the different parts of the whole body,—the limbs, the back and the 
spine, the abdomen, the neck, and, lastly, the head. When a painful 
spot, or a part the seat of pain, is reached, the electrode should be 
allowed to rest upon it or repeatedly passed over it until some degree 
of relief is obtained. It is sometimes surprising to see how local symp- 
toms may be dissipated in this way. Tender spine, for example, may be 
readily quieted for the time being, at least. When treating the limbs, 
it is desirable to make the muscles contract a few times through the 
motor points. The object sought is twofold,—the stimulation of the 
whole nervous system through the muscles, skin, and peripheral nerves, 
and the inhibition of morbid central nervous processes. Twenty min- 
utes will be found sufficient for a sitting. Care must be taken not to use 
too strong a current, otherwise stimulation will become irritation, and 
general secondary nervous symptoms may develop, to the chagrin of the 
physician and the disappointment of the patient. 
Electrization, in this disease particularly, may easily be overdone, 
and the physician will be unpleasantly surprised to find that, instead of 
benefiting his patient, he has made a bad matter worse. This is not true 
of all cases of neurasthenia, but only of a certain class. It is not possible 
to determine beforehand what cases belong to this class. 
So-called central galvanization is another mode of applying the 
galvanic current. I cannot help regarding it as a refinement, without 
practical advantage over other methods. It consists in placing one 
electrode over the epigastrium (the negative, as recommended by Beard), 
and applying the other to the spine, head, and “ sympathetic.” The 
object is to concentrate in this way the action of the current on the 
central nervous system. It does not appear that the results accom- 
plished by this mode of electrization are superior to those obtained by 
the other methods above described, or that the central nervous system is 
more directly acted upon. The brain is fully as well acted upon wiien 
both electrodes are placed upon the head, and the evidence is lacking 
that the spinal cord can be directly influenced by the current. Although 
clinical experience shows that electrization over the spine does have a 
therapeutic effect, this is probably due to reflex action. The same may 
be said of galvanism of the sympathetic, which de Watteville has shown 
to be a piece of imaginary therapeutics, as there is no reason to believe 
that the sympathetic is acted upon. He proposes the name “ subaural 
galvanization,” as the application of electricity to this region is believed 
to have a special effect in neuroses. 
Faradism is also recommended by some writers. Arndt advises 
that the faradic current be used when an indirect stimulation of the 
nervous system is desired,—that is, through the skin. This author cau- 
tions against the use of too strong a current, or too frequent or too NEURASTHENIA, 
extended applications of the same. In this he is quite right, though there 
are some cases which can he faradized without limit. General faradism, 
so highly spoken of by Beard, is also strongly recommended. The 
technique is the same as when using general galvanization. 
Another method of using faradism is that advocated by Rumpf,— 
namely, the brushing of large surfaces with the faradic brush. This 
method is based on the experiments (already referred to) by Rumpf, 
Nothnagel, and others, "who found that excitation of the skin was 
followed by contraction of the vessels of the brain and spinal cord. 
Rumpf claims to have obtained very favorable therapeutic results by this 
method. 
Of late years static electricity has come more and more into use. 
The ease with which it can be applied—avoiding, as it does, the necessity 
of the removal of the clothing and the wetting of the body—makes it a 
particularly convenient form of electrization ; and for this reason, when 
its effects are equally good, it will always be given the preference by 
the physician. In some forms of neurasthenia the effect of static elec- 
tricity is particularly good,—fully equal and often superior to that of 
galvanism or faradism. In relieving insomnia, headache,—above all, 
mental depression and spinal tenderness,—the writer has obtained very 
favorable results with it. The different effects that can be produced, 
according as the spark, the douche or breeze, or simple insulation is 
employed, render it a very valuable therapeutic agent. It can be even 
converted into the dynamic variety, with effects similar to that of the 
faradic current. The static breeze, applied to the head, will sometimes 
relieve depression and headache like magic. Severe peripheral pains and 
the different neuralgias are very readily relieved by the spark. Even 
the pains of neuritis are often temporarily modified. One has to be 
careful, however, with sensitive patients, not to begin too violently with 
this form of electricity. Very sensitive patients often at first respond 
badly to static electricity when given strong, and for this reason it is 
often best with them to begin with the milder galvanic current, and later 
change to static electricity. 
