CIRCULATORY AND SENSORY 
XJisorders of 
BY 
<_J. W. MCZI3F=?IED^T m. £□., 
MEDICAL SUPERINTENDENT MILD AUF'?E SAN1T/KIUM FOB NERVOUS DISEASES. 
(Reprint from Alienist and Neurologist, January, 1889., Some Circulatory and Sensory Disnrdsrs 
of NourasthEnia, 
J. H. McBRIDE, M. D., Milwaukee, Wis., 
Superintendent Milwaukee Sanitarium for Nervous Diseases. 
There is hardly any limit to the functional derangements that may 
accompany neurasthenia and its related conditions. The various 
organs being dependent upon the nervous system for the energy that 
directs their vital machinery it follows that to the extent to which the 
central power* fails in its supply of force will the organs also fail in 
that smooth and balanced performance of function that belongs to a 
physiological condition. 
Hence we find that the symptoms of neurasthenia or nervous 
exhaustion counterfeit those of almost every disease, and it is not 
always easy to separate the apparent from the real, and to decide 
whether the symptoms represent a functional or organic condition. 
As this is especially true of the vascular and sensory disorders of 
neurasthenia I have thought it would be instructive to give a brief 
statement of the chief derangements of the sensory nervous system 
and of the circulation that are frequently found in this disorder. 
Except inflammation there is scarcely a disorder of the vascular 
system that is not observed in nervous exhaustion. We find func- 
tional derangement of the heart simulating valvular disease, transient 
congestions, anaemies, oedematous swellings; and in other cases still, 
a medley of symptoms that may combine some features of several 
diseases. 
One of the frequent symptoms of neurasthenia is functional 
derangement of the heart and it not only alarms the patient, but may 2 
cause serious inconvenience and distress. It is perhaps no exaggera- 
tion to say that four-fifths of the cases of this disorder suffer from 
functional heart trouble. The most usual form is excited action of 
the heart. Excited and even violent action of the heart may be 
caused by the most trivial occurrences, such as the receipt of a 
letter or a telegram, and the excitement may be so great as to cause 
faintness. 
A lady patient of mine had an attack of syncope on receiving a 
telegram about a very ordinary matter, and at another time she 
fainted on seeing' a messenger boy approaching the door. 
There is a class of cases in which violent and tumultous action of 
the heart occurs on lying down at night, and these paroxysms are 
sometimes so severe as to seriously interfere with sleep. In a few 
cases I have observed it as the first indication of an approaching break- 
down of the nervous system, and whereas at first it is usually transient 
and of mild form, it becomes more marked with each recurrence, and 
of longer duration. One peculiarity of this trouble is that the palpi- 
tation occurs only on lying down at night. The patient can lie down 
and sleep during the day-time, being entirely free from it; but at 
night the paroxysm comes on. This form of trouble seems to occur 
at about the age of puberty. Indeed tumultuous heart action with 
flushed face and throbbing temporal arteries occuring at night appears 
in subjects of nervous temperament at about puberty and sometimes 
in conditions of apparent perfect health. 
I have seen a number of such cases. One, a young man of 
nineteen, who lost much sleep on this account, and during a period 
of two years he slept little at night, though he slept without difficulty 
during the day. In a female of sixteen this trouble prevented sleep the 
first half of the night for many months, though at times for several 
days she was entirely free from it. The pulse which was normal, 
during the day, would, on lying down at night, run up to no, being 
of high tension and irregular. The patient afterward recovered from 
the neurasthenic condition from which she suffered, and the peculiar 
cardiac disorder (if such it can be called) disappeared, though no 
remedy I gave had the least influence in relieving the special difficulty. 
From my experience I think it quite useless to give remedies for this 3 
special symptom, and where it occurs in neurasthenia it disappears 
on relief of the general condition. 
