GASES OF HYSTERIA. 
NEURASTHENIA, 
Spiral Irt italici|. 
Allied Affections; 
WITH REM 
I ' 
BY GEO. IMI. BEARD, 3VH. ID., 
KEW YORK. 
From Chicago Journal of Nervous and Mental Pi-ease. 
CI//CA GO: 
J. j. Spalding & Co., Printers, 158 Clark Street, 
1874. CASES OF HYSTERIA, 
NEURASTHENIA, 
SPINAL IRRITATION, 
AND 
ALLIED AFFECTIONS; 
WITH REMARKS. 
George M. Beard, M.D., 
New York. 
From Chicago Journal of Nervous and Mental Disease. 
TTNDER this head I propose to detail a few cases of 
nervous disease—commonly called functional—that are 
at once exceedingly frequent and exceedingly annoying both 
to patients and physicians. I shall treat the subject mainly 
from the clinical and practical stand-point, reserving the dis- 
cussion of its scientific and philosophic relations for another 
occasion. 
By hysteria and allied affections I mean that large and 
increasingly numerous class of affections that pass among the 
people and among the profession by the vague and half-erro- 
neous terms, spinal irritation, nervous exhaustion, general 
debility, general neuralgia, etc. 
In a work on which I have been long engaged, and which is 
now slowly progressing, I hope to be able to unify these dis- 2 
eases—to show that they have in general a common pathology, 
a common history, a common group of symptoms, and a com- 
mon therapeutics. I shall seek to show that these 'diseases, or 
symptoms of disease—or, as they might, perhaps, with better 
justice be called, results of disease—are expressions of a com- 
mon nervous diathesis ; that they are all liable to run into 
each other, and to act vicariously to each other; that they are 
a part of the price we pay tor civilization, being confined 
mostly to the enlightened peoples of modern times ; and that 
they are, in all their dreary shapes, most abundant in the 
northern portions of the United States of America. 
I shall not anticipate the details of the systematic arguments 
by which these propositions will be supported, except so far 
as certain points of interest may be suggested by the following 
cases. 
Those who are unwilling to give a provisional acceptance of 
my general theory of these maladies, or even to think favorably 
of it, may yet, perchance, attend to the recital of the results of 
treatment in cases, some of which are richly suggestive and 
quite rare ; arid from the therapeutics they may, I trust, be 
led to reason backwards toward the diagnosis and pathology. 
GENERAL PKINCIPLES OF TREATMENT. 
I treat all these affections, by whatever name known, on 
the same general principles, varying and adapting the method 
according to individual need. ()f the various methods of using 
electricity, I depend mainly on general faradization and 
central galvanization, using them sometimes in alternation— 
in some cases finding the former, in others the latter, more 
beneficial.* 
Internally, I use preparations of phosphorus- and cod-liver 
oil, and sometimes arsenic. I make a large use of the cod- 
liver oil emulsion. I have seen good results from the oxide 
and phosphide of zinc and chemical food. 
* The comparative value of these two American methods of using electri- 
city in medicine is] discussed by Dr. Yater, of Prague, Germany, in an 
elaborate series of articles now being published in the Wiener Allgemdne 
Zeitung. The series began with the May number. Dr. Yater confirms in 
full detail all that I have ever claimed for these methods. 3 
Externally, I use ice and hot-water bags to the spine with 
studious caution, and mild and cautions counter-irritation to 
tender points on the spine. My method of counter-irritating 
nervous patients is, to take one of Alcock’s porous plasters and 
cut off a piece of about the size and shape of my little finger ; 
along the centre of this I place a little Spanish-fly ointment, 
and then apply over the tender spot, and let it stay there until 
it falls off. Counter-irritation thus used is not very annoying, 
and is quite effective. I use Alcock’s porous plaster because 
it sticks better than anything I can find. 
Except when I am experimenting, I use all these remedies, 
or several of them, simultaneously. 
NEURASTHENIA, CEREBRASTHENIA, MYBLABTHENIA. 
The old and almost forgotten term, neurasthenia, 1 have for 
several years applied to the condition known in common lan- 
guage as nervous exhaustion ; and I have recently subdivided 
this condition into cerebrasthenia and myelasthenia, according 
as the exhaustion is chiefly manifested in the brain or in the 
spinal cord. When the exhaustion shows itself chiefly in the 
brain, there are the symptoms of insomnia, headache, vertigo, 
flashes before the eyes, muscae volitantes, tinnitus, etc. 