Electric baths remain to be spoken of. These have been strongly 
advocated by some writers. Electrization is certainly more general by 
this method than by any other, but wThether it is more effective remains 
to be proved. Theoretically, there does not seem to be anjr reason why 
it should be, or even as effective. I have not myself had any experience 
wdth electric baths, and, therefore, cannot express an opinion on this 
point. It is probable that they appeal to the imagination, and, therefore, 
have a psychical influence. One advantage that this method has is, that 
it combines the effects of baths and electricit}". Hot and cold baths, 
particularly the former, are often very soothing and refreshing in 
neurasthenia, I have known them to be very useful in this respect, and, 
when combined with electricity, I can imagine the effect to be very PRINCE. 
pleasant. Those who have used them declare them to have an invig- 
orating effect; but the local action cannot be as powerful as when the 
electrodes are applied directly to the body. 
Association Neurosis. 
There is a neurosis to which I have elsewhere1 called attention, and 
to which I ventured to give the name association neurosis. It includes a 
number of local affections, which are generally classified as hysterical, 
neurasthenic, traumatic, etc. It consists of a group of symptoms wrhich, 
as a rule, have originated in some previous acute affection, such as in- 
flammation, traumatism causing local injury or nervous shock, fever, or 
true neurasthenia, and which have become welded together by the process 
of association so that they persist as a distinct neurosis after the sub- 
sidence of the original disease. Many cases of hysterical joints are of 
this nature, as are also many of the so-called “ railway spines ” (spinal 
concussion) and neurasthenia (pseudo-neurasthenia). 
The constant and synchronous excitation of any group of symp- 
toms tends to associate them together, so that in course of time the ex- 
citation of any one of them awakens the others, and they become 
perpetuated as a neurosis. The psychical element is a very large factor 
in keeping them alive. As long as the mind dwells upon them, con- 
sciously or subconsciously, it is very difficult for such a group of 
symptoms to subside, though the original physiological condition, such 
as an inflamed joint, muscular strain, or nervous shock, has ceased to 
exist. Auto-suggestion is, then, the active agent for maintaining the 
affection. For this reason, when such a neurosis has originated in the 
shock from a railway accident, recovery is apt to take place rapidly after 
the cessation of litigation, and in such cases an unjust suspicion is apt 
to be entertained of the assumed character of the disability. This 
pathology explains their persistence without accompanying physical 
signs of disease, and the recovery from them after a cessation of the 
mental agitation. They persist, however, in other cases, without evident 
mental cause, and when apparently the patient’s mind is free from all 
anxiety regarding the condition. The neurosis is then maintained by 
the force of the association of morbid processes. Such a neurosis is 
sometimes termed “ neuromimesis,” and is not infrequently mistaken for 
more serious disease. 
A case of coiyza reported by Mackensie, of Baltimore, so aptly 
illustrates this neurosis that I am tempted to again cite it here, and, for 
convenience, quote from the communication above referred to. It shows 
the association of a single mental state with a pure physical process:— 
It was that of a lady who had been for years a terrible sufferer from rose cold, or hay 
fever. The disease became aggravated by the addition of asthmatic attacks, which com- 
plicated the coryza. She had become so sensitive that the number of exciting causes of 
‘Journal of Nervous and Mental Diseases, May, 1891. ASSOCIATION NEUROSIS. 
an attack was very large. She was so sensitive to roses that the mere presence of a rose in 
the same room was sufficient to induce an attack. Suspecting the nature of her trouble, 
Mackensie obtained an artificial rose of such exquisite workmanship that it presented a 
perfect counterfeit of the original. One day, when the lady came to his office, alter assur- 
ing himself by careful examination that she was perfectly free from coryza, Mackensie pro- 
duced the artificial rose from behind a screen, where it had been concealed, and held it in 
front of her. Almost immediately a violent attack of coryza developed. Her eyes became 
sutlused with tears, the conjunctivas injected ; ttie puncta lachryma began to itch violently ; 
her face became flushed, the nasal passages obstructed, her voice hoarse and nasal; she 
complained of a desire to sneeze and tickling and intense itching in the back of the throat and 
in the auditory meatus ; there was also photophobia and secretion of fluid from the nasal 
passages ; to this was added a feeling of oppression in the chest and a slight embarrassment 
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of respiration. Examination showed the nostrils almost completely obstructed by swollen, 
reddened, and irritable turbinated structures, and filled with fluid. The raucous membrane 
of the throat was injected. At this point Dr. Mackensle stopped the experiment, thinking 
it had gone far enough, and the patient left the office with a severe attack of coryza. 