Just why these paroxysms of palpitation and vascular excitement 
should occur only at night, I have been unable to decide; but then 
there are many symptoms of neurasthenia that are obscure and appar- 
ently past finding out. Cardiac debility, shown in palpitation or even 
in attacks of syncope on exertion, are not unusual in the severer forms 
of neurasthenia. One female patient who had been confined to bed 
for many months, fainted on being propped up in bed, and after 
regaining the power to walk she would faint if she walked rapidly or 
a little farther than usual. These cases of heart debility are found in 
those in which the prostration is extreme, and also where the patient 
has been confined to bed for some time. 
Chills, followed by high fever, are not infrequent in cases of nerv- 
ous exhaustion or more properly in cases of brain exhaustion. By 
brain exhaustion I refer to a class of cases, usually men, in which 
overwork has resulted in a set of symptoms referable almost entirely 
to the brain, the bodily health remaining good. There is usually cere- 
bral congestion, sleeplessness, despondency, inability to apply the 
mind to work, or to consecutive thought, and loss of interest in usual 
occupations. This condition is generally curable, though it is some- 
times the first step in the long descent of mental deterioration. The 
chills may recur at regular intervals and, with the fever, simulate 
malaria; and in fact are sometimes mistaken for it. I have seen a 
number of cases where this form of nervous chill had been considered 
malarial, and treated for it. 
A gentleman sixty-three years of age, who was under my care with 
chronic cerebral congestion and slight loss of mental power, had 
severe chills for a period of six months, recurring about twice a 
month, and each chill followed by high fever. The chills were caused 
by anything that tended to exhaust him, over-exertion, worry or 
excitement. The fever that succeeded the chills usually reached a 
temperature of 102 and abated in about six or eight hours. The 
fever was accompanied by rapid and full pulse, and all the symptoms 
of marked cerebral congestion. On several occasions he was partially 
unconscious for a number of hours during the continuance of the 
fever, and he was always confined to bed on the succeeding day. It 4 
is interesting to note that this gentleman entirely recovered, and is 
now, at sixty-eight years of age, in good health. 
Another patient, a lady, had severe attacks of congestion of the 
brain, during which she was frequently unconscious for several hours. 
These attacks were sometimes, though not always, preceded by a 
chill, and were always accompanied by severe headache, so that they 
might have been properly called congestive headaches. Though she 
was benefited she was not relieved of these attacks by treatment; 
and now, after the lapse of twelve years, she still has them though 
they are not so frequent nor so severe as formerly. The attacks were 
occasionally accompanied by some strange and interesting mental 
phenomena, which I may detail at some future time. 
Local congestions and anaemias are frequent in neurasthenia, for 
in these cases the circulation is unstable, irregular and inefficient. 
Patients have symptoms of bronchitis or congestion of one lung, that 
will appear and disappear in a few hours. Congestions elsewhere are 
frequent. 
Bloating of the hands and feet occur where the circulation is fee- 
ble, and I have known it mistaken for Brights's disease. Bloating of 
the skin of the entire body is not uncommon. All these conditions 
of bloating of the body are worse in the evening, and appear and 
disappear irregularly during the disease. In two or three cases I have 
observed bloating of one limb while the other remained perfectly 
normal. 
In speaking of functional cardiac disorders mention should have 
been made of the paroxysm of sudden, rapid action of the heart 
that occur without any immediate exciting cause. In one such case 
I discovered a valvular murmur, though in intervals of the paroxysm 
the heart sounds were normal. This was observed not only once but 
many times. This phenomenon has been observed by others, but I 
know of no explanation of its cause. 
An abnormally slow pulse is occasionally observed in neurasthenia. 
This is usually associated with evidences of deficient blood supply to 
the body generally, and is accompanied by cold hands and feet and 
feeling of chilliness in a room that is comfortably warm for persons in 
health. Some neurasthenics have a persistently rapid pulse, and it is 
usually weak in proportion to its rapidity. The heart in such cases 5 
being weak, it attempts to make up in rapid action for its lack of 
vigor. In other cases the rapid action is apparently due to lessened 
arterial tension, which removes the peripheral resistance, and there- 
fore the heart works more easily and more rapidly. 
