The simulation of hysteria / by Tom A. Williams.

  • Williams, Tom A. (Tom Alfred), 1870-
Date:
1910
Catalogue details

Licence: In copyright

Credit: The simulation of hysteria / 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.

    12/18 (page 295)
    path; nor need I discuss the combined flexion sign, which we also owe to Babinski; and I need only mention the sign described by Hoover, and its modification of Zenner, which depends upon the synergic downward pressure of one lower limb when a patient attempts to raise its fellow while both are extended upon the bed. They are all now elementary neurological tests. Sensory Symptoms.—To detect the simulation of a hyperaes- thedc area, the examiner may press at the same time with two fingers, one on the painful spot and the other close by, so as to cause both impressions to be felt as one. Pressure on the alleged hyperaesthetic area is then to be gradually ceased. A simulator will continue to complain of pain. Of course a really painful spot will cause a more rapid pulse when it is pressed upon, and may also produce homolateral dilatation of the pupil. But these signs are both inconstant and difficult to estimate even with the aid of the sphygnamomanometer, which may, however, show an altera- tion of the plateau and a dicrotism. It is very difficult to unmask simulated deafness; but simulated blindness is often revealed by an affection of clumsiness in button- ing the coat, touching the fingers together, striking a match, etc. A really blind man is quite adroit in any of these manoeuvres. A hysterical patient with contracted visual fields does not fall over objects placed to either side, a simulator does so. Hart- ridge’s a modification of the Flees’ box is very convenient in un- masking simulated amaurosis of the eye. The patient who simulates aphonia will pretend that he cannot whistle, which a hysterical generally does quite freely. The simulation of hysterical convulsions may be taken for epilepsy, which itself is well known to be often simulated. In the true epileptic dt, the pupils are, however, paralyzed or at least sluggish; and blood and urinary changes, chemical or physical, should render the diagnosis not difficult. Flora23 has alleged that the muscles that are weakened in the course of a traumatic neurosis “ nearly ” failed to respond by tetanos to long faradic stimulation. His assertions have not been confirmed; and I have no experience of the test. The same may be said of Lombroso’s allegation that the temperature is one degree lower on the diseased side. In conclusion, I need only emphasize the importance of a knowl-