When the exhaustion shows itself chiefly in the spinal cord, 
there are the symptoms of pain in the back, at any point below 
the first cervical and last dorsal vertebrae, and mostly between 
the shoulder and in the lumbar region; spinal tenderness 
(though not always); weakness of the lower limbs, and some- 
times of the arms ; flatulence; feeling of oppression on the 
chest; gastralgia, intercostal and abdominal; neuralgia of the 
bladder and sexual disturbance ; numbness of the extrem- 
ities, etc. While the term neurasthenia implies both cere- 
brasthenia and myelasthenia, yet in some cases the exhaus 
tion seems to be almost exclusively confined to the brain alone, 
or to the spinal cord alone. 
The terms cerebral irritation and spinal irritation indicate 
symptoms that are usually prominent in cerebrasthenia and 
myelasthenia: the head as well as the spine may be tender, 
either at points or all over. The terms cerebral irritation and 4 
spinal irritation, simply refer to one symptom, and do not 
rightly express, even in a general way, the nature of the 
disease. 
The meaning of these terms will be made more clear by the 
following cases: 
NEURASTHENIA, CEREBRASTHENIA, AND MYELASTHENIA. 
Vertigo ; feeling of tingling and pricking all over the body ; spinal tenderness ; 
mental depression; improvement under general faradization and central 
galvanization, combined with internal medication. 
Case I.—Mr. L , aged 36, was referred to me, June 25, 1873, by Dr. 
Geo. Baker. For several months, since January, 1873, the patient had suffered 
from vertigo, feeling of tingling, pricking, and stinging over the surface of the 
body ; pain in the back ; dyspepsia ; constipation ; insomnia, and mental 
depression. The spinal irritation was quite variable in its seat, being some- 
times in the lower, sometimes in the upper vertebrae. Sometimes there was 
tenderness of the cervical vertebrae, with stiffness of the neck. 
The diagnosis was neurasthenia, including cerebrasthenia and myelasthe- 
nia ; and the pretty evident cause was excess in sexual indulgence combined 
with over work in business. 
I gave general faradization alternately with central galvanization, for one 
month ; and, at the same time, used phosphide of zinc pills in doses of 1-10 
of a grain, and chemical food. Counter-irritation was also employed over 
the tender vertebrae. July 5, he was much better. August 1, still better ; 
and September 1 he resumed active business. 
In the following case there was profound myelasthenia, and 
but very little cerebrasthenia. 
MYELASTHENIA OF THREE YEARS5 STANDING. 
Tenderness of the vertebrae; occasional numbness of the arms and leys ; peculiar 
susceptibility to hot water; pain in the back with great weakness; mental 
irritability and despondency. Relief under central galvanization, general 
faradization, continued counter-irritation, and internal medication. 
Case ll.—Mr. W , aged 27, a merchant of New York, was first seen 
by me in consultation with Dr. H. W. Thayer, of Brooklyn, in the fall of 
1871. 
For three years the patient had been afflicted with symptoms of general 
debility, so called ; great weakness in the lumbar region ; occasional attacks 
of numbness in the left leg usually, sometimes in the left arm, and lasting 
for a few hours or days. The numbness would be brought on in both sciatic 
nerves and their branches by long sitting. All the symptoms of weakness and 
numbness were aggravated by over physical exertion, especially by long 
standing or walking, or labor. Whenever the patient put his left hand in 5 
warm water, the muscles contracted and the hand felt very disagreeable : 
very much as when the hand is put in water that is connected with an electric 
current. 
Weakness of the bladder, to a very slight extent, had been observed at 
times,—a trivial slowness in passing water, and nothing more. These 
attacks came on only by long intervals, and were scarcely noticed. Lying 
down for a short period seemed to relieve the symptoms, especially after 
great exertion: but attacks of localized numbness had come on while in 
bed. 
Physical examination showed tenderness of the lumbar and dorsal 
vertebra? between the shoulders. The sesthesiometer showed no anaesthesia 
of the limb ; electro-muscular contractibility wTas normal; except insomnia 
and mental depression at times, there was no evidence of cerebral disease 
beyond pure exhaustion. Mental labor, however, when protracted, made 
him worse. The pulse was slow, but tolerably full. 
