The Year's Work in Showgirls Studies

Melissahardie
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THE YEAR’S WORK IN
SHOWGIRLS
STUDIES
The Year’s Work:
Studies in Fan Culture and Cultural Theory

Edward P. Dallis-Comentale and Aaron Jaffe, editors

THE YEAR’S WORK IN
SHOWGIRLS
STUDIES

EDITED BY
MELISSA HARDIE,
MEAGHAN MORRIS,
AND KANE RACE

INDIANA UNIVERSITY PRESS

This book is a publication of

Indiana University Press

Office of Scholarly Publishing
Herman B Wells Library 350
1320 East 10th Street
Bloomington, Indiana 47405 USA

iupress.org

© 2024 by Indiana University Press

All rights reserved

No part of this book may be reproduced or utilized in any form or by any means,
electronic or mechanical, including photocopying and recording, or by any
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 CONTENTS

• ACKNOWLEDGMENTS

• INTRODUCTION
MELISSA HARDIE, MEAGHAN MORRIS, AND KANE RACE

• PART I ESSAYS
1 Getting It Just Right: Elizabeth Berkley’s Ways of Knowing in
Showgirls
ANNA BRECKON

2 Self-Shattering in Showgirls and Black Swan

KANE RACE

3 “Ain’t anyone ever been nice to you?”: Discharging the Guilty

Pleasure of Showgirls
KIERYN MCKAY

4 Badness
ADRIAN MARTIN

5 Showgirls, Showgirls 2, and the Fate of the Erotic Thriller

BILLY STEVENSON

6 Fifty Shades of Showgirls: Better Living through Mediation

MELISSA HARDIE
7 The Instability of Evil: Double Trouble and the Working Girl
MEAGHAN MORRIS

• PART II CONVERSATIONS
8 The Accidental Showgirl: Reminiscing with Performer and
Pioneer Feminist Lynne Hutton-Williams
JANE CHI HYUN PARK AND SHAWNA TANG

9 “Fuck you! Pay me”: Stripper Art and Storytelling Speaking Back
from the Stage
ZAHRA STARDUST

10 On Cliché, Camp, and Queer Temporality: Discussing Showgirls

KARA KEELING AND MEAGHAN MORRIS

• PART III ARCHIVE

11 Loose Slots: Figuring the Strip in Showgirls
MELISSA HARDIE

12 Round Table: Showgirls, Film Quarterly 56, No. 3 (Spring

2003): 32–46

• INDEX
 ACKNOWLEDGMENTS

Many years in the making, this book has required a lot of love to
bring it to completion from its beginnings in a small conference
organized by Melissa Hardie for the intellectual pleasure of Showgirls
fans in 2015. We must therefore first thank our contributors for their
patient commitment to the project, and we thank Kate Lilley, André
Frankovits, and Stephan Omeros for living through the process with
us. We also express our gratitude for the meticulously caring work of
Gareth Richards, Helena Dodge-Wan, and Eryn Tan of Impress
Creative and Editorial in consolidating our manuscript for
presentation to Indiana University Press.
Given that The Year’s Work in Showgirls Studies is critically
concerned with labor in visual and performance culture, we are
deeply indebted to the generosity of people who have gone out of
their way to provide us with artwork and images that articulate this
concern to broader social contexts. We say thank-you to Exotic
Cancer, Glitta Supernova, Katia Schwartz, Bella Green, Queenie Bon
Bon, Frankie Valentine, and Despo Debby for using their artistic
mediums and creative platforms to build stripper culture, and to
Carol Burman-Jahn, Sylvia Cowen, and Lynne Hutton-Williams for
helping us document some historical links between circus and
showgirl life in the mid-twentieth century. Grateful thanks go to
Shlomo Adam Roth and family for their time and generosity in
facilitating permission to reproduce a precious photograph of a 1995
Showgirls billboard.
Another key concern of this book is the community-building
power of small or local cultural events and the productive longevity
and spread of the conversations these enable. Kane Race is indebted
to Sydney’s long-running film festival Queer Screen for the unique
experience of watching Showgirls with a gay and lesbian Mardi Gras
crowd in Double Bay’s Village Twin Cinema in the late 1990s.1 While
Melissa Hardie and Meaghan Morris first saw the film in the more
mundane context of its 1995 Sydney commercial release in
downtown Sydney’s Village Cinema City, a shared conversation about
it began with BOLD, a Philosophy and Women’s Studies conference
convened in Canberra at the Australian National University’s
Humanities Research Centre by Elizabeth A. Wilson and Helen Keane
in July 1996. On the invitation of Efi Hatzimanolis and Brigitta
Olubas, this event led to the publication of Melissa’s pathbreaking
paper “Loose Slots” (here, chap. 11) in an early feminist refereed
journal, Xtext, based in the School of English at the University of
New South Wales.
The editors wish to thank Derek Covington Smith for allowing us
to reproduce a portion of his artwork “Neon Nomi” for the cover of
this book.
Apparently long gone now, these and other experimental cultural
initiatives created on the boundary between community activism and
academic work in and around the time of Showgirls unleashed
energies that continue to shape our lives and our work today.
Without them, this book would not have come into being.

