charge called the writer into consultation.

Physical Examination Aug. 20--A well-developed, fairly well nourished woman,
appearing to be about thirty-five years of age. Face wears an anxious
expression and she shuns the examiner's direct gaze. Movements of the right
hand and arm are now fairly free. There is no appreciable difficulty in any
of its functions according to tests made for ataxia, strength, recognition
of form, finer movements, etc., in fact, she uses this hand to write with,
as she cannot talk at all. Such writing is free, unaccompanied by errors in
spelling, there is no elision of syllables and no difficulty in finding 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