A strongly built man, with many reflexes increased and a lively dermatographia. The reflexes of the left, or contractured, leg were lacking; the mastoid processes were painful, and the occiput and temples were painful to percussion. The spinous processes of the vertebral column in the lumbar region were painful. The other phenomena have been sufficiently indicated above. The head sensations were peculiar; there were no pains but a peculiar itching. Contraction of the fingers of the left hand was painful. There was a feeling as if there were lice under the skin in the left upper thigh. There was itching in the nose, which the patient described as due to the sulphur “out there,” meaning shell gases. Sleep and appetite were good. Memory was imperfect: he could no longer remember the names of the battles, and of late had had to count on his fingers to find out how much was 2 times 2. As to the curious parietal headache, contralateral to the contractured leg, Binswanger inquires whether we may not here have to do with localized vascular phenomena of the brain part which might conceivably be related with the innervation of the leg. Binswanger remarks that if the plaster cast be left on too long, it may happen that hysterical contracture will take place in the new position.
As to the will exercises used in the present case, Binswanger remarks that the patients must be intelligent and attentive, and naturally they must desire to get well. Fortunately, many of the war hysterics do want to get well, since the contrary experience is had in various industrial cases.
Wound of thigh: Pseudocoxalgic monoplegia with anesthesia. Cure of anesthesia by faradism at one sitting. Cure of lameness by reëducation and electricity in one month.
Case 230. (Roussy and Lhermitte, 1917.)
An infantryman, observed at Villejuif, February 9, 1915, was suffering from a right-sided crural monoplegia of a pseudocoxalgic type, following a wound September 9, 1914. The wound had been a through-and-through one in the upper right thigh. Every active movement could be performed as well on the right side as on the left; but the strength of the movements was less on the right, especially that of leg-extension. The reflexes were normal, the lameness was slight, with toeing out; the sole came down flat upon the ground. There was an absolutely complete anesthesia of the entire right leg and side up to the umbilicus.
Energetic faradization of the skin caused the anesthesia to disappear the day the patient was brought to the hospital. The cure of the lameness required a month of reëducation and electricity.
According to Roussy and Lhermitte, crural monoplegia is less frequent than brachial monoplegia. The flaccid form is rare, and when it occurs, complete, though the patient always remains capable of executing some voluntary movements and can walk with crutches or cane. During the automatic movements of walking, some muscles may be observed to contract that remain immobile when the patient is being examined recumbent. Naturally such a difference in contractions standing and lying, would be very exceptional in a case of organic monoplegia.
Contusion of thigh: HYSTERICAL right crural MONOPLEGIA. An ORGANIC CRUTCH PARALYSIS develops in the right arm, unobserved by the patient whose main concern is his useless leg. Cure of leg by psychotherapy.