Note
1. “Queer Screen History,” Queer Screen,
https://queerscreen.org.au/aboutus/history/#_ga=2.9686256.496548770.1666848
795–1796401238.1666848795.
THE YEAR’S WORK IN
SHOWGIRLS
STUDIES
 INTRODUCTION
MELISSA HARDIE, MEAGHAN MORRIS, AND KANE RACE

The twentieth anniversary of the release and catastrophic box office

failure of Paul Verhoeven’s film Showgirls in 2015 prompted
celebrations, interviews, reappraisals, and reflections as diverse—
and divergent—as the responses elaborated over the preceding two
decades. Proliferating online with a galvanizing force not available to
fan communities in 1995, when Showgirls recouped less than half of
its $45 million budget and scored a record number of Razzie
nominations for “worst of the year” awards, the flow of passionately
thoughtful public engagement with this much-derided film did not
subside with the anniversary year. In 2017, for example, the Film
Society of Lincoln Center for the Performing Arts in New York hosted
a screening and a discussion with Verhoeven and actor Gina
Gershon; Adam Nayman’s short monograph It Doesn’t Suck:
Showgirls, first published in 2014, had a special new edition in 2018;
and an archive of critical essays together with Showgirls-related clips
and interviews has expanded online.1 Then, in 2019, Jeffrey McHale
released You Don’t Nomi, a feature-length documentary about the
reception and significance of Showgirls today.2
The form of this reputational controversy is not unique in film
history. In the 1950s, Douglas Sirk’s sumptuous and torrid Hollywood
melodramas were widely dismissed as soapy trash. A general
consensus around their brilliance formed only after some key
interventions, led in the first instance by Jean-Luc Godard and
Rainer Werner Fassbinder, whose essays from 1959 and 1971
respectively were translated into English around the same time as
Sirk on Sirk: Interviews with Jon Halliday was published by the
British Film Institute, while Halliday coedited Douglas Sirk with Laura
Mulvey for the Edinburgh Film Festival.3 Perhaps no European auteur
since Sirk, however, has been more misrecognized and rehabilitated
than Verhoeven, whose 1990s Hollywood films Basic Instinct (1992),
Showgirls (1995), and Starship Troopers (1997) were almost
parodically misread and consigned to the trash heap.4 The impulse
to “rescue” Showgirls, Verhoeven’s most infamous work, from the
ignominy of dismissal has followed two tracks, both neatly
reproduced in You Don’t Nomi. One track rehabilitates Showgirls by
asserting the vision of an auteur, tracing its debt to and interaction
with Verhoeven’s pre-Hollywood oeuvre and finding complexity in his
adaptation of genre conventions within that auteurist vision. This is
the Sirkian mode of revision. The other track prosecutes an
argument about the varieties of encounter the film elicits: camp and
cult consumers whose wit and close-reading verve demonstrate the
depths of what can be known about the film. This track of
rehabilitation urges revival rather than revision: not inclusion in a
canon but seclusion as a unique instance whose various parts make
an inimitable whole.
It’s not an accident that scenes of vomiting from a series of
Verhoeven films are spliced together in You Don’t Nomi to make
these points. A montage of vomiting, typically into a toilet bowl,
metaphorizes elements of Showgirls’ narrative that McHale’s film
deftly goes on to narrate: the intrusion of an unpleasant
phenomenon or experience into the everyday, the return of the
unexpected, and a revisiting of earlier pleasures in a distinctly
unwelcome form. It also captures the critical disgust of many early
reviewers of Showgirls as viscerally as they often expressed it at the
time, but then it negotiates this disgust by making its very
representation, in its repetitions, a sign of an auteurist project.
Disgust is often aligned with cult and camp spectatorship and with
the witting deployment of tropes of off-center consumption in camp
and cult cinema.5 Led by Nomi’s vomit scene early in Showgirls, this
physical embodiment of disgust or fear is aligned with other ways in
which Nomi’s body is laden with meaning.
 David Schmader, a promoter of camp reception events,
comments in You Don’t Nomi that on first viewing Showgirls he was
struck by “Nomi having bizarre responses to people who are just
trying to give her a hand,” a comment illustrated by scenes of Nomi
responding aggressively to either physical or verbal approaches from
strangers or, in a couple of cases, her boss. Schmader’s comment
feels awkward both in the context of the film’s diegesis, which
abundantly demonstrates why Nomi fears for her own safety, and in
the context of watching the film today, post #MeToo. It strains
credulity on any watching of the film to understand these strangers
as merely “giving a hand,” as the gentle Good Samaritans they
