Hysterical A ncesthesia, with a Study of 
the Fields of Vision. 
BY 
JOHN K. MITCHELL, M. D., 
Attending Physician to St. Mary's Hospital; Assistant Physician to the Hospital of the University op 
Pennsylvania and to the Infirmary for Nervous Diseases. 
AND 
Ophthalmic Surgeon to the Philadelphia and Children’s Hospitals; Ophthalmologist to the 
G. E. deSCHWEINITZ, M. D., 
Infirmary for Nervous Diseases. 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
FROM 
November, 1889. Extracted from 
The American Journal of the Medical Sciences for November, 1889. 
HYSTERICAL ANAESTHESIA, WITH A STUDY OF 
THE FIELDS OF VISION. 
ATTENDING PHYSICIAN TO ST. MARY’S HOSPITAL ; ASSISTANT PHYSICIAN TO THE HOSPITAL OP THE 
UNIVERSITY OP PENNSYLVANIA AND TO THE INFIRMARY FOR NERVOUS DISEASES. 
John K. Mitchell, M.D., 
AND 
G. E. DE SCHWEINITZ, M.D., 
OPHTHALMIC SURGEON TO THE PHILADELPHIA AND CHILDREN’S HOSPITALS I OPHTHALMOLOGIST TO 
THE INFIRMARY FOR NERVOUS DISEASES. 
The achromatopsia, or dyschromatopsia, which has been described by 
various authors as occurring in hysteria, and especially in those cases in 
which the not uncommon symptom of hemi-ansesthesia is present, was 
first studied by Galezowski,1 especially in Charcot’s wards of the SalpS- 
triere. Briquet has called attention to the forms of amblyopia which 
sometimes accompany hysterical losses of sensibility, and Landolt,2 also 
working with Charcot, examined and reported many cases. These all 
seem to have presented unilateral anaesthesia with changes in the extent 
or arrangement of the fields of color-vision, chiefly in the eye of the 
affected side, or total loss of color-perception in one eye. It is rarely, 
says Landolt, that both eyes are not in some degree deranged. 
“There are colors for which the visual field is physiologically more exten- 
sive than for others, and these differences in extent of the visual field are 
always reproduced, following in every case the law for each color. Thus, the 
field for blue is the largest; yellow, orange, red, green follow in this order, 
and last, violet is perceived only by the most central portions of the retina. 
In the pathological state with which we are concerned these characteristics 
of the normal condition appear in some sort exaggerated, but in varying 
degrees. The various circles which correspond in the examination with the 
limits of vision for each color, narrow concentrically after a fashion more or 
less marked, following the rule established by the normal condition.” 
Charcot describes the arrangement of the color-fields as follows: 
1 Galezowski (These, 1865, p. iii.) reported the first case of hysterical amblyopia, 
which was observed in the service of Dr. Grisolle, in the Hotel-Dieu. The patient was 
a Miss Y., aged nineteen, who, in addition to the entire list of hysterical symptoms 
presented trouble with the left eye to such an extent that she could only read large 
letters, and had complete internal hemiopia. With this eye she had also lost the faculty 
to distinguish colors, so much so that yellow and pink appeared white; red and blue 
seemed black. This condition lasted for two weeks. See also Gazette des Hopitaux, 
1877, page 75. 
2 Archiv de Physiolog. normal, et patholog., tome ii., 1875, p. 624. 2 
MITCHELL, DE SCHWEINITZ, HYSTERICAL ANESTHESIA. 
Instead of simple concentric diminution of the color-fields, some of 
the French patients had a reversal of the order of occurrence of the 
colors, and some bad cases had absolute loss of the color-sense, seeing 
everything, as Bernutz phrases it, like a sketch in India-ink. 
Bernutz, in speaking of the loss of sensibility in hysteria, says that 
“Anaesthesia, either of the whole body, which is infinitely rare, or of one- 
half, and that usually the left half of the body. . . . constitutes .... one 
of the primordial symptoms of this neurosis.’’ 
