HYSTERIA IN BOYS; 
WITH THE REPORT OF A CASE. 
BY I 
S. HENRY DESSAU, M.D., 
Physician to the Out-Door Department of the N. Y. Foundling Asylum. 
Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, Vol. XIII., No. IV., October, 1880. 
NEW YORK: 
WM. WOOD & CO.. PUBLISHERS, 27 GREAT JONES STREET. 
1880. HYSTERIA IN BOYS; 
WITH THE REPORT OF A CASE. 
BY 
S. HENRY DESSAU, M.D., 
Physician to the Out-Door Department of the N. Y. Foundling Asylum. 
Reprinted from the American Journal of Obstetrics and Diseases 
of Women and Children, Vol. XIII., No. IV., October, 1880. 
NEW YORK: 
WM. WOOD & CO., PUBLISHERS, 27 GREAT JONES STREET. 
1880. HYSTERIA IN BOYS. 
WITH THE REPORT OF A CASE. 
BY 
S. HENRY DESSAU, M.D., 
Physician to the Out-door Department of the New York Foundling Asylum. 
The fact that hysteria affects children as well as adults, 
and boys as well as girls, is no longer new; but it has not yet 
received due recognition from the great body of the medical 
profession. All of the authorities on diseases of children, 
so far as I am aware, totally ignore such a disease as hysteria, 
although a few have in all probability described it under other 
names. West, and Meigs and Pepper more particularly have 
fallen into this error. On the other hand, all modern writers 
on and investigators of diseases of the nervous system agree 
in the fact that hysteria does occur in boys as well as girls, 
though more frequently the latter. 
The term hysteria has been used to describe a peculiar de- 
gree and quality of nervous disturbance occurring in boys, as 
it is best adapted to convey an idea of a train of symptoms 
which are the counterpart of those seen in the female under 
like conditions. As Reynolds remarks in his article on hys- 
teria (System of Medicine), “ the older nomenclature, although 
retained on account of its practical utility, is virtually exploded 
as to its etymology.” To say that hysteria is a disease which 
affects a particular organ or sex is no longer accepted as true. 
It has now been clearly shown that it is a well-defined func- 
tional disturbance of a certain group of nerve-centres. These 4 
include tlie pyschical, sensory, motor, reflex, and vaso-motor 
centres. It may be developed at as early an age as the per- 
ceptive faculties are. It possesses the characteristic feature 
of presenting an unlimited combination of symptoms, by 
which almost all other functional diseases are resembled. 
But there is no intention in this article to go minutely into 
the subject of hysteria, any further than it relates to the ex- 
istence of the disease in boys. The name has perhaps hitherto 
been an obstacle to its ready recognition in males, young or 
old, but, as before remarked, it is a disease whose pathology is 
better understood than at the time it was christened. In the 
present number of this Journal is an abstract of an article 
on the occurrence of hysteria in children, by Dr. Hermann 
Smidt, which gives some highly interesting information upon 
the literature of the subject. It will be seen that it was so 
late as the year 1824 when hysteria began to he recognized as 
an affection of children, including both sexes, by Georget. 
Afterwards it was mentioned by Landouzy in 1846, Brequet 
in 1859 and later by Scanzoni, Althaus, Annum, Bonchut, 
and Jacobi. Dr. J. Bussell Beynolds, in his System of Medi- 
cine, article Hysteria, brings the fact of the existence of hys- 
teria in boys into prominent notice, also Wilks and Bosenthal 
in their respective works on Diseases of the Nervous System. 
The last-named author gives perhaps the most complete infor- 
mation on the subject, of any writer on nervous diseases. He 
considers the disease a rare occurrence in hoys, however, and 
states that he has only seen two cases. Dr. Win. Boberts, of 
Manchester, England, reports in the Practitioner (London) 
for November, 1879, four cases of hysteria in hoys occurring 
in his practice. They are highly interesting and present 
nearly all the various phases of this protean disease. Dr. 
Henry Thompson also reported a most typical case of hysteria 
in a boy to the Clinical Society of London, which is published 
in the Lancet of November 3d, 1877. 
When it is considered that hysteria is a functional nervous 
disorder, irrespective of sex, it seems strange, in the light of 
our present knowledge, that it was not sooner recognized in 
children. And it is stranger still that it is so frequently over- 
looked, even at the present day, when we reflect that the nerv- 
ous system in the child is in an active state of growth, and 5 
therefore more highly susceptible to disturbing influences. 