In regard to the sensory disorders of neurasthenia one is embar- 
rassed with the multitude of facts that even a limited experience will 
furnish. If a record were made of all the morbid sensations of neu- 
rasthenics, volumes would be necessary to contain it. Certain pecu- 
liar sensations are associated with headache. One patient who was 
subject to congestive headaches had a feeling of having her skull 
filled with crumpled paper, as she called it. She said she could hear 
the paper-like substance rattling as the headache came on; and she 
desired to know if it were not possible for the membranes to become 
dry, so that the sensation could be thus produced. 
These various sensory disorders are especially annoying, and in 
those cases where the prostration is extreme and the mind is some- 
what weak and impressible, they assume in the estimation of the 
patient a degree of reality that approaches the delusional. 
A feeling of tire in the head is a common sensation. It occurs 
most frequently in men who suffer from brain exhaustion from over- 
work. One may be entirely free from this feeling of head weariness 
during the day, but the exhaustion of the little excitements of read- 
ing or conversing causes it to return toward evening. Those who are 
troubled with this feeling find that it is especially apt to be excited by 
reading, or anything that requires even a trifling mental effort, such 
as card-playing or listening to an interesting conversation. Many 
patients have a feeling of a band around the head, that seems to 
compress it, and it is often a persistent and distressing symptom. It 
more frequently occurs in association with brain congestion and in 
persons of full habit. In a few cases I have observed it in persons 
in whom there was no apparent tendency to congestion. 
Dr. G. M. Beard long ago called attention to the frequent occur- 
rence of tender spots on the scalp in neurasthenics, and anyone who 
has seen much of this disease must have frequently observed the 
symptom. In some cases the entire scalp is tender, in other cases 
there are irregular patches of tenderness. It is especially trouble- 
some in combing the hair, and causes more inconvenience to ladies 6 
from the weight of their hair and the manipulations necessary in 
dressing it. Some ladies who suffer from nervous exhaustion find it 
necessary to leave the hair undressed, as the irritation of the hair 
"done up" snugly cannot be borne. 
In a few cases I have observed a loss of sensation on one side of 
the face, occurring after excitement or extreme exhaustion. Anaesthe- 
sia occurs in every form and every degree in neurasthenia. One 
patient who had occasional periods of depression had for about 
twenty-four hours previous a loss of sensation in the right side of the 
face, with some trouble in articulating distinctly. 
This patient subsequently had hemiplegia, involving the right side 
and including paralysis of the right side of the face and deviation of 
the tongue to the right. The previous anaesthesia and difficulty of 
articulation were doubtless symptoms of the first stage of central 
degeneracy that finally issued in a sudden hemorrhage and paralysis. 
Both pain and anaesthesia occurring in the extremities and in 
various parts of the body are common. Ladies especially are apt to 
suffer from pain in the legs at night, and they sometimes simulate the 
shooting and tearing pains of locomotive ataxia. These pains are 
sometimes persistent and annoying, and may be among the last symp- 
toms to depart. As an instance of morbid sensations that border 
upon the delusional the following may be instanced: 
A gentleman of fifty-eight was in a state of extreme nervous 
prostration, and was timid and despondent. After a sleepless night, 
when he would be nervous and apprehensive, he had a fancy that the 
air he breathed was hot in one lung and icy cold in the other. At 
times he had the feeling that the air passed from his lungs down his 
legs, and though he did not believe it to be a reality yet he would ask 
if it were not possible for it to occur. At other times he said he felt 
the air passing from the right lung to the right side and into the right 
arm. He was troubled with various other sensations of similar 
nature, all of which would only last an' hour or two after rising in the 
morning. He would then be much amused in recalling them and had 
no trouble in recognizing that they were not realities. His mind was 
as vigorous as ever and he was quite capable of judging of the affairs 
of an extensive business. 
