Observations placeholder

As described in Illustrations Of The Influence Of The Mind Upon The Body In Health And Disease, Designed To Elucidate The Action Of The Imagination - Daniel Hack Tuke, M.D., M.R.C.P.,

PART II. THE EMOTIONS.
CHAPTER VIII. INFLUENCE OF THE EMOTIONS UPON THE VOLUNTARY MUSCLES.
SECTION II. — Irregular and Excessive Muscular Contraction : Spasms and Convulsions.

Dr. Todd [Clinical Lectures on Paralysis, &c By Dr. Todd, F.Pv.S. 1856] gives the case of a boy, set. 9, thin, but otherwise healthy- looking, who, a day or two before the symptoms appeared, was much frightened by his sister, who had covered herself with a white sheet and appeared before him unexpectedly while he was in bed.

" There is here, then," observes Dr. Todd, " that which we so frequently — indeed, I might say, so constantly — observe, namely, the connection of sudden fright with the origin of these cases. Although a certain diathesis seems to be always present in cases of chorea, the disease seldom occurs without some sudden emotional excitement, such as fright."

None of this boy's family had been similarly affected, but there was a tendency to rheumatic complaints, and the patient himself had been attacked with rheumatic fever (giving rise to endocarditis) ten weeks before admission, and two months before the appearance of the choreic symptoms, which came on suddenly.

The boy went to bed as well as usual, but in the morning, when his mother went to give him his breakfast, she was surprised to find that he could not hold his cup, and that he was quite helpless. He had lost the power of directing his movements properly ; the motions of his limbs were exaggerated and ungovernable, and if he attempted to take hold of anything, his arm appeared to be violently jerked, in the right direction, perhaps, but usually beyond the object of his search, as if by some power over which he had no control. Among the early symptoms which manifested themselves in this way was difficulty of deglutition, which came on and continued for some days prior to the more common and characteristic symptoms.

The dysphagia was due partly to the want of full contracting power over the tongue, and partly to a want of due harmony in the action of the pharyngeal muscles. This symptom is peculiarly interesting, from the marked connection which subsists between this malady and emotional excitement.

The treatment of this boy consisted of splashing him with cold water every morning, and at the same time feeding him well. He improved much in general nutrition, the irregular movements diminished, and when the report was made — eighteen days after admission — he was able to walk without assistance.

Dr. Todd gives the details of two other cases of emotional origin, one a girl, set. 14, with a history of rheumatic fever when two and a half years old, who was met and accosted about three weeks before the appearance of the symptoms by a drunken man, and was very much alarmed at the time. On this case Dr. Todd remarks that, although the interval seems very long, " I think we may fairly refer the excitement of the disease to this cause ; in many instances, indeed, even longer periods have elapsed between the fright and the accession of the malady I have known it occur six weeks before the chorea manifested itself." ……………………

The opinion of Dr. Todd as to the seat of emotion has been referred to at p. 118 of this work, and he observes on these cases,

 "If I were to refer to any particular part of the brain as more particularly the seat of the disturbance, which gives rise to the development of the peculiar phenomena of chorea, it would be to that which may be regarded as the centre of Emotion. The remarkable frequency with which the attack of chorea is traceable to fright as its cause, points clearly to this part of the brain (which has the most extensive connections with, and influence over, other parts of the nervous system) as the primum movens in the production of choreic convulsions.
The chain of phenomena would then be as follows :

First, a peculiar diathesis, then a more or less enfeebled nutrition ; thirdly, a strong mental impression, which disturbs the centre of Emotion, and through it deranges the action of more or less of the nervous system, and of a corresponding portion of the muscular system."