The more recent conceptions regarding hysteria and their relation to the traumatic neurosis / by Tom A. Williams.

  • Williams, Tom A. (Tom Alfred), 1870-
Date:
1909
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Licence: In copyright

Credit: The more recent conceptions regarding hysteria and their relation to the traumatic neurosis / by Tom A. Williams. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    [Reprint The Medicah PR{ \, Jammry, 1909.] .c:^. -i+Ti-t' -jl * ' THE MORE RECENT CONCEPT lOI^S RE- GARDING HYSTERIA AND THEIR RE- LATION TO THE TRAUMATIC NEUROSIS. By Tom a. Williams, M. B., C. M., Hdiii., Washington, D. C. The medical profession has often been reproached for its incompetence in the face of certain long-standing nervous affections of which the functional nature is later proved by a cure through Chris- tian Science, i\Jental Healing and other Faith cures. Sometimes the psychic ele- ment in the recovery is not so clear, as when it is disguised in such procedures as Chiropraxy, Osteopathy, Homeopathy, or even, in some cases, Fdectro-therapy when indiscriminately applied. .\ny of' these means, just as surely as drugs, may affect a symptomatic cure merely through the suggestion they convey. In this respect, it is to be regretted that the j^rocedure of too many practitioners is defective. For many, who should better merit the name doctor, when uncertain or vague in their diagnosis, will run the gamut of their armamentarium on the chance of a lucky hit. Even the thera- peutic hhmderbus is by no means ex- tinct. There was formerly some justification for this demerit; hut nowadays, pre- cision in neurological diagnosis has re- moved all excuse. Even though the general practitioner himself has not be- come versed in the clinical technique for investigating the nervous system, yet it is not difficult to find a competent neurol- ogist who can in most cases distinguish with certainty symptoms arising from organic defect from those arising in an idea, emotion, or defect of will. No longer need we rely upon the method of exclusion for diagnosing ])sychic disorder. The signs by which we distinguish ])sychic symptoms are as positive, clear and demonstrable as any other reaction observed at the bedside. For instance, a blush induced by a sug- gestion by the investigator is as much an observable, unmistakable,' pathog- nomonic reaction as is the more simple extensor reaction of the great toe when the sole of the foot is lightly stroked in a patient*having a disorder of the motor projection fibres in the pyramidal tract or elsewhere in their course. The tests we employ for the estima- tion of attention, perception, memory, association of ideas and fatiguability differ not in kind but only in complexity from those employed in the mensuration of motility ancl sensibility, including the function of the special senses, the validity of which is disputed by no one. Even the emotions are now being studied by an exceedingly delicate galvanometric method devised by Jung in Switzerland and now being used in this country by Petersen and Sidis among others. We are not yet in a position to measure the very complex reaction known as sug- gestibility ; but it would be as absurd on this ground to forbid us to ascertain it clinicall}' as would be the prohibition of the cardiac murmurs as physical signs unless we measured their sonority in- strumentally. Just as skill in an ap- preciation of cardiac muriiiurs requires a long apprenticeship in auscultation, much more does the technique for the elicitation of suggestibility require train- ing and experience. Many of us may remember when it was not a commonplace to postulate a source of infection upon diagnosing an abscess. lEit the finding of organisms has taught us to do this. New technique is now permitting us to find syphilis when we diagnose tabes or dementia paralytica. It is becoming known that a hysterical symptom is always the prod- uct of a suggestion. The t\vo following cases are striking instances of the burial of a suggestion for a long period, and its final emergence as a symptom con- stituting a hysteria: The first case was that of a Hebrew bo}q in whom hysterical retention of urine was found to have as its source the fixed idea engendered by the effort to retain his evacuations during a period of three days while he was hiding from the Russians in a large barrel during the massacres of the Jews. Although, how- ever, the boy presented other hysterical symptoms within six months of this in- cident, it was fully a year before the retention developed. The second case was that of a jrirl