THE TREATMENT OE ACRO-PARESTHESIA 
(NUMBNESS OF THE EXTREMITIES). 
BY 
WHARTON SINKLER, M.D., 
OF PHILADELPHIA ; 
PHYSICIAN TO THE INFIRMARY FOR NERVOUS DISEASES AND NEUROLOGIST 
TO THE PHILADELPHIA HOSPITAL. 
FROM 
THE MEDICAL NEWS, 
August 18, 18Q4. [Reprinted from The Medical News, August 18, 1894.] 
THE TREATMENT OF A C R 0 - P A R E S T H E S / A 
(NUMBNESS OF THE EXTREMITIES)} 
By WHARTON SINKLER, M.D., 
OF PHILADELPHIA; 
PHYSICIAN TO THE INFIRMARY FOR NERVOUS DISEASES AND NEUROLOGIST 
TO THE PHILADELPHIA HOSPITAL. 
In 1884 I read before the College of Physicians 
of Philadelphia a paper on a form of numbness 
which occurred principally in the upper extremi- 
ties ; and my observations showed that it was usually 
met with in women at about the change of life, 
although it occasionally occurred in men. I re- 
garded it as a vasomotor neurosis, because of the 
circumstances under which it was most likely to 
occur, and because it seemed to be one of the an- 
noying symptoms which belonged to the menopause. 
Dr. James J. Putnam had already described some 
cases of the same kind, and suggested that the affec- 
tion was probably due to alteration in the blood- 
supply of the terminal nerve-branches. Omerod, 
who had also written on numbness of the extremi- 
ties, believed the condition to be allied to Raynaud’s 
disease, and probably the result of vascular spasm. 
“Waking numbness” is a condition which has 
been recognized for years, and recently several 
1 Read by title before the Pennsylvania State Medical Society, 
May 17, 1894. 2 
articles on paresthesia of the extremities have ap- 
peared. The view now generally held in regard to 
this disorder is that it is a form of peripheral neu- 
ritis. Collins1 has recently presented an interesting 
paper on this subject, and analyzes forty-three cases 
of the affection. He holds that the trouble is due 
to defective innervation of the bloodvessels, which 
causes a low degree of blood-pressure and lack of 
proper blood-supply to the terminal branches of 
the peripheral nerves. He thinks that the most 
striking factor in the etiology of the affection is 
occupation, as he found that 75 per cent, of his 
patients were women who did either washing, sew- 
ing, scrubbing, or needle-work of some kind; and 
he believes that bodily fatigue, over-exertion, and 
poor nourishment are predisposing factors. 
Schultze2 reports twelve cases of acro-paresthesia, 
as he calls the affection, and makes an elaborate 
study of the symptomatology. He thinks the symp- 
toms are all opposed to the theory of peripheral 
neuritis, but believes that the disease is somewhat 
analogous to neuralgia. He considers the etiology 
obscure, and regards manual labor as having but 
little influence. He admits that many cases occur 
at about the climacteric, but says that the influence 
of that period is wholly unknown. He states that 
he has found treatment not very efficacious; that 
drugs are of no use, except to relieve pain, when 
present; but that electricity, warm baths, and warm 
applications may do some good. 
1 Journal of Mental and Nervous Diseases, August, 1893. 
2 Deutsche Zeitschrift fur Nervenheilkunde, 1893, iii, p. 300. 3 
Friedmann1 regards the affection as independent 
and individual, but harmless, notwithstanding its 
persistency. He also refers to the menstrual period 
in women as influencing the onset of the disease. 
He is disposed to ascribe the trouble to general 
anemia, with a weak circulation, and thinks that 
there is often some cardiac affection, usually a 
slight amount of fatty degeneration. He divides 
the affection into four classes: the acute and the 
chronic; a form in which the symptoms begin 
suddenly and are associated with vertigo (this 
variety is probably due to some brain-lesion) ; and 
a fourth class of cases, in which there is a ten- 
dency to rheumatic troubles. He is inclined to 
refer the trouble to two pathologic conditions: 
passive hyperemia of the extremities and irritation 
of the peripheral branches of the nerves. In treat- 
ment he recommends electricity, tonics, and cardiac 
stimulants. 
