Literary Notices. clxxi 



weakness in lumbar region succeeded the shock. After some time in 

 bed could walk a little with crutches, with great pain in his back. 

 Legs very feeble, especially the left. Left hand and fingers also 

 lacked force. Was treated m Paris hospital. Lumbar pains dimin- 

 ished, but weakness of arm und leg increased until, in six months, 

 left hemiplegia became complete. In attitude, a slight spinal curva- 

 ture ; incapable of standing erect more than a few seconds ; unable 

 to retain equilibrium of posture with his eyes closed. In walking, 

 body bent to the right and step irregular. Muscular force almost nil 

 in left limbs, which seem almost lifeless. Thermic sensibility entirely 

 destroyed on entire left side ; dolorific sensation quite absent on lelt, 

 as also tactile sensation. Reflexes greatly deranged, especially on 

 left side. Odor and taste absent on left side and hearing feeble. Vis- 

 ual apparatus quite unaffected. Upon diagnosis, at first sight, we 

 considered the patient's hemiplegia of organic nature. But more 

 careful examination brought the conviction that some of the phenom- 

 ena were due to hysteria. This conviction has several elements; based 

 on objective examination - 



I St. Total hemianesthesia of the left side, with entire loss of 

 muscular sense, which, in hemianesthesia of capsular origin is usually 

 preserved. 



2nd. Bilateral anesthesia of the conjunctiva and bilateral loss of 

 taste and odor. 



3rd. The absence of facial paralysis. 



4th. The contradictory character of the hemiplegia. In fact, 

 though the olecranian and patellary reflexes were exaggerated, the 

 arm, when lifted up, fell back heavily like an inert mass. 



5th. The deformation of the vertebral column can be imputed to 

 hysteria. It may be explained with the unconscious positions taken 

 by the patient as a result of rachialgia of which he suffered for four 

 years. 



The conclusion solidly supports the condition that these phenom- 

 ena were caused by hysteria alone. The following arguments verify 

 our diagnosis : 



I St. Hemianesthesia has always confined itself to the region of 

 the shoulder. 



2nd. The inferior left member has reacquired muscular force 

 and normal mobility. The improvement began immediately after the 

 patient in question entered the hospital. The superior member im- 

 proved more slowly, but not less really and progressively. 



3rd. The crisis of rachialgia and the paralysis of the right leg, 



