THE SKIN AND COMMON SENSATION. iooi 



In one case 1 a boring, tearing pain in one half of the body, accompanied by 

 motor weakness the day following its onset, led to suicide two years after the 

 attack. A lesion was found post-mortem in the thalamus (nucleus externus), ad- 

 joining the posterior third of the posterior segment of the internal capsule, in the 

 hemisphere opposite to the hemialgesia. In another instance 2 there was " severe 

 pain for a number of years in the right side of the body, and for five years 

 weakness of the right side, with involuntary movements of the right hand and 

 sometimes leg. On movement of the parts, pain could be produced in arm and 

 leg throughout, but while at rest pain Avas chiefly in elbow and knee. The 

 tactual sense was intact, although there was slight hyperesthesia. Localisation 

 power and the temperature and muscle senses were intact, except slight 

 numbness to cold. There was a high degree of hyperalgesia to pressure, per- 

 cussion, and all passive movements. A vertical section through the pulvinar 

 of the left thalamus displayed on the edge of the middle and posterior third a 

 round pea-sized cyst, filled, and a web of connective tissue, lying in the imme- 

 diate neighbourhood of the internal capsule." In another case, 3 a solitary 

 tubercle in the right half of the pons was the only lesion found to account for 

 severe pains existing in the left limbs, with complete anaesthesia of their skin. 

 "anaesthesia dolorosa." 



Cognition and feeling seem almost concomitant. To abstract either 

 from other can only be done as a conventional simplification for logical 

 purposes. There is therefore no a priori reason for expecting cognition 

 and feeling to be respectively adjunct to spatially separate cerebral 

 organs. As regards pain and the cortex, some argue that the feeling of 

 bodily pain is elaborated in the Eolandic region, and that thence are 

 initiated emotional movements, respiratory, vascular, and facial, etc. 

 Pain aura in epilepsy seems to be very rare. 4 It has been suggested 5 

 that the severe pains of hysterical and hypochondriacal patients are, 

 in some instances, of cortical origin. Witmer 6 had a " painless " 

 man for some time under observation. He had worked at a show 

 as " the human pincushion." " He could be cut with a knife, or 

 stuck with pins or needles, without showing the slightest sign of pain. 

 I have known him to hold a red-hot coin in his hand without 

 wincing, until it had burnt itself deep into the flesh. It is impos- 

 sible to say positively whether this subject inhibited the expression 

 of pain, or whether he inhibited the pain itself. He said he felt 

 pain on ordinary occasions, when he had not made up his mind to be 

 insensible to pain, but he reported that when once he had decided not 

 to feel pain of the stimulus, the pain was no longer felt. There were 

 areas of the skin which he could not render insensible to pain. I am 

 inclined to believe he inhibited the sensation of pain, and not its 

 external manifestations." Kant describes that he learnt to inhibit the 

 pains of his gouty attacks. 7 Cases of hysteria present phenomena ana- 

 logous to the above. Pain disorders are much more readily produced by 

 hypnotic suggestion than are disorders of any of the other senses, 8 

 except perhaps the muscular. 



1 Edinger, Deutsche Ztschr.f. JVerrenh., Leipzig, 1891, Bd. v. S. 262. 



2 Biernacki, Deutsche med. Wchuschr., Leipzig, 1893, No. 52. Also Henschen's case, 

 "Klin. Beitr. z. Path. d. Gehirns," 1890, Bd. i. S. 103. 



3 Marot, Bull. Soc. anat. de Paris, 1875 ; also Nothnagel's case, "Diagn. d. Gehirnk.," 

 Wien, 1879, S. 586. 



4 For a case, see Pierce Clarke, Am. Journ, Insan., Utica, N. Y., 1897. 



5 Edinger, cq>. cit. 



8 "Twentieth Century Practice of Medicine," 1897, vol. xi. p. 939. 



7 Letter to Hufeland, " Ueher d. Macht d. Genmths." 



8 Witmer, op. cit., and Journ. Nerv. and Aleut. Dis., N. Y., April 1894, p. 1. 