sometimes purport to be. And that makes it all the more surprising
that Schmader uses Nomi’s physical domination in these scenes as
an index of the bizarre rather than as an assertion of her bodily
strength and autonomy. But it reminds us that a certain strain of
“cult” reading reproduces the reductive logic by which Showgirls
(and Elizabeth Berkley’s performance as Nomi) was minimized as a
feminist icon and fable when the film was released.
For students of fan cultural phenomena, however, a different
dimension for thought is opened up by perhaps the most poignant of
the 2015 anniversary celebrations, the Cinespia screening of
Showgirls in the Hollywood Forever Cemetery, Los Angeles, on June
28, with Elizabeth Berkley present for her first viewing in twenty
years of the film that derailed her career. Accessible endlessly for
now on YouTube, the love exchanged between the four thousand
fans who turned up for the screening and Berkley as she blurred into
Nomi onstage manifests itself with an intensity echoing Berkley’s
performance in the film itself.6 In thanking those fans for keeping
faith with the film over the years and giving her the “sweet” moment
she expected but was painfully denied in 1995, Berkley bears
witness not only to the capacity of fan formations over time to affect
critical judgment but to the power of shared popular cultural
pleasures, passions, and sensibilities to transcend a myriad of
personal traumas in communal moments of joy.
 This volume, too, had its genesis in the anniversary year, with a
one-day symposium at the University of Sydney organized by Melissa
Hardie in September 2015, precisely with the communal aim of
sharing intellectual joy. Small-scale and informal, the “Showgirls
1995–2015” event brought some of our contributors together for the
first time and confirmed at the outset our interest not only in the
mutable pleasures the film has provided over the years but also in its
capacity to activate responses connecting with wider social worlds of
sexuality, spectacle, and labor, then and now. This collection leans
toward the view of Showgirls as offering the realistic vision of life
that Verhoeven’s first auteurist champion, Jacques Rivette,
memorably described in 1998 as “surviving in a world populated by
assholes.”7 This is not a simple orientation to adopt, however, since
the filmmaking process itself folded into the “real” of that vision by
putting intimate survival pressure on some of the performers. If all
“backstage” stories reflect in some way on the cultural industries
enabling their creation, Showgirls in 1995 was embedded in a
gendered production economy of intense exploitation, with novice
female stars Berkley, Gershon, and Gina Ravera playing roles devised
by the then Hollywood alpha male team of Verhoeven and writer Joe
Eszterhas, flush with the box office success of Basic Instinct and
testing the power of the NC-17 rating to put “in-your-face sexuality,
copious nudity and over-the-top melodrama” into a mainstream
cinema release.8 The subsequent critical trashing of Berkley’s acting
is well known, but Gina Ravera has only recently described the
“ordeal” of filming the gang rape scene in her role as Nomi’s friend,
Molly Abrams. Unprepared for what it would it be like (“you’ve got
two men holding you down; my wrists were bruised, and my body
was just covered in bruises after it because of what was asked for
the camera”), she was traumatized physically as well as emotionally
by the “exuberance” of Verhoeven’s pursuit of realism: “The [punch]
you see in the film made contact. My jaw was not right for years.”9
In spite of this, for Ravera the experience of making Showgirls
was “mixed; there’s some good stuff,” and she credits Verhoeven
with understanding that she was playing the Hollywood stereotype
of “Black best friend” and giving her freedom to develop the role. In
this collection, we emphasize the labor and the perspectives of
performers, whose “ways of knowing” (as Anna Breckon puts it in
her chapter) have been occluded by the prominence in much
Showgirls appreciation of the figure of the camp spectator.
Accordingly, the problematic “realism” of Showgirls is explored here
not only in critical essays but through documentary, ethnographic,
and archival approaches to those “mixed” experiences that inform
and continue to relay the significance of the film to fans.
In particular, the “Conversations” section provides a thick
documentary context of three dialogues dealing with life experiences
and ideas that may enrich our understanding of the serious social
import of Showgirls. This section situates the showgirl historically
and socially in a series of skilled professions and takes up issues of
race as well as gender and sexuality that were not always well
