"You
will
verify the fact for yourself, as I am fortunate enough to be
able to place under your observation this patient. We are thus enabled
to make you touch with the finger, as it were, the most interesting
peculiarities connected with rhythmical chorea. The disease in question
seems to be most frequently allied to hysteria, or to be even of
hysterical origin; although it may exist in some cases by itself,
independent of all phenomena indicative of hysteria.
The
patient had both spontaneous attacks and such as were provoked. The
former usually come on after a meal, and are as it were a sort of relic
of the original hysterical attacks of the ordinary type. The patient
experiences pain and palpitation in the epigastrium combined with a
feeling of repletion. Then the right upper extremity begins to move,
and is soon followed by the left, and then by the lower extremities.
Then you witness a succession of various and very complex acts, in
which you recognise the characteristics of rhythm, or cadence, and of a
perfect imitation of certain voluntary purposive movements. When it is
started spontaneously, the attack begins without any other aura than a
blinking of the right eyelid. The induced attacks can be obtained by
pulling on the left arm, or by striking a hammer on one or other
patella tendon such as I am now doing. When you have excited the attack
by means of pulling the left arm, that arm immediately commences
performing rappid rhythmical movements in which the patient seems to be
whipping eggs. Then she bends her fingers, applying the tips to the
thumb; and raising her arm, makes the gesticulation of an orator who is
demonstrating. From time to time the whole of the upper extremity
performs extensive movements of circumduction. The lower extremities
are also affected by movements in their turn, and if the patient is in
the erect position, she dances alternately on each foot, very nearly
imitating the dance of the Tsiganes, or of the Zingari of Andalusia.
During the whole time of the attack the patient is perfectly conscious;
and strange to say, when anyone is placed close to her when she is
executing some of these violent movements, which would have the result
of violently striking the person near her, she warns them to take care
before the commencement of the gesture. It would appear then, and this
is an important feature from a psychological point of view, that the
act is preceded by a mental representation which warns the patient of
what is about to happen. You can question her during the attack and she
will reply that she does not suffer; that she is simply fatigued, and
inconvenienced by violent palpitations. After awhile she stops and
rests for a minute; you think that the attack is past; but no, soon it
recommences, and the same phases are reproduced. The total duration of
an attack varies from one to two hours. She then lies down and it is
all finished. When she gets up she feels a bit tired.
The patient may now retire. We shall be able to relate
more fully, in
her absence, the other peculiarities of her history."
Jean-Martin Charcot
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