The Journal of Abnormal Psychology, vol 10 | Page 5

regular period of occurrence of these headaches except
that there is also some relation to quarrels, etc. On several occasions the patient has lost

her voice for short periods ranging from a few minutes to several hours following
particularly stormy domestic scenes.
On July 29 of this year she was suddenly paralyzed. That is to say, she was unable to
move the right arm, the right leg, the right side of the face, and she lost the power of
speech entirely; there was complete aphonia. This "stroke" was not accompanied by
unconsciousness, but was preceded by severe headache and much nausea. During the
three weeks that followed she remained in bed, recovering only the function of the arm.
Her husband fed her by forcing open her mouth with a spoon. She did not lose control of
the sphincters. As she manifested no other progress to recovery despite the administration
of drugs, numerous-rubbings and liniments, the physician in charge called the writer into
consultation.
Physical Examination Aug. 20--A well-developed, fairly well nourished woman,
appearing to be about thirty-five years of age. Face wears an anxious expression and she
shuns the examiner's direct gaze. Movements of the right hand and arm are now fairly
free. There is no appreciable difficulty in any of its functions according to tests made for
ataxia, strength, recognition of form, finer movements, etc., in fact, she uses this hand to
write with, as she cannot talk at all. Such writing is free, unaccompanied by errors in
spelling, there is no elision of syllables and no difficulty in finding the words desired.
The face is symmetrical on the two sides. There is no evidence of paralysis of the facial
muscles. In fact, the cranial nerves, by detailed examination, are intact, except in so far as
respiration and speech are concerned. The right leg is held entirely spastic, the muscles
on both sides of the joints, that is, flexors and extensors, being equally contracted. It is
impossible to bend this leg at any joint except by the use of very great force. The reflexes
everywhere are lively but are equal on the two sides, and none of the abnormal reflexes is
present, including in this term Babinski, Gordon and Oppenheim.
Sensation--There is very markedly diminished reaction to pin prick all over the right side,
including face, arm, chest, leg and tongue. In some places complete analgesia obtains.
Reaction to touch is likewise diminished and recognition of heat and cold is impaired.
Speech--There is complete loss of the ability to make any sound, either voiced or
whispered; that is to say, there is complete aphonia,-- there is loss of all voice. The
patient understands everything, however, and writes her answers to questions rapidly and
correctly. She can read whatever is written, there is no difficulty in the recognition of
objects, no evidence of any aphasia whatever.
The diagnosis--hysteria--can hardly be doubted. The history of headaches, fainting spells
without marked impairment of consciousness, vomiting spells, hemianaesthesia,
hemianalgesia, complete aphonia and an exaggerated paralysis, not only of the right leg,
but of the ability to thrust out the tongue, while at the same time all other cranial
functions were unimpaired together with the apparent health of the individual in every
other respect, make up a syndrome hardly to pass unrecognized.
Treatment--The patient was entirely inaccessible to direct suggestion, for no amount of
assurance that her leg was all right enabled her to move it. When such suggestions were
made, she shook her head firmly and conclusively, and this is true of suggestions
concerning speech. This point is of importance in the consideration of the mechanism.
Attempts at hypnotism failed ingloriously. Psychoanalysis was deferred for the time, and
recourse was had to indirect suggestion and re-education.
The first function to be restored was the power of bending the leg which hitherto had

been held entirely spastic. The patient was assured that while she had lost the power of
using the limb, a little relaxation of the muscles of the front of the leg would permit it to
be bent. Her attention was distracted while at the same time a firm, steady pressure was
put upon the leg above and below the knee joint and advantage taken of every change in
the tone of the muscles involved in keeping the leg extended. Little by little the leg was
bent until finally it was completely flexed, this for the first time in three weeks. Her
attention was called to this fact and she was assured that upon the physician's next
attempt to bend her leg, resistance would be lessened and she would be able to aid
somewhat as well. This proved true. Then the leg was only partly supported by the
physician while the patient was assured that with his help she would be able to bend