He adds that it may be said to be a general rule that the anaesthesia 
is limited to one part, perhaps of the skin of the body, perhaps of the 
mucous surfaces, in especial that of the conjunctiva of the left eye, 
“ which exists in almost every hysterical subject, with or without achro- 
matopsia, as described by Galezowski.”1 
been carefully studied for color and general pain- and touch-senses in the 
clinic of Dr. Weir Mitchell at the Infirmary for Nervous Diseases, and 
the following reports show some of the results. We have not thought it 
necessary to give the histories of our patients in more detail than would 
suffice to show their hysterical characteristics clearly, and careful state- 
ments of the tactile, thermal, and pain sensibility—as these are the points 
of whose relations with the changes in the color-sense we wish to speak. 
Since attention was called to these cases in this country, many have 
Case I. Complete hysterical analgesia; aphonia; normal visual fields. 
—Private patient, aged sixteen, small for her age. She has been men- 
struating irregularly without pain, and is the youngest of a large family 
in the South. She had been indulged from her birth and had naturally 
lost all power of self-control, having been denied the advantages of con- 
trol by others. 
In May, 1888, she became nervous and was taken ill at a school 
whither she had been sent against her will. During this illness an 
overdose of mercury slightly salivated her, and after this she became 
better. She was at this time attacked with aphonia, became very violent,, 
refusing all food for days, and screaming if any noise offended her hear- 
ing, which had become extremely sensitive. The bowels were costive 
and had to be kept open by enemata. 
A careful examination showed all her organs to be in good order, but 
she had what has been described by Dr. Mitchell, in his book on the 
Nervous Diseases of Women, as “ hysterical ataxia.” The fear of a fall 
or other accident from this trouble of incoordination indisposed her 
to attempt to walk, or to use her will, and she was becoming rapidly 
will-less. The urine was clear, but it was passed only once in twenty-four 
hours, sometimes only once in forty-eight hours, and then not more than 
two or three ounces. For some weeks she did not pass more than four 
ounces a day. She was analgesic from head to foot, almost as com- 
pletely so as was Case 11. 
It is best illustrated by saying that she had no sensation in the breast 
or under the finger-nails. The most severe test of this condition with 
1 Nouveau Diction, d. Med. et Chin, art. Hysteria. MITCHELL, DE SCHWEINITZ, HYSTE RIG AL ANAESTHESIA. 
3 
which we are acquainted, is the use of a faradic current with two wire 
brushes on the nipple. To this she was perfectly indifferent. Never- 
theless, her sense of touch was fair and her localization good, but her 
appreciation of thermal differences was very feeble. Unless the tem- 
perature was extreme, she found it difficult to decide if it were heat or 
cold. 
The examination of the eyes revealed the following conditions: 
Vision one-half and two-thirds respectively of normal, which, by the 
correction of a hypermetropic astigmatism under a mydriatic, rose to 
full sharpness of sight. The following formula was found to correct 
the optical error: 
. .j. 20 
0. D. -f- 1.00s O -90c axis V. • 
O. S. -f 1.50s O + l.c axis V. ~ 
xx 
There was deficiency in the amplitude of accommodation corresponding 
to the error of refraction, together with a low degree of insufficiency of 
the internal recti. The ophthalmoscope revealed oval disks, somewhat 
distended and slightly tortuous retinal veins, with undue prominence of 
the central lymph sheaths. There were no abnormal pupillary phe- 
nomena. The form-fields in each eye were absolutely normal. The 
color-fields—blue, yellow, red, green—followed in the order given and 
without any material contraction. Thus in the right eye; 
Outward. 
Upward. 
Inward. 
Downward. 
Blue . 
75 
38 
42 
48 
Yellow 
75 
28 
32 
38 
Eed . 
56 
30 
25 
35 
Green 
45 
20 
25 
25 
The left eye presented no material difference from that just recorded 
These observations were several times repeated, the last time just before 
the patient was discharged. 
It is not necessary here to go into the treatment, but the little savage 
was easily tamed, and after three months’ time went home in blooming 
health and has had no relapse since. 
Case 11. Complete hysterical analgesia; nearly normal visual fields.— 
Private patient, aged twenty, single, white, living in Pennsylvania. 
