Reprinted from the 
University Medicae Magazine, 
March, 1889. 
REPORT OF A CASE OF HYSTERIA SIMULATING 
LARYNGISMUS STRIDULUS. 
In Dr. H. C. Wood’s book upon “ Nervous Diseases,” mention is made of 
laryngismus stridulus as a rare affection in adults, It is there stated that the 
disease in man denotes trouble of serious import, it being in most cases depend- 
ent upon dangerous organic disease. On the contrary, in women the prognosis 
is favorable, as the instances on record show that the attacks are frequently 
hysterical. Such was the case in the woman to whose history I now wish to 
call attention. 
M. A. R., set. 22, born in Germany, unmarried, by occupation a waitress, was admitted 
into the University Hospital, November 13, 1888. 
Her family history was not very good, but elicited little of interest bearing upon the 
patient’s condition. Father died suddenly, of possible heart trouble, set. 37 ; mother, set. 46, 
is still alive, but in poor health. The family consisted of nine children, two of whom are 
still living, the rest having died in infancy ; could obtain no history of any hereditary 
neurotic temperament. 
Her personal history was very good up to time of present illness,—at sixteen had 
diphtheria, but previously was always healthy; menstruated at seventeen. Shortly after- 
wards her sickness stopped, without any assignable cause, and did not recur until brought 
on with medicines about a year later ; since then she has been perfectly regular. During 
the past year or two has suffered more or less with dysmenorrhoea, especially has the pain 
been severe upon the left side. Has had considerable leucorrheal discharge ; the menstrual 
flow has never been excessive. 
Present ill-health dates from last spring a year ago. It started, as she said, with her 
stomach, which became very irritable, especially at dinner time. She would become deathly 
sick, and had a constant desire to retch. After eating she frequently vomited. Under 
treatment she improved very much. 
In August last, she began to have violent spells of coughing, once a day regularly. 
In three weeks’ time they came on as often as twice daily. This continued until September, 
the spells growing more and more severe, when she consulted a doctor, who cut the uvula, 
which was enlarged and elongated, and was thought to be the main factor in producing the 
cough. This operation resulted in lessening the frequency of the attacks for awhile ; in 
fact, she would go several days at a time without one of these paroxysms occurring. 
At various times, she had experienced the sensation as of a ball rising and sticking in 2 
A CASK OF HYSTERIA. 
her throat; and for several years back has been obliged to get up and pass her urine once or 
twice during the night. 
At the time of admission to the hospital, under the charge of Professor H. C. Wood, 
she had been attended by Dr. Samuel W. Morton, who advised her leaving her position as 
waitress, and placing herself in a hospital, where she could receive proper attention and 
nursing. 
An examination revealed the following condition of affairs : Was a well-nourished, 
healthy-looking person ; eye-balls markedly prominent; pupils small, and sluggish in 
response to light; tongue furred, moist and somewhat coated; chest welldeveloped. 
Examination of lungs, negative ; heart, normal; impulse of apex beat, heaving and some- 
what diffuse ; pulse, quite rapid, but regular and full; liver and spleen, normal ; reflexes 
were all together with marked tenderness along the vertebral column and over 
the prominent nerve trunks. 
With the exception of an excess of phosphates and urates, the urine was normal. 
By request of Dr. Wood, Dr. W. Constantine Goodell made an examination to see if 
any uterine trouble existed, with negative results, so far as the uterus or appendages were 
concerned. From the marked sensitiveness of the parts, as well as the great increase in 
size of the labiae, it was concluded that the woman was addicted to masturbation. This, as 
might be expected, she denied. 
The first day of her residence in the hospital she had three attacks of coughing, the 
last two of which I witnessed. They began with evident difficulty in breathing; inspira- 
tions were harsh and whistling, possibly best described as crowing. Eyes bulged, and the 
face and the lips became very much congested and cyanosed; the body was bathed in a 
profuse perspiration; patient with one hand clutched at her throat, with the other 
grasped hold of whatever came within her reach ; her efforts to get breath were painful to 
witness ; the muscles of the neck became rigid and the vessels prominent. During all this 
time she was violently coughing, the character of the cough being of a shrill, ringing, 
croupy sort, indicative of spasm of the glottis. The duration of these spells was from 
four to five minutes, sometimes longer, unless medicinal relief was afforded. After these 
attacks the patient always became drowsy and quiet. 
Nitrite of amyl caused gradual relief, but the most effectual remedy, and that which 
finally caused the greatest improvement was apomorphine, used hypodermatically. In the 
dose of from one-fifth to three-tenths of a grain thus administered it produced vomiting in 
thirty seconds, and the spasm was at once overcome. 
After the second use of this drug she did not have an attack for four days. Each 
subsequent attack was treated in the same way with marked success, so much so, that in six 
weeks after entrance into the hospital she was discharged, not as absolutely cured, but as 
greatly improved. For ten days previous to dismissal she had not only no attacks, but no 
apparent tendency towards having any. Dr. S. W. Morton, who has again assumed charge 
of the case, has seen no recurrence of previous trouble up to present writing. 
That this was a case of hysteria—pure and simple—seems positive. The 
general appearance of patient, the globus hystericus, the irritable stomach, the 
bladder symptoms, together with the treatment pursued and its result, all point- 
ing in that direction. 
The cause, primarily, in all was masturbation. 
Besides the local treatment already mentioned, the patient’s general condi- 
tion was toned up and her diet regulated. 
The case is interesting as demonstrating the fact that the simulation of 
disease by hysteria is often very remarkable. 
Kkwis H. Adder, Jr., M.D., 
Resident Physician, University Hospital.