During the period of the attack the whole right side becomes anaesthetic to all forms of sensations, kinaesthesis included, so that he is not even aware of the spasms unless he actually observes the affected limbs.
The affected limbs, previously normal, also become paretic. After the attack has subsided, the paresis and anaesthesia persist (as sometimes happens in true idiopathic epilepsy) for a few days, after which the patient’s condition remains normal until the next attack. After his last attack, however, the anaesthesia and paresis continued for about three weeks.
He has had every year one attack which, curiously, sets in about the same time, namely, about the month of January or February. The attacks have of late increased in frequency, so that the patient has had four, at intervals of about three or four months. On different occasions he was in the Boston City Hospital for the attacks.
There was a profound right hemianaesthesia including the right half of the tongue, with a marked hypoaesthesia of the right side of the pharynx. All the senses of the right side were involved. The field of vision of the right eye was much limited. The ticking of a watch could not be heard more than three inches away from the right ear. Taste and smell were likewise involved on the right side. The muscular and kinaesthetic sensations on the right side were much impaired.
The patient’s mental condition was good. He states that he has few dreams and these are insignificant, concerned as they are with the ordinary matters of daily life. Occasionally he dreams that he is falling, but there is no definite content to the dream.
These findings were indicative of functional rather than organic disease. The previous history of the case was significant. The first attack came on after peculiar circumstances, when the patient was sixteen years of age and living in Russia. After returning from a ball one night, he was sent back to look for a ring which the lady, whom he escorted, had lost on the way. It was after midnight, and his way lay on a lonely road which led by a cemetery. When near the cemetery he was suddenly overcome by a great fright, thinking that somebody was running after him. He fell, struck his right side, and lost consciousness. The patient did not remember this last event. It was told by him when in a hypnotic state.
The patient was a Polish Jew, densely ignorant, terrorized by superstitious fears of evil powers working in the dead of night.
By the time he was brought home he regained consciousness, but there existed a spasmodic shaking of the right side, involving the arm, leg, and head. The spasm persisted for one week. During this time he could not voluntarily move his right arm or leg, and the right half of his body felt numb. There was also apparently a loss of muscular sense, for he stated that he was unaware of the shaking of his arm or leg, unless he looked and saw the movements. In other words, there was right hemiplegia, anaesthesia, and spasms.
For one week after the cessation of the spasms his right arm and leg remained weak, but he was soon able to resume his work, and he felt as well as ever. Since then every year, as already stated, about the same month the patient has an attack similar in every respect to the original attack, with the only exception that there is no loss of consciousness. Otherwise the subsequent yearly attacks are photographic pictures, close repetitions, recurrences of the original attack.
A series of experiments accordingly was undertaken. First, as to the anaesthesia. If the anaesthesia were functional, sensory impressions ought to be felt, even though the patient was unconscious of them, and we ought to be able to get sensory reactions.