The sequel is equally interesting. The true nature of the rose was shown to the pa- 
tient, with the result that on her next visit she plunged her face into a bunch of real roses 
without ill effect.1 
In this case we have all the phenomena of inflammation, a series of apparently or- 
ganic processes set into activity by the force of an associated idea. It would seem as if the 
physiological processes of secretion of tears, secretion of mucus, vasomotor action (causing 
injection of tissue), pain, etc., were united into an automatic mechanism, and the whole 
1 Am. Joum. Med. Sciences, vol. xci, p. 45, 1886. The reader is referred to this interesting 
paper for accounts of numerous cases of neuroses, of various kinds, associated with a fixed 
idea. PRINCE 
connected (associated), as with a spring, with a higher visual centre, which, when touched, 
set off the whole mechanism. The principle here involved is an important one, and it will 
be well to bear it in mind when we come to consider other complex associations. It shows 
conclusively the possibility of an automatic nervous process of considerable complexity 
becoming established, and afterward excited anew as an independent neurosis by a purely 
physiological stimulus. 
The whole process is illustrated by the diagram on preceding page. 
Originally the peripheral stimuli which created the neurosis came from the nasal 
mucous membrane. Afterward, when the different centres had become welded together 
into an automatic whole, the entire process was exploded by the visual impressions from 
the optic nerve stimulating one of the associated centres. 
It is not always that this neurosis is met with in a pure form. More 
frequently it is observed in a group of symptoms which have developed 
in the course of neurasthenia, or some other affection, of which it forms 
the most prominent feature: or the main disease having subsided some- 
what, this group is left in still greater prominence. The association 
neurosis, in either case, stands out in relief as the chief disability, but a 
careful examination will show the existence of the original disease. 
Sometimes the neurosis remains hidden amongst a mass of neurasthenic 
or hysterical symptoms, from which it can be separated only by keen 
analysis of the existing symptoms and by investigation into their origin 
and occurrence. 
The following cases will illustrate the character and treatment of this 
class of nervous affections :— 
Observation l.—Q. B., young man about 25 years old. Eeferred to me by a specialist 
in genito-urinary disease for localized pain in the right inguinal region and frequent mictu- 
rition. The patient was unable to retain his urine but for a short time, because of the pain 
which was produced by distension of the bladder. The pain, after continuing for a time, 
diffused itself somewhat over the lower abdomen. Obliged to get up frequently at night. 
As patient expressed it, probably somewhat hyperbolically, he “ spent all his time in the 
water-closet.” Secondary symptoms developed after the pain persisted for some time, such 
as faintness, pains in other parts of the body, etc. Muscular exertion seemed to bring on 
the pain, or he thought it did ; so he had given up all exercise and was disinclined to work 
at his business as a salesman. Cross-examination brought out the fact that he attributed his 
trouble to his having strained himself during connection with a woman, for on the following 
day he noticed the pain, and at the same time had uncomfortable feeling in the urethra. These 
increased and frequent micturition followed. Was afraid at the time he had gonorrhoea, or 
had injured himself. These symptoms had persisted for a year, during which time he had 
been treated by several physicians, all of whom had told him “there was nothing the 
matter,” but the neurosis had increased rather than decreased. In accordance with this 
opinion of physicians, his parents had shown little sympathy, and obliged him to work. In 
consequence of this home-treatment he had become morose, depressed, and ill-natured ; 
considered himself badly treated. This had reacted on parents, etc. Confessed that the 
idea of having seriously injured himself had preyed upon his mind. 