addressed in the earlier reception life of the film. In the first of these
conversations, Jane Park and Shawna Tang interview Lynne Hutton-
Williams about Lynne’s life as a trapeze artist “accidentally” turned
Las Vegas showgirl some decades before the time in which the film
is set, situating that performance culture in relation to the circus
world familiar to Lynne and tracing her trajectory through to
adventures in British and Australian feminist institution building in
the 1970s. This is followed by a chapter by Zahra Stardust drawing
on her use of autoethnography among strippers, pole dancers,
burlesque artists, queer performers, and sex workers in Sydney
today to document the literature, arts, and storytelling produced by
strippers themselves as they organize and advocate from within the
industry. The third conversation piece takes the form of a dialogue
on race, gender, aesthetics, and the moment of Showgirls in US
social history and popular culture between Meaghan Morris,
speaking from an “outside” as an Australian film critic, and the
American cinema scholar Kara Keeling, whose book Queer Times,
Black Futures provides concepts that enable their cross-cultural
dialogue.10
 These conversations are complemented by an archival section
that serves to complicate our sense of the history of Showgirls’
reception. We introduce this section with Melissa Jane Hardie’s essay
“Loose Slots” from 1996.11 The essay was originally published in an
Australian small press journal, XText, which was devoted to
theoretically and politically informed cultural criticism across
academic and institutional boundaries (the “X” or “cross” of the
journal’s name). We assume from experience that the popularity of
Showgirls among feminist academics in Australia was not
exceptional, although it is rarely represented in traditional histories
of the film’s reception. Hardie presented her essay as a paper at a
feminist conference, BOLD, at the Australian National University in
Canberra. Convened at the Humanities Research Centre by Elizabeth
A. Wilson and Helen Keane in July 1996, under the auspices of the
Australian National University’s Women’s Studies and Philosophy
programs, BOLD proposed that compelling feminist cultural analysis
arose when diverse disciplinary practices were brought together
(coeditor Meaghan Morris also presented on martial arts studies at
BOLD). “Loose Slots” here represents tangible evidence of a
feminist, antihomophobic, theoretically informed fandom for the film
from its release.
A critical moment in the history of Showgirls’ reappraisal was the
2003 publication of a set of short responses to Showgirls in Film
Quarterly, which we reprint. Rather than argue a simple revision of
the film as a lost classic, the round table identified evaluation itself
as a critical vulnerability exposed by the reception of the film. Across
this group of responses, the film complicates popular and academic
versions of film criticism because of its capacity to complicate or blur
distinctions vested in taste culture. For example, Akira Mizuta Lippit’s
contribution (pp. 349–353) dissects the film through an evaluative
apparatus supplied by Leonard Maltin’s Movie & Video Guide 2002.
Before IMDb, Rotten Tomatoes, and other online resources made
evaluative descriptions of films easily available, Maltin’s guides were
exercises in epigrammatic description and assessment of value.
Lippit’s intricate deconstruction of the apparatus of evaluation—star
ratings and Maltin’s version of the “thumbs down,” the BOMB rating
—demonstrates how all varieties of judgment are encapsulated in
this system and its application to Showgirls. Lippit’s hypothesis that
Showgirls concatenates pornography and melodrama as
“pornodrama” signals some of the work the film does to play with
genre; he describes these generic medleys as “immersions” of styles
that never settle into a blend as such but that sit together in a state
of suspense.
Reflecting on one such style, a mode of satire (“the blood that
we do not see”) that does not signpost itself as such and allows only
fleeting glimpses of an underlying moral of redemption, Chon
Noriega sketches a complex critique of its racial foundation in the
subservient roles of the Black characters and of the crushing by a
celebrity production team of the “rank and file actress who did what
she was paid to do” (p. 361). In a different approach to evaluation,
Jeffrey Sconce’s “I Have Grown Weary of Your Tiresome Cinema”
introduces the principle of rewatching as transformative, noting that
it takes precisely “four screenings of the film to transform it from
one of Hollywood’s most notorious flops to absolute transcendence”
(p. 377). This account of sublimity achieved through repetition
introduces a common trope in Showgirls critical history: a narrative
of conversion, one already centered elsewhere by Adrian Martin in