The back was so weak that riding in the cars caused great distress, and 
lie wished to have something constantly pressed against it to sustain it. For 
that purpose he sometimes took a pillow with him as he traveled. In order 
to improve his health he had spent several months traveling in Europe, but 
was more injured than benefited thereby. Long standing in 'picture galleries 
seemed to have aggravated all the symptoms. 
In the excessive heat of summer the patient was always worse ; Dyspepsia 
was more or less constant in the system ; also chilliness up and down the 
back, and coldness of the lower limbs. Hypermthesia of the nerves of the 
chest and abdomen was observed; also great susceptibility to tickling around 
the neck, breast, and stomach. 
The sexual power was not specially impaired, the appetite was tolerable, 
and the nutrition well maintained. The queries that arose in the diagnosis 
were, whether the case was one of spinal congestion going on to posterior 
spinal sclerosis, or single myelasthenia with cerebrasthenia. At first I held 
my judgment in suspense, but finally concluded that the latter was the true 
condition : that it was caused by overwork, perhaps the excessive use of the 
sexual organs acting on a nervous constitution. The results of treatment 
seemed to confirm this view. 
I prescribed and used for several months, by intervals, the following 
treatment : Central galvanization, general faradization, the internal use of 
Horsford’s acid phosphate, cod-liver oil emulsion, and counter-irritation to 
the spine by means of various blisters of cantharides and tartar-emetic 
ointment. 
Under this combined treatment the patient slowly improved somewhat ; 
was soon able to attend to business in a moderate way ; slept better, and 
could walk farther. Under the influence of excessive physical exertion he 
relapsed, and afterwards improved slowly. The patient subsequently re- 
lapsed, and was again treated, with success, by phosphide of zinc. 
The symptoms of transient numbness of the extremities on 
pressure is a very common one in all forms of nervous exhaus- 
tion, as I have long observed. 6 
The value of time as a remedy was shown in the following 
case. 
NEURASTHENIA AT CHANGE OF LIFE 
Headache; weariness; extreme exhaustion ; mental degression. Slight benefit 
from general faradization and central galvanization. Subsequent improve- 
ment and recovery under time and hygiene. 
Case 111.—Mrs. T , a lady 50 years of age, was referred to me July 
36, 1871, by Dr. Belden. The patient was at the change of life, so called, 
hut all her previous life had been unusually strong and free from nervous 
disorder. Her symptoms were, severe headache, with clavus hystericus 
occasionally; anorexia, insomnia, great mental depression, and profound 
nervous exhaustion. She could not read, or walk two blocks without being 
utterly overcome. 
The pulse teas good, and the nutrition was well preserved. She had taken 
various and judicious internal remedies. A course of treatment by central 
galvanization accomplished something for her, but not much. In the course 
of a year she recovered, and time seemed to do the work. 
The peculiar obstinacy of some cases of neurasthenia to all 
forms of treatment, electrical, etc., is shown in the following 
case. Every now and then I meet with a case similarly 
rebellions. 
REMARKABLE CASE OF NEURASTHENIA INDUCE!) BY OVER-TOIL. 
Ijmg standing ; great debility and little or no pain ; localized burning sensa- 
tions, complicated with, but probably not dependent on, anteflexion of the 
uterus and dysmenorrhcea. Great susceptibility to electricity. JVo marked: 
benefit from all methods of electrization or medication. Improved by time. 
Case IY.—Miss G , a young lady of about 34 years of age, was first 
seen, with Dr. C. L. Mitchell, Nov. 34, 1871. The patient was of a very 
line organization, and of slight, fragile build. Left an orphan at an early 
age, she had worked hard as a copyist in a telegraph office, where she toiled 
many hours a day to support herself and her younger brothers and sisters. 
For two years or more she had been in a condition of excessive debility, 
which her physician could control only imperfectly by medication. 
She could not walk a single block, or even a part of a block, and so 
remained constantly indoors. Her appetite was feeble and fickle; sleep 
was uncertain and disturbed ; the circulation unequal. The pulse, though 
weak and nervous, was yet tolerably strong for a delicate lady, but was very 
susceptible to mental influences. Careful examinations had been able to 
detect no disease of the lungs or heart, or of any organ ; the uterus had not 
been examined. 
Fainting spells, or spells resembling fainting, came over her after severe 
exertion ; even the shock of hearing the door open fearfully agitated her, so 7 
that she suffered for a number of minutes. She dreaded the coming of a 
new doctor, and iived in a condition of painful apprehension when she 
learned that I was to be called in to see her. 
