Neuro-Mimesis In Relation To Spinal Rigidity

Neuro-mimesis, the nervous mimicry of disease, does not, I fancy, attract so much attention now as it did twenty or twenty-five years ago, although, judging from personal experience, it is quite as important a clinical factor now as it was then. I may, perhaps, be pardoned if I remind you that the so-called intelligence displayed by young children is largely due to the results of pure imitation, and that during the early years of life the tendency, especially in girls, to imitate the characteristics and peculiarities of those with whom they continually associate is very strong; this imitative faculty being particularly attracted in certain subjects by any characteristic which is especially pronounced. Occasionally it happens that an unusually susceptible child, thrown constantly in contact with another individual, whether child or adult, suffering from some deformity or peculiarity, will unconsciously imitate the peculiar characteristic in a remarkable way. The commonest conditions thus imitated are, in my experience, disease of the hip and Pott's disease. Confining ourselves to the consideration of the subject of this lecture, I have seen cases of slight angular curvature at the cervico-dorsal junction so accurately imitated as to deceive very shrewd observers. A peculiarity, however, of the spurious condition is that it occurs in precisely the same position, and assumes as nearly as possible the same characteristics, as the original case, whereas in the case of organic disease, especially tubercle occurring in a second member of the same family, it is very rarely indeed of precisely the same form and distribution as the first - the very similarity of the two cases should, in fact, arouse suspicion as to the reality of the second. The stammering test will also invariably exclude the existence of organic disease, and if any ultimate doubt remains, the administration of an anaesthetic will finally settle the question by completely removing the rigidity if the case be one of the spurious kind. The moral of this matter is as follows: In a case of rigidity of the spine with, perhaps, apparent slight deformity, the mere fact that another member of the family has had tuberculous disease of the vertebral column is not necessarily any evidence that the second case is of the same nature, especially if the manifestations in the second case are precisely similar to those in the first; in such circumstances the possibility of neuro-mimesis should always be borne in mind.

An Instructive Case

Some years ago a girl fourteen years old was brought to me for an opinion concerning a curious stiffness about the neck and shoulders, and a peculiarity in gait which she had gradually developed in the course of eight or nine months. The attitude was singularly restrained - the head was thrust a little forward, the chin being slightly raised; on turning from side to side the head moved with the shoulders and the neck seemed quite stiff. The general attitude was precisely that of Pott's disease in the cervico-dorsal region. The girl was well nourished, very intelligent, and in apparently good general health. She complained of no actual pain, but readily became tired, and had given up any attempt to play games. On removing the clothes the position of the head and neck was as already described, the lower cervical and upper dorsal spine was apparently quite stiff, the vertebra prominens projected much more than is usual (which suggested a condition of slight angular curvature), there was no tenderness or thickening of any kind, the bony-outlines could be clearly made out, and the ordinary bending test only confirmed the impression of stiffness of the column. The stammering test I did not use, as I had not then become acquainted with it. I felt, however, that there was something deceptive about the case, and therefore examined the child under an anaesthetic, with the result that all the symptoms disappeared, the spine becoming during the anaesthesia entirely natural, whilst upon recovery from the anaesthesia the abnormal condition was resumed. What the condition during ordinary sleep was I do not know, as so far as I can recollect I never had an opportunity of satisfying myself on that point. The case puzzled me a good deal at the time; there was clearly no organic disease, and as a hysterical manifestation it was most unusual. It transpired on further inquiry that the girl had for a year or more before I saw her been constantly in the company of a patient who had tuberculous disease of the cervico-dorsal spine, and who wore a leather support having a collar round the neck to support the head and chin. This appeared to settle all doubt as to the nature of the case, which was one of nervous mimicry of the most striking kind. The position in which the patient held her head was, it will be noted, precisely that in which the head of a patient would be whilst wearing a spinal support of the kind mentioned. Removal from the associations under which the abnormality developed, and the use of massage and rational exercises, were followed by great, although somewhat slow, improvement.

The recognition of these cases is of considerable importance, for unless proper means are taken to correct the perverted function the abnormality may become permanent, a result which is all the more likely if in such a case a diagnosis of organic disease be made and the usual treatment by rest and fixation employed. There is no limit to the eccentricities which are shown by some of these patients. I remember a remarkable case at St. George's Hospital, in which a clearly neuro-mimetic talipes equino-varus in a girl disappeared under an anaesthetic and was found on the recovery from the anaesthetic to have been transferred to the opposite foot; the mistake, however, was not long in being corrected, for in a few hours the abnormality was again located in the foot originally concerned.

Reflex Irritation As A Cause Of Intermittent Spinal Rigidity

The reflex disturbances resulting from intestinal worms in children are so manifold as to be almost unlimited; at the same time I do not know that occasional spinal rigidity is generally recognised as one of them. There is no doubt, however, that intestinal worms do produce this complication, and sometimes in a very alarming degree. A case, for example, came under my notice in which a relapsing spinal rigidity of a very pronounced kind disappeared entirely after the passage of a large mass of tape-worm.