Family history unusually good. No injury, no special disease, no bad 
habits. She was in good health until she began to menstruate, between 
twelve and thirteen years of age. At this time she became easily excited 
by emotion whether of pain or pleasure. Her face began to twitch, and 
she suffered from a moderate amount of insomnia, which continued as 
she developed. At sixteen she had attacks of neuralgia in the head, 
face, and hands; these were not usually very great; occasionally they 
would be severe. Sometimes the headache would be in one eye, some- 
times in the other. The menstruation, which up to this time had been 
perfectly normal, began to be painful. She complained of “ ovarian 
tenderness.” On examination there proved to be no uterine disease 
whatever. The organ was in place and normal, nor were the ovaries 
sensitive on vaginal exploration; nevertheless, the abdomen on both 
sides was extremely sore, and she had been said to have ovarian ten- 
derness. The organs of digestion were in good order. The pulse was 
easily excited, but the arterial tension was normal. Inspiration was 4 
MITCHELL, HE SCH WEINITZ, HYSTERICAL ANAESTHESIA, 
25; the pulse 85. The sleep is slight and easily broken. Her general 
strength is moderate, but a walk of two miles excessively fatigues her. 
Her station is bad; on closing her eyes there is three inches antero- 
dextral sway. There is no vertigo and her gait is normal. There is no 
paralysis anywhere. Tactile sensation appears normal. As regards 
her temperature-sense, she sometimes mistakes cold for heat, but never 
heat for cold, though this is an error sometimes made in health. She is 
absolutely analgesic from head to foot. There is no part of her body 
into which it is not easy to thrust needles without causing her any other 
sensation than that of mere touch. After she had been subjected to 
such an examination she could tell from the sensation when a needle 
was thrust into her, and recognized it as different from a touch, although 
it was painless. In order to give an idea of the completeness of this 
condition, it is only necessary to say that a needle could be run into her 
breast, or under her finger-nails, without giving her the least sense of 
pain. When she first came under treatment she was nearly insensible 
to the most violent electrical stimulus, perfectly so to heat. But after 
a time she regained to some extent the power to feel pain, although 
never the ability to feel a needle thrust into her. She did not suffer in 
the least degree from a faradic current going through a wire brush over 
a dry skin. Excepting that she is extremely sensitive to all emotion, 
there are no hysterical manifestations whatever. 
By June, 1889, she made great general gain in strength, but scarcely 
any as regards sensory trouble, though well enough to be regularly at 
work as a nurse. 
Examination of the eyes of this case revealed the following facts: 
Direct vision normal; slight decrease in the amplitude of accommodation 
corresponding to the presence of a simple hypermetropic astigmatism ; 
no abnormal pupillary reactions; an insufficiency of four degrees of the 
external recti (esophoria). Each optic disk was a vertical oval, the 
nasal edge slightly blurred by hazy retina, and the transverse veins dis- 
tinctly tortuous. An examination of the field of vision (Fig. 1) demon- 
strated that there was no change in the relation of the colors one to 
another, and no decided contraction in the field of vision. This exami- 
nation has quite recently been repeated now that the patient has gained 
in general strength, with the result of exactly confirming the previous 
observation, or, in other words, the field for form, blue, red, and green 
(green is not represented on the diagram ; violet and yellow were not 
tried) was the same during the period of universal anaesthesia that it is 
now since the restoration of the patient to more perfect health. 
Case HI. Complete left-sided hysterical anaesthesia; contraction of 
visual field.—The patient (private) is a case of neurasthenic conditions 
with highly hysterical developments. She is constantly in tears, and 
exercises emotion on the slightest occasion, and even when there appears 
to be no excuse for the display. She has slight twitching of the limbs, 
and occasionally hysterical hiccough. The remaining history of this 
case has no characteristic conditions. 
When first seen, in May, 1889, the patient had a very indistinct sense 
of pain over the whole left side. The needle-prick was felt very little 
in most places. It was perceived better when plunged , into the tissue 
deeply; it then created a sense of uneasiness. There were a few areas 
of insensibility. On the thigh and on the inside of the leg the needle- 
prick was better appreciated, but there was an unusual want of sensi- Fig. 1, Fig. 2. MITCHELL, DE SCHWEINITZ, HYSTERICAL ANAESTHESIA. 
7 
bility to pain in the left half of the face, the forehead, and the left hand, 
whereas in other parts of the body comparative pain was felt. The sense 
of touch was not quite perfect in her fingers’ ends. She was able to 
locate impressions reasonably well. Heat and cold she could determine 
with tolerable ease. She was, therefore, a case of complete lateral left- 
sided analgesia. 