To all medication she was extremely susceptible; even a few drops of dilute 
phosphoric acid seemed to do injury. Similarly all tonics and stimulants 
were badly borne. Some mental depression accompanied all these symp- 
toms; but the patient had considerable force of will, and when in good health 
was very energetic. There were no fits of laughing or crying. 
After a careful and thorough trial of general faradization, central galvan- 
ization, and galvanization of the cervical sympathetic, I gave up the case. 
She bore electricity as she bore everything else—badly, and no amount of 
treatment succeeded in bringing her to that condition where she could tolerate 
an average dose of either current. 
During the latter part of the treatment the uterus was carefully examined 
by Dr. Skene, who found a tendency to vaginismus and anteflexion; but 
these symptoms were regarded merely as accompanying or incidental phe- 
nomena, and were not treated. 
After electrical treatment was abandoned time came slowly to the rescue, 
and, under the care of her physician, she so far improved as to be able to 
walk out, but she subsequently relapsed. 
This case illustrates: First, that there are certain tempera- 
ments that will not bear electricity; secondly, that in nerve 
functional disturbances time, rest, and hygiene, may cure or 
greatly relieve, after medication has failed. In all these cases 
special pains must be taken to avoid over exertion, mental or 
muscular. A slight indiscretion may put back the patient for 
weeks or months. For the nervously exhausted to overdo, 
even for an hour, is a blunder that is almost a crime. 
SPINAL IRRITATION, ASSOCIATED WITH PROLAPSUS UTERI. 
Localized crawling sensations; neuralgia; improvement under central galvan- 
ization and general faradization. 
Case Y.—Madam J., a lady of middle life, was referred to me June 11,1872, 
by Dr. A. B. Crosby. The patient was of a good constitution, and had usually 
been well, but recently there had been symptoms of nervous exhaustion, 
with spinal irritation, and tenderness of the vertebrae, all associated with a 
not very severe degree of prolapsus uteri. 
Her most distressing sensation was that of crawling and creeping in the 
back, arms and legs. 
The sensations were most marked after fatigue, and were very annoying; 
these sensations were referred to the tender points in the dorsal and lumbar 
vertebrae. 
Turkish baths had given some relief. 
I treated her one month by central galvanization and general faradiza- 
tion alternately, and with good results. 8 
HYSTERIA WITH NEURASTHENIA IN A MARRIED WOMAN, FOLLOWING 
AN ATTACK OF REMITTENT FEVER, 
Rolling, heaving, beating motions in all parts of the body ; localized flushing ; 
sparks before the eyes; spinal irritation; mental depression; plethora; 
good pulse; decided improvement under central galvanization, general far- 
adization, internal medication and counter-irritation. 
Case YI.—Mrs. R , a married lady, 38 years of age, was first seen 
by me November 19, 1871. The lady was fleshy, full blooded, and had a 
very good pulse ; but was excessively nervous, and gave an interesting 
history of hysteria with neurasthenia. During the previous summer and 
fall, the patient had been prostrated by remittent fever that had left her in 
a condition of extreme nervous prostration, from which she seemed very 
slow to rally. 
Her debility was so great that she could walk or ride but a short dis- 
tance, and her despondency was so intense that life seemed hardly worth 
the struggle. Her most distressing symptoms were rolling, heaving or beat- 
ing motions, felt all the waking hours, especially in the head and stomach, 
but more or less in the legs, feet, arms, and in all parts of the body. The 
limbs would feel as though streams of water were rolling through them. 
Vertigo was a symptom that frequently annoyed her, and, as she ex- 
pressed herself, her “legs felt dizzy.” 
Localized flushings of heat were felt at various times in the face, legs 
and arms : these would appear and disappear in a moment. 
Flashes and sparks before the eyes were a frequent symptom. 
Tenderness of the dorsal and lumbar vertebrae, at the points where tender- 
ness is so often found, was manifest on moderate pressure. 
For these symptoms I prescribed central galvanization and general fara- 
dization, together with the internal use of Horsford’s acid phosphate and 
cod-liver oil emulsion. Counter-irritation, by means of small blisters of 
cantharides and tartar-emetic ointment was employed. Strychnine was tried 
internally, and, as is so often the case, aggravated the symptoms. 
Under this treatment the patient slowly but unsteadily improved, and 
with occasional relapses. February 1 the treatment was discontinued : long 
before that time the patient had been able to go out to walk and ride. 