Laquer2 analyzes eighteen cases in women between 
thirty-five and forty, and recognizes the features as 
described by Schultze; but, contrary to that ob- 
server, regards the influence of hard work with the 
hands as being of great importance in an etiologic 
relation. He regards the affection as a neurosis 
due to exhaustion. 
The observation of a considerable number of cases 
since 1884 has confirmed the views which I then ex- 
pressed as to the pathology and etiology of the disease. 
There is probably in all cases of paresthesia some 
1 Deutsche Zeitschrift fur Nervenheilkunde, 1893, iv> P- 45°- 
2 Neurologisches Centralblatt, March 15, 1893. 4 
change in the blood-supply of the peripheral nerves. 
In those of an intermittent character there is only 
hyperemia; but in others in which the symptoms 
are constant, there is, no doubt, a slight but distinct 
inflammation of the terminal filaments of the periph- 
eral nerves. A patient whose case I have already 
related1 illustrates the influence of the menopause 
in causing paresthesia: 
Mrs. Y., forty-one years old, was referred to me 
by Dr. Oliver P. Rex. Her menstruation had 
been regular until six months before, when there was 
a cessation for seven weeks, and then a uterine 
hemorrhage occurred. An extra-uterine pregnancy 
was diagnosticated, and at the end of three months 
celiotomy was performed and a fetus and both 
ovaries removed. The patient made a good re- 
covery and got up at the end of three weeks. Soon 
after this she began to have flushes of heat several 
times a day. Three or four weeks later she had 
attacks of numbness in the right hand when she 
awoke from sleep. At first there was only numb- 
ness, but later there appeared a sense of prickling 
and pain, which would awaken her from sleep. In 
a few days both hands were affected, and they soon 
became numb all the time. The numbness was 
most intense in the afternoons, and especially in the 
distribution of the ulnar nerve. When the woman 
went to sleep the whole arm became numb and pain- 
ful, and she was awakened by the sensation. Sleep 
was, therefore, almost impossible and she walked the 
floor most of the night. When I saw her this trouble 
had existed for five weeks; the temperature of the 
hands was normal, tactile sensation, localization, 
1 “ Remote Results of Removal of the Ovaries and Tubes/’ 
University Medical Magazine, December, 1891. 5 
and appreciation of compass-points were unchanged; 
but the patient was awkward about sewing and the 
use of her fingers generally. 
In this case the premature induction of the 
menopause by the removal of the ovaries brought 
on the vasomotor symptoms which belong to that 
condition when it comes on naturally, and the 
symptoms were more intense than those met with 
under ordinary circumstances. Complete relief was 
afforded by the administration of ergot. 
Various writers have suggested different plans of 
treatment for this form of paresthesia. Putnam re- 
commended strychnin, phosphorus, and potassium 
bromid, with the use of galvanism. Omerod found 
potassium bromid useful. Collins believes that there 
is no specific remedy, but regards prolonged rest, 
with restorative treatment, the most beneficial thera- 
peutic measure. The use of the faradic current he 
considers helpful, but he believes a general tonic 
plan of treatment, with out-door life and change of 
occupation, of the most importance. In my paper 
to which I have referred, I stated that the treat- 
ment that I had found most useful was the adminis- 
tration of ergot, and that I had used this drug with 
the belief that the cause of the paresthesia was a 
hyperemia of the nerve-trunks or of the terminal 
filaments. As ergot is supposed to cause contraction 
of the arterioles, it seemed the proper remedy. I 
also suggested that in some cases there might be 
congestion of the cervical enlargement of the cord, 
from the fact that the numbness is often bilateral, 
and that the attack is most frequently induced by 
sleep. More extended experience has confirmed 6 
the belief in the utility of ergot in this disease, and 
I shall cite two illustrative cases : 
Mrs. D., thirty-four years old, has always been 
healthy. Menstruation has always been scanty, and 
before marriage painful. She has been married 
twelve years and has had four children. She has 
had a slight attack of rheumatism, followed by pain 
in her left side, which becomes weak from over- 
work. Recently she has had great care and worry 
in nursing two sick children. Five or six months 
before coming under observation she began to have 
a sense of numbness in her shoulders, which ex- 
tended to the epigastrium, and then appeared in 
the hands and feet, changing its location from one 
foot to the other during the day, but becoming 
much worse at night. There is a continual sense 
of numbness of varying degree in the fingers and 
hands. It becomes painful in the early morning, 
but after use of the hands and arms for a time there 
is less intense prickling, and she is able to go on 
with her work. There is no anesthesia, and with the 
dynamometer the grasp of the right hand is ioo, that 
of the left 90. There is no change in the temperature- 
sense. The patient was very anemic, and was ordered 
twenty drops of the tincture of ferric chlorid three 
times a day, and advised rest and good food. She 
followed this treatment for two weeks and then re- 
ported that she was not so well. She was looking 
better and was less anemic, but complained of an 
increase of the numbness in the hands, arms, and 
feet, and had some dizziness and precordial pain. 