The following notes describe the condition of the eyes: Central vision 
normal; no muscular anomalies either in the external or internal mus- 
cles. Oval optic disks, with slightly mellowed nasal edges, and full cen- 
tral lymph-sheaths. Low hypermetropia. The fields of vision (Fig. 2) 
exhibit concentric but irregular contraction without change in the normal 
order of white, blue, red, and green. 
Case IV. Distributed incomplete hysterical anaesthesia; irregular con- 
traction of the visual fields, and partial reversal of the normal relation of 
the colors.—This case (private) does not differ greatly from other cases 
of the hysterical state. There is slight weakness of the legs. The pro- 
verbial mobility of all hysterical symptoms is well shown in the distri- 
bution of the anaesthetic areas. All over the body want of sensibility to 
pain is found in patches, but from day to day the situations of these 
spots vary very greatly. There is the usual complete acuteness of touch- 
sense, except that it is less perfect than normal in the fingers at all times. 
Repeated examination showed that the areas of anaesthesia were fre- 
quent, and more marked in general upon the left side, especially the left 
arm and leg, while other spots of insensibility were distributed over the 
right side and scattered irregularly over the trunk, face, and limbs. The 
patient herself was fully conscious of the lessening of sensibility, and 
hailed with delight the rapid recovery of feeling under the daily use of 
the faradic current and a wire brush. 
An ocular examination revealed no change in the central vision, in 
the external excursion of the eyes, or in the pupillary reactions. The 
optic disks were oval, the edges slightly blurred, and the refraction a 
low hypermetropia. The fields of vision (Fig. 3) revealed decided con- 
traction both for form and for blue, red, and green (yellow and violet 
were not tried). 
Right eye: The blue and red lines cross each other in such a manner 
that on the nasal half and below, the blue is greater in extent, while in 
the temporal half and above, the red is larger in area. The green, 
greatly restricted, occupies its natural position in the sequence of the 
colors. 
Left eye : The red field is greater in extent than the blue field in the 
entire circumference except at the horizontal meridian of the nasal side ; 
the blue and then the green field, much contracted, follow. 
Case V. Complete left hysterical anaesthesia; contraction and oedema of 
the left leg; irregular visual fields; partial reversal of the color-fields.— 
Patient (private), aged thirty-one, is the mother of three children, the 
youngest born three years ago. Menstruation is nearly painless. There 
is no organic disease. In July, 1887, she had a sharp attack of dysentery, 
which lasted over a week, after which she had what was probably hys- 
terical paralysis of the bladder and rectum. The urine had to be drawn 
off, and the rectum emptied of its contents by mechanical means. At 
this time she became extremely nervous, and had “ sinking spells,” with 
spasms of the left side of the face, head, and foot. The left hand became 
violently shut, and the foot passed into a state of extraordinary extension. i • 
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MITCHELL, DE SCH WEINITZ, HYSTERICAL ANESTHESIA. 
The difficulty chiefly complained of at present (May, 1889) is a hys- 
terical contraction of the left leg. The knee can be straightened with 
difficulty, but it soon regains its bent position. If, as she states it, it is 
“ locked ” in a straight position, it remains so, but, if she attempts to 
walk, it instantly bends, and refuses to be straightened again. She has 
curious attacks of oedema of the left hand, lasting for an hour, caused 
by excitement, whether pleasurable or otherwise. The leg has also at 
times been swollen above the ankle, and nearly all the time it is a little 
swollen at the ankle. At her periods this oedema is greatly increased, 
and becomes then very notable. She has ache of the spine; in four or 
five places pressure causes pain, the situation of which varies. The whole 
left side is more or less insensible to pain. It is worse in some areas than 
in others. The sense of touch is considerably impaired. The compass 
points are not felt as two anywhere on the fingers or lips. The sensation 
as to heat or cold is imperfect on the left side. Heat is felt as pain, 
unless it is very great. This observation is often made in reference to 
other cases, and is somewhat difficult of explanation. The case is worse 
when seen than would be supposed from the notes. 
The following notes describe the condition of the eyes: Vision two- 
thirds of normal in each eye. Pupils large, equal, and actively respon- 
sive to the reactions of light and shade, convergence, and accommodation. 