TRAUMATIC HYSTERIA. 
I have applied this term to those cases where symptoms 
clearly hysterical are caused by concussion or some form of 
direct or indirect injury to the central nervous system. A 
severe fall or blow on the head may, through concussion, 
bring the central nervous system into a state where symptoms 
precisely similar to those that are found in hysteria, spinal 
irritation and neurasthenia appear. The symptoms thus ex- 9 
cited have all the vagueness, the transitoriness, the protean 
character of hysterical and neurasthenic symptoms in general. 
Under this head also I bring those cases where similar symp- 
toms are excited by sunstroke, or cerebro-spinal meningitis.* 
In the following case the symptoms—as here narrated by 
the patient herself, the daughter of a physician—followed a 
severe attack of cerebro-spinal meningitis. The symptoms 
are accurately and fully described, and are representative of a 
certain class of nervous symptoms. 
Case VII.—“ For many months I had a tremor or chill, when just at the 
point of going to sleep, or on waking in the morning, and through the 
middle of the day felt miserably, having but little appetite. Some days 
I was sleepy and stupid all the morning, and others, uneasy and restless, with a 
pricking sensation in spots all over the body, more especially the face and 
arms. The sore spot in the left of my head seemed like an inflamed nerve 
—to press upon it, caused pain ; and any fatigue whatever, gave such a 
weariness to that part of the brain, that I seemed unable to use it,—a feeling 
of perfect exhaustion. 
“ As summer wore on, I could see that I gained in strength of mind con- 
siderably, but was a long way off from health. My left foot began to have 
a slight feeling of numbness in the bottom, and the whole limb was weaker 
than the right one ; also the left arm and hand were occasionally slightly 
numb. 
“ When I began to sit up, about three weeks after the first attack, 1 tried 
to read, but found I could read but a few words without pain, or a dazzling, 
blurred feeling back of the eyes. Through the summer my eyes grew 
worse,—a sort of dimness seemed to rest upon everything I saw, and I had a 
heavy, compressed feeling in the forehead, which weighed down the lids of 
my eyes so that I sat with them closed much of the time. I was unable to 
look at anything above the level of my eyes, or downward, by moving the 
neck, wdthout causing dizziness. As winter came, I found I could read 
rather better, but not without the same dazzling sensation, and often it 
seemed as if the nerves of my eyes were losing their power altogether. 
“ For months after the first attack, the back of my head and neck pained 
me very much, and became very weak, so that I was hardly able to sit erect, 
and generally felt comfortable only when the head was leaned back consid- 
erably : something seemed to be drawing it back. My dreams were some- 
times fearful during the early part of my sickness. One night I woke with 
the impression that my head was being slowly crushed, and for some time 
after the nerves of my head felt as if contracted. 
*For details, with cases, I may refer to my paper on Certain Nervous 
Sequelae of Cerebro-Spinal and Thermic Fever, in Brown-Sequard’s Archives 
of Scientific and Practical Medicine, No. 4—1878. 10 
“ During the whole year, but chiefly through the first few months, I felt a 
crawling sensation, as of worms, upon different parts of my body, and 
dreamed of them as creeping over my head, and sticking their feet in my 
brain ; or of running beneath trees, whose branches scratched the top of 
my head.” 
The above case was treated by central galvanization, gen- 
eral faradization, and the phosphoric emulsion,* and with 
excellent effect. I have recently treated a case with similar 
symptoms, resulting from sunstroke, with very rapid im- 
provement. 
The importance of making a correct diagnosis between 
structural and functional disease is well shown by the fol- 
lowing case. The peculiarity of some exhausted states of the 
nerve centres, that the patient apparently holds his strength 
in full,"'or entirely under control for a short time, until he 
suddenly gives way, was, in this case, well illustrated. There 
was, ras will be seen, no paraplegia, except of a temporary 
character after exertion. 
WEAKNESS IN KNEES AND LEGS OF AN HYSTERICAL CHARACTER. 
Improvement under galvanization of spine; general faradization; counter - 
irritation, and internal medication. 
