PH YCII 80-iESTH KSIA 
(cold hknkationh), 
AND PSYCHUO-ALGIA 
(COLD I'AINk). 
BT 
CIIABLKB L. DANA, M. D., 
VklUnic rbyalHut lo IMUtu* HoaplUl; l*tnliß Hml Hmm 
IHMW. Ikllnw IluaplUl M«Ur*l Colbr*. 
Well) Yovte i«rHfc«l Journal 
RKinuNTRi) num tub 
fur Fritruary tti, Uf9S. Reprinted from the Netr York Medical Journal 
for February 26, 1898. 
PSYOIIUO-J2STIIESIA (COLD SENSATIONS), 
AND PSYOHRO-ALGIA (COLD PAINS)* 
IW CHARLES L. DANA, M. D., 
VIHITINU I’IIYHIOIAN TO HRI.I.RYUR HOArtTAL ; 
OUORKHMOII or NKUVOI'M DI'KAHKH, lIKI.I.RVIR HOM’tTAL MROK Al. (01.1.R0K. 
Intkoductouy.—ln a recently written article on the 
subject of panesthceia f I have tried to show with some 
new emphasis the significance and relationship of this 
symptom. I venture to quote here some of my introduc- 
tory paragraphs: 
Paresthesia is the name given to a number of sub- 
jective sensations, such as prickling, numbness, creeping 
sensations, tickling, and burning. It includes, in fact, 
nearly all the subjective sensations of the skin, except 
those of pain. It is a condition which is, therefore, ex- 
tremely common, and in its mildest and most trivial 
character is much more often experienced than pain. 
When these sensations fix themselves in a certain local- 
ity, following the tract of the nerve, or fastening them- 
selves upon the hand or foot, they take on a certain clini- 
cal picture, and deserve to have the name of a disease 
to just the same extent that a neuralgia does. Para?s- 
thesia, in almost all cases, implies simply a lower grade 
* Road before the Now York Neurological Society, October ft, 1597. 
f Ttvf liook of Nrrvoim Dimunri, fourth edition, p, 152, 
Oorriuuiir Ihuh, uv I). Aoomto* a>o Oompakt 2 
PSYCIIHO-yfcSTIIKSIA AND PBYCIIHO-ALGIA. 
of irritation of the nerve fibres than occurs in neural- 
gia, and is a kind of ghostly simulacrum of that disease. 
It very often precedes or accompanies attacks of pain. 
There is sometimes a tingling of the teeth or burning in 
the face which has a shadowy likeness to a toothache or 
trigeminal neuralgia. In the same way, one finds par- 
cesthesias affecting the head, causing sensations of pres- 
sure and constriction, of burning, and general undefin- 
ablc discomfort, which arc entirely comparable to head- 
aches. 
In conditions of neurasthenia, panesthesias of the 
head are more common even than the headaches. Par- 
a'sthesia sometimes follows the course of a nerve, as 
when one feels numbness of the hand if the ulnar is 
pressed upon at the elbow, or numbness in the foot 
when the sciatic is pressed upon, as when the legs are 
crossed. 
There is also pancsthcsia affecting one of the inter- 
costal nerves or one of the crural nerves. On the other 
hand, panesthesia may affect all four extremities, so that 
they feel entirely benumbed or prickling. There is, 1 
repeat, a very close analogy between these groups of 
panesthesias and neuralgias. 
Panesthesia affects single ccrcbro-spinal nerves just 
as neuralgia docs, or it may be more generally distrib- 
uted. In the latter case it affects most the feet and 
hands, and it is called acro-parceslhesia. 
We meet then with: 
1. Cephalic panesthesias, comparable to diffuse head- 
aches. 
2. Local panesthesias, comparable to local neural- 
3. Acro-panesthesia, involving the feet or hands or 
both diffusely. 
