Hysterical Analgesia in Children

T. Barlow
1881 BMJ (Clinical Research Edition)  
OF late years, the observations of Ml. Charcot and others have led them to insist on the importance of antesthesia, and alterations in the special senses, as indications of hysteria. The soundness of these conclusions has been challenged; and there are those who consider the alleged anoes-.hesia, and other sensory defects, either as feigned disease or the results of expectant attention. Now, with respect to colour-blindness, deafness, and the like, there is certainly the difficulty that we are
more » ... ependent on the statements of the patient. The same objection applies to antesthesia. But, without considering the statements of patients at all, it will be admitted that in some people there is absence or deficiency of response, by way of movement or expression, to a stimulus, which, in a normal healthy person, would be a painful one. The special aim of this paper is to draw attention to the fact, that such absence or deficiency is not confined to young women who are domiciled in the wards of a hospital, where they are objects of repeated experiment and demonstration; but that it can be found even in very young children, who manifest other signs of the hysterical neurosis. It may be safely admitted that, although the elements of feigned disease and expectant attention cannot be absolutely excluded in the consideration of children, they are less likely to embarrass us in them than in adults. For example: a little boy, aged two years and nine months, had the skin between the roots of his fingers pricked with a needle, precautions having been taken that he should not know what was to be done. He neither winced nor withdrew his hand. Is it likely that such a child would have pretended not to feel the prick? WYhen subsequently one side of his face was pricked, there was the slightest possible play of the features. When the other side was pricked, he cried. There was no reason to suspect any organic brain-disease at all. The boy had been brought on account of fits, which were unquestionably of the hysterical type. They had followed upon a fall, which had not bruised him, but had frightened him. In the following cases, the analgesia was tested by the prick of a pin, the pinch of a pair of dressing forceps, and the application of strong faradism. Great differences were noted in the degree of analgesia and in its distribution. In the most marked case, strong faradism was tolerated with complete indifference on one side; while a moderate current applied to the other side elicited an expression of pain, although not a loud one. The application of strong faradism for many minutes, on a second occasion, at length brought out a slight expression of discomfort. In another case, strong faradism was tolerated with perfect indifference when applied to either leg. This was continued for a quarter of an hour, and there was gradual return of sensitiveness, and at length some expression of slight discomfort. In another case, some distress was shown directly faradism was applied, although a needle had been pushed into the skin without the child withdrawing the limb. In a fourth case, the needle was tolerated for several minutes, and then the limb was slowly withdrawn, but without any cry. As to distribution, although more marked on one side than on the other, my impression is that, in most of the cases, there was some general defect. Generally, the analgesia was more marked in thelimbs than on the face. As to sex, six of the cases occurred in girls, two in boys. The youngest case was 'wo years and nine months old, the eldest eleven and a half years. In all the cases, there were symptoms, either related or observed which strongly pointed to the existence of hysteria. In one case, there was paraplegia, which had lasted for nine months without any wasting, and which gradually clearerd up after the use of faradism for a quarter of an hour. In the others, there were fits, which in several cases had followed what may be called a moral shock. With respect to the fits, it is doubtful whether there was in any case loss of consciousness, although in some of them the patients fell down suiddenly as though they had been shot. In most cases, there were coordinated movements. Opisthotonos and to-and-fro movements of the trunk were marked features. Movements of the eyelids were noted but no facial distortion; and in no case were the fits one-sided, as far as I could see or learn. The analgesia had not, I believe, been tested in these children before they were brought to the out-patient room ; but the mother of one (a girl aged five and a half years) showed no surprise when she saw the results. She remarked, indeed, that the child had never " seemed to feel like other people". A few days before coming, she had had her arm scorched, over a patch about three inches long, without crying at all. On a former occasion, her thigh had been deeply cut by a piece of broken pottery, when scarcely any distress was shown. The consideration of these cases will, I believe, lend support to the view that, in