Extracted from the 
American Journal of the Medical Sciences for April, 1887. 
WAKING-NUMBNESS :* 
A HERETOFORE UNDESCRIBEJ> NEUROSIS. 
By Andrew H. Smith, M.D., 
PHYSICIAN TO THE PRESBYTERIAN HOSPITAL, NEW YORK ; PROFESSOR OF CLINICAL MEDICINE AND 
THERAPEUTICS IN THE NEW YORK POST-GRADUATE MEDICAL SCHOOL. 
Six years ago the following case came to my notice, and I have had 
constant opportunity to observe it since: 
Case I.-A gentleman, forty-three years of age, in perfect health, 
and very actively engaged in professional work, experienced every time 
that he awoke from sleep a sensation of numbness in the ulnar distribu- 
tion in each hand. The sensation exactly resembled that which results 
from pressure upon a nerve, and with which we are all so familiar, when, 
as we say, the foot goes to sleep. But it was soon observed that motion, 
sensation, and the tactile sense were entirely unaffected, while in the 
case of pressure upon a nerve, all these functions are suspended. The 
condition occurred independently of posture and of any other circum- 
stance, save the essential one of waking out of sleep. If the patient 
dozed a moment in his chair, the peculiar sensation was sure to be 
present when he awoke. 
For some months the numbness or tingling was confined to the little 
finger and the ulnar side of the ring finger, but gradually it spread over 
the whole of both hands, then up to the elbows, and finally reached the 
shoulders, and overspread the upper part of the thorax. Next, the tip 
of the tongue became affected, and in the course of two or three years 
the lips were included. Since then there has been no further progress; 
on the contrary, for the last year and a half the shoulders and chest 
have been exempt. The period during which the patient is conscious of 
the sensation does not exceed a minute. He thinks that for some time 
past it has been absent very frequently, but he has become so accustomed 
to it that it may pass unobserved, unless more than usually intense. 
Quite often a position is assumed during the night in which the ulnar 
nerve is compressed. The opportunity is then afforded of contrasting 
the two conditions. In the ulnar distribution there will be paralysis of 
motion and sensation, and the tactile sense will be lost; while in the 
rest of the hand these functions will be intact. The feeling of numb- 
ness, however, will be uniform throughout the hand. 
I have been able to collect three cases of this affection, besides the 
one described above. One was in my own practice, and the others in 
1 A convenient name for this would be narkophypnia; vapKT), numbness; aovrrv6G), to awake. 2 
SMITH, WAKING-NUMBNESS. 
the practice of friends, to whom I am indebted for the histories. The 
second case in my own practice occurred in the person of a type-setter, 
forty years of age, who came under my observation November 5, 1886. 
Case II.-No history of syphilis, rheumatism, or the alcohol habit 
could be obtained. Was well until five years ago, when, on waking one 
morning, he found himself partly paralyzed in the right arm and leg. 
There was also some thickness of speech, which, however, soon disap- 
peared. The paresis continued, and two years later was followed by a 
similar attack affecting the left side and the left half of the face. This 
attack was accompanied by intense abdominal pain and severe con- 
stipation, and was followed by oedema of the right leg. The paresis still 
continues, being most marked in the right leg. He drags the right toe 
in walking. He is cachectic and badly nourished, and there is a blue 
line along the gums. Has had several attacks of lead colic. The patellar 
reflex is diminished on the left side, and slightly exaggerated on the 
right. Umbilical reflex normal on the left side, absent on the right. 
Cremasteric absent on the left side, normal on the right. Plantar reflex 
exaggerated on the left side. Electro-muscular contractility everywhere 
normal. 
Patient complains of a sensation of numbness or tingling in the fingers 
of both hands on awaking out of sleep. There is no impairment of 
motion, and he can appreciate the qualities of the bed-clothes, for exam- 
ple, by the sense of touch, as well as ever. There is no change in the 
appearance or temperature of the fingers. The sensation is always 
present on awaking, even if it be only from a short nap in the daytime. 
It passes off in the course of one or two minutes, without having recourse 
to rubbing or other means for its removal. Occasionally it is felt on 
the left side of the face and neck. The patient is an intelligent man, 
and his statements are very clear and definite. 
