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.

    1165/1256 (page 1123)
    case when chronic alcoholism plays a role. Despair caused by inability to support a family, anger over presumable or actual injustice, and similar emotions, are usually the cause of suicide. The prognosis as regards cure is much more unfavorable than in regard to life. Here it may be laid down as a law that if there are claims for dam- ages, no matter of what nature, the prognosis is decidedly more grave. This law needs no elaboration after what has been stated of the psychical genesis of traumatic neurosis. For it is to be hoped that the connection between corporeal and psychical phenomena has been so clearly outlined that what I have said may not be construed as meaning that the patient who makes a claim for damages purposely, and as a rule, prolongs the period of con- valescence. Cases of deliberate prolongation of convalescence are certainly rare. On the other hand, the dominating thought of obtaining material damages for the injury, at the time, but only for the time, is such a dominat- ing psychical factor that, without straining conscience, it stimulates the development and continuance of a hypochondriacal mental state quite distinct from the injurious psychical effect due to the excitement of court investiga- tion of the claims. But even if no such claims are made, the prognosis is by no means good. Psychical and somatic factors may prolong the purely functional affection for many years, even when the patient is most anxious to recover. The indi- vidual traumatic neuroses show distinct differences in 'prognosis', it is best in the mild or moderately severe cases of neurasthenic type following simple peripheral injuries or slight head trauma and in those with not too severe, purely hysterical symptoms. When pain is persistent—as, for example, with ’ rigidity of the back and hysterical symptoms—the prognosis is more serious. In those hysterical cases combined with cardiac and respiratory symptoms or with conspicuous tremor, there is little tendency to improvement. In op- position to the foregoing statement, the prognosis is often somewhat better in hysteria accompanied by spasmodic attacks. Those cases in which the neurosis is based upon imbecility are exceedingly unfavorable, as are also all true traumatic cases of hypochondriasis. The gradual transition of the latter into paranoia is* not rare, and this renders the prognosis absolutely hopeless. The duration of the disease is never to be reckoned by day$ or weeks, but usually by months, and sometimes by years. As a rule, the pathologic picture of cases with a bad prognosis remains not only qualitatively but quan- titatively unchanged. Remissions are rare; on the contrary, transitory ex- acerbations are common, usually occurring after excitement or the like. Intercurrent disease may temporarily make the symptoms of traumatic neu- rosis secondary. After this intercurrent affection has run its course, the nervous phenomena appear Unchanged, prominent, and sometimes even in- creased by the addition of symptoms which are nervous “ transitional ” forms of the sequelae of the intercurrent disease. The prognosis of traumatic neurosis is generally the same in men and in women; children occupy a special position.1 The prognosis in children is i Compare Paul Schuster and Kurt Mendel: “ Traumatische Nervenkrankheiten bei Kindern,” Monatsschrift für Unfallheilkunde, 1899, Nr. C.