Traumatic Hysteria. 
BV 
AUGUSTUS A. ESHNER, M.D. 
REPRINTED FROM 
MEDICINE. 
GEO. S. DAVIS, Publisher. 
July, 1897. BY AUGUSTUS A. ESHNER, M.D., 
Professor of Clinical Medicine in the Philadelphia Polyclinic; Physician to the Philadelphia 
Hospital. 
The development of distinct groups of symptoms as a result of. 
traumatism in general, suddenly and violently inflicted, and of rail- 
way injuries in particular, is now an established and accepted fact. 
In some cases there results actual organic disease of the spinal cord 
or its membranous envelops; in others the bones, the ligaments, the 
fasciae or the muscles may suffer from strain or laceration or contu- 
sion; while in yet another group of cases it may be impossible to 
detect any evidence of organic disorder. To cases of the last kind 
it has become the custom to apply the designation of traumatic 
neuroses, but they usually fall easily into the category of either 
neurasthenia or hysteria. Simulation is probably rare, although 
exaggeration is common. 
The two cases that I desire to report are instances of traumatic 
hysteria. The symptoms of this disorder do not differ essentially 
from those of hysteria of any other origin, but I have used the term 
in order to express disapproval of it. One of the cases is of special 
interest on account of its long duration and the further fact that it 
has already been briefly placed on record; and the second is note- 
worthy from the presence of muscular atrophy. The first was com- 
plicated by a suit for damages, but a settlement out of court was 
unattended with any amelioration of the symptoms; in the second 
the question of damages did not arise at all. 
Among a group of seven cases reported by Dercum2 in a paper 
entitled "The Back in Railway Spine'' was that of H. M. G , 
at that time 23 years old and employed in a rolling-mill. Under 
date of May 7, 1890, it was noted that the spine was excessively 
tender, rigid, and sensitive to superficial pressure. The general 
surface of the back was hyperesthetic, and there was soreness in the 
small of the back on deep pressure. There was also pain in this 
region on flexion, torsion, and transmitted shock; slight lateral 
curvature to the right; decided spasm of the lumbar muscles on the 
right; and the reflex excitability of the muscles of the back generally 
was great. The knee-jerks were excessive and ankle-clonus was 
present. The grasp was weak and tremulous. The patient limped 
with the left foot and there was pain over the instep. Sensation 
appeared to be good everywhere, although occasionally errors of 
1 Read before the Northern Medical Association, May 28, 1897. 
1 American Journal of the Medical Sciences, September, 1891, p. 247. 
TRAUMATIC HYSTERIA.1 2 
TRAUMATIC HYSTERIA 
localization were made. The man evidently was neurasthenic. 
The visual fields were much contracted. On a number of occasions 
there had been convulsions. 
The patient presented himself on May 29, 1896, at the age of 
29 years, at the Philadelphia Orthopedic Hospital and Infirmary for 
Nervous Diseases, in the service of Dr. S. Weir Mitchell, when the 
following history was elicited: 
On May 3, 1889, while riding with a number of friends in a 
coach the vehicle was run down by a rapidly moving locomotive. 
Of the party two were killed outright and seven were injured. The 
patient received several lacerated wounds of the scalp and one at 
the external canthus of the left eye, but no other significant injury 
was noted. He thinks he may have lost consciousness at the time 
for a few hours. He was removed to his home and remained in bed 
for about a month following the accident, during this time being 
much distressed. He suffered a good deal from pain in the left half 
of the chest and was unable to lie upon that side. Sleep was greatly 
disturbed. The sphincters remained under control and it was not 
recalled that a catheter had to.be used.1 
When the patient arose from bed he found himself extremely 
weak and suffering greatly from pain referred to the dorsal spine. 
