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.

    1150/1256 (page 1108)
    is sometimes extremely difficult because hysterical arthralgias may so closely resemble organic joint affections—certainly in regard to fixation and position of the member and in the pain—as to make mistakes extremely likely. Hypotonia of the muscles, actual decrease and flaccidity of the muscular tonus, is seldom observed in these patients. The flaccidity of the muscles after injury to the joints is generally due to inactivity. We must now consider active motility in these patients, and what has been said in regard to the difficulty in the diagnosis of muscular tension may here be repeated. Whether there is complete and real paralysis of an extremity—for the condition may be due to hysteria—cannot always be de- termined by a single examination, but after repeated investigations this should not be difficult. Whether, however, there is merely a diminution in the power of certain movements, or of an entire extremity, or—which often happens—this is simulated by the injured person, is one of the most difficult problems which the neurologist is called upon to decide. True “ adynamia ” or “ hypodynamia ” is more easily diagnosticated when it implicates the en- tire motor apparatus of the body than when the power of only a single member is diminished. General adynamia, which is more conspicuously shown by the abnormally great exhaustion than by the slight production of power, accompanies hysteria as well as neurasthenia and hypochondriasis. Local hypodynamia is decid- edly more common in neurasthenia and hypochondriasis than in pure hysteria. It is to some extent characteristic of general adynamia that in the upper extremities the grasp of the hand in particular appears weak while the shoulder- and elbow-joints are still powerful. Inversely, in the lower ex- tremities the movements of the foot are quite forcible while those of the Lip- and knee-joints are hypodynamic. Hypodynamie conditions in the course of the cranial nerves are not rare in these patients. They are revealed by an inability to wrinkle the forehead, to open the eyes widely, to rotate them outwardly, and to protrude the tongue. The movements of the eyes and, even more so, of the tongue are occasionally impeded by hysterical spasms. In the same frequency with which the power of motion is decreased co- ordination is disturbed. Undoubtedly ataxic movements take place, but only rarely and in certain forms of hysteria. A symptom which is usually re- garded as a sign of coördinative disturbance is that on closing the eyes and placing the feet close together the patients sway or even fall. Sometimes this swaying occurs when the feet are in juxtaposition with open eyes. This is not the true Romberg’s symptom, but is a psychical phenomenon, for sway- ing with closed eyes and feet close together is also noted in amaurosis. The disturbances of the gait in traumatic neuroses are many and various. Some of the patients when walking exhibit only such sluggishness and flac- cidity as corresponds to the general motor weakness; others, and this is by far more common, simply drag the injured leg and try to spare it. The leg is then slowly abducted and extended at the knee-joint, probably at first voluntarily although often unconsciously, in the subsequent course of the disease from habit and unconsciously; these disturbances in the gait are usu- ally observed in neurasthenics and hypochondriacs. More manifold and interesting are hysterical abnormalities of gait. Here