Treatment: Nature of malady carefully explained to patient, and strong static sparks 
applied to the seat of the pain. The strongest were borne without flinching, the patient ap- 
pearing to enjoy the pain of the electricity.1 He left the office free from pain for the first 
time for a year, and, of course, in high spirits. The pain returned after a number of hours, 
but with diminished intensity. Electricity was given in all seven times. After each sitting 
the intervals of relief became longer and pain returned in milder degree ; ability to retain 
urine increased at same time. After seven applications, discharged well. In this case the 
1 This is not uncommon, when the original suffering has been persistent and severe. ASSOCIATION NEUROSIS. 
symptoms (pain, hyperaesthesia of bladder, etc.) had probably originated in some muscular 
strain and urethral irritations. After the cessation of the morbid physiological process, the 
symptoms had by association become bound together with other bodily sensations and move- 
ments, such as distension of bladder and movement of the abdominal muscles, and had per- 
sisted as a habit neurosis. The physiological excitation had prevented them from subsiding. 
The electricity not only allayed his mental fears, but broke up the association by suppressing 
the pain. There were no hysterical symptoms. 
Numerous personal observations might be cited to illustrate this 
neurosis. A few only will be mentioned here, as it is not desirable to 
introduce the accounts of more cases than are necessrry to make clear 
the view maintained here of the pathology of the affection. 
The following, already published, is a case in point:— 
Obm-vation 2.—A woman, 41 years of age, came to me complaining of paroxysms of 
pain, from which she had suffered for ten years past. The pain was located in the epigas- 
trium, and sometimes was accompanied by pain under the right eye and in the soles of the 
feet. It was described as hot and burning in character, “just as if you put yourfingeron the 
stove” (as she said). These paroxysms came on nearly every day, and lasted from one minute 
to half an hour; when occurring at night, she was unable to obtain any sleep. As a rule, 
during the day she “ could not go over two hours without pain” of greater or less severity. 
Physical examination showed nothing abnormal beyond a tender spot at the junction of the 
sixth or seventh rib with the sternum, on the left side. She was of a nervous, anxious tem- 
perament, easily worried, and disturbed by trifles. Cross-examination revealed the fact 
that ten years ago she received a great nervous shock in the form of some “ terrible news.” 
She thinks the first pain came simultaneously with the nervous shock, and she ascribes her 
condition to that accident. At that time she became “ numb all over” ; “ for four or five 
months could not sleep at all” ; felt dazed and confused in mind ; if spoken to, voices sounded 
“ away, away off.” This is the best description I can obtain of her condition at that time. 
At present any mental worry or excitement causes a paroxysm ; for example, after waiting 
two hours in my office without seeing me, she went away, under the disappointment, “ all 
doubled up with pain.” Physically she is in good condition ; is strong and can walk long 
distances ; her spirits are easily depressed or elevated ; overtire, worry, or disappointment 
—in fact, anything that upsets her mental equilibrium—brings on a paroxysm. 
The treatment in this case was static electricity. After a few sittings the paroxysms 
of pain ceased; she was in every way better mentally and physically. She said she “ felt 
like a different woman.” She was free from any attack while under observation, for a period 
of four or five weeks, when she was discharged. 
The order of events in this case I conceive to be as follows : Ten years ago this pa- 
tient was attacked with an acute nervous illness, of which two prominent symptoms were 
mental distress and epigastric pain. These two processes were so frequently associated 
together that a reflex physiological connection became established between their nervous 
centres; the presence of the one then necessitated the reproduction of the other; and 
when, later, recovery from the acute illness occurred, the association being persistent, the 
presence of any physiological excitement or anxiety was necessarily accompanied by a par- 
oxysm of pain. The pathological condition lay in the association of two centres, and not 
in the centres themselves. The treatment resulted in the breaking up of this association, 
probably by means of suggestion. 
One curious mode by which this neurosis may arise is pure mimicry, 
—that is, where simple observation of the person affected with a disease 
is sufficient to induce similar symptoms in an impressionable subject. 
