TWO CASES OF TRAUMATIC HYSTERIA. 
BY 
HENRY HUN, M.D., 
ALBANY, N. Y. 
PROFESSOR OF DISEASES OF THE CHEST AND NERVOUS SYSTEM IN THE 
ALBANY MEDICAL COLLEGE. 
REPRINTED FROM TRANSACTIONS OF 
THE MEDICAL SOCIETY OF THE STATE OF NEW YORK, 
FEBRUARY, 1891. [Reprinted from the Transactions of the Medical Society of the State of New York, 
February, 1891.] 
TWO CASES OF TRAUMATIC HYSTERIA. 
HENRY HUN, M.D., 
ALBANY, N. Y. 
The study of injuries resulting from accidents is of peculiar 
interest, inasmuch as in them other important questions beside that 
of treatment are presented. Accidents are usually the result of 
negligence, and injuries caused by such accidents usually involve 
suits for damages, in which the physician or surgeon must state in 
court how seriously the patient is crippled by the accident for enjoy- 
ment and usefulness in the world. This, in the present condition of 
expert evidence in this country, is an extremely unsatisfactory pro- 
cess. In the case of injuries to the bones and muscles this question 
concerns the surgeon alone, and can generally be definitely answered. 
When any portion of the nervous system is injured the answer is 
more difficult, and concerns not only the surgeon, but also the physi- 
cian, and especially the neurologist. When the injury occasions, as 
it sometimes does, an organic disease of the nervous system, such as 
a cerebral tumor, a myelitis, or a neuritis, the diagnosis and prog- 
nosis of the case is not difficult, except that these diseases are often of 
very slow development, and it may take months or years before the 
tumor attains sufficient size or the myelitis sufficient extent to give 
rise to definite and diagnostic symptoms. Therefore, in many of 
these cases the full extent of the injury done to the nervous system 
is not manifested until long after the question of damages has been 
settled. But beside these organic diseases, it has been recognized 
for a long time, and is now being recognized more and more clearly, 
that not infrequently there result from accidents functional diseases 
of the nervous system which are very obscure both in their symp- 
toms and their pathology, and which depend in their etiology prob- 
ably quite as much on the fright as on the physical injury. 
These cases of functional nervous disease are not apt to occur 
associated with severe injury of the bone and muscle. Probably 2 
HENRY HUN, 
because the long stay in bed which these latter injuries require, and 
the concentration of the patient's attention on these grosser forms 
of injury, are very favorable factors in the treatment of the func- 
tional neuroses, and may prevent their occurrence; although these 
neuroses do sometimes occur associated with severe injuries of the 
bone and muscle. Many of these cases of traumatic functional 
nervous disease were described by Erichsen under the name of 
spinal concussion, or railway spine, and were considered by him, as 
the name implies, to be due to a concussion of the spinal cord. But 
the more the symptoms of these cases were studied, the more difficult 
it became to regard them as due to any disease of the spinal cord, 
and it became more and more clear that the symptoms were of cere- 
bral origin, and the term spinal concussion or railway spine was 
replaced in turn by the terms railway brain, traumatic hysteria, 
traumatic neurasthenia, and traumatic neurosis. As these diseases 
are of a functional nature, their symptoms are such as can be simu- 
lated voluntarily or involuntarily; and as the temptation to voluntary 
simulation is great on account of the damages claimed, the question 
of deception is a most important one and one to be carefully con- 
sidered. These cases have been the subject of many discussions in 
various neurological associations during the past few years, but, on 
account of their wide interest, I need no apology, I think, in calling 
the attention of this Society to two cases belonging to this class, 
which present many of the points of interest common to all such 
cases: 
The first case is that of an unmarried dressmaker, aged nineteen years, 
who was sitting in the last car of a railway train standing before the 
station, and saw another train on the same track approaching rapidly from 
behind. Everyone in the car shouted: " Jump for your lives!" and ran to 
the forward door. She got through the door, and, as the platform of her 
car was crowded, she stepped on the platform of the forward car, and was 
about to jump to the ground when the two trains collided and she was 
thrown upon the track. A young woman who had stood beside her on the 
platform was thrown off and instantly killed. She was carried into the 
station and did not think she was much hurt, but soon became unconscious. 
When she regained consciousness and was helped on board the train, she 
found that the right leg was numb and paralyzed. When she arrived 
home, she presented a few slight bruises and complained of a numbness 
and weakness of the right leg, and of a pain in the lumbar region, which 
during the ensuing weeks grew steadily worse and was associated with 
severe pain in the occiput. About a month after the railway accident she 
had an attack of convulsions, and again ten days later she had another 
similar attack. After she had been lying about twenty-four hours in this TWO CASES OF TRAUMATIC HYSTERIA. 