The cephalic panesthesias are usually symptoms of 
neurasthenic or litha?mic states. Among eighty-five 
cases of local and acro-panesthcsife, not symptomatic of 
other and organic nerve disease, 1 found that there were 
of the local forms thirty-five cases, of acro-panesthesia 
fifty cases. The local panesthesias affected tlio arms in PSYCIIKO-JCSTHESIA AND PSYCHRO-ALGIA. 
3 
eighteen cases, next the thigh ami leg nerves in twenty 
cases, and, last, the trigeminal nerve in three cases. 
The following analysis of eighty-five cases of parnes- 
thesia occurring in my practice shows something of the 
cause and local development of the malady. The most 
frequent causes I find to be those concerned with occu- 
pation, I‘anesthesia, in its general manifestations, may 
lie considered almost an occupation neurosis. The list 
of cases may he put down as follows; 
Occupation 10 
Kheumatism 10 
Alcoholism A 
Infection A 
Senility. A 
Keflex irritation 2 
Hysteria 8 
(Mimnoleric change 2 
Various causes, such as neuras- 
thenic state, puerperium, etc. 12 
Males. 
Kcmaln. 
Total. 
11 an<Im hihI foot, or lioth, nffcotod 
B 
11 
17 
18 
ft 
12 
Foot and 
10 
10 
20 
4 
4 
14 
12 
26 
86 
49 
85 
Among 85 cases there were 50 males and 19 females: 
The special nerves affected were: 
Trigeminal 4 Sacral I 
lirncliin) R Sciatic 1 
Ulnar 7 Plantar * II 
Kadial 1 
Orural 4 
Peroneal 1 
The commoner form of panesthesia is simply that of 
a sensation of prickling 
asleep. A more rare form is that accompanied by sensa- 
numbness or of a part being 
tion of heat, and hero (he perverted feeling verges closely 
upon pain. In fact, the sensation of heat is often so 4 
PSYCHRO-.KSTHESIA AND PSYCHRO-ALdIA. 
distressing that the patient considers it to all practical 
purposes a pain, although it may not correspond to the 
strictly technical psychological definition. 
Psychro-asthesia.—Among the rarer forms of par- 
esthesia are those of sensations of cold (psychro-esthesia, 
from cold). These sensations are felt quite 
apart from any actual lowering of the temperature of 
the body and without any objective evidences of vascu- 
lar change in the allectcd part. Cold paresthesias are 
not usually very distressing, and, although they are 
sometimes described as cold pains, they are not so akin 
to pain as are the heat sensations. The term psychro- 
a?sthcsia was first used by Pollaisson (Lyon medical, 
1887). Later it was adopted by Silvio {La Hi forma 
medica, February 17 and 18, 1890), and these authors 
have reported several cases of this kind, A case was 
also reported recently by Dr. L. G. Guthrie in Brain, 
spring and summer number, 1897. These two later arti- 
cles have drawn renewed attention to this interesting 
symptom. A number of cases have occurred in my ex- 
perience, and it seemed to me that it might bo worth 
while to report a few of them in hopes that a fuller 
knowledge of the rctiology and pathology of the condi- 
tion might be obtained. 
Case I.—Dora C., aged fifty-three years; Ireland; 
washerwoman. The patient for three years had had 
constant tinnitus aurium, especially in the right car, 
troubling her most at night. She had disease of both 
internal ears and chronic middle-car catarrh, and both 
external canals were almost filled by soggy epithelial 
scales. Such was the report of her condition by Dr. 
A. M. Fanning. Her special complaint was of the cold 
sensation which she felt continuously in the forehead 
during all this period of three years. This annoyed 
her so much that she thought she could not get along PSYCIIIIO-yKSTIIKSI A AND PSYCH RO-ALGIA. 
5 
without a bandage over her forehead to keep it warm. 
