Diseases of the nervous system / edited by Archibald Church.

Date:
1908
Catalogue details

Licence: In copyright

Credit: Diseases of the nervous system / edited by Archibald Church. Source: Wellcome Collection.

    1132/1256 (page 1090)
    hyperalgias, which often accompany hysterical rachalgia, must not be for- gotten. (f) With Diseases of Other Organs.—The regional topoalgias give suffi- cient cause for mistakes of this kind. First the articular topoalgias must be considered. I advocate a minute surgical examination in all of these cases. If there be any doubt an X-ray examination is necessary. If there be any suspicion of tuberculous joint inflammation careful temperature records are necessary. I am in doubt whether there are a greater number of reckless operations performed on account of an inconsiderate diagnosis when pure hysterical topoalgia is present or whether the necessary operation is omitted more frequently from a hasty diagnosis of hysterical topoalgia. For this reason alone a minute surgical examination is required. If no surgical affec- tion is present the well known characteristics of hysterical topoalgia, as a rule, are sufficient for a correct diagnosis. Other hysterical topoalgias may simulate gall stone disease, a gastric affection, angina pectoris, a peritonitis, etc. In these instances all of the diagnostic aids known to internal medicine are to be invoked, and only then should a diagnosis of hysterical topoalgia be made by exclusion. I cannot enter upon a minute differential diagnosis of these conditions, they will be found in the respective chapters of this work dealing with the separate maladies. There is often the greatest difficulty in the differentiation of hysteria from malingering. The hysteric impression of “ not being able to walk ” cannot be so readily discerned from the “not being.willing to walk ” of the malingerer, as it might appear. It finally depends upon this: whether or not in the occurrence of the symptom under consideration a conscious con- ception has been active from which advantage is to be expected. Where this is the case an attempt at aggravation is the motive. If the conscious con- ception which produces the symptom, from which an advantage is expected, is the only cause of its presence, the case is one of simple malingering. Practically when we are considering the question “ simulation or hysteria ” we must investigate whether the report of the patient is contradicted by the actual psychic condition present, for example, whether he maintains, against his better knowledge, that he cannot walk, etc. I cannot describe the different methods which are in use to obtain this knowledge. Most of those in vogue, to unmask simulated disturbances in sight and hearing, cannot be employed in this condition. If we determine, in the well known manner, that a person who simulates right-sided deafness nevertheless hears upon the right side while we make him believe that he is hearing with the left ear, whereas the sound wave actually strikes the right ear, this argument would not be ap- plicable in hysteria, for here the entire disturbance is dependent upon im- pression : a hysteric who suffers from hysterical deafness upon the right side must, if he is able to appreciate sound waves in the right ear, hear these, although he may believe that only the left ear is capable of appreciating sounds. It is necessary to point out that simulation of the entire pathologic picture can never be demonstrated from the proof of simulation of a few symptoms. Exaggeration and aggravation are so common in hysteria that we must always reckon upon a combination of actual and simulated symp- toms or with an exaggeration of actual symptoms. We may only speak of complete malingering when we are able to demonstrate that each separate