3 
second attack, I saw her for the first time, in consultation with her attend- 
ing physician, Dr. Melick, of Fort Edward. She was then in a typical 
hysterical convulsion, her head being strongly retracted. Her movements 
were very violent, but though she threw herself from one side of the bed 
to the other she did not throw herself out of it, nor did she hurt herself 
against the wall. In her convulsive movements all parts of the body 
moved. There were exaggerated knee-jerk and trace of ankle-clonus 
present in both legs. The pupils were equal, and reacted to light. She 
was constantly shouting and raving that she was in a lunatic asylum, and 
begged not to be sent up-stairs among the noisy ones whom she heard 
shrieking. She also saw knives and blood on the walls of her room. 
The attending physician stated that she did not feel pin-pricks in her 
right leg, but did in her right arm.' Before examining her I stated, in her 
presence, that it seemed to me that the arm must be anaesthetic as well as 
the leg, as hemianaesthesia was usually present in such cases. She responded 
well to my suggestion, and when I examined her I found that the right arm 
and leg were absolutely insensible to pin-pricks, and the right side of the 
face very nearly so. Ovaries somewhat tender, but deep and continued 
pressure on them did not arrest the attack. Great tenderness over the 
spinous processes of the lumbar vertebrae, not over the others. Toward the 
end of my visit, as I made a feint of leaving to return to Albany, she ceased 
her convulsions and raving and talked rationally enough, complaining only 
of pain in the head. 
After my visit the patient remained in about the same condition, making 
very slow progress toward recovery. She continued to have convulsions at 
irregular intervals, and complained of numbness and heaviness of the right 
leg, which she seemed to be utterly unable to move. She showed marked ten- 
derness of the spine. The right side of the face was very slightly anaesthetic, 
the right arm was slightly more anaesthetic, the right leg was completely 
anaesthetic. She was unable to walk or bear any weight on her right leg, 
principally because it caused such a severe pain in her back. There was no 
increase of the reflexes in her leg. She was unable to sit upright, but re- 
clined during the day in an invalid's chair. The railway accident occurred 
in November, 1888. In March, 1889, without litigation, the railroad com- 
pany paid her $8500 damages, and after this the gradual improvement in 
her condition which had been taking place did not seem to be in the least 
accelerated. She remained a cripple, unable to use the right leg and suf- 
fering from frequent attacks of hysterical convulsions, during the next 
year. 
Many times during this year she was urged to come to the hospital for 
treatment, but could not be persuaded to do so. Finally, after months of 
waiting, in April, 1890, she entered St. Peter's Hospital. At that time she 
complained of some headache in vertex and occiput, and of paralysis of 
the right leg. She also complained of severe pain in the left ovarian region 
and shooting around to the back. This pain was worse during and before 
menstruation. She was having from three to six attacks of convulsions 
each month, was well nourished, walked with the aid of crutches, and in so 
doing dragged the right leg. There was complete paralysis of all the mus- 4 
HENRY HUN, 
cles of the right leg, and complete anaesthesia and analgesia of that leg. 
Passive motion of the right leg was painless, but showed much muscular 
resistance, and the muscles could be felt firmly contracted, certainly with 
enough power to move the leg. There was no muscular atrophy nor 
fibrillary contraction. The movements of all the muscles except those of 
the right leg were normal. Exaggerated knee-jerk and trace of ankle- 
clonus were present and equal in both legs. There was slight anaesthesia 
and analgesia of right hand and arm, but not of face, and there was ovarian 
tenderness on both sides, most marked on the left. 
After entrance into the hospital, the patient was given fifteen grains of 
quinine every night for the first three nights, and a very strong faradic cur- 
rent was daily applied to the right leg. This strong current was scarcely 
at all painful, but caused active muscular contraction, and the patient was 
urged to increase the movements of her leg which were occasioned by the 
muscles contracting under the application of the electricity. She was con- 
fidently assured that a rapid recovery would take place, and was encouraged 
in every way. Each day the leg moved more freely during the application 
of the electricity, and the patient found that directly after the electricity 
had been applied she could herself move the leg a little. Improvement, 
having once commenced, was rapid. At the end of five days she could 
walk better, the leg felt less numb, and the application of the faradic cur- 
rent, which was at first almost painless, had become extremely painful. 
