touch, pain, muscle sense, and sense of posture. Condition of motor function: an absence of real paralysis in right arm and leg, but the arm is not used spontaneously for voluntary acts: lies as if paralyzed along side of patient; arm is used for reflex acts, like scratching, and for unconscious acts, like bracing herself when arising from a sitting or recumbent position to a standing one. When shown how to make a movement, and especially when the movement is made passively in the arm several times, the patient is able to repeat it perfectly. These are then apparently normal and not clumsily made nor is it necessary for patient to control these movements with her eyes" (pp. 148-149. Italics mine.)
Here we have a case which on the mental side illustrates three sorts or grades of movement:
(a) The highly volitional. Because of amnesia and lack of practice (it will be recalled that for four weeks the arm was not moved) this patient had apparently entirely forgotten certain arm and hand movements. These movements were made again by means of visual sensation from, and attention to, similar movements first made by the physician and also by means of visual sensation from, and attention to, the arm itself while the movements were being made.[1]
(b) The practiced voluntary. After practice, it was observed, the patient could make these arm movements without immediate visual control. (It is, however, always necessary to remember that the arm was not completely anaesthetic.)
(c) The reflex instinctive (?) These movements ("scratching," "bracing," etc.) did not require a period of learning and practice before they could be made without imitation and visual control, but appear to have been carried over into the anaesthetic condition from the normal condition. For these the remaining kinaesthetic sensibility seems to have supplied a sufficient sensory cue for their ready performance.
F. Müller describes a case of right-sided anaesthesia so nearly total that the patient could not distinguish passive movements
- ↑ Another instructive case has been kindly supplied me by Dr. Fair" banks of N., Mass. The patient, a young woman who suffered from spinal meningitis when ten years old, has lost sensibility in the fingers of both hands and cannot do anything with her fingers unless she can see what it is; for example, she can button or hook a garment that opens in front but not one that opens in the back. She can put her hat pins in if she is in front of a mirror. After anaesthesia appeared (which was not until about fifteen years of age) the attending physician recommended horseback riding, but this had to be given up because the patient could not hold the reins unless they were constantly kept in the field of vision. This case is particularly significant, because there are no other complicating disturbances, the patient being in all other respects highly efficient.
