On the Registration of Diseases
Authors: G. H. Philipson
Journal: BMJ (1869)

be shaken physically and frightened morally; he is told to rest; he has nothing to do; all his kind friends who call on him tell him of the Messrs. So-and-so, all of whom met with "just such an accident," and wvho became " quite paralysed after a time."His doctor asks him if he feels this and that; his lawyer shakes his head mysteriously, and the last straw that often breaks his back is either the very grave face and sympathetic tone of the " Company's doctor," that convinces him that something is very seriously wrong, or, on the other hand, the extreme cheerfulness of that functionary, which is, to the patient's mind, distinct evidence that his hopefulness is all put on.The man becomes really ill, but the region of illness is idea.6.The degree to which the form of malady enters into the compli- cated histories of chronic cases of nervous disease, is one of its most interesting features; because it often happens, on the one hand, that such symptoms as it can produce may be supposed to be the result of real organic lesion, and so place the case among the category of incurable diseases, and, on the other, that a recognition of their true nature may lead to their speedy removal, and an amount of encouragement that shall be very useful in the alleviation of more grave derangement.A few facts of an actual case will illustrate this point.A married lady, the mother of four children, and the victim of several mishaps, suffered much from haemorrhoids, fissure of the anus, great debility, and convulsive seizures of epileptoid character.She was intensely anemic, had much headache, attacks of occasional delirium, sometimes hysteric in form, but sometimes passing beyond that type.There was much to distress her in surrounding circumstances, impaired fortune, and a necessity for exertion beyond her powers.She gradually became para- plegic, lost control over the sphincters, and was confined to bed.Her nights alternated between fainting and delirium, the passage from the one to the other being marked by some convulsive seizures, of what may be termed hysterico-epileptic character.This state of affairs con- tinued for many months; the helplessness of the patient, and the dis- tress of her husband, increasing week by week.Upon examination, I found inahility to move the lower limbs to any extent, occasional in- voluntary micturition, and escape of faeces ; but the nutrition of these limbs was not specially affected, there was no alteration of sensibility, no bed-sore, and no tenderness of spine on deep pressure ; but there Wvas a great sorrow on account of her helplessness, and an admission that she had for a long time " feared that she might become paralysed."This patient was quite well in a fortnight, and the treatment that was used was that which I have already described.The first night that she was taken to the hospital, the evacuations occurred in bed; but she was told by the nurse that " such things were not allowed," and they never occurred again.The subsequent history of the case was one of the kind that might be supposed; some of the nervous symptoms remained in a diminished degree, but the general health became fairly good, and the paraplegia disappeared altogether.7. The diagnosis of the conditionwhich I have endeavoured todescribe