Ten days after entrance into the hospital the patient walked with only a 
slight limp, and the right leg was only slightly analgesic; and in less than 
a month after entrance she was entirely well, and has remained so ever 
since, and has never had any return of the hysterical convulsions. 
There are many things about this case which make it seem not 
impossible that the whole thing was assumed for the purpose of 
obtaining money from the railway company. After the railway 
accident the patient did not seem to be particularly hurt, but went 
home, where she was surrounded by a sympathetic family and sym- 
pathetic friends, who undoubtedly suggested to her the possibility of 
obtaining damages from the railway company. After this had lain 
in her mind for a month or more, she began to develop symptoms of 
a severe nervous disorder, which symptoms might have been feigned. 
She seemed to be unconscious, but in that state she was capable of 
receiving suggestions, as, for instance, that " the whole of one side 
of her body was anaesthetic, instead of the leg alone, and acting 
upon this suggestion the whole side of her body became anaesthetic j 
also when I told her that I must go back to Albany, and she would 
lose the benefit of my visit, she very promptly came out of her 
attack of unconsciousness and talked to me quite rationally. Then, 
too, the long-continued paralysis of motion and sensation in the leg 
was evidently a mental one purely, because under purely mental TWO CASES OF TRAUMATIC HYSTERIA. 
5 
treatment-that is, isolation in a hospital and the application of 
the faradic current-this paralysis rapidly and entirely disappeared. 
And yet all these symptoms and conditions are what we frequently 
meet with in ordinary cases of hysteria, and it is no longer main- 
tained that hysteria is assumed simply for the purpose of troubling 
relatives, friends, and doctors, but that it is a real disease, although 
exaggeration and involuntary simulation are prominent symptoms 
in it. If we had seen this patient without having obtained any 
history of a railway accident, we should have regarded her as simply 
a case of hysteria, such as often results from a sudden shock or 
long-continued worry or mental strain, and which recovers promptly 
under appropriate treatment. 
We have, then, the alternative of regarding this case as a case of 
functional disease of the nervous system dependent on fright, and 
either hysteria or very closely allied to it, or to regard it as a case 
of malingering pure and simple. With the first supposition the 
symptoms and course of the case correspond exactly, and it resem- 
bles cases of hysteria which are of frequent occurrence. Under the 
second supposition, however, the case is not so easily explained. 
The patient has not complained of some simple symptom like vague 
neuralgic pains, dizziness, general weakness, or loss of memory, in 
regard to the reality of which we must depend merely on her word, 
but she has simulated an actual and very complicated disease, and 
has simulated it accurately, which is no easy thing, even if she had 
had abundant opportunity of studying such cases, which is not prob- 
able. Moreover, it seems altogether probable that if it were a case 
of malingering she would have shown a sudden, or, at least, a 
more rapid, improvement after having been given the large damages 
which she obtained. Undoubtedly, in many cases of hysteria there 
is a decided element of exaggeration and deception, and both these 
elements may have been present in this case, and the prospect of 
damages did not tend to diminish these factors. On the other hand, 
it certainly seems true that as the basis of this case there was really 
a functional disease of the nervous system consequent upon the fright 
and shock of the accident, and that the diagnosis-traumatic hysteria 
-is justified. 
The second case which I have to report is that of a woman, aged thirty- 
six years. On October 1, 1885, while walking in the street her foot caught 
in a hole in the pavement, and as she struggled hard to pull it free, it was 
suddenly released and she was thrown some distance, her head and the left 6 
HENRY HUN, 
side of her body striking the ground violently, so straining and bruising 
herself that she had to be carried home. She did not lose consciousness, 
but during a month she remained in bed, vomiting everything that she 
swallowed, and having pain in her head, throat, abdomen, and left side of 
the body. The same symptoms continued during the next month, but she 
got out of bed, and then found that her left leg seemed shorter and was 
weaker than the other, so that she could not lift it from the floor. 
She entered the Albany Hospital March 7, 1887, stating that since the 
accident she had suffered from nausea, vomiting, pains in the head and in 
various parts of the body, and had had two attacks of general trembling. 
During the thirteen months previous to entrance she had taken nothing to 
eat but peptonized milk, except that on two occasions she had tried solid 
food with disastrous results. On entrance the patient wTas anemic, the 
spine was tender, and there was some hyperesthesia of the left side of the 
body and great tenderness in the left ovarian region. The left side of the 
pelvis was drawn up by muscular contraction so as to cause an apparent 
shortening of the left leg. There were ankle-clonus and exaggerated 
patellar reflex in left leg. She could walk only with a crutch and cane. 