This is a form of auto-suggestion. Secondary symptoms may be added 
to the suggested or mimetic ones, oftentimes as the result of emotional 
disturbance, and the whole may become grouped together by association PRINCE. 
into a true neurosis, which may persist by itself indefinitely. The 
following is a case in point:— 
Observation 3.—A certain person was affected with cerebral syphilis, from which 
disease he eventually died. His eyes were also attacked by the disease, and he presented 
an unpleasant sight. A friend of this person, who saw him frequently, was much im- 
pressed by what appeared to him a horrible disease. Syphilophobia developed, and he 
began to imagine that he had the disease himself. Soon his eyes began to pain severely, 
and he ran from one physician to another, without relief, until one told him that the pain 
in his eyes was purely mental, and then this symptom subsided. Meanwhile, a train of 
symptoms had developed, which he described in this way : First, the idea of the man with 
the real disease kept coming into his mind. Then he thought that he himself might have 
it. Then he became frightened ; his body was bathed in sweat, and he felt nauseated. 
Then severe pain in the top of his head was added ; he felt weak, depressed in spirits, and 
had insomnia. He had twichings in the muscles of his arms and legs. His nights were 
disturbed by horrible dreams. At first these symptoms only developed when the idea of 
the syphilitic patient was present to his mind. Later they became more persistent, lasted 
a longer time, until, finally, anything that depressed his mental equilibrium or overtired 
him brought them on. When he presented himself for examination, about six months 
after the beginning of the neurosis, he was attacked by this group of symptoms several 
times a day, the exciting influence being usually some unpleasant idea or overtire. He 
recognized perfectly the nature of his malady, but said it was absolutely impossible for 
him to control it. He was fully aware of the effect of his imagination in producing these 
symptoms. Pain in the head, mental depression, and insomnia were the most distressing 
of the symptoms, and beyond his control. On a previous occasion he had suffered from a 
very similar train of symptoms, due to the fact that he was bitten by a cat, and imagined 
he had hydrophobia. Nausea and vomiting had occurred at the beginning of both these 
attacks. This patient has been cured by electrical treatment and physical hygiene. 
Electricity is a very powerful agent in curing this neurosis. It 
probably acts in two ways : first, by inhibiting by local stimulation one 
or more of the symptoms composing the group, and thus breaking up 
the association ; and, second, by suggestion allaying the psychical factor 
and allowing the process to subside. I have found static electricity very 
valuable for this purpose, both in the form of breeze and sparks. It 
should be given locally for the individual symptoms, and generally for 
its refreshing, tonic effect. Faradism and galvanism also work well, but 
1 have relied more on the static variety, without, however, having made 
comparative tests. The technique is the same as in other neuroses. 
The aim of treatment should be to inhibit, if possible, the various 
individual symptoms, so as to break up the morbid association. For 
this purpose electricity should be applied so as to attack separately the 
various psychical and bodily symptoms. The same methods are appli- 
cable as in the treatment of the psjmhoses and neurasthenia, which have 
already been described. The next important problem should be to do 
away with such psychical influences as tend to keep up the neurosis. 
Auto-suggestion plays a very conspicuous part in this respect, and, so 
long as the patient’s mind constantly dwells upon his ailment, it is 
difficult to accomplish much in the way of relief. Therefore it is well, 
with most patients, to begin by explaining carefully the nature of the 
malady and giving assurance of the absence of serious disease. When TRAUMATIC NEUROSES. 
neurasthenia or hysteria co-exists, as it frequently does, it should be 
independently treated. 
Electricity does not always effect a cure in these cases. Sometimes, 
as in other affections, its results are very disappointing; and, although, 
in some cases, we may feel absolutely sure of the correctness of our 
diagnosis, it seems almost impossible to break up the pathological asso- 
ciation. An instance in point is the case of neurasthenia already referred 
to on page K-54 (“ Observation 3 ”), where, although I was firmly con- 
vinced that the great mass of symptoms were dependent upon a morbid 
association process in a neurasthenic subject, yet I found it impossible, 
by electricity or any other treatment, to effect a cure. The patient suf- 
fered from every kind of neurasthenic symptom. There were gastric, 
intestinal, cardiac, cephalic, and vasomotor disturbances, combined with 
malnutrition, all associated together; and the presence of one, as a little 
dyspepsia, brought with it the whole train of other disturbances, like 
the explosion of a train of gunpowder fired by a match. The patient 
was treated by the Weir-Mitchell rest-cure, but, although fattened and 
improved, immediately broke down again on resuming her social duties. 
