Jefferson Medical College - Clinic Yearbook (Philadelphia, PA)

Page 99 text:

sim, l , l , . A i , l , ' 5 Q. N chest wall He was supposed to have an ankylosis of the shoulder and the X ray plates were thought to show certain changes in the bones and joint which would account for the disability As massage electricity and exercise had accomplished nothing after months of use operation was advised From the general muscular rigidity whenever the patient attempted abduction and from the fact that when this was overcome by persuasion certain movements could be easily carried out a diagnosis of hysterical spastic palsy was made and in ten minutes this boy was carrying the arm up in full extension over his head Massage electricity apparatus operation all have their place but are harmful in this condition since they only prolong it and because it can be quickly cured by psychotherapy An important point is that patients should not be allowed to get into this condition and it is easily prevented. In this connection I would advise all young surgeons to read Colonel Hurst s article in the Osler Memorial Volume on 'What the War Has Taught us About Hysteria. One who doubts the effect of mind over matter should read Klauder's paper Q . A. M. A., November 28, 19251 on the Cutaneous Neuroses, in which he shows among other interesting tests, that by suggestion blisters can be made with postage stamps. The diagnostic habit needs to be cultivated by the surgeon and the young man needs to be taught that there is a something more in the art of surgery than operative skill and technic. The link between surgery and psychology is too important to be neglected. Lawrence Sterne said ofhis teachers at Cambridge that they were men of reading who .z a p : fa II ' , X . . . . - . - . . l i , . Il I WJ i u K 1 pf fi i gl thought that 'wisdom can speak in no other language than Latin and Greek,' and I sometimes think there are too many practitioners of medicine who, in making a diagnosis, depend too much on the laboratory findings and fail to recognize many perfectly patent signs and symptoms which one experienced in the att sees at a glance. The wise practi- tioner knows his Latin and Greek of the laboratories and uses them, but he does not start or stop with them. Cans: thou not minister to a mind diseas'd, Pluck from the memory a rooted sorrow, Raze out the written troubles of the brain, And with some sweet oblivious antidote Cleanse the stuff'd bosom of that perilous stuff Wliich weighs upon the heart? Page Ninety-:ix

Page 98 text:

friends tell our abdominal cases that they will not get over the effects of the operation for a year and some of them will try their best to carry out the program. Tell a patient after a fracture of the leg that he will be lame for six months, and whether he needs to or not, he will limp for the allotted time. Limps in the absence of shortening or fixation are nearly all hysterical and can be readily overcome. Not only should the surgeon know something of the neuroses, but he should be able to recognize the various manifestations of hysteria and realize their close resemblance to the symptoms of real surgical lesions. We have all known patients to undergo repeated operations for hysterical vomiting and for hysterical intestinal obstruction and then to be disappointed because further operations were refused. In the held of traumatic and industrial surgery, something more is required than a knowledge of surgery. The surgeon in this field must be able to distinguish the real sufferer, the hysterical sufferer and the malingerer, and the last is the most infrequent and the second much more common than is generally believed. Even in many cases in- volving compensation or litigation the apparent malingerer is not a malingerer at all, but suffering from hysteria the result of suggestion at the hands of friends, of fellow-workers, of his legal adviser and of partisan medical experts. This fact is pretty generally known, but do we realize how often it applies to cases in which there is no question of litigation? We must get over the idea that hysteria will always produce the physical stigmata of Charcot. Babinski and others have shown the fallacy of such an idea and that a perfectly normal person can suffer from hysteria. We surgeons can, in out own experience, amply illustrate this fact. The hysterical incapacities after operation and injury are every day occurrences, and although we may not designate them as hysterical, we prevent and cure them by suggestion and persuasion, and in doing so we are practicing psycotherapy, although we may not realize it. I shall always feel indebted to Sir William Oslet for suggesting a visit during the War to a neuropathic hospital in charge of Colonel Hurst, for here I learned in one morning a great deal about hysterical spastic palsy, which has proved of great value since. There are hundreds of men, women and children wearing apparatus or submitting themselves to repeated operations for this condition, who could be easily cured by sug- gestion. These are the patients who largely represent the cures accomplished at Lourdes, at Ste. Anne de Beaupre and at other shrines and by the bone-setters and the Christian Scientists. That these poor people get into this apparently hopeless condition is due largely to the fact that the nature of their affiiction is never properly diagnosed or because we do not know how to prevent or cure it. I saw many cases of perfectly honest British Tommies who had suffered for months, and some for years, from these palsies for which some of them had been discharged from the army as incurable, cured in ten minutes by psychotherapy. A good example is that of a sergeant who had a through- and-rhrough wound of the forearm a number of months previously and who since his arm was taken off the splint had held his fingers tightly flexed on the palm until the growing nails had made ulcers. This man in five minutes was completely extending his fingers, together and individually, much to his own astonishment and joy. Another case in civil life which illustrates very well what I want to say, was that of a young man who was sent to the jefferson Hospital from one of the towns in Northern Pennsylvania. He had had a fracture of the clavicle which a surgeon had wired and following the operation the patient had never been able to abduct the arm more than a few inches from the Page Ninely-five

Page 100 text:

9 E e .e . s s a B W C5 03f-Q