He limped somewhat with his left leg, although there was no actual 
palsy. He continued pretty much in this state for about two years, 
when on resuming his usual pursuits he would, on attempting to 
engage in physical effort or upon excitement, fall to the ground and 
be seized with general convulsions of so violent a nature as to 
require the combined efforts of eight men to restrain him. In these 
attacks there was no loss of consciousness and no biting of the 
tongue, although at times there was frothing at the mouth and the 
patient often attempted to bite his own hand. The attacks recurred 
at varying intervals, from once a week to once a month, and they 
were followed by weakness and headache, but not by drowsiness or 
sleep. They lasted a variable time, the active convulsive movements 
occupying perhaps fifteen minutes. Sometimes a series of attacks 
followed one another in quick succession. The attacks were often 
relieved by homeopathic medication. In the year preceding the 
time of the patient's first visit it was thought that the character of 
the attacks had changed, and this alteration was attributed to the 
treatment employed. Now, instead of going off into a convulsion 
the patient would become weak and would then seat himself, so that 
he no longer fell. During the first two years in which the more 
1 Dercum (loc. cit.) has on the contrary recorded that for a time the patient could not 
pass his urine aijd had to be catheterized. TRAUMATIC HYSTERIA 
3 
aggravated attacks occurred the patient would cry out in the con- 
vulsive stage that he heard the locomotive coming, the bell ringing, 
etc. In anticipation of some of these attacks he felt weak and had 
pains in the head; often the eyes would become suffused. For six 
months the patient had felt that he was growing weaker, that his 
memory was failing, that his general nervousness was increasing, 
that his appetite was suffering, and many similar things. His last 
seizure had taken place May 21, 1896, and in this the left side espe- 
cially was involved, the right but little. Sleep followed. The 
patient knew of no means by which the attacks could be aborted. 
The man was evidently anxious and worried. He was pallid, 
though apparently well nourished. The pupils were equal, regular, 
and reactive to light. Dr. A. G. Thomson found vision almost 
normal in both eyes, the discs and fundi healthy, and the fields of 
the left eye for both color and form contracted to io° in all direc- 
tions. The reflexes were preserved in the upper extremities. The 
gait was somewhat decrepit, but station was quite steady. The 
knee-jerks were ready and active and a little irritable, and abortive 
ankle clonus could be elicited. No significant deformity of the 
spine could be detected. The gentlest touch upon various parts of 
the back, especially over the spine, gave rise to manifestations of 
severe pain. Percussion with a plexor in the same region, as well 
as upon the anterior aspect of the left half of the chest and upon the 
head, was also painful. Suggestion appeared to minimize the pain, 
and it was thought that the pain was less when the patient did not 
anticipate the sensory impression. No anesthesia could be detected 
anywhere. The heart was overacting; the first sound was booming, 
the second clear. 
There was nothing noteworthy in the family or personal history. 
The patient took no alcohol, and tea and coffee only in moderation, 
although he chewed and smoked tobacco to excess. He had origi- 
nally entered suit for $25,000 against the railroad company that he 
held responsible for the accident and his disability, but he had made 
a settlement out of court for $5000. He was, however, utterly 
unable to shut out of his mind the memory of the accident. 
Removal of a plug of wax from the left ear by Dr. R. W. Seiss 
corrected a discharge that set in and relieved the aural discomfort. 
Under varied treatment, in which suggestion played a large part, 
marked improvement ensued, although mild convulsive attacks 
would recur from time to time, and the general nervous state per- 
sisted. A single attempt at hypnotism proved unsuccessful. 
I think there can be no doubt about the hysterical nature of 4 
TRAUMATIC HYSTERIA 
this case. Its mode of origin, its whole course, the convulsive 
seizures, the hyperesthesia, the influence of suggestion, the absence 
of all evidence of organic disease, stamp it with a certainty that 
scarcely permits of mistake. There can be no question of shamming 
here, and it is noteworthy that the pecuniary adjustment was fol- 
lowed by no mitigation in the severity of the symptoms. The 
prognosis naturally grows less favorable with the longer continu- 
ance of the disease. It is impossible to estimate what well-directed 
and persevering treatment from the beginning might have accom- 
plished. 
The second case is of a somewhat different type, as to both its 
origin and its manifestations. 
