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The Quasi-Nervous Diseases

pain, sensations, organ, condition, evidence and female

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THE QUASI-NERVOUS DISEASES - § 1. important distinction we have drawn tween objective and subjective phenomena, derives its fullest illustration from this protean malady. Here the sensations of pain and uneasiness are out of all due proportion to the ment of function and of nutrition; the feelings of the patient are the all-absorbing idea in her mind, and so completely do they take possession of her faculties, of her very nature, that vital functions over which she has really no voluntary control, are swayed by the force which these feelings exercise when they become trated on any particular organ. Although most fully developed in the female sex, and originally deriving its name from a sup- excitement of the female generative organs, an analogous is not unfrequently seen in men exhausted from any bilitating cause, or effeminate from over care and nursing of themselves ; extreme nervousness is the only term in common use to express such a state. There is no exact line of tion between this condition and one in which, the attention coming fixed on some particular organ, sensations are supposed to arise there, of the non-existence of which we are satisfied by collateral evidence of their absurdity or impossibility ; to this the name of hypochondriasis has been applied ; it merges into insanity. The question of diagnosis then simply takes the form of an inquiry into the reality and importance of the complaints of the patient. When these stand alone, or are out of due proportion to other evidence of disease, we conclude that they are ated if not unreal; and when their intensity, as described in guage, is not borne out by the actual effect upon the individual, we conclude that they are unimportant. The following remarks will apply to either sex, although especial reference must be had to the female in discussing the subject of hysteria. There is usually such a constant simulation of other diseases, that it is possible to draw any general picture of it which would apply to every case, the only feature which they have in common, being the negative one of the absence of some important indication which is absolutely essential to the existence of the reality which is imitated by it; the function which ought to be deranged is unchanged ; the sign or the symptom which ought to be found is wanting; or we may even obtain direct evidence that the organ which is supposed to be the seat of disease is in a perfectly natural and normal condition, except that it is the point on which those morbid sympathies are concentrated.

It has been already pointed out, how impossible it is to form any standard of comparison by which to measure expressions of pain. Other sensations admit of more analysis, and generally have a more definite range. Thus a sensation of numbness may be analyzed into actual deficiency of sensitive power, or into mere tingling, which produces a relative feeling of insensibility ; a sensation of weight, whether in the head or at the epigastrium, is an explicit statement of what we can understand, and what we can generally refer to some coexisting morbid state. Of pain generally it is most important to remember that it does not imply inflammation : too frequently these words are regarded as almost synonymous, and complaint of severe pain ca ls forth all the energies of antiphlogistic treatment: it is in reality nothing more than an expression of irritation of some nerve, and the cause of that irritation is to be sought for. Practically we have to remem ber that the ultimate filaments of the nerves are distributed to various organs, and that every abnormal condition of the organ may give rise to sensations of pain. Thus, no doubt, in persons of weakly frame, muscular effort, which is painless in the robust, is a cause of more or less permanent aching; and errors in diag nosis can only be avoided by searching out the site as well as the cause of irritation.

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