She took iron in full doses for a month. At the 
end of that time the paresthesia was no better, if 
anything, worse; and she was then ordered gtts. 
xxx of the fluid extract of ergot, three times a day. 
In two weeks she reported that she was very much 7 
better, having taken the half-dram doses of ergot 
steadily. She was now ordered to return to the 
iron, and took this for two weeks, when she again re- 
ported that the numbness in her hands had increased. 
Ergot was once more prescribed, with immediate 
relief to the symptoms, and she took this remedy at 
intervals for some weeks. There was a return of 
the numbness several times, but it was always 
relieved by the administration of ergot. 
Mrs. B., thirty-three years old, has two children, 
and has always enjoyed excellent health, with the 
exception of an attack of chorea, which lasted from 
the twelfth until the fifteenth year, since which time 
she has always been somewhat “nervous.” She is 
a very healthy-looking woman, with bright color, 
and is in good flesh. The urine was found to have 
a specific gravity of 1018, to be slightly acid, and 
contained neither albumin nor sugar. She has had 
some dysmenorrhea since marriage, but menstrua- 
tion has otherwise been regular and normal. About 
three months before coming under observation she 
began to have numbness in the left hand on rising 
in the morning. This soon extended to the right 
hand, and then became painful. The numbness and 
painful prickling soon extended to the shoulders. 
In a few days sleep became disturbed, and soon the 
numbness was so great that she would be awakened 
by it soon after falling asleep, so that for several 
weeks her rest was greatly broken. Within a few 
weeks the numbness extended to the feet and legs 
during sleep. There is no loss of sensation, and the 
patient is able to use the hands in sewing and in 
performing other acts. She was ordered a pill of 
ergotin, grs. ii, and the extract of cannabis indica, 
gr. yA(, three times a day. In three or four days she 
reported very marked relief from the numbness, and 
the dose of ergotin increased to grs. vi ter in die. 8 
In two weeks she stated that she was very much 
better, that the numbness had left all of the ex- 
tremities except the left arm, and it was here very 
much less. She was then directed to withhold the 
ergotin and to take lithia-water freely. She re- 
mained free from the numbness for two weeks, when 
she had a sharp attack, chiefly affecting the fingers 
and hands. She was then ordeied to renew the pills 
of ergotin and cannabis indica, and in a few days 
reported complete relief. She was still nervous, and 
was given a pill of iron valerianate, quinin, and 
strychnin, and has remained free from any numb- 
ness up to the last report that I have had of the case. 
While ergot relieves very quickly the numbness 
and painful formication in these cases of paresthesia, 
it is always necessary to use additional means for 
the improvement of the general nutrition. Massage 
is of great value, and general faradization is also 
useful. Change of air, and tonic doses of iron, 
quinin, strychnin, usually effect a cure after the re- 
lief of the symptoms by ergot. There are cases of 
paresthesia which are due to lithemia, and these 
usually yield to appropriate anti-lithemic remedies. The Medical News. 
Established in 1843. 
A WEEKLY MEDICAL NEWSPAPER. 
Subscription, $4.00 per Annum. 
The American yournal 
OF THE 
Medical Sciences. 
Established in 1&20 
A MONTHLY MEDICAL MAGAZINE. 
Subscription, $4.00per Annum. 
COMMUTA TION RA TE, $7 jo PER ANNUM. 
LEA BROTHERS dr* CO. 
PHILADELPHIA.