A case of Séglas', from whom stigmata of hysteria were absent, was possessed, among other things, with the fear of having swallowed certain objects, such as pins, knives, etc. The obsession eventually became so vivid and so intense at certain moments, that it began to be accompanied with a sensation as of a foreign body arrested in the œsophagus, and the anguish thus created revealed itself by various reactions, one of which consisted in excessive salivation and ceaseless expectoration, entailing the carrying about and use of numbers of handkerchiefs.
It is scarcely possible for the mechanism of deglutition, the orderly succession of muscular contractions, to be interfered with by the will, but increased frequency of these movements may constitute an abnormality. Hartenberg's[107] case of deglutition tic was characterised by a continual desire of swallowing saliva; the patient, it is true, was an hysteric.
Rossolimo[108] has called attention to what he distinguishes as amyotaxic troubles of deglutition, a dysphagia of which three types, motor, sensory, and psychic, may be specified. Cases of the last form had already been described by Bechterew.[109] The patient either suffers from a genuine obsession, or is ever at the mercy of an involuntary or even an unconscious dread of choking as he eats, a dread with which he is powerless to cope, though in the case of others the phobia and the dysphagia may alike be intermittent. In the majority of instances there are grave hereditary or personal neuropathic antecedents.
Some people are afflicted with eructations so continual that they amount to tics. One of us is acquainted with a family several of whose members present this peculiarity in different degrees, yet none of them suffers from hysteria.
Otto Lerch[110] has published a case of multiple tics, among which may be enumerated opening and closing the eyes, rolling of the ocular globes, tilting back of the head, with instantaneous recovery of position, inclination of the whole trunk to right or left—each and all of which movements are frequently attended, especially at night and in the morning, by profound eructations.
Of course, the prominent place occupied by these signs in hysteria is well recognised: the demonologues of old regarded them as an index of the departure of the devils that dwelt in the possessed. In a case of hysteria that came under the notice of Raymond and Janet,[111] a general tremulousness of the whole body was replaced by a chorea of the right arm, which in its turn was succeeded by the perpetual emission of sonorous eructations. In another instance[112] inspiratory hiccoughs and expiratory eructations co-existed. A similar example is cited by Cruchet in his thesis.
In the same category of facts are included those to which the name of aerophagic tic has been applied. Various cases have been narrated by Pitres and by Séglas,[113] the latter of whom, in a remarkably complete analysis of the condition, has demonstrated its identity with the tics, and written very instructive commentaries on his observations.
I was consulted (says Séglas) by a man thirty-four years of age, who was sent to me as a hypochondriacal neurasthenic. No sooner had he entered my consulting-room than I was astonished to find he was giving vent to repeated sonorous eructations at very brief intervals. His story was to the effect that several weeks previously he had been suddenly seized in the middle of a meal by a sort of vertigo, and had lost consciousness. A consideration of subsequent events made it more than probable that he had had an ictus; the patient, however, was for no apparent reason persuaded that he had been poisoned by badly cooked food, and from that moment became despondently preoccupied with the state of his stomach. A few days later the eructations made their appearance.
A closer examination very soon dispelled the idea of their gastric origin, seeing that the digestive functions were in every respect normal, whereas the symptom in question occurred at any moment, independently of the stage of digestion, and the gases evolved were absolutely inodorous. On the other hand, one could easily satisfy oneself that the eructations were preceded by an inspiratory effort and by two or three very obvious movements of deglutition, accompanied by a low, rumbling, pharyngeal noise, and followed almost immediately by the expulsion of gas. Their reproduction several times a minute was spasmodic in character and irregular in rhythm, and continued, it might be, for hours.
Of this series of phenomena the patient had conscious knowledge only of the last—viz. the eructations—and affirmed their involuntary nature and his desire to be rid of them.