the hysterical neurosis, there is a torpid condition of the sensory part of the brain. In extreme cases, this may involve the centres of the special senses; whilst, in the very slight cases, the only abnormality may be more or less blunting in the appreciation of ordinarily painful impres. sions. The sensorium of the lhysterical patient may, no doubt, be awakened by many peripheral stimuli-the best of which, in my experience, is cutaneous faradism. The importance of analgesia in practical medicine appears to me, I confess, to rest entirely on the fact that it is a valuable aid to the diagnosis of hysteria. It hardly seems to merit special treatment. Vigorous but well regulated exercise of mind and body, which will rouse the nervous centres into healthy activity, seems to me the only therapeutic measure worth trying. CASE I.-F. U., a female child aged IIY2, came under observation as an out-patient in November, I876. She was brought on account of peculiar fits, which had commenced, according to the mother's statement, shortly after the child had been knocked over by a dog two years before. There was no injury beyond a few scratches, but the child was greatly frightened. There was no fit then; but she looked very pale afterwards, became very dark round the eyes, and strange in her behaviour. In addition to singing and dancing fits, and the repetition of hymns and prayers for a long time continuously, she very soon developed attacks, of which the main features were nodding and grimnacing; picking at her clothes; violent to-and-fro movements of the trunk; attempts to bite anybody who restrained her; and, finally, falling down as though she had been shot. Occasionally after this she slept, but more frequently screamed out with some delusion-such as that a nman with a white sheet was coming to her, and the like. After these attacks were over, she invariably complained of being cold and sat by the fire, and she often asked for food. Generally, after the fit, she used to go out to micturate. When she walked into the out-patient roonm, she looked a pale, listless, expressionless, languid girl; but there was nothing else worthy of note about her. I found that, all down the right side of the body, and also on the left cheek, there was complete analgesia, so far as the prick of a pin and pinching were concerned. She did not wince in the least when a single-celled Stohrer's faradic battery was applied on the left side, whilst a moderate current to the right side caused her to wince. She was unable to localise the spot where she was pinched on the right side, but she had no difficulty when the left side was pinched. Gentle pinching of the right arm and leg made the skin red, but no such effect followed a similar pinch of the left arm and leg. There was no difference, so far as muscular contraction to faradism was concerned, on the two sides, and there was not the slightest sign of contracture or paresis anywhere. On roughly examining the child's field of vision, I found it consi,erably limited; but equally so, I believe, all round, and to an equal amount on the two sides. Firm pressure on the right inguinal region did not bring out any sign of distress, and nothing abnormal was felt here. Above the middle of the left Poupart's ligament, an olive-shaped body, with its long axis parallel to the ligament, was felt. It was slightly elastic and movable; moderate pressure over it made the chilcl flinch. I believe this body was the left ovary, and that was the inmdcpendent opinion of several others who examined the child. A few days afterwards, on the suggestion of my friend, Dr. Allen Sturge, I faradised the right arm and leg for a short time, and after this the child wa ascole to localise pin-pricks. She now winced a little whe a pirncled, DUt not so much as when the other side was pinched. The faradism was continued, and after several minutes she began to feel it painful, and then it was found also that she withdrew her arm and leg away after a pinch or pin-prick as well as when the other side was irritated. HIer sensory centres were awakened. At no time, when I saw her afterwards, was the analgesia present. Two months afterwards, she began to have xwhat her mother called blind fits. Sometimes, for a whole day, she would find her way about entirely by " groping". She was brought one day to the out-patient room in one of those blind fits. Of course, it was impossible to say whether she really saw or not. When I held up my fingers, and asked her howv many there were, she immediately began to feel with her hands as a blind person might. A moderate faradic current was applied abouit the forehead and temples, and she w-as soon able to give correct answers; and, instead of " groping" home, she walked in an ordinary way. On two or three occasions subsequently, the same treatment was efficacious. In the middle of Mlarch, her blind fits ceased. I did not, I am sorry to say, examine her at that period for achromatopsy; but in one respect thbi was more satisfactory, because I learned from the mother subse-
doi:10.1136/bmj.2.1092.892 fatcat:chcmvut46je6jfbvj6odpy24yy