Tlio sensation was bilateral and involved the upper part 
of the forehead, like a brow headache; the skin was not 
cold or in any way changed to the sight or touch. She 
had some of the ordinary parsesthesias in the hands and 
feet of the prickling pms-and-needles kind. She was 
slightly nervous and slept badly. There was no dyspep- 
sia, and the bowels were regular. She drank a good deal 
of tea—five or six cups a day. Examination showed no 
amesthesia in any form and no signs of organic nervous 
disease. 
Hero was a case of cold para?sthesia of the forehead, 
associated with the ordinary paresthesias which occur in 
middle-aged women who do a great deal of washing and 
drink a good deal of tea and, perhaps, alcohol. 
Cahu ll.—Francis L. L., aged fifty-six years; mar- 
ried; United States; mechanic. Family history good; 
no syphilis; habits temperate. His occupation com- 
pelled him to stand all day. The patient had some 
chronic bronchial trouble, and a year and a half ago 
ho began to have paresthesia of the legs below the knees. 
Ho said the trouble came on at two in the morning. 
Very soon after this he began to have sensations of cold- 
ness in the feet, which were always worse in the morning 
and lasted until the middle of the afternoon. During 
this time he felt as if standing upon ice, and he would 
try by heat and rubbing to get rid of the discomfort. 
Toward three o’clock the cold sensations changed to burn- 
ing sensations, which lasted until night. He had some 
tremor, the pulse was rather rapid, and he showed signs 
of arterial sclerosis. The lungs, heart, and sexual or- 
gans were normal; digestion normal, and a physical ex- 
amination showed absolutely no amesthesia of the affect- 
ed parts and no change in the vascularity. The reflexes 
were slightly exaggerated. 
Here, again, we have a case of cold parasthesia asso- 
ciated with heat and the ordinary prickling paresthesia, PSYCHRO-iESTHESLA AND PBTCHUO-ALOIA. 
due probably to exposure, to defective venous circulation 
dependent on the man’s habits of standing at his work, 
and probably to some rheumatic influences. 
Case lll.—lxjwis S., aged forty-two years; mar- 
ried ; butcher by occupation. Family and previous 
history negative. The patient was a healthy-looking 
man, who came to the clinic complaining of a sensa- 
tion of coldness over the left thigh, especially marked 
on its anterior surface. This had lasted for six months, 
and had been gradually increasing. During the previ- 
ous year he had had the same sensation in the right 
thigh, but this had disappeared, lie denied syphilis 
and rheumatism. Ho drank, but not to excess. Exam- 
ination showed absolutely no objective signs. Sensation 
was normal as to temperature, touch, and pain. The 
tongue was thickly coated, and there was some history 
of dyspepsia. On questioning him I found that in his 
occupation his thigh was constantly brought into con- 
tact with the edge of a table or counter; in other words, 
there was constant slight trauma. Dr. (Jcorgc It. Elliott, 
who examined his urine, concluded that there was a tox- 
aemia from digestive disorder. 
Case IV.—James 0., aged sixty-two years; Ireland; 
married; occupation, clerk. The patient had suffered 
several years from bronchitis. For three weeks previous 
to being seen by me he had been suffering from some 
prickling panesthesia of the fingers and in the lower ex- 
tremities, and, at the same time, ho had sensations of 
cold in these parts. He had dyspepsia, poor appetite, 
and constipation. Examination showed nothing ob- 
jective in the hands and feet; the knee-jerks were pres- 
ent : there was no loss of power in the legs, and no nnirs- 
thesia over the affected parts. The sensations of cold 
were not due to actual vascular changes, but were sub- 
jective. The patient had no signs of tabes dorsalis. 
Case V.—.Jeremiah H., aged forty-nine years; mar- 
ried; Ireland; laborer. The patient had always been a 
healthy man and did not drink intoxicating liquors. 
For four successive winters ho had suffered during the PSYCIIRO-ifiSTIIESIA AM) PBYCHRO-ALGIA. 
7 
wliolo of the cold weather from a sensation of coldness 
on the left leg, on the outer side just above the ankle. 
