In the case of young children particularly, the impossibility of the paralysis being due to an organic lesion is often revealed by the fact that only- one function of the member is abolished. Babinsky designates this condition paralysic hysterique systematique. The classical exarnple is aslasia-abasia, in which both walking and standing are impossible although the child is able to move its legs normally and vigorously as it lies in bed.
Add to this the ease with which many hysterical symptoms can be suggested to the child and the frequency with which such symptoms result from imitation of symptoms either in another child or in its own person, which it remembers from some former organic disease—this is so marked as even to attract the attention of laymen—and we have quite a collection of diagnostic points to aid us in recognizing the hys terical nature of a monosymptorn.
It is because hysteria has been chiefly studied by neurologists that those forms of the disease which simulate nervous diseases have been known longer and better than any others. But as soon as one has the key which unlocks the mystery of any hysterical symptom, in whatever guise it may present itself, one begins to see a surprising number of conditions which simulate diseases of the respiratory or digestive organs or even surgical diseases. The circulatory apparatus appears to be affected less than any other.
It would take much more space then we here have at our disposal to give a comprehensive and systematic des.cription of the symptoma tology of hysteria, and we shall therefore confine ourselves to the most important of the individual phenomena.
Among the symptoms referable to the nervous system, the first rank must be accorded to palsies with or without contractures. They manifest themselves in the guise of paraplegia (es.pecially of the legs) or monoplegia of an entire limb or portion of a limb, as for example, one hand, one foot—rarely as hemiplegias or as tetraplegias. As a rule the face is not involved in hysterical herniplegias. The diagnosis is made by noting that the paralysis, as regards its distribution and the accompanying disturbances (trophic diminution of electric irritability, reactions of degeneration, sensation and the like) presents deviations from the type of a central or peripheral lesion which on anatomic grounds arc impossible. In flaccid and in spastic paralysis of the arm the depend ent hand is sometimes the seat of (edema, which can be explained on mechanical grounds as a passive cedema and does not necessarily have to be interpreted as a trophic disturbance. Similarly, emaciation of the muscles—always slight—is to be regarded as simple atrophy from disuse.
With regard to the contractures Bruns calls attention to the fact that they are usually characterized: (1) by the extreme degree of muscular contraction; (2) by the intense pain as compared with that which accompanies an organic contraction. They relax during sleep, but return as soon as the patient begins to awake at the examiner's touch. The same behavior is noted when the patient comes out of a deep chloroform amesthesia. Owing to the intense pain, which is es pecially apt to be referred to the joints, these conditions have been mistaken for articular neuralgias.
Of other paralytic types astasia-abasia has already received brief mention. Although paralysis disappears entirely during rest in bed, the children are unable to stand or walk when they are taken up and either sink down in a heap or their movements are so ineffective and atactic that normal function is impossible. In this condition also the polymorphous character of hysteria is shown by a wealth of variations in the motor disturbance and its combination with pain in the legs, contractures and the like.
Astasia-abasia, like hysterical palsies in general, usually develops suddenly after a slight injury (a fall on level ground) or a mild febrile disease which has confined the child to bed for a few days; sometimes it comes on after fright. In some cases no cause can be discovered; the astasia-abasia is suddenly noticed in the morning when the child awakes. Young children just old enough to play seem to be chiefly- affected.
The hysterical disturbances of speech are both numerous and varie gated, presenting most frequently the picture of aphonia and mutism. While mutisrn, or sudden complete failure to make any attempt at speaking, bears the stamp of hysteria, it is neeessary nevertheless, in order to recognize an aphonia as hysterical, that the paralysis of the vocal cord be present only during the act of speaking and disappear during coughing, singing ancl the like. Such a state of affairs is of course impossible in the presence of an organic lesion. Stammering, stuttering, hesitation and similar articulatory as well as genuine aphasic speech disturbances (Bassenco) may develop singly or combined or in altcrnation on a hysterical basis. If one bears in mind the general viewpoints enu merated above, the diagnosis is usually not difficult and may be con firmed by the prompt results of suggestive treatment. If suggestive treatment fails or the results are slow, as for example, in the case of hysterical sensory aphasia (speech deafness) in a child seven years old, described by Mann, serious doubts of the diagnosis must arise (Oppenheim).