Case 177. (Crouzon, March, 1915.)

A man of 32 (never well, with general weakness, ideas of consumption and vacuous thinking following a good recovery from bronchitis at 28, unsuccessful in business, subject to weaknesses) had had eighteen months antebellum of what might be called psychasthenia. There were spells of loss of consciousness without convulsions, and probably of hysterical nature. There had been for two years insomnia and a general hypobulic slowing down of work.

In military service the crises became more frequent, coming two or three times a week. Tuberculosis could not be shown, nor was there any organic lesion of the nervous system. The arterial tension (Potain sphygmomanometer) stood at 11.

According to Crouzon, arterial hypotension is an objective sign tending to assure the organic nature of a psychasthenia. Whereas simple neurasthenics are hypertensive, others have long been recognized as hypotensive; but heart experts have recognized this asthenic hypotension more than psychiatrists or neurologists. In differential diagnosis it is necessary to consider and exclude the early hypotensions of pulmonary tuberculosis and those of Addison’s disease. This hypotension is most frequently observed in constitutional neurasthenics and psychasthenics. Hypertensive drugs, adrenalin, tincture of colchicum, have produced a transitory improvement in a number of cases, but the amelioration has halted with the stoppage of the drugs.

Re hypotensive and hypertensive cases, see remarks of Lépine under Case 176. See also Case 169, illustrating some contentions of Green, from Mott’s clinic.