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Related post: and feels more or less sick, but he does
not act sick. Now, the mistake is made
in assuming that one can state that any
man is sick simply because he feels sick
and he acts sick.
That is the reason for our psycho-ther-
apeutical cures, for those of Christian
Science and other religious cults. They
handle individuals who are not sick, but
who feel sick and when, through a psy-
chological process they cease to feel sick,
they are cured.
The diagnosis, then, of this condition
depends upon the understanding of the
symptoms and the physical signs that the
patient presents. The symptoms we in-
clude under the heading of feeling sick,
and physical signs come under the heading
of acting sick ; and what I mean by being
sick is pathologj'.
In the central nervous system the feel-
ing and acting sick of organic conditions
are absolutely consistent with what we
know of the anatomy, physiology and
pathology of nerve tissue. The symptoms
and clinical signs of neuroses are not con-
sistent with our knowledge of physiology
and the anatomy of the nervous system
unless the patient has a knowledge of
these subjects. Every man builds his
502
SOUTHERN MEDICAL JOURNAL
June lit 17
neurosis according to his knowledge and
according to his needs. The neurosis is
alwavs an explanation. It is the explana-
tion "the individual gives to himself and
to the world why he unconsciously feels
sick; and if one can alter the explanation
to a more rational one he recovers. Thus
we see the reason for the inconsistencies
in symptoms and signs which stamp these
things as neurotic, psychological and not
as organic.
I shall mention a few of the common
symptoms of neuroses one meets in a
large clinic. These are the things the
patient feels. He comes to us feeling a
certain thing and acting out a certain part
which would make those feelings appear
rational. They may be quoted under three
heads: (1) Pains and paraesthesias ; (2)
anesthesia; and (3) weakness.
THE PAINS AND THE PARAESTH'SIAS
The pains of the neurotic are matters
of perception and not of nervous impulse.
The pains and paraesthesias of the trau-
matic neuroses are usually located in or-
gans or members important for the wel-
fare and happiness of the individual.
These pains are not constant as are pains
of organic origin- The pain in the arm,
in the traumatic neuroses, for instance,
is not the steady pain that one sees in a
fracture or in true neuritis or in the
spinal cord tumors. They very seldom
interfere with the patient's sleep, and this
is a rather important diagnostic point.
When the patient's mind is distracted
from his painful limb, head or spine,
or whatever it may be, he no longer feels
the pain. He does not show any signs
of pain until his attention is again at-
tracted to it. Neurotic manifestations
do not as a rule exist outside the Buy Tadapox field
of attention. Again, the neurotic pains
may or may not be accompanied by ten-
derness.
We Tadapox Online know that in local lesion pains are
always accompanied by tenderness. It
is a necessary accompaniment to pain,
for tenderness simply means an increase
of pressure pain. In neuroses tenderness
is only seen, if there is tenderness, in the
field of attention. One finds, for instance,
a man with an arm that is extremely pain-
ful, and when you touch it he will scream
with pain. If his attention be distracted,
you may apply considerable pressure to
that painful limb and elicit from the pa-
tient no further evidence of the pain,
showing that it is rather a matter of
psychological interpretation than true
pain sensation. The pain in these neu-
rotic arms usually is increased by passive
motion. But often again this is inconsist-
ent. One often finds in painful arms that
by rotating the arm in a way from which
one w'ould expect to find the pain in the
shoulder, that is external rotation at the
shoulder with the elbow semi-flexed, the
neurotic complains of the pain oftenest
around the elbow, especially if you grasp
the elbow rather firmly in the process.
In other words, he does not get the pain
where he should get it. The same is seen
in internal and external rotation of the
hip. Here the pain is felt not in the hip,
but most often in the knee.
THE NEUROTIC ANESTHESIA
Here we have a matter of real sensa-
tions which do not get into the conscious-
ness. The sensations go up, all right, but
they do not get past the threshold of at-
tention and so never become conscious.
Very frequently we find that the touch
sensation may be perfect, while that for
pain may be lost. Nevertheless, temper-
ature sensations are seldom disturbed,
and pain anesthesias of organic origin do
not exist without temperature anesthesias-
The anesthesia usually occurs in the par-
alyzed parts. Besides this, we may point
out several other things which make the
diagnosis as due to a condition of purely
psychological origin. In the first place,
you never see the burns or skin injuries
which are such common accompaniments
of syringomyelia. Those individuals do
not harm themselves with fire and harm-
ful things. Again, we do not see the
glossy skin of neuritis. The skin looks
healthy and normal. It is healthy and

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