The nature of the malady was carefully explained to her, but, although 
her co-operation and faith were given most generously, little permanent 
result was effected. Electricity was without benefit. The final history 
of this patient is instructive. After she left my hands she tried “ Chris- 
tian Science,” and was cured in two weeks. Her faith literally “ made 
her whole.” Therefore, it may be said that, while some cases yield like 
magic to treatment, others are very rebellious, although every case is 
susceptible of cure. 
Traumatic Neuroses. 
As traumatic neuroses include a number of different affections, such 
as traumatic neurasthenia, traumatic hysteria, nervous shock, etc., the 
treatment of them is more properly included under the head of these same 
affections when due to other causes than traumatism. The treatment 
of traumatic neurasthenia, for example, differs very little from the treat- 
ment of the same neurosis when occurring under other conditions, and 
what has been said of the effect of the electrical treatment of these idio- 
pathic affections is true of them when due to injury. There is much differ- 
ence of opinion among neurologists regarding the prognosis in such cases. 
In the opinion of the writer, however, both traumatic hysteria and trau- 
matic neurasthenia tend toward recovery,—much more so than do the 
same affections when occurring idiopathically. There are, however, 
marked exceptions to this general rule. As has been before so often 
insisted upon, the presence of litigation and other conditions tending to 
keep alive the symptoms is always an obstacle in the way of electrical 
as well as of all other treatment, and little can be expected in the way 
of cui’e so long as such conditions exist. For the electrical treatment PRINCE. 
of these various neuroses the reader is referred to what has already- 
been said. 
There is a form of traumatic neurosis, however, which, perhaps, 
requires separate discussion. Although most cases of injury to the 
nervous system may be classified under one of several well-recognized 
types of disease, organic or functional, we sometimes meet with other 
cases which present groups of symptoms, of irregular distribution and 
complex in their arrangement, which cannot very well be classed under 
any recognized affection of the nervous system. They seem to be sui 
generis, and a distinct pathology has been claimed for them by the 
German school of neurologists. To them the term “ traumatic neuro- 
sis ” has been more distinctively given. It has been claimed that they 
are due to anatomical changes in the central nervous system, such as 
capillary haemorrhages and inflammatory softenings, which have been 
induced by the physical shock or concussion. The fact that some of 
these cases do not recover—and a few have ended fatally—has been 
adduced in support of some such serious pathological condition. The 
old dogma of cerebro-spinal concussion has thus taken on a new form. 
In the opinion of the writer, however, the symptoms in most, if not all, 
of these cases are to be looked upon as an expression of profound 
physiological, and not of anatomical, shock. It is the overstimulation 
of the central nervous system by psychical and sensory impressions that 
has induced the complex group of symptoms, and not the phj'sical 
injury per se. It seems to the writer that, notwithstanding the vigorous 
opposition of a certain school, particularly in Germany, the tendency of 
modern neurologists is toward this view, rather than 
toward that of anatomical degeneration due to physical concussion. 
Psychical and sensory impressions, when sufficiently intense, tend 
to be propagated beyond their normal limits, and to “ slop over,” so to 
speak, along adjoining nerve-tracts until thejr reach remoter-connected 
centres, and thus to induce symptoms which would not be awakened Ity 
normal and moderate stimulation of the same kind, in much the same 
way as when a river, owing to a freshet, overflows its banks and inun- 
dates the adjoining county, or when an electric storm induces in tele- 
phone- and telegraph- wires currents which ordinarily are inappreciable, 
and plays havoc with the recording instruments. Symptoms which have 
once been excited in this way do not easily subside, but persist as a 
neurosis. In a minor degree this has been observed by every one in the 
tremor of the limbs, in praecordial anxiety, headache, and what not, 
brought on by slight mental shock, emotion, or fear. Imagine all these 
to be intensified a hundred times, and see how easily a symptom-picture 
may be produced similar to that exhibited by these traumatic neuroses. 
Such a symptom-picture would be neither one of hysteria nor of neuras- 
thenia. More properly it may be designated as a traumatic neurosis, as 
it is only by traumatism that such a state of things can be excited. TRAUMATIC NEUROSES. 
