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        IN the consideration of this case, there is primarily traceable from grandmother. to granddaughter, through the father, a tendency towards similar disproportionate reactions under approximately similar conditions. This tendency, which presumably in grandmother and in father did not approximate a psychopathic condition, has definitely reached this point in the present case. In her father the dream life has been exceedingly active, with disproportionate influence upon waking states. In the patient this activity developed into somnambulism. This persisted to the patient's fifteenth year. The character of the trances was not recalled, except in regard to their general tone, which was decidedly unpleasant.

        Revival of these states was not attempted, because of limitations placed by family. The persistence, therefore, of dominating subconscious memories could not be demonstrated. Patient's history, previous to accident, can be briefly reviewed. The general tone of her life was idle and purposeless. Further, there were no somatic diseases of an exhausting type which at times precede as agencies of a causative series. The manner of the determining accident has been previously detailed. A slight sprain, usually invaliding one for a period of seven to ten days, in this case produced conditions persisting for two years. The preceding history of the joint was not of a nature to warrant such a reaction as the result of an even more severe strain. The degree of stress to which the joint was subjected certainly was alone insufficient to produce the result. The main factors were evidently psychical in character.

         It has been observed that with individuals of so­called "peculiar temperaments" accidents slight and insignificant produce many and diverse untoward effects. In this case, the excessive pain and the emotional shock was preceded by a dissociation primarily slight, but which, by a systematization developed to a considerable degree of extent and fixity. From the field of consciousness, certain normally contributory psychomotor systems have been dissociated. These systems dropping to the subconscious, produce psychomotor disturbances.

         As to the pre-existence of determining subconscious memories, nothing further than a suspicion could be maintained. An examination clearly revealed the fact that the patient's subconscious life was rather highly developed; patient was an active dreamer and a somnambulist. Of the sufficiency of affective states to produce such results, a number of cases are on record.

         The similarity is to be discovered in their common reference to one cause―that of psychic origin, usually consisting in a mental dissociation of psychomotor states. Of the many cases on record, we take a few for illustrating our point of view:

         In the Journal de Médecine et Chirurgie, Paris, 1895 (pp. 888-890), a case is reported in which the contracture evidenced was traceable to a slight fall and severe mental shock, with consequent amnesia for a short time. The contracture noted at the time of his later attack was an exact reproduction of that assumed at the time of the psychic trauma causing mental dissociation.

         Janet reports cases in which contractures regularly followed dissociated states or dreams. In one case, for instance, the patient had dreamed vividly of playing the piano, compassing octaves rapidly. The "hands became contracted in the position a pianist would give them in trying to stretch an octave." In another case, the contracture assumed was presented by a young woman in a state of religious ecstasy. The rigidity, sufficient to maintain the body, is a marked psychomotor manifestation of the subconscious working of a dissociated system.

         In another case a young man, a sailor on a merchant-vessel, received upon the chest and abdomen the shock of a barrel rolling on the deck. He was not hurt, but he remained bent forward by a permanent contracture of the muscles of the abdomen and thorax.

         Féré reports a case of paraplegia following a dream. The patient dreamt that she was pursued by men, and awoke with a feeling of weakness in both legs. For two weeks in succession this dream kept on repeating itself, occurring even in the daytime, finally developing complete paraplegia.

         An interesting case is reported by Dr. Henry L. Winter, Associate in Anthropology at the former Pathological Institute of the New York State Hospitals. Since the case is closely allied in character to the one presented in this paper, a more or less full account of it is given here:

         Family history: Grandparents, negative. Mother died of apoplexy during confinement, aged thirty­eight years. This was the second attack. First attack three years previous. Mother's only brother living and well, but of very emotional nature. Father, living at present, aged seventy years, suffers from double cataract. Two of father's brothers became blind at about same age from the same cause.

         Personal history was negative up to ten years of age. The death of his mother occurred at this time and was announced to him under conditions which excited him greatly. He became mentally depressed and at the funeral attempted to throw himself into his mother's grave. From that time he has continued to be very emotional, and at present laughs and cries without provocation, not infrequently laughing when the occasion calls for serious action. These emotional outbreaks are so pronounced as to interfere with his business and the discipline of his home. At eleven years of age, the patient had an attack of Bell's palsy, which has never entirely disappeared. He has had no other illness up to April, 1899. At that time he says that while asleep he dreamed that he was falling, and awoke to find a considerable loss of power in the right hand and, somewhat less marked, in the right leg.¹ His voice, previously firm and clear, became weak and husky. He told his wife that he had had a 'stroke.' These symptoms continued for about two months, during which time he was under treatment. The arm recovered first and then the leg. Patient says that speech never became perfectly normal. Patient has always had the well-defined idea that he would die of paralysis, and the same idea was apparently held by other members of his family. He had been bowling considerably about the time the above symptoms appeared, and his family had told him to stop that form of exercise because it would lead to paralysis. He, himself, ascribed the condition to excessive bowling. On November 13, 1899, he began to suffer with severe occipital headache, which continued for several days. On the 17th, four days after the onset of the headache, the right hand began to feel numb and weak and the headache ceased. About two hours later the voice began to diminish in volume, and after the lapse of about two hours more the leg began to feel ' lifeless.'

