A treatise on common forms of functional nervous diseases / by L. Putzel.

  • Putzel, L. (Leopold), 1855-1942.
Date:
1883
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Licence: Public Domain Mark

Credit: A treatise on common forms of functional nervous diseases / by L. Putzel. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    therapeutic standpoint. Rosenbach showed (and I have verified his state- ment on several occasions) that the passage of a constant galvanic current through the spinal column will reveal tlie presence of tender points, at times when they are not appreciable upon pressure with the finger. But these tender points are not, by any means, invariably present in chorea, and some writers have been unable to detect them. If we bear in mind the great frequency of this symptom in hysteria, spinal irritation and general nervous prostration, we will not be tempted to lay much weight upon its appearance in chorea. I know, from personal observations, that physicians will sometimes regard this symptom as present when more careful examination shows that the position of the tenderness varies from time to time during the course of a single examination, is absent when attention is diverted, etc. Mental disturbances are rarely absent in chorea. As we have men- tioned in the beginning of this article, the children usually become peevish, irritable, and obstinate, at the onset of the affection. We desire to call at- tention emphatically to these symptoms, since they are almost invariably present, whether the disease be mild or severe, and because, in our judg- ment, they furnish important indications of the position of the lesion in the affection under consideration. But in rarer instances, true insanity develops during the course of chorea. Arndt,' Avho called attention to the close relationship which exists between the two diseases, states that many cases of insanity merely represent the transmission of the chorea from the motor to the intellectual centres of the brain. Insanity de- velops more frequently during chorea than is usually supposed. Krafft- Ebing ’’ divides this form into three classes, viz., mania, melancholia, and a variety characterized by delusions of demonomaniac persecution. He regards them as “ inanition-jjsychoses,” caused by exhaustion induced by the violent character of the muscular movements, and by the dimin- ished sleep. It is more than doubtful, however, whether these views will hold good with regard to all cases of this character, and one of my cases, at least, can not be included in this category. The insanity commonly oc- curs at the height of the choreic affection and the mental manifestations present a disjointed character, furnishing an analogue, as Arndt pointed out, to the phenomena observed in the muscles. Cliorea sometimes simu- lates insanity although the mental powers are intact. Thus, the patients may ajjpear to be incoherent in their speech, owing to the fact that articu- lation is interrupted by choreic movements of the muscles of phonation, giving rise to the involuntary utterance of words or disjointed sentences, foreign to the matter under discussion. T.his apparent incoherence of ideas, together with the destructive tendencies manifested by the patient on account of his lack of control over the muscles, has led physicians, in several instances, to make a diagnosis of insanity although tlie intellec- tual manifestations were entirely normal. An English alienist, whose name escapes me, has reported two cases of this nature Avhich had been committed to an insane asylum. The ordinary course of chorem mania is exemplified by the history of the following patient under my charge. Case III.—Fanny M., mt. 17|- years; family history is entirely negative as regards any neuropathic tendencies. The patient always enjojec ' Arch. f. Psych. Bel. I. * Haudb. f. Psychiatric. Bd. I., 1879.