F. L. G , a brakeman, 31 years old, applied at the Phila- 
delphia Orthopedic Hospital and Infirmary for Nervous Diseases on 
April 30, 1897, in service of Dr. S. Weir Mitchell, relating that 
on October 2, 1896, while engaged in braking, he was caught 
between a moving car and a platform and rolled between the 
two the length of a car. He stated that five ribs were broken 
on the left side, one of them penetrating his lung. He spat 
blood and also passed blood by the bowel. He vomited, but 
no blood. He believes that he was unconscious for several 
hours. He thinks the left shoulder was crushed and that a frac- 
ture of one of the bones resulted, but no splint was applied 
by the surgeons at the hospital in which he was received and 
where he remained for four weeks and two days. According to 
the statement of the patient's wife the little and ring fingers of the 
left hand were stiff from the beginning and the arm from the 
shoulder down was numb. The man had been unable to use the 
member to any great extent since the accident, and wasting had 
taken place in the muscles of the arm and hand, especially in the 
interossei. The fingers of the left hand were partially flexed in the 
claw-position and could be only feebly flexed further or extended. 
The knee-jerks were preserved, though feeble. Slight ankle-clonus 
could be elicited. The deep reflexes were preserved in the upper 
extremities, though perhaps not quite as active on the left as on the 
right. Gait and station were steady. There was some tenderness 
over the vertebrae from the seventh dorsal to the first lumbar. 
Tactile, painful and thermal sensibility was entirely lost in the left 
hand and greatly impaired in the entire right upper extremity and 
the adjacent half of the chest. Heat was sometimes merely appre- 
ciated as common sensation and sometimes as cold. There was no 
tenderness in the course of the nerves. The patient is rather loqua- TRAUMATIC HYSTERIA 
5 
cions and possessed of only average intelligence. His wife states 
that since the accident he has had attacks in which he goes about 
the house acting irrationally. No hallucinations could be elicited, 
and there have been no convulsive seizures. Visual acuity and the 
fields of vision for both form and color were found to be normal. 
No degenerative change was found in the wasted muscles on electric 
stimulation. The patient was on several occasions hypnotized 
readily, and various suggestions were made. The Paquelin cautery 
has also been applied over the lower part of the spine. Distinct and 
progressive improvement has taken place in both motility and sensi- 
bility, and it seems not unreasonable to hope that complete recovery 
will eventually ensue. 
There has been no question of damages in this case, inasmuch 
as the patient had entered as an employee into an agreement with 
the railroad company not to prosecute any such suit in case of 
injury incurred in the performance of his duties. 
In view of the considerable traumatism reported to have been 
received there was at first just a shade of doubt as to whether or not 
the case was one of hysteria solely, especially on account of the 
trophic changes in the muscles of the left hand; but the peculiar 
localization and the atypical distribution of the manifestations, 
together with the patient's susceptibility to hypnotism and the 
beneficial effects of suggestion, seem to justify the diagnosis and 
shape the prognosis. 
Concerning the intimate nature of hysteria we can as yet but 
theorize. To designate the disorder a nezirosis adds nothing to our 
knowledge, and to burden this designation with such qualifications 
as functional or reflex or idiopathic or traumatic in no wise tends to 
clarify our notions upon the subject of its pathology. Death rarely 
takes place as a result of hysteria, and in fatal cases no distinctive 
lesion or residuum of a former lesion has been found. Aberration 
of function, however, bespeaks alteration in nutrition, and it is to 
influences of this kind that we must direct our scrutiny in the 
endeavor to elucidate the pathology of diseases of the type of hys- 
teria. In hysteria we have to deal essentially with a defect in the 
nervous coordination, an adequate cause for which can be conceived 
to reside in the metabolic alterations in the ultimate nervous ele- 
ments resulting from modifications in cellular nutrition. Such a 
conception is not in conflict with the alluring theory of the motility 
of the neuron so ably advocated by Dercum and others, as it is prob- 
able that the metabolic processes taking place in all of the tissues 
are attended with cellular movement. This view can be made to 6 
TRAUMATIC HYSTERIA 
account for the diversity, the variability, and the transient character 
of hysterical symptoms, their wide and irregular distribution, and 
at times their identity with and mimicry of those of organic disease, 
as well as the possibility of perfect recovery. In it also is to be 
found the rationale of our treatment of hysteria, whose aim is ever 
the restoration of a condition of nutritional equilibrium. It carries 
with it finally a suggestion bearing upon the heredity of hysteria 
and other so-called neuroses. It is not improbable that every cell is 
endowed with its own metabolic peculiarities, which it transmits in 
turn to its offspring throughout all time. 