Distinct insufficiency of the internal recti muscles. Oval, rather gray, 
optic disks with hazy nasal edges. Many lymph reflexes throughout the 
eye-ground. No macular lesions. The refraction a simple hypermetropic 
astigmatism. In the fields of vision the following peculiarities were 
noticed (Fig. 4): 
Right eye: An irregularly contracted form-field. The blue field is 
next in extent, except below and to the nasal side, where it is exceeded 
in limit by the yellow line, which in turn is the next largest field, except 
above, where it is surpassed in extent by the red field. In the left eye 
there is a distinct contraction of the form-field especially above, contrac- 
tion, but natural position of the blue field, while the red and yellow 
lines cross each other in such a way that in all meridians the red is the 
greater in extent except directly below. In both eyes the green field, 
much contracted, occupies its natural position in the sequence of the 
colors. 
Case VI. Hysterical swelling; paresis and incomplete ancesthesia of the 
left arm ; normal visual fields.—Hospital patient (service of Dr. S. Weir 
Mitchell), aged twenty-eight, teacher. Has had no injury or disease 
capable of producing serious consequences. Previous to May, 1886, 
she appeared perfectly well, but was over-worked and had some worry. 
She began to notice that she was physically feebler than she had been, 
but she continued at her work. By degrees she became insomnic, waking 
early in the morning. She complained of some pain in the back, and 
gave up work in May, 1886. She continued to take care of herself 
without doing any work during the summer. She still suffered a great 
deal in the back of her head and neck, and with a painful spine, all of 
which troubles were increased by fatigue and excitement. In October, 
she observed that at her periods the right arm began to swell. Soon 
after it was found to be always swollen. In February, she ceased to 
be able to write, and every motion increased the swelling. At this 
time there began a sensation of burning in the arm, although it was cool 
to the touch, and this was increased by use. The arm at present seems MITCHELL,DESCHWEINTITZ, HYSTERICAL ANESTHESIA. 
11 
to vary very much in size. (See Table I.) All excitement or emotion is 
felt in the arm, and she insists that all shocks are felt in that member, or, 
as she says, “go to the arm.” In obedience to the law which seems to 
control this form of oedema it varies greatly ; sometimes the swelling does 
not extend above the elbow, and sometimes it reaches to the shoulder. 
Undoubtedly, at her worst, the right leg is affected as well. The right 
breast is certainly smaller than the left at all times. At seven inches 
above the wrist the right arm measures eight inches in circumference, 
and the left seven and a half inches. For the right hand the dyna- 
mometer registered 25 and the left 25, but she says the right hand used 
to be twice as strong. K.-J. -j—|- on both sides; reinforcement normal 
on both sides. On the right side, however, there is a faint attempt at 
clonus, the foot moving three or four times and then coming to a pause. 
The arm muscles and elbow-jerk are normal. 
Table I.—Measurements or Wrist, Middle, and Upper Forearm, in 
INCHES, BEFORE AND AFTER MENSTRUAL PERIOD. 
Wrist. Middle forearm. Upper forearm. 
March 7. Day before menses appeared, 61 71 9 
During this period she suffered unusually. 
March 13. Third day after cessation of flow, 61 7 8f 
March 16 6f 71 8| 
At this time she went home for a week, and while there wrote a good 
deal, the arm becoming worse. On her return a careful examination 
was made as to sensation, which had been neglected at the previous 
examination. The pain-sense below the elbow was greatly reduced in 
the right arm, scarcely existing at all. Touch-localization was much 
less perfect than it should have been. The condition was difficult to 
state with exactness, as the distribution of the change seemed unequal. 
Everywhere from the shoulder to the elbow the tissue was difficult to 
pick up with the finger and thumb. A large part of the swelling was 
clearly not cedematous in the sense in which we use that term. A very 
remarkable change was observed in the temperature of the two hands, 
which is illustrated by the table appended. 
Table 11. 
Morning. 
Evening. 
R. L. R. L. 
February 13. Hand ... 97|° 98|° 
Arm ... 94| 96f 
February 14. Hand . . 92|° 93|° 97| 97£ 
Axilla ... 98 j- 99 
Arm . . . 91| 95 94 96| 
February 15. Hand . . 9s| 95| 95| 
Axilla . 98 98 98£ 98J 
Arm . . .95 95| 92| 94| 
February 16. Hand . . 92| 93 86 89 
Axilla . 98 98 97§ 97| 
Arm . . .90? 92| 90 92 
Axilla . . 98 98| 97 97 12 
MITCHELL,DE SC H WEINITZ, H YSTE RIC AL ANAESTHESIA . 