The most urgent symptom in the case was the persistent vomiting, and to 
relieve this she was given a quarter of a grain of hydrochlorate of cocaine 
in a half-teaspoonful of water five minutes before eating. This method of 
treatment, which I have never known to fail in cases of simple irritable 
stomach, acted well in this case also, and the vomiting ceased and did not 
return. About two weeks after entrance, during which time she had taken 
three meals of solid food daily, she was etherized and the left leg was moved 
about violently in all directions. Before the etherization she was assured 
that under treatment and while under ether the leg would be restored 
to its proper length. Since that time the left leg has seemed to her to be as 
long as the other. Her back was cauterized several times. She remained 
in the hospital six weeks, her treatment consisting of frequent cauterization 
of the back, the application of electricity to the leg, and encouragement. 
When she left the hospital she could walk without cane or crutch, and 
limped but very slightly. She ate well and had no nausea nor vomiting, 
although she still had some pain in her back and in different parts of her 
body. She herself said she felt like a different woman. 
In July, 1890, she received after long litigation the sum of $6500, and on 
December 11, 1890, I saw the patient again. She walked freely about the 
house with a slight limp, but in the street carried a cane, because she fre- 
quently felt as if her legs were collapsing under her, and as if she would 
fall if she did not sit down or have some support. She limps because her 
left leg feels awkward and seems short, as if the cords at knee and ankle 
were contracted and drew the leg up. The shortness of the left leg is 
entirely relieved when her back is cauterized, after which during a few 
days she does not limp. The cauterizations are made every two or three 
weeks, on account of attacks of vomiting associated with intense pain about 
the waist and in all the upper part of her body, and with great hyperes- 
thesia of the skin, all of which symptoms are entirely relieved by the 
cauterization. She also has dizzy spells, in which she sometimes falls to 
the ground, but in which she never loses consciousness. TWO CASES OF TRAUMATIC HYSTERIA. 
7 
In this second case the symptoms are in many respects quite 
different from those of the first, and yet there can be no doubt 
that it is a clear case of hysteria such as we are constantly meeting 
with in practice, and under appropriate treatment the hysterical 
symptoms almost completely disappeared. In this case the great 
improvement was obtained more than three years before the damages 
were awarded, instead of after the damages had been awarded, as in 
the first case. In both cases hospital treatment was necessary, and 
I doubt not that a stay in the hospital nowr of some months would 
make a complete cure in the second case as well as in the first. Just 
as in the first case, in this second case also, the receiving of large 
damages did not favorably modify the disease, the patient being in 
the same condition now as she was for a year before the damages 
were received. In regard to the question of malingering, the same 
thing may be said concerning the second case as was said concerning 
the first, and the fact that the second case improved so much under 
hospital treatment several years before the damages were awarded to 
her, makes the question of simulation extremely improbable, because, 
if the disease were simulated, the simulation would almost certainly 
continue until the damages were received. 
In conclusion, I would say that in this short paper I have not 
attempted to exhaust the subject of the traumatic neuroses, but I 
have merely wished to present to the Society two cases of well- 
marked functional nervous disease, belonging to such a clear type of 
nervous disease as hysteria, which were the result of accidents. 
Similar cases have been reported by many observers, so that I think 
that the occurrence of hysteria following and occasioned by accidents 
cannot be doubted. 
If these cases of traumatic hysteria, as well as the other forms of 
traumatic neuroses, were in their early stage isolated from their 
family and friends and given special treatment in a hospital, there 
can be no doubt that they would recover much more rapidly, and 
would obtain a much smaller sum for damages from the parties 
responsible for the accident. Of course, these cases cannot be con- 
fined against their will in a hospital, but if, when a suit for damages 
on account of a traumatic functional nervous disease was commenced, 
the defendant were to make the offer to pay all expenses of the treat- 
ment in a hospital, in the hope of obtaining a rapid and complete 
cure, I think that in many cases the offer would be accepted, and in 
the other cases the fact that the offer had been made would put the 8 
TWO CASES OF TRAUMATIC HYSTERIA. 
defendant in a better light before the jury, for no expert could deny 
that had such a course of treatment been adopted the case would 
have stood a better chance for recovery. Finally, in estimating the 
amount of compensating damages, it should be remembered that a 
considerable number of these cases are rapidly cured under proper 
treatment, especially so after the question of damages has been 
definitely settled.