The Journal of Abnormal Psychology, vol 10 | Page 5

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 it more freely. From this, she passed on to the ability to move the leg without any assistance on the part of the writer. After having been given exercise in bending the leg for some twenty or thirty times, with complete restoration of this ability, she was induced to get out of bed, and while standing erect she was suddenly released by the physician. She swayed to and fro in a rather perilous manner but did not fall. Finally, by gradation of tasks set, by a judicious combination of encouragement and command, she was enabled to walk. She was then put to bed and assured that upon the physician's next visit she would be taught to walk freely. Meanwhile, the husband was instructed that he must not allow her to stay in bed more than an hour at