Many neurasthenics have numbness of the legs when sitting, due 7 
to pressure upon the edge of the chair. Patients are apt to think this 
an indication of a tendency to paralysis, but there is no necessary 
relation between them. Lying on one side in bed may produce numb- 
ness of the side and lying on the arm frequently causes entire loss of 
sensation in it for hours. 
Some patients have uncomfortable sensations of heat and cold in 
different parts of the body. One side of the body may feel cold, 
while the other is apparently excessively warm, or one side may be 
normal while the other has a feeling of being very cold or very warm. 
Others suffer from cold feet; others from their feet being too warm. 
One lady slept with her feet uncovered in cold weather because of 
their feeling uncomfortably warm. 
The epileptic patient who said that as a fit came on he had a 
"horrible smell of green thunder," aptly expressed the sensory dis- 
orders that separately and transiently afflict many neurasthenics. 
One gentleman had what he called a constant "humming noise in 
his ears, " that on over-exertion passed into a familiar tune that would 
haunt him for hours. Others hear familiar voices speaking to them, 
and others hear snapping noises as though something had burst in the 
head. Dr. S. Wier Mitchell has called attention to this phenomenon. 
The patient on going to sleep is apt to be wakened by a snapping 
or loud explosive noise, as one patient expressed it, as if a "gun had 
been fired off inside his head. " 
Apparently from mere exhaustion of the nerve centers the hear- 
ing sometimes becomes dull, and I had one patient who became 
hard-of-hearing on becoming exhausted and heard again with normal 
acuteness after resting. Apparently from mental apathy, patients are 
sometimes dull of hearing in cases of neurasthenia. Weakness and 
various defects of sight are common, and there are few neurasthenics 
who can read without suffering from the exertion. Some cannot dis- 
tinguish letters of ordinary type, apparently from debility in the 
adjusting apparatus of sight. 
Many patients have elaborate visions, and some court them at 
night to while away the hours of sleeplessness. One patient stated 
that after any unusual mental exertion his entire field of vision was 
filled with kaleidoscopic views of changing colors. He would have a 
confused view of a celebrated landscape painting he had once seen 8 
and which was at first of normal colors, then of confused coloring. 
This gradually faded to whiteness, and the vision disappeared in a series 
of flashes like sheet lightning. One patient saw double at a distance, 
though he could read ordinary print without difficulty. On looking 
out on the lawn one person appeared as two, and a forest a few rods 
away appeared as a confused mass of darkness. He had no paralysis, 
and his defects of vision disappeared as his nervous system regained 
its vigor. 
The above are but a tithe of the peculiar manifestations of neu- 
rasthenia but they fairly illustrate the chief disorders of the vascular 
and sensory systems. 
Finally, concerning neurasthenia, it may be observed that there is 
no disease more generally curable if treated under proper conditions; 
and it is equally important to observe that there is no disease more 
rebellious when methods of treatment not exactly suited are adopted. MILWAUKEE SAHITABIUM FOB NEBV0US BISEASES. 
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The Sanitarium is beautifully located in the country, three miles 
from the city of Milwaukee. It is within a few minutes' walk of the 
Chicago, Milwaukee & St. Paul depot, but is in a quiet and retired spot, 
where patients have the freedom of a large park without observation or 
intrusion. 
The institution is designed for the treatment of nervous disorders 
including mild cases of insanity. 
The buildings are new and were constructed for the special purpose 
of a Sanitarium. They are heated by steam and lighted by electricity 
and the entire sanitary arrangements of the institution are the best. 
Each patient is provided with a separate room, and skilled nurses 
are always in attendance. 
It has been the constant endeavor to make the Sanitarium assimil- 
ate, as nearly as possible, to a home, with few of the characteristics of an 
institution and with every diversion that can contribute to the entertain- 
ment and improvement of the patients. 
Terms reasonable. 
For information, address the Medical Superintendent : 
j. h. McBride, m. d., 
WAUWATOSA, 
MILWAUKEE CO., WIS.