         I first saw the patient three days later, [Monday] November 20, 1899. At that time there was a right hemiplegia with almost complete aphonia. The paralysis was more marked in the leg than in the arm. Pressure on the dynamometer registered 40 with the right hand and 100 with the left. The superficial and deep reflexes were slightly increased on the right side. The muscles were slightly spastic. Irregular spots of partial anæsthesia were present on the dorsal surface of the hand, over the tight deltoid muscle, and on the right side of the face. There was complete anæsthesia about the mouth on both sides. Examination of the throat by Professor Coakley revealed a perfectly healthy larynx, without any paralysis. The emotional condition above referred to was very marked; patient cried during entire examination. Heart, arteries, and kidneys were normal.

         The history and condition of the patient were suggestive of a psychical origin for the hemiplegia, and I decided to treat him on that basis. I gave the patient positive assurance of speedy recovery and advised him that the leg would recover first, then the arm, and finally the voice.

         On [Monday] November 27th patient reported improved. The paralysis in the leg was greatly diminished.

         Dynamometer registered a pressure of So with the right hand and 100 with the left. Condition of voice unchanged. Reflexes still slightly increased on right side. The anæsthetic spots disappeared from the hand and diminished in size over shoulder, but remained the same on the face. Patient was advised that the leg would be entirely free from paralysis when he next returned, and that the arm would be greatly improved and voice stronger.

         [Monday] December 4th patient again reported. The paralysis had entirely disappeared from leg. Dynamometer registered a pressure of 65 with the right hand and 105 with the left. Reflexes normal. Condition of voice unchanged. Anæsthetic areas had disappeared from shoulder and diminished in size and degree on face. Patient advised that by the time of his next visit he would be entirely well.

         Patient reported on [Monday] December 11th. At this time the paralysis in arm had disappeared. Dynamometer registered 110 right and 100 left. Reflexes normal. The aphonia, however, was still present. The inability to speak above a whisper did not appear to the patient to be of grave consequence, and he ceased treatment.

         On December 12, 1900, about one year after the occurrence of the conditions just mentioned, the patient came into my office dragging the right leg and with the right arm hanging. He could not speak above a very low whisper, and it was only by putting my ear close to his mouth that I could hear what he said. He pronounced the words properly, but seemingly with great effort. He said that, except for a weakness in his voice, he had been perfectly well from the time I had last seen him until two days before. At that time he went to his home, after bowling for about two hours, and was preparing for bed when he felt dizzy. He sat down and almost immediately lost consciousness. This lapse of consciousness lasted for about five (?) minutes, and when he recovered he could not move his arm or leg nor make himself heard when he tried to speak. He suffered from a slight occipital headache and soon fell into a deep sleep which lasted all night. In the morning he felt well, with the exception of the paralysis.

         On examination, I found a complete right hemiplegia, including the face. (At the first attack there was no paralysis of the face except what remained of the old Bell's palsy.) The muscles were in a spastic condition and the leg and forearm were contracted. The reflexes were only slightly increased. The vocal cords and larynx were not examined. The entire right side of the face was anæsthetic, but there were no areas of anæsthesia elsewhere.

         This time I concluded, if possible, to decide the nature of the paralysis, and gained the patient's consent to induce hypnosis. I made him no promises beyond stating that I believed the treatment would be of benefit to him. During the first three days I was unable to induce anything but a light sleep, failing to get the patient to respond to any suggested movements. At the fourth trial, however, the sleep was considerably deeper. In this state the conditions remained unchanged. At this time I told him that I was going to apply a very powerful drug to his tongue, after which he could speak distinctly. Taking a swab of cotton, I wet it with warm water and applied it to the tip of the tongue, at the same time asking, 'How do you feel now?' 'Very well, thank you,' the patient replied in a moderately strong voice. I then told him that I was going to awaken him, and that after five minutes he would feel that his tongue was warm and would speak about it, his voice being strong and natural. After awaking him I waited six minutes, and then, as he failed to speak, asked him if everything was all right. He shook his head, but said nothing, and after waiting a moment took up his hat and said that he was going home. His voice was about the same as before the hypnosis.

