DIAGNOSTIC POINTS AMONG THE MOTOR PHENOMENA OF ITYSTERIA.1. In aphonia, etherization and faradization of the throat will cause the patient to speak. Talking during sleep may occur, and singing is possible in many cases. The aphonia may have come on suddenly after emotional disturbance of trauma tism. Paralysis of the vocal cords is al ways bilateral in hysteria; unilateral pa ralysis is due to organic disease. The aphonia disappears suddenly.
2. In hemiplegia the face is not par alyzed, although it is often anesthetic on the side corresponding to that of the hemiplegia.
3. The leg is dragged or shuffled, the foot is not swung outward in bringing it forward, and the toes do not catch on the ground or floor as is the case in hemi plegia from organic brain disease.
4. The nutrition and electrical irrita bility of the muscles are well preserved.
5. The deep reflexes may be normal, and the plantar absent on both sides. If the knee-jerks are increased, the differ ence between the two sides is not great. Absence of the plantar on one side rarely occurs in hysteria.
G. On testing the strength of the flexor muscles there is abnormal contrac tion of the extensor muscles of the joint.
7. The flexor contracture of the hand is not lessened by forcibly flexing the wrist as occurs in organic disease.
S. Ptosis of hysteria is not due to pa ralysis of the levator, but to spasm of the orbicularis, and the spasm is increased on requesting the patient to look up. If
double, the head is thrown backward on trying to look upward. If the head is held by some one both orbiculares con tract (Gowers).
9. The ataxic gait is exaggerated be yond that of organic disease, and has the same psychical character as the muscular movements of the hysterical convulsion.
10. Astasia-abasia, inability to stand or walk, is always presumptive evidence of hysteria.
11. The tremor usually ceases during repose if the patient thinks that she is not watched, but it sometimes continues while the patient is sitting or lying. Vol untary motion increases the tremor. If the patient is requested to touch with the index finger of one hand a small object, little difficulty is experienced in doing this, but after the finger has been in con tact with the object a short time, irreg ular jerky movements of the arm begin, differing from the tremor of dissemi nated sclerosis, in which great effort is frequently required in bringing the finger in contact with the object, but, this accomplished, the tremor ceases im mediately (Buzzard).
12. It is probably safe to say that par alytic incontinence of urine and forces never occurs, and the presence of incon tinence of either should always arouse suspicion of organic disease.