A treatise on orthopedic surgery . rsist unduly. The first class of cases is small, the second is large. Simulation, whether voluntary or involuntary, of organic dis-ease can deceive only those who are not familiar with the char-acteristics of the disability that is simulated. Every disease hascertain well-defined symptoms which can no more be imitatedby a well person than a disabled part can suddenly take on the:normal appearance and function. THE NEUROTIC SPINE. The neurotic spine is much more common in adolescenceand in adult life than in childhood, and the subjects, usuallyfemales, are oft
A treatise on orthopedic surgery . rsist unduly. The first class of cases is small, the second is large. Simulation, whether voluntary or involuntary, of organic dis-ease can deceive only those who are not familiar with the char-acteristics of the disability that is simulated. Every disease hascertain well-defined symptoms which can no more be imitatedby a well person than a disabled part can suddenly take on the:normal appearance and function. THE NEUROTIC SPINE. The neurotic spine is much more common in adolescenceand in adult life than in childhood, and the subjects, usuallyfemales, are often of a nervous or neurasthenic type. In cer- DISEASES OF THE NERVOUS SYSTEM. 665 tain instances the symptoms appear to be induced by injury,and in others by worry or overwork. Symptoms.—The patient usually complains of a dull pain inthe back of the neck, or in the lumbar or sacral region, of a con-stant tired feeling, and, not infrequently, of sharp neuralgicpain localized about a certain point in the spine, often the Fig. The neurotic spine. Characteristic attitude. vertebra prominens. The contour of the spine may be normal,but most often there is a lessening of the lumbar lordosis, abackward inclination of the body and a forward droop of thehead, an attitude that signifies muscular weakness and strainupon the ligaments. One of the common symptoms of theneurotic spine is extreme local sensitiveness, or hypersesthesia, ofthe skin at certain points along the spinous processes. Thus,if one passes the finger gently along the spine the patient will 666 OBTHOPEDIC SURGEBY. often shrink or cry out because of the pain. As a rule, there isno limitation of motion or muscular spasm. The pain is local,not referred to the terminations of the nerves; in fact, the symp-toms are in great part subjective and irregular in character, ascontrasted with those of actual disease, which are objective andwell-defined. Treatment.—The treatment of the neurotic spine must begeneral in characte
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