In April, 1888, she was reexamined, and showed no change for the 
better. Prolonged pressure showed a small pitting indicating a slight 
amount of oedema. The analgesia in both leg and arm appeared to be 
increased. 
This seemed to be a rather unusual and irregular case, such as was 
described by Dr. S. Weir Mitchell in The American Journal of 
the Medical Sciences, under “Unilateral Swellings of Hysteria.’ 
Although the analgesia did not exist through the whole side, it was still 
sufficient to make it worth while to study the color-fields. 
An examination of the eyes revealed no abnormalities other than a 
slight hypermetropia with corresponding deficiency in the amplitude of 
accommodation. There were no manifest insufficiencies of the external 
eye-muscles. The eye-grounds were healthy, with, perhaps, slight thick- 
ening of the fibre layer of the retina surrounding the upper and lower 
edges of small, vertically oval optic disks. A study of the color-fields 
made on several different occasions failed to determine any decided abnor- 
mality for blue and red. The green field was contracted to a smaller 
limit than that which is usually considered to be normal, and was smaller 
in contrast to the extent of the other colors. This was present alike in 
each eye, the fields of each corresponding in area. 
Case VII. Epilepsy; hysterical hemiplegia; partial left-sided anaes- 
thesia; contracted visual fields.—Hospital patient (service of Dr. S. Weir 
Mitchell), aged twenty-eight years, single, American. Since seventeen 
years of age she has been subject to fits, sometimes one a week, sometimes 
many in a day. For a week before the first examination she had none. 
Hereditation is good ; both parents healthy. The cause of the patient’s 
disease is unknown : she has no discoverable disease in any organ. At 
her menstrual period she has some pain in the iliac region, of which she 
sometimes complains in the intervals. When the fit is approaching, she 
has slight pain in the left arm and the prsecordium. This lasts for a few 
minutes, and may exist without any sequent fit. The onset of the spasm 
is sudden, and affects first the right face and neck ; it then becomes 
rapidly generalized, and sometimes lasts an hour with brief intervals. 
Occasionally she has had the lesser epilepsy. The disorder is more fre- 
quent in hot weather, occurring every other day. Her treatment does 
not here concern us, and her history is interesting only because she has 
had attacks of hysterical hemiplegia. 
For some two or three weeks past (May, 1889) she seems to have been 
more nervous and feeble than usual. She complains of pain in her left 
chest, and there is also a copious eruption of acne on the left side of the 
chest due to a belladonna plaster. She has been taking twenty grains of 
bromide three times a day, with arsenic, for two or three months. In- 
creasing nervousness marked the near approach of an attack, which took 
place May 15th. She had been annoyed and troubled for some days by 
a variety of matters. While sitting at dinner she found great difficulty 
in moving her left hand, and felt her face turned slightly to that side, 
with a sense of tingling at her fingers’ ends. Within an hour this devel- 
oped into moderate chilliness on the whole left side. Neither the speech 
nor the power of swallowing was affected. Since then she has gradually 
become better, but still there is very little gain of strength. The dyna- MITCHELL, DE SCH WEI NITZ, HYSTERICAL ANAESTHESIA. 
13 
mometer shows 35 for the left side, and 48 for the right. A sensory ex- 
amination in this case of the paretic condition is important. Portions of 
the left side, of the left face, and the fingers of the left hand were slightly 
altered as to touch, but not enough to enable us to detect any difference 
by the points of the compasses. As to pain, there was a different state of 
things. The whole left side was rather less susceptible to pain, even 
when pain was felt. In the right side, in the right arm and right leg 
below the knee there was insensibility to the prick of a needle. But 
here, as in other cases, a sense of pain, which seemed almost extinguished 
at a number of points, could be made active with the aid of a strong 
faradic current, if the conductors were dry and uncovered. It is to be 
observed that in some places insensibility was perfect in a limited area 
for an inch or two in diameter, but just outside the line sensation was 
again distinct. Also, it appeared in this case, as in many others, these 
pain-areas would continue to move. For instance, pain-sense would exist 
in a given area, and in half an hour that portion of the body would be 
again insensible. She had, as is usual in persons in this state, a sensitive 
region on the left side of the abdomen, a soreness which is popularly 
attributed to sensitive ovaries, but in the present case far too extensive 
to allow any such explanation. 
