REPORTED FOR THE PHYSICIAN AND SURGEON BY OUR PARIS CORRESPONDENT.

man.

GENTLEMEN: I present to you a patient who is a curious example of the affection called hystero-traumatic paralysis in I have frequently called your attention to hysteria of traumatic origin in men, but these cases are not so well known as they should be, for they are not at all rare. This man is a mason, twenty-four years old, and had not suffered from any serious illness up to the time he fell from a scaffold, some twelve feet, falling on his back. After some time in bed, at home, he tried to go to his work again, but on attempting to raise a sack of plaster he fell again on his back, and this time his lower limbs were paralyzed. He was then taken to a surgical service, in another hospital, and the surgeon in attendance made an examination and gave a diagnosis of Pott's disease. The man at that time complained of pain in the back, and said that he had spitting of blood, and felt a band of pain around his abdomen, while he had retention of urine, with the paralysis. A Sayres jacket was put on him, cauteries were applied along his spinal column, and after three months' rest there, the surgeons found his bladder all right and pains gone; so they tried to make

him stand, but without success. They then called to mind my cases of hystero-traumatic paralysis and sent him to this Hospice. He told us that his only sister and brother died young, of convulsions; but let us go back to his fall. He says that he slipped from the scaffold, falling on his right hip and back; he tried to rise, but his legs would not support him; carried to a drug store near by, they, as usual, rubbed him with arnica, and gave him plenty of ammonia to smell, with the result, also as usual, of acting so on his nervous system, that he fainted, more from fright, no doubt, than anything else; carried home he says he had stools of black blood and also vomited blood, and that his belly was much distended, while there was an absence of urine. After two months at his home he tried to get to work again, with the result, as we said before, of falling paralyzed; then followed his removal to the hospital, and the surgeon's diagnosis of Pott's disease. Well, if you will call to mind the symptoms of that trouble, you will remember that often a cheesy focus is developed in the body of a vertebra, and that can open into the spinal canal, and the pus, or tubercular matter, as you like, can pass downwards, causing trouble, and often after passing through the sheaths of the muscles, causes an abscess about the hip. It can also make compression on the spinal marrow, and be the cause of a myelitis, and paraplegia may follow without any deviation of the spinal column, so that in this weak looking young man, complaining of localized pains in the back and hip, you see there is plenty of excuse for the surgeon's first diagnosis of Pott's disease. Let us examine the spinal column. We do not have to press hard, for with the slightest pressure we soon come to a painful point, and he says: "Oh, that goes away up my neck, and I feel it in my ears and temples." This, gentlemen, is a real hysterogenic zone, and if the skin alone is pressed a little hard here, we could send him into a hysterical attack, as we have already proved. These hysterical zones are characteristic of his trouble. Let us now examine his form of paralysis. Notice the left side; his left leg, arm, and even the head trembles when he tries to walk, but this is hysteric trembling only. The right leg is almost impotent, he can hardly raise it above the level of the bed. It should be enough for you to see him walk to at once diagnose hysteric paralysis. A hemiplegic patient walks by making movements of circumduction, slinging his leg around like a man mowing hay with his leg. An infantile paralysis, on the contrary, makes all sorts of irregular movements, according to the different groups of muscles

involved, but our patient drags his leg after him as if it were a log, or as if it were dead. The modification of sensibility in fact is another of the characteristic symptoms of this affection. There is a complete anesthesia of his right leg. I pull and drag at it, pinch and stick a pin in his toes, but he does not move, and indeed, does not know what I am doing; he has lost all sense of feeling in the limb. When in bed he says he has to seek for his leg, and take care of it just as if it were a foreign body. When we pass the electric current the muscles act, but he does not feel them.

When you have this history of fall, swelling of the belly, retention of urine, paralysis, with the characters as you see them in this man, you may be sure that it is a case of hysteroparalysis. We have seen these cases last for months without any atrophy, or other change in the nutrition of the muscles, and in a few cases some atrophy, but no loss on movement on electrization.

In order to fix this disease well on your minds, I show you this second patient. He is quite a different type of man, being a peasant, who came to Paris, and got work about a railway station. One day he was struck by a car on the shoulder, and fell unconscious for twenty minutes, and in five or six days afterwards he presented a complete monoplegia of the arm. It is now nearly two years ago, and he still has hardly any movement in the fingers. The symptoms and anesthesia are the same as in the other case, and grouping them together, no other form of paralysis presents the same symptoms. When, for instance, there is a paralysis which has its origin in the brachial plexus of nerves, there is, of course, impotence in the arm, but in from eight to thirty days there will be atrophy of the muscles, and as a consequence of it, and the degeneration of the nerves, there is no reaction to electricity. Again, if there is a slight lesion of the brachial plexus, the troubles of sensibility are but temporary, and they will pass away in a month or two. Let the nerves alone, and see what a lesion of the spinal cord itself would do. We know that the most common of these troubles is that of infantile paralysis, which may occur in adults; but here in four or five days there is a reaction showing a degeneration of nervous action, as the electric current will not act; and then later on appears most certainly atrophy of the muscle. Suppose again that there is a lesion that is localized to one-half of the cord, giving for instance a monoplegia of the right side; well, here there would be found the syndromes of Brown-Séquard, that is