Neurological examination
This is especially true of the psychoneuroses. To avoid misunderstanding it is well to speak the language which the patient understands best. While a neurologist may be to make a psychological test the determination of intelligence quotients in mental defectives had better be left to trained psychologist.
Every patient, no matter whether one is confused with an obvious psychosis or equally obvious psychoneurosis should receive a careful neurological examination. In fact the more convinced one is that the case is functional, the more complete the physical examination should be. Aside from the fact that organic manifestation may be discovered when least expected, a trough physical examination not only convinces a psychoneurotic that he is taken seriously but serves as an excellent therapeutic measure. It is needless to add that every patient is to be undressed. In the case of women one may allow sufficient draping to pay the necessary tribute to modesty. Finally, the patient should be reexamined from time to time and notes made on the original history records.
Before making a meticulous examination of system a rapid survey may reveal a number of important points. Abnormal attitudes of postures, contraction, contractures and deformities, atrophies or hypertrophies (see below), flatfeet, hypnosis, scoliosis or lord sis, enlarged glands, especially the thyroid, varicose veins, hernia, eruptions and pigmentations, bed sores and other vasomotor or tropics disturbances, bodily and facial distributions of hair, fat distribution, color of skin, and tumor masses. The patient is asked to walk alone if he can, or he may be supported by the examiner if necessary. He is made to walk in a straight line, backward and sidewise, then on his toes and heels, and finally he is asked to run.