A study of the eyes showed central vision very defective owing to the 
presence of a high degree of compound hypermetropic astigmatism asso- 
ciated wdth manifest convergent strabismus, the left eye being more 
amblyopic than its fellow. The optic disks were oval, sharply excavated, 
distinctly waxy in their deeper layers, and the retinas hazy and full of 
lymph reflexes. The fields of vision for form and color were concen- 
trically contracted about ten degrees in all meridians, but there was no 
reversal in the order of the colors, nor crossing of the lines, nor reenter- 
ing angles, nor peripheral scotomata. 
Case VIII. Right hysterical hemi-ancesthesia; partial left ancesthesia; 
reversal in order of color-fields.—Hospital patient (service of Dr. Wharton 
Sinkler), aged thirty; single; Irish servant; family history good; men- 
struated at thirteen and since irregularly; previous history ordinary. 
Four years ago she experienced loss of power in the right foot, wdiich 
became worse on exertion, however slight. The disability travelled up- 
ward, involving gradually the foot, the side, and the arm. A numb feeling 
now affects the leg and back. There are sharp pains along the side of 
the leg. She says she cannot sit up in bed ; but, when ordered to do so, 
obeys without trouble. There is some twitching of the thigh at night. 
She walks badly, dragging the right foot. Patellar reflexes -j- on both 
sides; reinforcements not obtainable. Repeated blows easily produce 
very rapid contractions. Elbow-jerk normal on the left side, less than 
normal on the right. Dynamometer (Burq)—right, 6; . left, 27. 
There is an attempt at ankle clonus (?). Sensation much worse on right 
side. She distinguishes touch, but cannot differentiate the head from the 
point of a pin in the right arm, hand, and shoulder. On the right chest 
and neck she recognizes the point, but not pain. Sensation is less, 
diminished in the right leg than in the right arm, but it is also analgesic. 
The left side is also analgesic, but distinguishes head and point. There 
is no pain on pressure over the nerve trunks. 
Globus hystericus is nearly constant. 
Heart and lungs normal. 
An examination of the eyes elicited the following points: The vision 14 
MITCHELL, DE SCH WEINITZ, H YSTEEIC AL ANESTHESIA. 
was equal in each eye—two-thirds of normal—the slight deficiency being 
due to a low grade of myopic astigmatism. The pupils were small, 
round, and normal in their reactions. The pupillary distance was 
unusually wide, 68 mm. The fields of vision were found in the follow- 
ing order: 
Right Eye. 
Outward. 
Upward. 
Inward. 
Downward. 
White 
. 80 
38 
40 
60 
Red .... 
. 25 
10 
20 
15 
Yellow 
. 25 
10 
18 
10 
Green 
. 18 
8 
12 
7 
Blue .... 
. 5 
6 
8 
5 
Left Eye. 
White 
. 80 
35 
40 
25 
Red .... 
. 80 
12 
20 
18 
Yellow 
CO 
O 
10 
18 
18 
Blue . 
. 15 
5 
10 
8 
Green 
. 5 
5 
10 
5 
From an examination of these numbers it will be seen that in the right 
eye the red field occupied the greatest area, next and about equal to it 
was the yellow, then the green, while the narrowest was the blue which, 
greatly contracted, surrounded the fixation-point. In the left eye the same 
conditions obtained, except that the green field was in all meridians 
smaller than the blue, except upward and inward, where it was equal to 
it in extent. The white field in each eye was much restricted. The 
optic nerves were oval; in the right eye the color a dirty gray with a 
sharply marked scleral ring; in the left eye the same gray color in the 
temporal half with a brick-dust hue of the nasal side, and similar sharp 
marking of the scleral ring. The central vessels were unchanged. 
It is evident from an examination of these cases that in no instance 
was there loss of the color-sense, the achromatopsia of Galezowski, nor 
was there any disappearance of the colors in a constant order. In the 
two cases of complete ansesthesia there was no departure from the 
normal sequence of the colors; and, practically, no limitation in the area 
of the field of the one (Case I.), and but slight restriction in the other 
(Case II.). 
In the cases of partial anaesthesia, in one (Case VI.) no abnormality 
for blue and red existed; green was by contrast contracted, and in two 
others (Cases 111. and IV.) there was concentric irregular contraction 
of the color-fields; but in all three the normal sequence of the colors 
was undisturbed. 