The affected area was sharply mapped out and measured 
about eight by four inches. It was not exactly painful, 
but gave him a great deal of annoyance and apprehen- 
sion. The sensation disappeared as the summer /eather 
came on. There were no other complaints. Examina- 
tion showed nothing abnormal in touch, sensation, or 
pain, nor were there any objective changes to be seen in 
the part affected. A careful general examination was 
made without discovering any signs of organic disease. 
The patient described his symptoms vividly, and he was 
shown to my class ns a case of cold panesthesia, due to 
some irritation of (he peripheral filaments of the external 
popliteal nerves. 
Cash Vl.—Elizabeth J., aged forty-one years; Ire- 
land; domestic. For about a year the patient had suf- 
fered from some pains in the right ankle, together 
with prickling sensations which ran down to the toes 
and up to the knees. The part from the knee down also 
felt constantly cold, and this cold sensation was asso- 
ciated with para?sthcsia and prickling. The patient de- 
nied ever having had rheumatism, and also denied drink- 
ing and other had habits. Her general health was good, 
and there were no objective symptoms connected with the 
part affected. The legs and feet were not tender, nor 
was there any redness or swelling. The knee-jerks were 
present, and there was no particular weakness of the ex- 
tremities. The patient complained of the coldness, but 
perhaps even more of the prickling and pain. 
Cast. VII, Mr. ('. C., aged forty-four years; 
United States; married; occupation, business. Family 
history good. The patient had had syphilis twenty years 
before, with secondary symptoms afterward. lie was a 
well-nourished man and apparently in good health, ex- 
cept for the particular symptom complained of. This 
consisted of a sensation of intense coldness over the 
left hip on its lateral surface. The area was limited, 
and extended from the knee about two thirds of the way 8 
PSYCHRO-.ESTIIESIA AND PSYCHRO-AUiIA. 
up the thigh, mostly in the distribution of the exter- 
nal cutaneous nerve. Tic felt, he said, as though it had 
been painted with menthol. Warmth and exercise made 
it disappear for a time, but it returned. The part af- 
fected looked and felt to the touch perfectly normal. 
There was no anaesthesia of touch, pain, or temperature. 
A careful examination failed to reveal any trouble with 
the general bodily functions. The urine, digestion, 
heart, and lungs were normal. The pulse was 08, A 
further careful examination was made for tabes, but ho 
showed no signs of this. There was no loss of knee-jerks; 
no eye symptoms; no bladder symptoms. The patient 
simply suffered from this continual sensation of coldness 
of the thigh. 
The foregoing cases all occurred in patients in whom 
it was impossible to detect any absolute signs of organic 
disease of the central or peripheral nervous system. I 
have under observation now at the Montcfiorc Homo two 
patients, one of whom is certainly suffering from syrin- 
gomyelia in an advanced stage. The other probably has 
syringomyelia in an early stage. In both cases the pa- 
tients complain of a sensation of coldness over the upper 
extremities. This sensation is felt from the hands up to 
the elbows, and is simply a cold feeling not associated 
with pain. Both patients have some slight sensory dis- 
turbances, such as thermo and pain amesthosia, but these 
are not marked. They are not accompanied with sensa- 
tions of prickling or of heat, or with the ordinary panes- 
thesias. 
I have presented the foregoing clinical data very 
much condensed, for the reason that I know that my 
hearers are familiar with cases of this kind, and it does 
not seem to mo necessary tc go into elaborate detail to il- 
lustrate further their character. 
Analysis of Symptoms.—We have apparently two rSYCHKO ifCSTIIKSIA AND rSYCHRO-ALGIA. 
9 
classes of cold parassthesia. In one the symptom is not 
definitely limited to certain areas, but involves a whole 
extremity or all four extremities, and is associated with 
other paresthesias or with pain, and often with evidence 
of vasomotor disturbance. 
