H. Higuier (Wiener. Klin. Wochenschr., 1895, Nos. 1, 2, 8, 5) relates two cases of interest, one of hysteria simulating tabes dorsalis, and another of locomotor ataxy complicated with hysteria. The diagnosis of an involuntary simulation of tabes dorsalis is not so difficult. To establish the existence of actual locomotor ataxy we must endeavour to demonstrate the presence of “tabetic stigmata,” especially the loss of pupillary reflex action to light, the optic disc atrophy, Charcot's joint implication’(which, though frequently absent, must be included among the earlier symptoms of the affection), and lastly the absence of patellar reflex. The accessory tabetic symptoms are in this relation of less value. When a combination of hysteria with tabes is suspected, however, the recognition becomes more difficult. The hysterical stigmata may cloud the tabetic, and the presence of various anæsthesiæ—hemianæsthesia, pharyngeal anæsthesia, concentric contraction of the visual field, deep epigastric anæsthesia, etc.—may make us overlook the presence of the organic affection. The contraction of the visual field in hysteria is mainly concentric; in tabes it is mostly irregular. The dyschromatopsia of hysteria is wholly unlike that of tabes. The ophthalmoplegia externa of tabes is limited generally to one muscle; in hysteria it embraces associated groups of muscles, is as a rule hardly observable, and is induced by contraction of antagonistic groups, etc. By this careful observation it has been possible to demonstrate in one case symptoms of tabetic implication of one eye and hysteric affection of the other.
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