In two cases (IV. and V.), while the colors were correctly appre- 
ciated, their natural order was changed, the blue, red, and yellow lines 
crossing each other in such a manner that the red field became in some 
meridians the greatest in extent. MITCHELL,DE SC HWE I NIT Z, HYSTEHI C AL ANAESTHESIA. 
15 
In only one case (Case VIII.) was there an approach to complete 
transposition of the colors so that the red became the largest field, fol- 
lowed by yellow, green, and blue. In none of the cases was marked 
amblyopia present, except in Case VII.; here the deficiency in visual 
acuity was due to a high grade of hypermetropic astigmatism and con- 
comitant convergent squint. 
We have had the opportunity of studying two cases of absolute hys- 
terical hemiansesthesia, presenting the phenomena of crossed amblyopia. 
In one, a woman aged twenty-five years, seen by the courtesy of Dr. H. 
C. Wood, these symptoms appeared several months after the shock of a 
railroad accident. There was complete right-sided hemiansesthesia and 
loss of the special senses on the anaesthetic side, with amblyopia in s» 
high a degree that quantitative light-perception was absent. The vision 
of the left eye was reduced to one-ninth of normal; red was the only 
color correctly appreciated, and there was left lateral hemianopsia. 
In the other case, examined by the kindness of Dr. G. Oram Ring, 
who will publish the notes in detail, precisely the same conditions 
obtained, except that the amblyopia was less marked upon the anaes- 
thetic side. In both of these cases the ophthalmoscopic appearances were 
normal. 
If, as may fairly be supposed, these eight cases, taken at random from 
a large service, represent the ordinary conditions, then our conclusions 
as to the occurrence of achromatopsia with hemianaesthesia must be very 
different from those of the European observers. The patients were 
selected for study because they all presented greater or less degrees of 
loss or change of sensibility. As to this, it should be said that we can- 
not find any statement by the French writers, who are the original 
students of this subject, concerning the relative frequency of hemianses- 
thesia in all hysterical cases, except statements like that of Dr. Bernutz, 
already quoted, that it is “ one of the primordial symptoms,” or Char- 
cot’s remark in exactly the same sense,1 which would imply that it was 
present as an almost constant characteristic. Further, as to generalized 
anaesthesia, or, more properly, analgesia, Bernutz calls it “ infinitely 
rare,” and Charcot “ relatively exceptional.” The results of the ward- 
service as well as of the out-patient department of the Infirmary for 
Nervous Diseases would not allow us to make assertions which should 
corroborate these. These services may, we think, be considered to 
represent well at least the Eastern United States, as patients come from 
all of them to seek treatment, and our eight quoted cases are natives of 
several States—Pennsylvania, Wisconsin, New York, Virginia, and New 
Jersey. Every case differs in the quality, too, of the sense-changes, and 
1 Lemons snr les Localisations, etc., L. x. “In hysteria we have to do . . . with 
a unilateral anaesthesia. Total anaesthesia appears in relatively exceptional cases.” 16 
MITCHELL, DE SCHWEINITZ, HYSTERICAL ANAESTHESIA. 
some have that very curious symptom of ability to feel heat, when great, 
as pain, while they cannot appreciate a needle-thrust. 
The only general conclusions which it does seem possible to draw are 
that general anaesthesia, infrequent though it be, cannot for this country 
be supposed so rare as in Europe ; on the other hand, complete or nearly 
complete unilateral anaesthesia, while commonly present, is yet by no 
means so constant a feature of ordinary hysterical cases with us as with 
these foreign authors, and when either of these states is a symptom, it is 
certain that changes in the perception of colors are far less often to be 
found accompanying them than the study of the French and German 
writers would lead us to expect, and are practically absent in the cases 
of complete anaesthesia. Just as these observers see more often than we 
grave hysteria with convulsive seizures, hysteria, in the male and hystero- 
epilepsy, so it would seem they find hemiansesthesia with achromatopsia 
more common. Some of their facts, as that mentioned by Landolt of 
the frequency of concentric contraction of the fields in such states, are as 
true for this country as for Europe.1 
1 Quoted by Charcot. See also the observations of Moravcsik in Laufenauer’s clinic 
at Buda-Pest. Centralbl. f. ISTervenheilkunde, 1887, p. 301. THE AMERICAN JOURNAL 
OF THE MEDICAL SCIENCES. 
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