Some cases run round and round, only stopping to fall exhausted and senseless to the floor. Another variety manifests no motor excitation whatever; the pa tient will suddenly, in the midst of some rational action, wander quietly off by himself, accost persons on the street, and, at times, threaten to do violence if the one addressed does not agree to some absurd demand on his part. Then comes the awakening. The patient does not know where he is or how he got there, and exhibits signs of exhaustion and thirst.
The treatment of these cases is the same as that for idiopathic epilepsy.
Hysteria of Childhood.—In referring here to hysteria, we shall simply con sider that type in which there are ob served automatic movements.
Hysteria of childhood is a condition which frequently simulates anomalous epilepsy, and at times it is only with ex treme difficulty that a differentiation can be made. Like epilepsy, there is often an initial scream, which differs in quality from that of epilepsy, and which usually is not given until the patient is aware that she (usually a female) has an audi ence. The patient then falls to the ground in a way that she will not be hurt. At times a very fair representa tion of opisthotonos is presented. En gorgement of veins about the head is fre quently noted, and more or less active tonic spasm is present. After this fol lows a condition of relaxation, with wild quasipurposeful movements of the arms; broken short sentences, explosions of passion and profanity, weeping, laughing, and grinding of the teeth often follow. The larger and more sympathetic the audience, the more varied and emotional will be the manifestations.
Anesthesia, paralyses, hallucinations, and ecstasies have their turn, and grad ually the patient quiets down to normal. The notable feature in these eases is the imperative and purposeful movements, mostly confined to the arms, which the patient will often assert, during the at tacks, she cannot possibly stop.
[Dr. Alfred Reginald Allen, my assist ant, aborted a most pronounced one of these seizures in a hospital ease by an hypodermic injection of sterilized water with a dull needle. In another case of the same kind he used hypnotism, the sudden command, successfully. J. MADISON TAYLOR.] A thetosis should never be confused with any other automatic condition, and all that need be said of it here is that when hysterical, or secondary to some functional or mild disorder, a good prog nosis may be given, otherwise it should be guarded.
Automatic Rhythmical Movements.
In this term are broadly included head nodding, or movements of assent; head shaking, or negation movements (synon ymous with spasmus nutans and nieti tatio spatia); gyrospasm; head-banging; eclampsia nutans, or salaam convulsions; and eclampsia rotans.
Head-nodding and head-shaking are manifestations which appear in the infant at any time between the ages of two and eighteen months. It is sometimes pre ceded by injury to the head, as might be occasioned by a slight fall. But the con dition has appeared so many times when such history cannot be elicited that it would lead one to think injury not an essential factor in the etiology. In most cases the nodding and shaking are pre ceded a week or ten days by nystagmus, which may be vertical or horizontal, or vertical in one eye and horizontal in the other. At times there is only a uniocu lar nystaginus. When the nodding and shaking appear they are usually limited to a few attacks a day, which tend to in crease in number. There sometimes ap pear cases in which there is almost con stant nutans of a mild type, with strong exacerbations. In the great majority of cases the movements seem to be accentu ated when the attention is distracted, or if the child makes an effort to hold his head still. Caille (Arch. Pmd. Soc., 'S9) reports cases where movements ceased when attention was fixed and also if eyes were bandaged. His treatment of the case was to keep the eyes bandaged for some weeks—only removing the dressing to flush out the conjunctiva:. Recovery ensued. The pupils are usually dilated, the eyegrounds normal. The few cases in which fundus changes have been found are coincidental. Occasionally there occur periods of unconsciousness, with marked deviation of eyes to right or left (Iladden).
Very frequently there is a history of rickets, and the rosary and other features are well marked. In most of Hadden's cases there occurred, as an early symp tom, the throwing back of the head and looking at objects with partially-closed eyes.