That hysteria is of more rare occurrence in boys than girls is 
one more reason why the attention of the physician should be 
directed to its importance. 
I have introduced the subject of hysteria in boys mainly 
for the purpose of presenting a case occurring in my practice, 
which had misled several physicians as to its true nature and 
had alarmed the family exceedingly, owing to the persistency 
of the case and the unfavorable prognosis given by the medical 
attendants. 
I was asked to see Patrick D , a well-grown boy of 
thirteen years of age, in July, 1877, in order to give “ my 
opinion ” of his ailment, as his former medical attendants, of 
whom he had had several, had considered him incurable. 
The history that I obtained was, that he had complained more 
or less, fourteen months before, for six weeks of a pain in his 
right ear. Previous to and even at that time he was attending 
school and was a bright scholar, standing well in his class. Soon 
after the pain in his ear ceased, he began to complain of a pain in 
his right side, hypochondriac region, which gradually extended 
over to the left side. About the same time he contracted a severe 
cough, with loose muco-purulent sputa which soon passed away. 
The pain in the left side had continued up to the time of my visit, 
and lie also had a dry, empty, barking cough, which afterwards be- 
came somewhat hoarse and sounded like the barking of a dog. Six 
months before I saw him, he began to complain of a pain in his 
left ankle-joint and later on in the knee-joint of the same leg. 
The pain in the ankle had disappeared, but he still complained, up 
to a few weeks before, of the pain in his knee. The left leg was 
flexed at about a right angle, and so firmly contracted that I 
could not extend it even with much force. The manipulation of 
the joint appeared to give him some pain, as he contracted the 
features of his face; but he gave no indication as to the amount 
he suffered, either in speech or otherwise. There was no swelling 
about the knee, nor, according to the mother’s statement, from 
whom all of my information was obtained, had there ever been 
any. There were purplish scars upon the calves and inner side of 
both legs, the remains of an eruption which, from the description 
given, resembled an ecthyma. This eruption had occurred after 
the contracture of the limb began. He was extremely anemic 
and had not spoken for several weeks. He ate very little, and 
that after much persuasion. He did not vomit. His bowels 
were obstinately constipated, not being moved without an enema. 
His abdomen was very large and tympanitic, tender to pressure 
apparently, but not hard. The lungs, liver, and spleen were nor- 
mal. The pupils of his eyes were somewhat contracted. He 
slept soundly. No assignable cause for his condition could be 6 
discovered. A favorable prognosis was given, and after the use 
of an emulsion of cod-liver oil with the hypophosphites of lime 
and soda, and the syrup of iodide of iron for one month, he was 
entirely cured. He is now employed in a large drygoods house 
on Broadway. 
In reviewing this case, it will be noted that many of the 
features associated with disturbance of the nervous functions 
in the adult female were not present. I refer here more par- 
ticularly to exaggerated emotional and perverted mental symp- 
toms. In the case reported by Dr. Thompson above men- 
tioned, paroxysms of laughing and crying, and the globus 
were, however, present. The absence of such symptoms does 
not go to prove anything in regard to the nomenclature of the 
disease or its ready recognition by the physician, only that in 
the use of the name hysteria we are apt to be on better terms 
of understanding with the affection we have to deal with. If 
the various manifestations of perverted nutrition or functional 
disturbance of the nerve-centres were referred to one term, it 
certainly would be of great assistance to the medical practi- 
tioner, and such a generic term is found in hysteria, until a 
better one can be devised. 
The main symptoms of my case were the contracture of the 
knee-joint, the loss of speech, and the profound anemia. Con- 
tracture of the various joints in subjects affected with disturbance 
of the nervous functions have attracted much attention since 
the days of Sir Benj. Brodie. The literature upon the subject 
has increased rapidly of late, and the profession is recently in- 
debted to Dr. Newton M. Shaffer, of this city, for a very elab- 
orate and exhaustive article on “ Tlie Hysterical Element in 
Orthopedic Surgery ” [Archives of Medicine for Dec., 1879, 
Feb., 1880, and April, 1880). In the paper mentioned, con- 
tracture of the various joints of the limbs engrosses the greater 
share of attention. Two instances in boys are furnished, where 
this condition was at first the only marked symptom of the 
hysterica] state. One such case is related as following an in- 
jury to the knee. Charcot has written on the influence of in- 
juries in developing hysteria in the adult (Progres Medical, 
May 4th, 1878), and considers “ local hysteria ” the result of 
an injury, “ as equivalent to those local neuropathic symptoms, 
contracture of joints, which are the most singular attributes of 
infantile hysteria. In such instances of the latter kind, gene- 7 
ral hysteria is found developed in after-life, when the first 
symptoms had been long forgotten.” Loss of speech is often 
observed in hysterical patients. It would appear to belong to 
the psychical class of disorders, being an illustration of the loss 
of will-power over the action of the muscles concerned in the 
mechanism of speech. In fact, there may not he sufficient con- 
trol over the will to exert the cerebral cells to reproduce words 
from the memory. 