         The same plan was pursued on the following day. About five minutes after I had awakened him he suddenly put his hand up and touched his tongue, at the same time saying, 'Doctor, my tongue burns.' His voice was loud and clear, but he evidently did not notice this fact, because when I said, 'Why, your speech is all right now,' he began to deny it, but was convinced by the continuation of its full volume, and became greatly excited. After the excitement had subsided I examined him and found that the paralysis of the face had also disappeared (except, of course, the remains of the old Bell's palsy). The patient conversed with me for several minutes, the voice retaining its strength and fullness.

         On the next day the voice still continued strong, and has remained so to date (June, 1901). The paralysis of the face had not returned. Patient was again hypnotized and asked if he could walk without dragging his feet. He replied that he could not. 'Yes, you can,' I replied. 'Try it!' He refused to try, and I again ordered him to walk. This time he stepped, but dragged his leg. The command was repeated. He hesitated for a moment and then walked normally. I asked him what was the trouble with his arm, and he replied that it was paralyzed. I told him that 'it was not, and ordered him to put it out. He tried, but apparently could not; then tried again with greater success. I urged him to put it out straight, and he complied without hesitation. I placed the dynamometer in his hand and commanded him to press it, which he did, registering 100. After making him exercise the arm in various ways, I told him that the paralysis was all gone, and that it would never trouble him after he woke up. Then seating him, I told him to open his eyes. For a few minutes he sat watching me while I wrote, and then, apparently forgetful of the former paralysis, reached out his right hand and took his hat from the table. I then bade him good-morning, and he left without making any reference to his condition.

         The next morning he returned accompanied by his wife, who said that while he had used his arm and leg well he had been stupid and dull since he arrived at home the preceding day, and had failed to take any interest in things which ordinarily appealed to him. Patient appeared still to be partially under hypnotic influence, and I accordingly rehypnotized him, and after repeating the same commands as on the previous day, I told him that he would be wide awake as soon as I touched his eyes and told him to open them. After I had done this, the patient remained seated for a moment, and then jumped up and began walking up and down the room considerably excited. I spoke to him, and he immediately controlled himself and sat down and talked rationally. There was absolutely no paralysis (except, again, the remains of the Bell's palsy), and the voice and speech were perfectly normal.

         The patient reported to me from time to time up to [Monday] May 1, 1901, when he left town. There has been no return of the trouble, but the emotional disturbances still occur, though not so frequently."

         Characteristic tremor-tracings under conditions of fatigue taken of this case by Dr. Sidis in the Psychopathological Laboratory are interesting from the standpoint of the relation of neuron energy and fatigue to various states of dissociation, with their underlying conditions of neuron-disaggregation and neuron degeneration. Along with other experiments and tracings they will be published in a special paper.

         Dr. Winter goes on to say: "Several theories have been advanced, the most widely known of which is probably that of the Nancy School. The conceptions of Bernheim do not, however, appear to explain the various conditions with which we come in contact clinically. My own views are based upon the theories advanced by Sidis."² We agree on this point, but as the more theoretical aspect of the phenomena under investigation is relegated to another place, we omit Dr. Winter's discussion. What is specially interesting in the case "is the close similarity of type with the one presented here. There is a history of patho-psychosis, of a high degree of emotionalism and suggestibility, a tendency towards psychopathic dissociations caused by the death of patient's mother, the presence of a psychic trauma subconsciously experienced in a vivid dream and giving rise to psycho­motor disturbances, to loss of kinæsthetic sensations and memories in waking life. From this standpoint we can realize the paramount importance of the account elicited from the patient, that "while asleep he dreamed that he was falling, and awoke to find a considerable loss of power in the right hand and somewhat less marked in the right leg."

         The reverse process, however, may happen: Instead of taking place subconsciously the psychic trauma occurs in waking life, the dissociated system sinks into the obscure, dreamy, subwaking region of the subconscious, and from thence causes psychomotor disturbances in the normal waking state. Such was the course of the process in the present case. From whichever region, however, whether waking or subwaking, the psychopathic process may start, the outcome is the same,―the psychomotor disturbances are due to persistent dissociated subconscious systems.

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1. The italics are mine.
2. The Medical News, New York, January 4, 1902.

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