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.

Medical experience fully confirms the remark of Marshall Hall, that by far the most common cause of the accession and of the aggravation of paralysis agitans is Emotion ; hence during sleep the movements are calmed.

Hall cites the case of the Abbe, who, during the reign of terror in France, was seized by the mob with cries of "A la lanterne!" He escaped, "but he was ever afterwards subject to violent tremor of the limbs."

Also that of a gentleman in whom the disease was induced by the mental anxiety occasioned by a ruinously expensive parliamentary election. He was unable to walk alone, but walked very well "if his wife gave him her hand in the gentlest manner." The loss of power over his muscles was complete when anything occurred to excite agitation or emotion.

In a third case, the disorder also originated in anxiety about money ; and the son of this patient being intrusted with a large sum of money to convey to a bank, and delaying his return by going to the theatre, was the cause of a great aggravation of the symptoms, almost amounting to hemiplegia. M. Hall, who speaks of paralysis agitans as emphatically "a disease of emotion," adds that he could adduce many examples of the same kind as the above (London Hospital Reports. Vol. i. 1864, p. 23).

A case of paralysis agitans, under Oppolzer, is an excellent illustration of the disorder :

The patient, a man, set. 60, happened, during the bombardment of Vienna in 1848, to get in the midst of the fight. He was struck with such terror that he could not return home by himself, and had to be taken there. He had scarcely got over his fright when a bomb burst near his house and alarmed him again. A few hours afterwards, on trying to take some food, he found himself perfectly unable to use his hands, because as soon as he tried to move them, they began immediately to tremble violently. He noticed also after a short time that his lower limbs trembled in the same manner, but less violently, so that he could still walk. The disease not only resisted all the measures employed against it, but also grew gradually worse. The trembling persisted even when he lay down; and involved other muscles; lastly, paralysis was superadded to it. After a few years, he became incapable of standing erect, and, as soon as he made the attempt, he had an irresistible tendency to fall forwards; so that in order to avoid falling down, he was obliged to lay hold of neighboring objects, or to walk hurriedly. The keenness of his senses and of his intellectual faculties had diminished slowly, but progressively. Twelve years after the fright he fell down in a fit, and was unable to rise, though not unconscious, and a few weeks after was admitted into the Hospital under Professor Oppolzer, from whose observations Trousseau gives the particulars. On admission the muscles of the face, tongue, neck, and upper limbs were affected with violent trembling, only suspended during sleep. The tremulous muscles were at the same time rigid. His strength rapidly diminished ; he had severe convulsive seizures, and he died three weeks after admission. A post-mortem examination revealed, among other appearances of less importance, very decided induration of the pons Varolii and the medulla oblongata. The spinal cord was firm, and the medullary substance of the lateral columns, principally in the lumbar region, presented opaque gray stria. On making a microscopical examination, there was found in the substance of the pons Varolii and medulla oblongata, an abnormal production of connective tissue, accounting for the induration of those parts.

The opaque stria in the lateral columns of the cord were due to the presence of connective tissue in process of development. In the substance of the right optic thalamus there was an apoplectic cyst of the size of a small bean, the walls of which contained pigment.

(For the case in full, see Trousseau's Clinical Medicine. Translated for the New Sydenham Society by Dr. Bazire. 4 vols. 1868, I, pp. 446-9.)