A system of medicine : by eminent authorities in Great Britain, the United States and the continent / edited by William Osler.

  • William Osler
Date:
1910
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Licence: Public Domain Mark

Credit: A system of medicine : by eminent authorities in Great Britain, the United States and the continent / edited by William Osler. Source: Wellcome Collection.

Provider: This material has been provided by UCL Library Services. The original may be consulted at UCL (University College London)

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    exciting cause. Railway accident hysterica] paraplegias are of comparatively frequent occurrence. The onset is, as a rule, brusque, although its gradual development is observed, and Voss states that excessive tire of the lower extremities in anaemic young girls may be considered as a contributory cause. The distribution is apt to be extensive, although restrictive movements may be preserved. The patellar reflex is apt to be exaggerated in both types, but the absence of the signs already mentioned in the discussion on hemiplegia is indicative of the psychogenic nature of the disturbance. The functions of the bladder and rectum are usually normal, although several authors note involuntary defecation and urination. Mistakes in diagnosis, or imperfect observation, are here to be particularly guarded against, since the indefinite symptoms arising from small spinal-cord hemorrhages arc not infrequently diagnosed as hysterical. The distribution of the anaesthesia will largely depend upon the method of examination. A maladroit examiner can find almost anything lie wishes, and since the usual methods for examining for sensory disturbances are largely tinctured with clumsy suggestions, the beautiful figures of the Charcot School students are better evidences of such methods than scientific docu- ments. In examining for anaesthesia, the real point should always be guarded. The patient should never be asked if she feels, but should be questioned to distinguish between kinds of sensations. A consistent anaesthesia to all the types of possible test has never been encountered. The classical representations show a sensory distribution practically coinciding with the extent of the motor loss, but a great variety of irregular distributions has been figured. Atrophy may follow contracture, but without reaction of degeneration, although Dubois has well shown that a diminution to both galvanic and faradic irritability in the majority of cases is possible. Steinert's study shows that the previously held ideas concerning peripheral lesions and electrical changes are too narrow and in need of revision. After years of inactivity, paraplegic contractures may be absent. Astasia-abasia.—This is an irregular incomplete type of paraplegic disturbance, first described by Blocq, a pupil of Charcot, in 1888, differing from true paraplegia briefly in that there is no paralysis or ataxia of the limbs in the sitting or reclining position, but only when the patient tries to stand or to walk. Even complex motor acts may be performed, dancing, etc. Oppenheim, Binswanger, and others regard it as a syndrome met with in other conditions than hysteria. It is undoubtedly of psychogenetic origin, and, hence, should be considered as a hysterical complication of the other psychoneuroses, neurasthenia, psychasthenia, etc., rather than as an inte- gral portion of these psychoneuroses. Pseudo-tabes.—Pitres has given a full analysis of this allied disturbance. Pains, incoordinated ataxic movements, disturbance of the eyes, analgesia, etc., make a differential diagnosis extremely difficult at times. It is an interesting fact that Charcot made a diagnosis of true tabes in a patient who went to Lourdes and recovered. Hysterical symptoms in a tabetic are frequent, but with present clinical aids the diagnosis should not be difficult. Monoplegia.—Hysterical monoplegias are extremely frequent, and very irregularly distributed. Mention has been made of the paralyses of the third, fourth, or sixth nerves, of the facial and of the muscles of the pharynx