The peculiar hoarse cough, characteristic of a nervous ele- 
ment, might be noticed in this connection. It is short and dry 
and has a hollow tone, depending upon more or less paralysis 
of the vocal cords. The aphonia often observed in hysteria is 
due to the same cause, and sometimes alternates with the cough. 
This alternation of symptoms is diagnostic of hysteria. I 
lately saw this fact beautifully exemplified in a young girl who 
came to me with a hysterical facial paralysis of the right side, 
which no sooner disappeared under treatment than the leftside 
was affected. 
Rosenthal has arranged the symptoms of hysteria under the 
heads of sensory, motor, psychical, and vaso-motor disorders. 
Of these my case presented only those coming under the three 
last divisions, if the anemia was not due to an actual decrease 
of red blood-corpuscles. It is to be regretted that a micro- 
scopical examination of the blood was not made, and that the 
test for ischemia was not employed to determine this point. 
The condition which Charcot was the first to describe and 
which he calls ischemia or bloodlessness, is a vaso-motor disor- 
der and is of an entirely different pathological nature from 
anemia ; the one being a refusal of the blood to flow from a 
wound, the other being a depreciated quality of the blood. In 
both conditions there is paleness of the general surface, and it 
is likely that there*is an intimate relation existing between the 
two in their mode of production. If such is the case, it may 
be doubted whether the anemia produces hysteria or is itself, 
like ischemia, a product of the profound disturbance of nerv- 
ous nutrition. The scars upon the legs, mentioned in the his- 
tory of the case here presented, are evidences of an eruption of 
ecthyma. The nature of eruptions accompanying nervous dis- 
eases have been investigated by various neurologists, more es- 
pecially Charcot, who attributes their occurrence to a disorder 8 
of trophic nerve-fibres supplying the part. Foster, in his Text- 
book of Physiology, in summing up the evidence of trophic influ- 
ence, considers the balance turned in its favor. The presence 
of such trophic lesions in hysteria appears to ally the disorder 
of function to a degree of organic change in the nervous sys- 
tem.1 
An analogous transition of functional into organic diseases 
is illustrated in the case of carcinoma of the stomach following 
upon a persistent chronic catarrh of that viscus. 
In regard to the causes of hysteria in boys, they are numer- 
ous. In the first place, the tendency, or “ constitution ” as it 
has been called by Trousseau, and “ nervous temperament” by 
Smidt, may be inherited. This point is conceded by most wri- 
ters upon the subject. Boys of an effeminate nature, as they 
have been described, have nothing more than a highly devel- 
oped nervous organization. They are intensely emotional and 
have a most active perception. The principal immediate or 
exciting causes of the hysterical state in boys may be referred 
to either psychical influences, notably those of a depressing 
character, irritations of the genital apparatus, or the enfeebled 
state following any prolonged attack of sickness, such as the 
continued or eruptive fevers and pneumonia. The affection 
has often been known to become contagious in adults or, in 
other words, certain features of this or other diseases are mim- 
icked. It is possible that this mimicry may also occur in boys, 
but I have not learned of such origin of the disease. Other 
nervous affections in children, such as chorea and stammering, 
are well known to be contagious, and there is no reason why 
hysteria, which manifests a much higher grade of nervous dis- 
turbance, should not be. The tendency of an injury in a pre- 
disposed subject to develop a “ local hysteria ” has already 
been referred to. Trousseau mentions, in his Clinical Lectures 
on the subject of Chorea, the fact that any affection contracted 
in the ordinary way may set up a train of nervous symptoms, 
such, for instance, as a nervous cough following a bronchitis. 