Case YIII.—Miss S , a young lady of about twenty-four years of 
age, was referred to me June 2, 1871, by Dr. S. J. Holley. For three years 
and some months the patient had complained of inability to walk, for any 
considerable distance, without “giving out at the knees.” Although her 
general condition was not remarkably good, she complained of no other 
distinctive symptom; and this special difficulty in walking, that was referred 
to the knees, did not seem to be associated with any other symptom of 
sufficient importance to attract her attention. This weakness, it should be 
observed, would come on suddenly, almost instantaneously, while she was 
walking, and at once she would be forced to sit down, or seek some assist- 
ance. An attempt to walk even a single block, was sufficient to bring on 
the strange symptoms. Very naturally the patient had supposed the knees 
themselves were diseased, although no external evidences of disease could 
be seen on either leg. At one time she had been treated by localized fara- 
dization of the knees without benefit. 
The history of the case, in spite of its meagreness, at once suggested to 
me the view that the spinal cord was the true seat of the disease, whatever it 
* The method of preparing this most valuable emulsion of cod-liver 
oil, phosphoric acid, etc., is given in the Archives of Electrology and Neurol- 
ogy—May, 1874. 11 
might be. Examination of the spine showed tenderness of the lumbar 
vertebrae, of a decided, but not unusual, character; this tenderness, with 
the sudden giving way at the knees in walking, were the only symptoms 
from which the patient suffered. There was no anaesthesia, no feeling of 
numbness, no sensory disturbances whatever; no motor paralysis, and no 
diminution or modification of electro-muscular contractibility ; no feeling 
of a cord about the abdomen or limbs ; no difficulty of bladder or rectum, 
and no evidences of uterine disease. One fact of interest and suggestive- 
ness was that, for a few days, at one time the symptoms seem to leave the 
knees, and go to the abdomen and pelvic regions : then again return to the 
knees. By intervals, during the three years she had been afflicted, there 
would be almost complete recovery. The patient felt better in a recumbent 
position. Clearly there was no organic disease. The condition of the cord 
was apparently one of exhaustion, with anaemia. The evidences of anaemia 
were the debility that was brought on by an attempt to use the cord in 
walking, the entire absence of symptoms of congestion, or even of tran- 
sient hyperaeraia, such as tingling, pricking, burning and heat in the bottoms 
of the feet, or neuralgic pains, and finally, the fact that the patient felt 
better in a recumbent position. A favorable prognosis was given. 
The treatment used was general faradization and galvanization of the 
spine, counter-irritation over the tender vertebrae, and the internal use of 
Horsford’s acid phosphate and phosphide of zinc. Under this treatment 
her improvement was quite slow. In one month she was somewhat 
stronger, but yet far from being well : she could walk further, but not more 
than one-eighth of a mile. The idea that the knees were the diseased parts 
was so powerfully impressed on the patient’s mind that she was allowed to 
try the effect of elastic caps or stockings, without much benefit. In 
August the patient went to the country, where she continued to improve, 
and when we last heard from her she was nearly well. 
In another similar case the results were even better. 
astra.phobia (yurrparj, lightning, flnfiac, fear). 
I have applied this term to those cases where, on the approach 
of or during a thunder-storm, there is very great fear, with 
nausea, headache, diarrhoea, excessive debility, and, in some 
instances, convulsions. The disease is analogous to the agora- 
'phobia described by Westphal. It is found in both sexes. In 
the following case, astraphobia was complicated with other 
important symptoms: 
Hereditary astraphobia ; reflex paralysis of left forearm; writer's cramp; 
anesthesia associated with neurasthenia ; improvement under localized gal- 
vanization and faradization and central galvanization, spinal cord nerve 
current and plexus nerve current, combined with internal medication. 
Case IX.—Mrs. R , a widow of 39 years of age, was referred to me 
July 27, 1871, by Dr. A. W. Catlin. Eight weeks before that time she had 12 
run a needle into her right forefinger ; the needle was removed in three 
hours, but at once loss of power was experienced in the fingers, and in a 
week the forearm also had become very weak. 
The patient supported herself by copying many hours daily and nightly, 
and the query arose whether the affection was reflex paralysis, or writer’s 
cramp. The history of the' case and the special symptoms seemed to show, 
clearly enough, that the case was one of paralysis, probably reflex, induced 
by the injury, hut that the exercise of the arm in writing had acted as a pre- 
disposing cause. This opinion was strengthened by the fact that the 
patient had had some symptoms of writer’s cramp before the injury. 
Electro-diagnosis.—No loss of electro-muscular contractibility, but voli- 
tional contractility much diminished and considerable anaesthesia, made 
evident by examination with the aesthesiometer and the electric brush. There 
was also analgesia. 
