The hysterical element in orthopædic surgery / by Newton M. Shaffer.

  • Shaffer, Newton M. (Newton Melman), 1846-1928.
Date:
1880
Catalogue details

Licence: Public Domain Mark

Credit: The hysterical element in orthopædic surgery / by Newton M. Shaffer. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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    without any recognized cause and were as frequent at night as by day. She never awoke with pain and was, as a rule, free from it up to 9.30 o'clock, A.M., when it would generally occur : there was never any swelling of the joint which the patient could detect, though it was frequently hotter than the sound one : she was always able to move the joint with more or less freedom though at times with considerable pain : passive motion was accompanied by considerable resistance in the extremes of flexion and ex- tension. After some months the symptoms became worse and the family physician ordered crutches, which the patient has ever since used, without, however, the relief which was anticipated. Accompanying these local symptoms were other manifestations, affecting, especially, the head and neck. The sensations here were those of trouble in the back of the neck —pain, not in- creased by motion, a sensation of heat like a hot plate, in the cervical region, but no headache. It sometimes happened that when the knee did not ache, the neck did, and vice vejsa. The pain in the knee was not superficial but was referred to the very centre of the joint. It was either a gnawing or a lancinating pain : —there were no hyper^sthetic areas and, at the time of the examination, the local and general temperatures were normal. The ])atient did not look at all ill, and there were no facial traces of suffering so frequeni^ly seen in chronic osteitis of the joint ends : but there was hereditary history of phthisis, the mother having died therefrom. The case had been under the care of one who would be recognized as a competent observer, who, attributing too much weight, in the absence of specific symp- toms, to the phthisical history, had made a diagnosis of incipient osteitis of the knee. There were symptoms which suggested this lesion, but like all purely neurotic symptoms, they were extremely irregular and inconstant, and this very element was the basis of an exclusive diagnosis in the case. The crutches were dispensed with and the patient, who was an indefatigable teacher, was removed from her routine duties. It took the patient five days only to discontinue the crutches, though she had used them continuously for months and had not gone out of the house for the three months preceding Christmas, 1877 :—this discontinuance did not produce pain and their ab- sence, after the novelty wore off, was pleasant rather than other- wise. During the past summer the patient has been at the sea- side and among the mountains, has used no artificial support whatever, and has returned greatly improved.