I am indebted to Dr. Mitchell for the privilege of studying the 
cases reported in this communication. MEDICINE 
EDITOR-IN-CHIEF: 
Adjunct Professor of Medicine, Rush Medical College; Neurologist 
to the Cook County Hospital, Chicago. 
HAROLD N. MOYER, M.D., 
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A Monthly Journal of Medicine and Surgery, 
HAROLD N, MOYER, M, D., 
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v~» ~~ may. 1896. "' ~ 
CONTENTS, 
Original articles. 
f\V0 RARE DISLOCATIONS OF THE PATELLA Bv Edmund Andrews. M.D., LL.t) 
PRESENT STATUS OF OPERATIVE TREATMENT FOR BLADDERSTONE. By Arthur Dean 
Bevan. M D 35* 
The SURGICAL TREATMENT OF INFANTILE PARALYSIS BY ARTHRODESIS. By Carl Bick. 
M & 
AMPUTATION FOR DIABETIC GANGRENE. Bv A. M Cartledge. M D W 
AN IMPROVED STETHOSCOPE. FOR STETHOSCOPIC PERCUSSION By A R. Mitchell. M D 372 
TRAINING AND ENVIRONMENT AS CORRECTIVES OF DEGENERACY. AS ILLUSTRATED BY 
J M. W. TURNER AND MARGARET FULLER. By Harriet C. B. Alexander, B.A., M p . .. 374 
BOOK REVIEWS. 
Bon'ts f6r Consumptives By Charles Wilson Ingraham, M D. : ......TTT.r... 400 
Electricity in Electro therapeutics. By Edwin J Houston, Ph D . and A. E Kennelly. Sc D . 402 
The American Year Book op Medicine and Surgery. Under editorial charge ol Geo M Gould. M D . 402 
Twentieth-Century Practice Edited by Thomas L. Stedman. M D 40J 
Treatisl on the Medical and Surgical Diseases of Jnfa-ncy and Childhood. By J Lewis 
Smith. M D ' *»S 
American Text-book of Obstetrics. By American Authors. Richard C. Norris, NJ.D-, Editor .... 406 
PROGRESS OF MEDICAL SCIENCE. 
MEDICINE. . Jnjury to Median Nerve in a Child... v 4*3 
e'X'J"""■ w _ i«uroloov and mvcwatrv. 
* The Thyroid Treatment of Acromegaly 414 
SURGERY. Raynaud's Disease in Infants and Children ......... 425 
Alcohol as a Disinfectant for the Hands 411 ' 
LARYNGOLOGY AND OTOLOGY. 
PATHOLOGY. treatment and Prevention of Nasal and Post nasal 
Experimental Amyloid Degeneration 4>> /Catarrh in Young Children 425 
- The Operative and Dietetic Treatment of Suppura- 
BACTERIOLOGY. tfoa in the Accessory CavH.es ol the Nose ..... 4* 
Thl E^<4XSSihaS'S''»; *" OER.MATOIOOV AND SVVHILOLMV. 
iSttSla r,.e..c. : US ACmoOdycomFungdid.. .... . 
gonorrhea pl Rectum in Women 4»7 OPHTHaLHOLOGY. 
THERAPEUTICS. • The F.tmlogv of Acute Conjunctivitis 43* 
t. * Tbe Removal of a Cavernous Aogeioma from the 
IK.U . p.** «i»eo,im. ,u 
GYNECOLOGY AND OBSTETRICS. < OENITO-URINARY DISEASES. 
Again Hot Water 420 txterna) Urethrotomy and Urethrectomy 433 
Dangers of Viburnum Prunitolium io Abortion 42a. FORENSIC flEDICINE. 
PEDIATRICS. • Certificates of Insanity in... 437 
Antiseptics Io Infantile Diarrhea 4M Needle in the Heart. ... 439 
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