The next case is furnished by Dr. S. II. Hunt, of Long Branch, N. J., 
and I will give it in his own words: 
Case HI.-Miss G. S., set. twenty-five years, had, in August last, a 
severe attack of malarial dysentery, which lasted for one week, producing 
great emaciation and prostration. After a few weeks her recovery 
seemed complete, and she was able to perform her accustomed household 
duties. In the last week of November I was called to see her on account 
of a numbness of the right arm, which occurred only on her waking in 
the morning. It was referable to the ulnar side of the arm, and she 
complained mostly of those parts which received the terminal branches 
of the ulnar nerve. She stated that she had noticed it for the previous 
two weeks. There was no loss of motion or sensation, or of the tactile 
sense. It seemed to commence in the extremities of the fingers, and 
extended up the arm. She commenced rubbing her hand and forearm 
on waking, and this condition often lasted an hour or two. Knowing 
her previous history, and suspecting it might be attributable to malarial 
toxaemia, I gave her antiperiodic doses of quinine, twenty grains daily. 
On the first night she awoke at midnight, and said the sensation occurred 
at that time, but was very slight. On the repetition of the dose, there 
was an entire absence of the sensation, which led me to believe I had found 
the cause of the trouble. Much to my chagrin, there was a recurrence SMITH, WAKING-NUMBNESS. 
3 
of the numbness on the third morning. Quinine, iron, and strychnine 
were then given as a tonic, but the sensation was persistent and obstinate 
for another week. This tonic, with a change of climate and absolute 
rest, ultimately gave her relief, and the peculiar numbness disappeared 
with her general improvement. Up to this date, January, 1887, there 
has been no return of it. The arm " being asleep," from the position 
in which it is placed, is a frequent occurrence, but this sensation at 
waking, and lasting so long, has led me to inquire what is the cause or 
condition that gives rise to it. 
The next case occurred in the practice of Dr. S. H. Burchard, of New 
York, and is furnished to me by his associate, Dr. H. A. Mandeville: 
Case IV.-Mr. B. W. B., fifty-three years of age. Patient is now 
suffering from partial paraplegia dependent upon chronic myelitis. 
About six weeks ago patient began to complain of sensation of general 
numbness upon first awakening in the morning, which lasts until after 
free muscular movements of the body, when it gradually passes off; if 
the patient falls asleep again he experiences the same sensations, which 
are relieved in the same manner. During these attacks he has abso- 
lutely no loss of power; his common sensation, as well as his tactile 
sense, is perfectly normal. Urine contains a large quantity of oxalate 
of lime, and is highly acid, otherwise normal. 
The patient has been in the habit of sleeping with his head very low, 
and, thinking that the numbness might be due to an impeded cerebral 
circulation, it was suggested that he sleep with his bead higher. This 
was accordingly done, with relief to the more prominent symptoms in a 
few days, but he still complains of the numbness on first awakening. 
From a study of these cases it is apparent that the numbness is some- 
thing added to the normal condition, while nothing is subtracted from 
it. It is a purely subjective condition. There is no paralysis of motion 
or sensation, the tactile sense is unimpaired, there is no change in the 
temperature of the affected part, the surface is not blanched or mottled, 
there is no tenderness on pressure. These characteristics separate this 
condition widely from those known under the names of night-palsy, 
local asphyxia, digiti mortui, Raynaud's disease, erythromelalgia, and 
from the various paraesthesias and acroneuroses heretofore described. 
Doubtless the conditions upon which the numbness depends are present 
during sleep, but the sensation is not sufficiently strong to arouse the 
sleeper, and he first becomes conscious of it when awakened by some 
other cause. 
The cause of this condition is probably central, since the effect is 
usually symmetrical. It would seem to be connected with the lowering 
of the circulation which takes place during sleep, and to disappear 
when the circulation returns to the waking condition, whether the return 
be spontaneous, or the result of rubbing, etc. As to the latter, it is 
doubtful whether it has any other effect than that upon the general circu- 
lation which the muscular exertion would necessarily produce. 4 
SMITH, WAKING-NUMBNESS. 
As for treatment, in the only case in which the condition existed by 
itself, and independently of more serious conditions, ergot, digitalis, 
strychnia, and aconite were tried at different times, but without result. 
The inconvenience produced by the affection was so slight, that no treat- 
ment was carried out efficiently, so that even these negative results were 
of no value. In each of the other cases there was a diseased condition 
present, to which the numbness was subordinate, and which afforded the 
indications for treatment. In proportion as the treatment of the under- 
lying condition was successful the numbness disappeared. If it be true 
that the cause is central, no local treatment is likely be of service.