CLASS VII—NEUROSES

HYPERESTHESIA

This condition is characterized by morbidly acute sensitiveness to
external impressions. The painful phenomena occurring in hyper-
esthesia are started by external factors, while in dermatalgia they arise
spontaneously. Like anesthesia, it may be idiopathic or symptomatic,
although the far greater number of cases belong to the latter category.
As a rule, only a small or a large area of the skin surface may be affected,
but the condition may become general. The attacks excited may be
only of a mild character, or they may become exceedingly agonizing.
They have been compared to electric shocks, and described as pricking,
darting, and burning sensations. Hyperesthesia is usually unaccom­
panied by any local change of temperature. There are a number of
possible causes: it may be dependent on functional disturbance or some
pathologic change in the brain and spinal cord or other deranged condi­
tion of the nervous system; it is frequently met with in hysteria and neu­
rasthenia. In well-marked cases the cutaneous surface is sensitive to
an abnormal degree, and even contact with the clothes and the air gives
rise to decided discomfort. It varies in duration; it may be only tempo­
rary or may become chronic. Occasionally cases of hyperesthesia present
themselves in which it is difficult or impossible to determine the fons et
origo mali; such instances belong to the idiopathic variety.

The prognosis and treatment will depend wholly upon the character
of the underlying condition.

Meralgia Paræsthetica.—This peculiar, rare condition involving the
skin of the outer lower two-thirds of the thigh, to which some neurolo­
gists and White¹ have recently called attention, is characterized by
perverted sensations somewhat varied in the same case and sometimes
different in different cases. The most common sensations seem to be
those of tingling, formication, heat, and cold. Less frequently there
have also been noted pain, numbness, tension, constriction, distention,
hyperesthesia, anesthesia, imaginary movements and pruritus, and
rarely a sense of throbbing. They are not, as a rule, constant, and
usually occur when the patient is standing or walking. Various causes
have been assigned, such as neuritis, rheumatism, gout, alcoholism, and
as following infectious diseases, severe colds, etc. The area involved
seems to be that supplied by the external femoral cutaneous nerve.
Treatment is usually without effect, although massage has given partial
and temporary relief in some cases, and x­ray exposures may lessen the
frequency of the attack (White). Goldenberg had prompt cure in a case
from the wearing of a metal plate in the shoe for the relief of a flat-foot.

¹J. C. White, “Meralgia paræsthetica,” Jour. Cutan. Dis., 1906, p. 160; Sherwell,
ibid., 1910, p. 281, reports a case—patient being himself.

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