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.
Case 231. (Babinski, 1917.)
A certain lieutenant, following contusion of the right thigh, developed a crural monoplegia of hysterical nature. In fact, although the paralysis had lasted several months, the tendon reflexes, the skin reflexes, and the electrical responses of the muscles, were absolutely normal. Moreover, the good effects of psychotherapy confirmed the hypothesis. But besides the hysterical crural monoplegia, there was a radial paralysis on the right side, clearly organic in nature, due to the nerve compression by the crutch which the patient had employed on account of the paralysis of his leg.
Babinski notes that this association of conditions was remarkable in that it demonstrated that hysteria and simulation should not be confounded with one another. To be sure, it is difficult to tell simulation from suggested phenomena, for there are no objective characters that demarcate the two. Babinski had himself said that hysteria was a demi-simulation; but a demi-simulation is not a simulation. The patient was in fact, sincere enough in his belief that he could not move his leg. To obviate this paralysis, he had in fact leaned so conscientiously upon his crutch that an organic paralysis had resulted. In fact the radial palsy had only been discovered incidentally, and the paradox appeared that a purely imaginary trouble occupied in the patient’s mind for a long time a much more important place than the genuine organic trouble which accompanied it.