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SYMPTOMATOLOGY, PSYCHOGNOSIS, AND DIAGNOSIS OF PSYCHOPATHIC DISEASES
Boris Sidis, Ph.D., M.D.
Boston: R. Badger, 1914
BY anaesthesia is generally understood a loss of sensation in the epidermic layers of any of the sense organs, and specially a loss of sensation in the skin.
The anaesthesias may, with Janet, be classified as follows:
By local anaesthesia is meant a loss of sensitivity in some one part of the body. The usual stimuli applied to the affected part do not give rise to their appreciation in consciousness. One or more of the qualities of sensibility may be lost. The anaesthesia is frequently on the left side. It is sometimes confined to limited spots, sometimes to a part or to an entire extremity, or symmetrical portions of two extremities may be involved as in "glove and stocking" anaesthesia; it may again extend to one half of the entire body constituting hemi-anaesthesia.
The face may be involved, often on one side and along with it the eyes may be affected. Anaesthesia of one side of the face and appropriate side of the body may occur. When the eye is involved, not only the retina, but also the lids are anaesthetic. The eye muscles may also be affected.
Of all forms of sensation, pain and the tactile sense are most frequently lost. Muscular sense and articular sensibility are rarely affected. In severe cases the loss of sensibility includes the deeper parts and is more or less complete to all, even to intense stimuli, while in mild cases, strong continuous stimuli are felt. The anaesthesia may include parts of the mucous membranes. The abdominal viscera may be analgesic, strong compression giving rise to no pain.
Disseminated anaesthesia is like the local form, except that it is distributed over the body in patches. It may be in geometrical patches or in segments. The anaesthetic areas sometimes take the form of bands.
Special anaesthesia is a form in which the special senses are involved. Special anaesthesia may be either visual, auditory, gustatory, olfactory, or thermal. The most frequent form of special anaesthesia is that of limitation of the field of vision, usually of a concentric form. The loss of vision may be total, but this is a rare form. Visual acuity usually remains unaffected. There are not infrequently color disturbances, achromatopsia in which all colors are seen as grey.
Another far more common variety is that in which the reversal of the color field is present. In the normal eye the largest field is for white light,óblue, red and green come next in order, violet having the smallest field. The most frequent reversal in psychopathic visual anaesthesia is between red and blue, the red preceding the blue, and showing a larger field. The most frequent reversal in psychopathic visual anaesthesia is between red and blue, the red preceding the blue, and sowing a larger field.
Psychopathic deafness is less common than the other forms of special sense anaesthesia. In most of the cases there is also anaesthesia of the external auditory meatus and of the outer surface of the drum. The deafness is rather for notes of high pitch. The tendency to involvement of the various special senses is according to the law of adaptation, reproduction or recurrence. The senses involved in the trauma show the recurrence of anaesthesia. The auditory is more essential than the visual in carrying on social relations, and is therefore less frequently affected. Taste, smell, and muscular sensibility, which are still more important in carrying on life activity are more rarely involved. In the form of special anaesthesia one or both sides may be involved.
In general anaesthesia all forms of sensibility of skin and mucous membrane are involved. This general anaesthesia may be localized, in patches, or in bands; it may cover the entire body or half of it. When the anaesthesia appears in the form of patches or as hemianaesthesia, touching or pricking two symmetrical parts, the one normal the other anaesthetic, presents interesting phenomena. The normal side may become red from the stimulus, while the anaesthetic part remains relatively unaffected.
Occasionally anomalies of sweat secretion, such as increase or decrease of perspiration, are present. There is no difference in temperature or circulation or general nutrition of the two sides. The anaesthetic part usually retains its reflexes. When the lower leg is involved the patellar reflex may be increased, but often it remains unchanged.
The anaesthesia may be total, it may affect the entire body, involving also the mucous membranes. The anaesthesia may be for all qualities of skin sensation, such as touch, pressure, pain, heat and cold and may also involve completely or partially the special sense organs. This form, of anaesthesia is rare. In total anaesthesia the more frequent form is the loss of sensibility of skin and mucous membrane. The muscular sense is usually preserved, though in some cases it may be slightly diminished. In total anaesthesia the patellar reflex, the abdominal reflex, the secretory and vasomotor reflexes are present.
Systematized anaesthesia consists in the loss of sensibility in relation to definite systems of impressions, coming from certain external objects. That is, while the patient is anaesthetic to certain objects, he is not anaesthetic to other objects, though of the same nature. This form of anaesthesia may effect any of the senses, and is specially characteristic of the psychopathic state.
The tendency to dissociation or anaesthesia is in inverse ratio of its biological and social adaptations. Systematized anaesthesia becomes greater with emotional excitement and with increase of the intensity of attention. The pathological process here as in other psychopathies consists in a disaggregation of mental systems; it has its parallel in those forms of aphasia in which certain kinds of words only are forgotten, while others are retained.
Along with the anaesthetic or hypoaesthetic disturbances we sometimes find hyperaesthetic spots in which the sensitivity is abnormally great. On account of the general process of disaggregation the touching, or pricking of certain spots gives rise only to indefinite feelings, the patient indistinctly or vaguely feels the stimulus.
In some patients with psychopathic disturbances, touching, pricking, or sending even a strong electric current through a limb, a hand for example, is only vaguely felt and localized. This phenomenon is known as allochiria. If the hypersensitiveness is very acute, the patient may localize the impression in a symmetrical place on the opposite extremity. This may be termed complex allochiria.
In psychopathic hyperalgesia, while the slightest touch may give rise to pain, often a firm pressure is not painful. The mucous membranes may be the seat of the hypersensibility giving rise to pain during swallowing, urination, defecation, etc.
Hyperaesthesia of the special sense-organs may occasion disturbances of vision, smell, hearing, or taste. A common form of psychopathic paraesthesia is that of a boring pain at the vertex of the skull, as though a dull instrument were being driven into the head. This form of pain is sometimes termed clavus hystericus. There may be hyperaesthesia or more commonly anaesthesia of the genital organs. The breasts may often be the seat of paraesthesia. In some cases the paraesthetic member feels to the patients, as if amputated or belonging to some other individual.
There may also be anaesthesia relating to hunger, thirst, and micturition. When there is anaesthesia relating to hunger and thirst, the patient may go on for some time without food, or take but little nourishment as the desire for food is diminished. When there is anaesthesia of the bladder and urethra and also of the skin and muscles there may be incontinence of urine. The anaesthesia of the bladder may give rise to retention of the urine. Sensations of crawling, numbness, feeling as though snakes crawled beneath the skin are among the other forms of anaesthesia.
Disseminated or small islands of hyperaesthetic or paraesthetic spots are often found in psychopathic cases and may occur alongside of the anaesthetic ones. In psychopathic cases in which anaesthesia is present, there is almost invariably present some form of motor disturbance or paroxysm, occurring at irregular intervals. The anaesthesia always becomes more pronounced after the attack which may be considered as a form of hypnoleptic state.
There are often pains in different parts of the body, especially about the breast, ovaries, and spine. Pressure upon these spots may provoke a so-called hysterical attack or sometimes stop it. Such zones are termed hysterogenetic. Pains of psychopathic nature in the vagina or in the breast have sometimes led to diagnosis of organic disease and consequent operations. It must always be remembered that psychopathic sensory disturbances are psychic in character, they are disturbances of the patient's subconscious life activity.
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