Examination with the dynamometer showed loss of force over the 
muscles, and the difficulty of writing was so great that she had acquired the 
habit of copying with the left hand. The patient was of a thoroughly 
nervous constitution, and all her life had suffered from astro,phobia (fear of 
lightning). Even in her babyhood the approach of a thunder-storm had 
markedly disturbed her nervous system, and long before she was old enough 
to be afraid of lightning, she was a victim to the weakness, the distress, the 
malaise and after unpleasant nervous symptoms that lightning excites. Her 
grandmother had been similarly affected. 
Dr. Gatlin treated the patient by localized faradization and strychnine, 
and the patient observed that shortly after the electricity was used, the fear 
of lightning was removed. This was the more singular from the fact that 
only localized faradization of the arm was used, and no general faradization 
or central galvanization. 
I recommended the use of the electric brush, central galvanization, and 
the internal administration of Horsford’s acid phosphate. The details of 
the treatment, with the exception of the central galvanization, were carried 
out by Dr. Gatlin, and the patient somewhat improved. Subsequently the 
patient was terribly frightened by stumbling over the body of a drunken 
man, in a dark lane of the city, at midnight, and in an almost unconscious 
state arrived home, and was next day taken sick. Then followed pain in 
the very spot where, weeks before, the needle had entered the hand, and the 
muscles of the hand began to improve. 
June, 1873, the patient again consulted me. There was still, as before, 
local anaesthesia, only more profound, anorexia, insomnia, spinal irritation, 
and various symptoms of the neurasthenic condition. 
She was again treated, and again improved ; but her recovery was never 
absolute. 
In cases like the above, there is more than simple, ordinary 
fear. The condition of the atmosphere, before and during a 
thunder-storm, has been repeatedly shown, by observation, to 13 
be very different, electrically, from the usual conditions.* The 
changes and disturbances in the electrical state are very 
marked and very rapid, and it is probably on account of these 
changes that the excessive fear, the headache, vomiting, diar- 
rhoea, etc., are experienced. 
One of the worst cases of the disease I ever saw was in a 
young man who was otherwise well, and apparently strong. 
The symptoms of diarrhoea, in many, occur during sleep, even 
when the patient is not conscious of the existence of a thun- 
der-storm. A medical friend tells me that, for several years, 
he would wake up in the morning with a diarrhoea, when 
there had been a thunder-storm during the night, even though 
he had been all the time sound asleep. 
Astraphobia is one of the sequelae of lightning-stroke. A 
very interesting case of this kind, occurring in a physician of 
great strength of constitution and great native courage, will 
be published in detail in the Archives of Electrology and 
Neurology for November, 1874. The disease is clearly sub- 
ject to the laws of hereditary descent, as is proven by the 
above case, as well as by others that I have seen.f 
AGORAPHOBIA (PEAK OF PLACES). 
Of this form of morbid fear 1 have seen two cases. In 
these cases, the East Elver Ferry was the obstacle : for a long 
time neither of them could be induced to cross it. They seemed 
to have the same terrible dread of crossing the ferry that some 
people have of ascending a height. Both cases recovered. It 
may be queried whether the fear of ascending heights may not, 
in some cases, indicate a pathological state. It is certainly de- 
pendent, to a very appreciable degree, on the physical state. 
All the kingdoms of this world, and the glory of them, could 
not induce me to ascend a high ladder, or stand on the edge 
* See my paper on Atmospheric Electricity and Ozone: their Relation to 
Health and Disease ;in Popular Science Montidy for Feb., 1874. Also Beard 
& Rockwell’s Medical and Surgical Electricity—first edition. 
f I should regard it as a great favor if those physcians who read this 
article, and who have met with any interesting cases of astraphobia, will 
communicate with me in regard to them. 14 
of a tower or precipice, when I am at all exhausted Nervously. 
At such times, indeed, the very thought of standing on an 
eminence, the mere fancy that I might be placed in such a 
position causes an actual spasm in the stomach, with a peculiar 
sinking sensation, which is not imagination, but is as much a 
reality as small-pox or a broken leg. I cannot bear to hear 
my friends tell of their perilous ascents, and I suffer there- 
from not only at the time, but subsequently when I think of 
it. In other matters there is no other earthly thought or 
imagining that causes me such distress, and I find that, in 
this respect, much depends on the general state of my 
nervous system. 
J. J. SPALDING & CO., Pr nters. Chicago