so that he could not walk. The face or tongue was not involved. There was complete hemianæsthesia of the right side of the body. The bladder was normal. The mental condition good, though he did not sleep well for a few nights. The abdominal and thoracic viscera seemed to be normal.

Through the kindness of the visiting-physician, Dr. William G. Thompson, and the house physician, Dr. Cobb, I was enabled to make an examination of the patient, September 24th. He was then able to walk slowly and to use his right arm fairly well. He seemed to be an intelligent man, somewhat emotional, but anxious to tell the truth about his symptoms and to get well and back to his work. His mind was clear, and he suffered from no emotional depression or crises. He was sleeping well. His pulse was quite rapid (120) under my examination, but it had been normal, as were the temperature and respiration.

The face showed no paralysis, the tongue was protruded straight, and the pharyngeal arch was even. The right arm was weak, but he could execute all movements with it except raising it directly over his head. Dynamometer: right hand, 25; left hand, 40. There was a tremor in the arm and hand and occasionally in the leg. This tremor was rapid, but of rather large excursion, and increased on voluntary movement, or on directing attention to it. It was an "intention" and "attention" tremor. It did not affect the face or tongue. Speech was clear and deglutition normal. The leg was much more paretic than the arm. The foot and toes could barely be moved, the leg could be flexed and extended but partially. The tendon reflexes of arm and leg were present, but not exaggerated. The skin reflexes were well marked. There was anæsthesia in varying degree over the right side of the body. It was most marked in the lower limb, where it extended diffusely up to about Poupart's ligament in front and the gluteal fold behind. In the arm the anasthesia was more marked over the area of the ulnar, but it was present in a degree over the whole extremity. Around the shoulder and neck it became less. It was present over the right half of the face, including the tongue, but was less marked here than on the extremities. The anæsthesia was most marked for cold sensations, well marked for pain, and less marked for tactile sense. There was no muscular anesthesia or loss of coördination as tested by weights and by touching the nose and posturing the limbs.

The special senses showed peculiar conditions. The pupils were normal, even, and reacted to light and accommodation. There was no colorblindness. The man was presbyopic, but since his admission he had been unable to read well. (He had broken his glasses.) His right eye showed decided limitation of visual field, the left very much less, though some was present. No difference in visual acuteness was noted, and no hemianopsia.

The right ear showed hearing equally acute to the tick of a watch or the voice or tuning-fork, but absolutely deaf to bone conduction. A large tuning-fork vibrating on the mastoid was not heard; and vibrating on the teeth was heard only by left ear. Tested by Galton's whistle, the left ear showed a decided loss of hearing of high notes; the right still more. I had never met before a person so deaf to so great a range of the upper notes, though it is not very uncommon to find slight degrees of this deafness in the aged. The man had evidently a limitation of the auditory field comparable to that of the visual field.

There was an almost complete loss of smell in the right nostril, and a complete loss of taste on the right side of the tongue. There was also absence of pharyngeal reflex when the finger was thrust into the back of the throat.

There were no manifest secretory or trophic disturbances of the affected side. The man complained of very little pain. The electrical reactions were not taken.

We have here a case of traumatic hysteria of the type described by Charcot, Guinon, and the French writers. The points are so marked and characteristic that a discussion as to diagnosis would be supererogatory. We have the (1) hemiplegia not involving the face; (2) the anæsthesia distributed in the "gauntlet" shape, i.e., not following nerve tracts but involving mainly the limbs, and covering them like a stocking or glove; (3) we have the peculiar limitation of visual field (4) and auditory field, the bone-deafness, (5) the ageusia and anosmia, and (6) pharyngeal anaesthesia.

Three years after this accident, the patient was much improved but far from well. Case in litigation and not settled.

The auditory phenomena are particularly interesting, as they have not been investigated with as much care as the visual, and are in my experience rarer. The loss of smell on the right side is confirmatory of the view of a functional hemiplegia; for in organic hemiplegia from hemorrhages, etc., it is sometimes on the opposite side to the paralysis. It has also been claimed that the olefactory nerves do not decussate, and hence that hysterical hemiageusia is only apparent and due to trigeminal anæsthesia. This would not explain the present case. For the trigeminal anesthesia was very slight and the ageusia almost complete.