The other class of cold paresthesia, psychro-nesthesia 
proper, is a disorder in which the sensation is quite an 
isolated one. The patient suffers from a feeling of 
cold exclusively, or almost so, having with it no prick- 
ling or numbness and not always any distinct pain, al- 
though it may amount to such. Furthermore, this form 
of paresthesia is limited to some special area, oftenest 
upon the thigh or buttock, but sometimes upon the calf 
or upon the face, and more or less closely following the 
distribution of a nerve. 
The sensation is purely dermal and superficial. The 
mind refers it to the external world, so that it seems like 
an objective sensation similar to a touch. The patient 
feels as though some cold object were lying upon the 
part. 
The sensation may disappear in warm weather or 
under exorcise. 
In some instances it is not so much a cold sensation 
as a cold pain or psychro-algia, and it may be obstinate 
and distressing, especially in quite elderly and senile per- 
sons. 
Pathogeny.—The psychro-avdbegins of the first or 
mixed typo are met with oftenest in mild forms of neu- 
ritis, such as may bo caused by alcohol, or such as occurs 
in sciatica; they are also observed in locomotor ataxia. 
Among thirty-six cases care fully examined for this symp- 
tom by Dr. Joseph Friinkcl, he found two persons who 
spontaneously complained of sensations passing up and 10 
PSTCHRO-wESTHESIA AND PSYCHRO-ALOIA. 
down the back like waves of cold, or alTecting the logs 
in a similar manner. The symptom also occurs in the 
early stage of syringomyelia, as noted in my two cases. 
Mixed psychro-a?sthesia is thus usually due to neuritic 
irritation, but may indicate a lesion higher up. Yet in 
practically all cases it means a lesion of the peripheral 
sensory neurone at one part or another of its course.* 
The exciting causes are usually alcohol, lithtemia, ex- 
posure, and toxic agents that lead to nerve degeneration. 
The purer types of cold sensation and cold pain are 
found more often in men, and almost always in persons 
over forty years. The trouble is caused sometimes by 
trauma, combined with exposure and a rheumatic tend- 
ency. A neuropathic constitution favors its develop- 
ment. Polaisson attributes some cases to varicose veins 
and to uterine disease. 
So far as clinical experience and reading go, the cold 
paraesthesia of syringomyelia is less intense and less 
sharply limited than those in the cases described. The 
patients have simply a sensation of general coldness, 
but not of the same sharp smarting coldness complained 
of by the patients whose history I have reported. The 
sensation is really subjective, is like that felt in diffuse 
neuritis, and is perhaps due to vasomotor disturbances. 
Pathology.—There arc both special cold and special 
heat nerves distributed to the skin and some of the mu- 
cous membranes. The fibres carrying these thermal im- 
pulses run in the ccrebro-spinal nerves mingling with 
other sensory nerves. They separate again in the spinal 
cord, as shown in cases of syringomyelia and central-cord 
lesions, but apparently run very difTusedly in the brain 
* Dr. William H. Thomson reports n rase of psych ro-nsthesia due to 
a cerebral lesion. Such cases are unique.  AND I*SV(’HUO-ALOIA. 
axis and capsule, for local lesions here do not cause a 
differentiation of heat and cold anajsthesia. Hence 
(apart from psychical states) we must place the seat of 
the lesion in psychro-sesthesia practically almost always 
in the peripheral nerves. Its presence may, however, 
indicate a beginning syringomyelia or some other cen- 
tral cord lesion •; and also, in rare cases, locomotor 
ataxia. 
Treatment.—In most cases the treatment is that of 
an underlying neuritis or neuritic irritation. Antir- 
rheumatic drugs, mix vomica,exercise, and electricity are 
indicated. Locally, a liniment containing a little mus- 
tard oil is useful. Warm applications and friction some- 
times give relief. In very obstinate cases the question 
of syringomyelia should bo investigated. Where there 
are pain and evidences of decided neuritis, as in sciatica, 
rest is necessary. The New York Medical Journal. 
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