The psychical influences which may operate on the nerve-cen- 
1 Rosenthal attributes certain motor disorders in hysteria to a simple 
functional hyperemia, which, when it is chronic, may lead to an inflam- 
matory process that may terminate in secondary changes of the cord and 
nerve-roots. 9 
tres to cause hysteria in boys are of various natures, too 
lengthy too enumerate. Amongst the most ordinary are over- 
stimulation of the growing brain from excessive study, fear, 
certain disappointments, regret, ill-treatment, and grief. 
Irritation of the sexual organs, either directly or indirectly, 
is, perhaps, the most ordinary manner of developing hysteria 
in boys. This cause may sometimes operate through the influ- 
ence of the mind, as when prurient thoughts have been aroused 
from reading lewd plays or books, or hearing lascivious con- 
versations among their playmates. The common practice of 
onanism is a most fruitful cause of hysteria in boys, and has 
been alluded to at some length in a clinical lecture of the 
Seguin series by Dr. Jacobi. An adherent and contracted pre- 
puce has been recognized by Dr. Sayre as sufficient to produce 
an irritation of the nerves supplying the male genital organ, 
that may result in various contractures or paralyses. These 
have been supposed to depend upon reflex causes, but they should 
more properly be regarded as evidences of hysteria. The irri- 
tation of the genital organs from the presence of worms in the 
intestines has also been recognized as an exciting cause of hys- 
terical manifestations in children of both sexes. 
In regard to the general termination of hysteria in boys, it 
may be said to be favorable, so far as the manifestations are con- 
cerned. The hysterical condition or temperament cannot be 
expected to be removed, though it may be modified by judi- 
cious management. This opinion of the prognosis of hysteria 
differs with some writers, but all of the cases that have lately 
been reported of hysteria in boys have recovered. West has, 
on the other hand, reported in his Lumleian lectures, “ On 
Some Disorders of the Nervous System in Childhood,” a case 
of what might properly be considered a severe form of hysteria 
in a boy five years old, caused by intense emotional disturbance, 
which terminated fatally in sixteen days. There was no path- 
ological lesion sufficient to otherwise explain the nature of the 
affection. 
Very little need be said concerning the diagnosis of hysteria 
in boys, after it is known that such a disease affects them. 
The same irregular grouping of nervous symptoms that are fa- 
miliar to the physician when seen in the female, is sufficient to 
confirm the diagnosis. It is only where local hysterical symp- 10 
toms are met with, that there is room for any doubt, and this 
may always be removed by a careful and close inquiry into the 
psychical features of the case. Electrical and anesthetic tests 
may be employed where a paralysis or contracture exists with- 
out other discoverable symptoms. Electro-muscular contrac- 
tility without pain has been mentioned by Duclienne as char- 
acteristic of hysterical paralysis, but it is not always a reliable 
distinction, as other diseases of the nerve-centres occasionally 
present the same features; and I have seen a case of paralysis 
where the electro-muscular and cutaneous sensibility was suffi- 
cient to develop a paroxysm of hysteria. The easy flexibility 
of contracted joints under anesthesia precludes the presence 
of all inflammatory elements of disease. 
The treatment of hysteria has undergone quite as great a 
revolution as its pathology. As a rule, iron in various forms, 
cod-liver oil, maltine, and occasionally nux vomica or ignatia 
amara are all the drugs that are requisite to restore the nerv- 
ous system to its normal healthy function. In other words, the 
main therapeutical indications are to build up the blood and 
supply material for generating nerve-force. Dr. S. Weir 
Mitchell, of Philadelphia, has become the leader of this method 
of treating hysteria, for which, amongst other services, the high- 
est gratitude of both the medical profession and laity is due 
him. Cold shower-baths, wet frictions, massage and faradiza- 
tion or the interrupted galvanic current, singly or together, are 
all of valuable service. The moral management of hysteria 
is of great importance, and will often alone, in recent cases, 
accomplish wonders. A caution might here be given, however, 
that the therapeutics of hysteria are not to be considered, as of 
old, as unworthy of any special attention. The indifference 
shown in the presence of the patient in order to allay his ten- 
dency to exaggerate the importance of symptoms, and the ex- 
ercise of an authoritative tone of command, may assist the pa- 
tient materially in regaining a healthy control over the nerve- 
powers. But there is, beyond doubt, in the majority of cases, 
a faulty supply of nutrition to the nerve-centres, where the 
administration of iron and cod-liver oil are most essential.