CASE II.

Traumatic Hysteria with Violent Tremor.-Mr. X., aged fifty-four; of American birth and parentage; married; business man. The family history is good in every way so far as any details can be obtained. The patient himself had always been an active business man, traveling a good deal. There is no history of syphilis or alcoholic excesses; he has, however, been somewhat excessive in sexual indulgence. He had never sufered from any serious disease or injury, and was perfectly well at the time of his accident. He was riding on a horse-car when this occurred. There was a collision; his car was suddenly stopped, and he was thrown violently against another person, being struck on the side of the head. He was not knocked down, but was very much confused. He went home, however, being at the time somewhat excited and nervous over the accident, and in a few hours passed into a partially comatose state, which lasted for two days. This ended in a violent hysterical outbreak of a maniacal or delirious character. This had subsided in the course of a week, and he was then found to be unable to use the left arm or leg. One month later muscular twitching and tremor began in the left arm. This tremor extended and soon involved the right arm and the muscles of the neck and head. About this time there was found to be also a left hemianæsthesia. He complained all the time of pains in the neck and head while these various phenomena were developed. The pains in the

head and neck and the tremor were found to be somewhat relieved by pulling on the head, so that his physician constructed for him a juryinast by which permanent support was given, and while wearing this he stated that he felt more comfortable. He was able to walk about, though not without much difficulty. The patient was brought to me by his physician, Dr. Gray, for examination while in this condition, some six months

after the accident.

I found him to be a well-nourished man, not at all anæmic, but having a depressed and distressed look. He walked with a dragging of the foot on the paralyzed side, in a manner that was perfectly typical of hysterical hemiplegia. His face was not involved by either paralysis or spasm. The tongue turned slightly toward the left. The left arm and leg were nearly powerless. He could flex, extend, pronate, and supinate the forearm and hand, but his upper arm was weaker; he could only partly contract the biceps and could barely raise the arm out from his side a few inches. He could not keep the arm up when held. He showed the same general weakness in the leg, though this was relatively less paralyzed. He could stand and drag the leg along; he could extend and flex the foot; he could do all movements, though feebly. The paralysis of both arm and leg was of the flaccid type, and there was no rigidity or spasm. The knee-jerks were normal on the left, somewhat exaggerated on the right; the elbow-jerks the same. The arm was affected with a marked tremor, which was coarse in character, and did not increase with voluntary movement, but continued active. On resting the arm the tremor ceased. He could carry a glass of water to his mouth. There was more tremor in the right arm than in the left. There was a very decided antero-posterior oscillation or tremor of the head; this was lessened and almost stopped by taking hold of the head with the hands and pulling upward. There was no notable tremor of the legs. There was some cutaneous anæsthesia on the left side, involving especially the arm, the shoulder, upper part of the trunk, and to a less extent the leg. The face was not involved. There was no ataxia. There was a vasomotor paresis of the left hand and arm, which were reddened and felt colder than the right. There was a slight atrophy of the left arm, the left forearm measuring 83, the right forearm 94 inches. The electrical reactions showed a slight lessening of galvanic and faradic irritability. Electric sensibility was lessened in the left arm.

The pupils were normal in reaction, and not dilated. Some visual weakness in the left eye; concentric limitation of the visual field; no reversal of the color fields, but the green field was very much contracted.

The ears showed a loss of hearing to high notes, especially in the left ear, with a lessening of bone conduction in that ear.

There was impairment of taste on both sides and a loss of smell on the left side, also an anæsthesia of the nasal mucous membrane, although there was no evidence of anesthesia of the cutaneous surface of the face.

The patient was a man of fair intelligence. He was suffering a good deal from pain in the head and mental depression, and from the inconvenience of his tremor and paralysis. He had no convulsive attacks or crises of any kind after the first week following the accident.

The case was settled out of court and lost sight of by me.