Whether, more than this, deeper anatomical degenerations occur in ex- 
ceptional cases as the result of nervous shock or concussion, and which 
are the direct cause of the clinical phenomena, or whether, when found, 
they are not simply the concomitants of the nervous shock, are questions 
on which we are not at present in a position to dogmatize, although 
there is little proof either way. It is possible that, when these finer 
anatomical degenerations are found, they are only the secondary result 
of long-standing functional disease. 
Limiting, then, for the purpose of this article, the term “ traumatic 
neurosis ” to cases of this kind, it may be said that electrical treatment 
is often capable of producing a very beneficial influence upon them. 
Provided that due care is taken to remove all unfavorable surrounding 
conditions, and to subject the patient to favorable hygienic conditions, 
electrization can be often used with great advantage. which 
are distressing can frequently be overcome, and the patient rendered 
comfortable. Cases of minor severity are often rapidly cured. It is 
almost always desirable to give electricity a trial, as an adjuvant, at least, 
to other methods. The indications for its use and the technique are the 
same as for the treatment of neurasthenia and allied affections. Psychical 
symptoms can often be allayed by either galvanism to the head or by the 
static breeze. Insomnia and cephalalgia may sometimes be decidedly 
benefited. They should be treated as has already been described else- 
where. 
Pain in the form of false neuralgias, which are so common in affec- 
tions of this kind, can almost always be relieved by electricity. These 
neuralgias, though frequently of a psychical nature, are often very in- 
tense, so much so as sometimes, when long continued, to produce by 
themselves an hysterical condition. It is here that electricity becomes a 
most useful agent, and serves to keep the patient comfortable without 
the use of drugs and other undesirable remedies. Often local pains due 
to real injuries to parts, such as neuritis, are relieved, and the patient 
kept fairly comfortable, while time—if it be onty that—effects a cure. 
General faradization or galvanization sometimes works well in toning up 
the general condition, but it is the local symptoms which we can particu- 
larly hope to affect. 
Paralyses and ansesthesise behave as when occurring in the course 
of hysterical and allied neuroses. Some cases are uninfluenced by any 
treatment, and we can do little more than make the patient more com- 
fortable, and trust to time, change of scene and surroundings, and other 
hygienic measures to eventually bring about a restoration to health. It 
is not always sufficiently understood that, while litigation is in progress, 
as is apt to be the case in almost all of these cases, no treatment of any 
kind will be of service. The most vigorous therapeutic measure is to 
hasten the settlement of the case, and put the patient in a position to 
undertake a rational treatment. It certainly is rarely of use to employ PRINCE. 
electrization until this be done,—at least, with a hope of cure; although, 
the symptoms may be allayed and the patient made more comfortable. 
The technique, then, of these neuroses is similar to that already described 
when speaking of neurasthenia and hysteria, and the reader is referred 
to what has been said there. “ This International System is copiously 
illustrated, and the full chapters are all well 
written both as to conciseness and careful 
selection of correct language to convey the 
proper meaning. We have not space to call 
attention to any special points of discussion 
as to what electricity can or cannot do; but 
the purchaser may feel assured that the 
latest advances are herein well described. In 
short, any one having electro-therapeutic 
appliances and wishing to perfect himself by 
books in the absence of experience, cannot 
do well without this system, either for 
reference or text-book.”—Virginia Medical 
Monthly, April, 1894. 
International System of Electro- 
Therapeutics. 
For Students, General Practitioners, and Specialists. 
Chief Editor HORATIO R. BIGELOW, M.D., Phila. 
Fellow of tlie American Electro-Therapeutic Association; Member of the Societe d’Electro- 
Therapie; Author of “Gynaecological Electro-Therapeutics,” etc. Assisted 
by thirty-eight Eminent Specialists in Europe and 
America as Associate Editors. 
The character and scope of this work are such that, though it has 
been issued but a few short mouths, it already stands unrivalled as the 
cade mecum of the profession, and has taken the foremost place as the 
standard text-book in the colleges upon this increasingly important 
branch of medical science. 
It is handsomely and clearly printed, thoroughly illustrated with 
engravings, drawings, and plates where these elucidate the text, and at 
the end of the volume there is a full reference index. It is the most 
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