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 a time and that she must come to the table for her meals.

On the physician's next visit, two days later, it was found that the husband had not been able to induce his wife to come to the table, and that he had been unable to get her to walk. The physician then commanded her to get out of bed, which she did with great effort. She was then put back to bed and instructed to get up more freely and without such effort, demonstration being a visual one, in that she was shown how best to accomplish the task set. Finally, at the end of the visit, she was walking quite freely and promised in writing, for she had not as yet learned to talk, that she would eat at the table.

The next day instruction was commenced along the lines of speech. Upon being asked to thrust out her tongue, that organ was protruded only a short distance, and she claimed, in writing, to be unable to protrude it further. Thereupon it was taken hold of by a towel and alternately withdrawn from and replaced into the mouth. After a short period of such exercise she was enabled to thrust the tongue in and out. She was then instructed to breathe more freely; that is to say, to take short inspirations and to make long expirations, this in preparation for speech. She was unable to do this, the expiration being short, jerky and interrupted. Thereupon the examiner placed his two hands, one on each side of her chest, instructed her to inspire, and when she was instructed to expire forced his hands against her ribs in order to complete the expiratory act. After about fifteen or twenty minutes of this combination of instruction and help the patient was able to breathe by herself and freely. She was then instructed to make the sound "e" at the end of expiration. This she was unable to do at first, but upon persistence and passive placing of her mouth in the proper position for the sound, she was able to whisper "e." From this she rapidly went on to the other vowel sounds. Then the aspirate "h" was added, later the explosives, "p," etc., until at the end of about two hours she was enabled to whisper anything desired. Her husband was instructed not to allow her to use her pencil any more, and she promised faithfully to enter into whispered conversation with him, although it was evident that she promised this with reluctance.

Upon the next visit, two days later, she was still whispering, and when asked if she could talk aloud, shook her head and whispered "No," that she was sure she could not. Efforts to have her make the sound "a," or any of the vowels in a voiced manner failed completely. She was then instructed to cough. Although it is evident that a cough is a voiced sound, she was able to do this, in a very low and indistinct manner. She was then instructed to add the sound "e" at the end of her cough. This she did, but with difficulty. Finally, after much the same manoeuvering which has been indicated in the account of how she was instructed to whisper, she talked freely and well. When this was accomplished the husband was instructed to have her dress herself and to take her to: some place of amusement, and to keep her out of doors almost continuously.

At all times the patient had complained of a pain in her side which she claimed was the root of all her trouble. It had been "doctored," to use her term, by all the physicians in the city and, it was alleged, came after she had been lifting a paralyzed old lady in the house across the way. Despite all treatment this pain had not disappeared and the various diagnoses made—strain, liver trouble, nervous ache had not sufficed to console the patient or to relieve her. There was no local tenderness, no pain upon movement, but merely a steady ache. No physical basis whatever for this trouble could be found. Her medicine for the relief of it was discontinued, and so, too, were certain medicines she had been obtaining for sleep.

Upon each visit the husband and wife had been informed by the physician