MANIFESTATION OF TRAUMATIC HYSTERIA

IN THE ORGAN OF HEARING.

BY DR. ERNST BARTH, Sensburg.

Translated by Dr. CARL MUND, New York.

UNCTIONAL disturbances of hearing may constitute

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the only symptom of traumatic hysteria, while other organs show no hysterical stigmata whatever.

Two years ago I had the opportunity of observing a case of complete bilateral functional deafness.' The trauma was of a purely psychical nature-an intense fright. A girl, eleven years of age, enjoying good health and with no hereditary taint, was frightened by a dog that suddenly leaped at her in the dark. She was able to relate what had happened to her in a stammering manner. Her arms were thrown into convulsive movements and the power of speech was soon lost. After a good night's rest she was as well as ever, with the exception of complete bilateral deafness, which disappeared without treatment after eight days, when hearing again became normal. A week later, while in the darkness, she was frightened by a friend who suddenly appeared before her. This caused a recurrence of the deafness. Aside from a complete bilateral acoustic anæsthesia she presented no other symptoms characteristic of hysteria. A very interesting feature of this case was the fact that notwithstanding complete bilateral deafness, unconscious perception of musical sounds was unimpaired. After two weeks, hearing returned to normal.

'Barth, "Symptomatologie der hysterischen Taubheit," Deutsche Medicinische Wochenschr., 1900, No. 22.

The following case of hysterical affection of the ear also presented the symptom just described: the integrity of unconscious perception of musical sounds notwithstanding complete functional deafness. In this case, however, the affection of hearing was but one of the symptoms of an absolute sensitive-sensorial hemianææsthesia.

A. K., twenty-one years old, farmhand, always healthy; grandmother on maternal side showed insanity. Parents', brothers', and sisters' history negative.

June 14, 1901, he attempted to dive, while taking instruction in swimming. He was not afraid of the water, as he had been bathing quite often in former years. However, a few hours after bathing he claims that a little blood oozed from the left ear, and that on the following day he experienced difficulty in hearing. As a result, two days later he applied for treatment.

Status Præsens.-Well built, healthy-looking man; normal temperature; heart and lungs normal; no sign of any injury to either ear; left mastoid tip markedly sensitive to pressure, but without any inflammatory changes in the integument or glands of this region. Ear canals dry, tympanic membranes quite normal, showing no sign of any recent inflammation; a minute, old cicatrix visible in posterior-inferior quadrant of left tympanic membrane. Turbinals of both sides moderately swollen; choanæ normal; pharyngeal tonsil present, but does not extend beyond the superior border of upper choanal margin.

Functional examination: whispered voice not heard on either side, ordinary voice only near right ear.

Tuning-fork not heard by bone conduction on either side; air conduction on right side only; inflation produces no change. States that immediately after diving he had tinnitus lasting two days. Sensitiveness of the integument of left external auditory canal and left drum membrane not altered. Entire left half of body hyperæsthetic, points being described as blunt; skin and tendon. reflexes (patellar, plantar, abdominal, and cremasteric) normal.

No tremor of eyelid. Complains of pain in lower region of

sternum.

While patient is quietly lying in bed, one observes frequent convulsive movements in different groups of muscles, in the right pectoralis major, and especially in the abdominal muscles during and generally at the end of expiration.

During the following days, the sensory paralysis increased, although the patient had not been exposed to any further noxious influences. After ten days, the following was found: the facial expression became apathetic to a certain degree, indicative of distraction of mind. The entire left half of the body became completely anæsthetic to all sense of feeling. While eyes are closed, no perception on slight touching or of pressure with blunt objects, or of a needle prick even when latter is driven into the tissues to a depth of several centimetres. The temperature sense is also lost. This sensory paralysis does not extend beyond the median line, sensation of the right half of the body being normal. Skin reflexes of both sides intact. The left-sided hemianæsthesia affects not only the nerves of touch, pain, and temperature, including the muscular sense, but also the higher sensory nerves. The left-sided oral, pharyngeal, laryngeal, and nasal mucous membrane is likewise insensitive to touch, besides having lost its specific sensorial power. The left half of tongue and palate is paralyzed as regards the sense of taste. Bitter, sour, and salty substances are not perceptible, while the right half of tongue and palate appears normal. The same condition holds good for the left nasal mucous membrane. Even pungent odors, ether or ammonia, held before the left nostril, excite no reflexes. These substances, however, held before the right nostril, clearly cause a sudden thrusting-away motion.

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With 1 D, R, L. Pupils, of medium width, react to light, the left one somewhat more sluggish than the right. Consensual reaction from right eye, not from left. Sensitiveness of left conjunctiva and left corneal reflex greatly reduced. Marked contraction of visual field in both eyes, left more than right. Left eye color-blind, right eye color-blind for green (green called yellow). Fundus of eyes normal.

Sensitiveness of left external ear and of left external-ear canal completely lost; the left mastoid process, however, is hyperæsthetic, the slightest touch causing patient to twitch. Sensitiveness of left drum membrane reduced.

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Left ear completely deaf. Tuning-fork placed on vertex not heard in either ear, but perceived by right air conduction. left side, neither whispered nor speech-voice heard; on right side, only words which are loudly shouted directly into the ear can be heard.

Notwithstanding this absence of hearing, the unconscious power

of hearing musical tones is retained. Even though the right ear, which still possessed some hearing power, had been rendered completely deaf by means of a plug of wax inserted into the ear canal, he nevertheless, at a given sign, would begin to sing the same keynote as struck on the piano. He would continue this correctly for five or six notes, then it became absolutely indistinct, and after this the accompaniment of a song on the piano would fail to induce him to sing correctly. The first keynote was invariably repeated in the same given pitch as often as the experiment was made.

The patient's condition remained unchanged for months. complained of certain morbid sensations: a sensation of pressure between the eyes, extending from the root of the nose to the hairy scalp; in the left large toe, a feeling as though the toe felt wooden; in getting out of bed he noticed a stiffness in the joints of the left knee and the foot, which he always sought to overcome by means of passive motion.

Although no change had taken place in the acoustic anæsthesia described, he stated after a week that he was unable to hear at all in the open air.

All treatment was of no avail-inflation, suggestion, even hypnotism.

The effects produced by metallo-therapy were as follows: silver coins tied on left ear, no effect; a silver coin fastened and retained on right ear for two hours caused him to complain of the same sensitiveness on pressure over right mastoid process as was present over left one. This, however, ceased after a few hours on the removal of the coin.

Ten weeks after the beginning of the disease, the patient had total night blindness; immediately after sundown he was unable to find his way about and had to be led; eight months after the beginning of the disease, no change in the absolute sensitivesensorial hemianæsthesia. The disturbance in hearing unchanged in both ears, as also the color-blindness.

The decrease in vision, however, is remarkable; he now has myopia of 3 D; the correcting glasses bring vision only to of the normal. The night-blindness remains the same.

Sensitiveness of right conjunctiva and cornea distinctly reduced, and the right eye is changeable as regards the color test.

In comparison with the severity of the disease, the relative slight trauma as a causative factor is remarkable. Inasmuch

as the patient had dived intentionally, fright cannot have played any factor, though there may have been a psychical excitement. The few drops of blood which were noticed on his left ear after a few hours very likely were the chief exciting cause to make him imagine that the hearing was impaired; the following day difficulty in hearing appeared on the side on which the slight amount of blood was found, the mastoid process of same side being extremely tender on pressure, although there was no apparent sign of a trauma or of an inflammatory process.

The following day the patient was absolutely deaf in the left ear, and had marked difficulty in hearing in the right ear; during the following days, a complete sensitive-sensorial hemianææsthesia developed on the left side of the body; notwithstanding the absolute sensory paralysis, a hyperæsthesia of the mastoid region existed. The impairment of hearing of the right ear is remarkable, though the other sensory nerves of the right half of the body show no changes. Not until months later, a hyperæsthesia seemed to develop in the right conjunctiva and cornea.

This progressive course of the disease renders the prog

nosis unfavorable.