his famous 2000 essay, “The Offended Critic.”12 Appropriately, given
Sconce’s emphasis on the critic whose viewing experiences calibrate
the film’s value, his piece concludes with a call for a wry version of
Barthesian bliss and the liberation of the critic from the dreary role
of “cultural custodian” in favor of the pleasure of being smart about
film.
These and other essays in the archival Film Quarterly round table
offer precedents for the critical chapters of this collection as they
identify key historical and formal contexts for understanding the
reception of Showgirls and its endurance as an object of fascination,
repulsion, and celebration over more than twenty years. These
chapters complicate both auteurist traditions whose efforts to
revalue the film place the director in complete control of the
meanings that can be made of it and camp and cult reading
practices whose pleasures depend on a reassertion of its
categorization as bad. Instead, these essays explore the capacity of
Showgirls to generate new pleasures and insights into the workings
of gender, sexuality, labor, performance, taste, genre, popular
culture, mediation, and media ecologies.
In “Getting It Just Right: Elizabeth Berkley’s Ways of Knowing in
Showgirls,” Anna Breckon opens the essay section by developing a
reoriented epistemology for the film grounded in the figure of the
actor and her identification with the ambitions of her character. This
alignment gives Berkley’s performance an erotic and expressive
agency that defies conventions of taste, objectification, and
directorial intention. Next, in “Self-Shattering in Showgirls and Black
Swan,” Kane Race investigates how women who dance for a living
navigate the demand to deliver authentic performances of
heterosexual desire and stay “classy” in cultural institutions where
investments in class are used to exploit them. Where the protagonist
of Black Swan takes the “suicidal ecstasy” of masochistic desire
literally, Nomi plots a different course that mobilizes another more
situated sense of self-shattering.13
Kieryn McKay’s “‘Ain’t anyone ever been nice to you?’:
Discharging the Guilty Pleasure of Showgirls” tracks the mechanisms
by which MGM/United Artists strategically repurposed their box office
flop as a camp midnight movie and then as a DVD boxed set for cult
home viewing. Repackaging Showgirls for commercial advantage
mobilizes a politics of taste that for McKay precludes the film’s
sincere appreciation. In “Badness,” Adrian Martin suspends the
question of the badness of films in favor of an exploration of the
staging of badness in films. His wide-ranging tour of the mechanism
of the “show within the show” queries feelings of security in matters
of taste and showcases some diverse ways in which the varied tastes
of spectators can be represented, reworked, redefined, and
reclaimed.
Billy Stevenson’s “Showgirls, Showgirls 2, and the Fate of the
Erotic Thriller” situates Showgirls in relation to the changing media
ecologies, historical genres, and visual aesthetics of late millennial
screen culture. If Showgirls makes a case for the cinematic spectacle
as a category of pleasure, it also allegorizes its own displacement by
the postcinematic technologies used to cobble together its unlikely
sequel. For Melissa Hardie in “Fifty Shades of Showgirls: Better
Living through Mediation,” bringing together Showgirls and a more
recent flop, Fifty Shades of Grey, helps to historicize the films’
interest in plots of female rivalry and their embedding of that generic
mainstay in scenarios of libidinal complicity and contracted labor.
Showgirls orients its ingenue through a representation of her
capacity for calculation but more through her “thinkiness,” where
intellectual action joins other kinds of activity in her negotiation of
genre and medium. Finally, in “The Instability of Evil: Double Trouble
and the Working Girl,” Meaghan Morris connects Showgirls to Pitof’s
Catwoman (2004) through the twinning of ethically imperfect female
characters around the issues of women’s labor in creative industries
that structure both films in different ways. Exploring the use these
films make of the motifs of the double and the orphan to model
practices of self-invention for women outside the bonds of family life,
Morris draws on the autobiographies of the singer, actor, and dancer
Eartha Kitt (for whom duality was a key to survival in the
performance worlds she knew) to propose a queer historiography
capable of tracing in temporal depth the diverse experiences and life
struggles of women who labor in cultural industries that then claim
to “represent” them.
The essays that make up this volume are addressed in diverse
ways to the disciplines from which they emerge—film studies,
cultural studies, gender and queer theory, and others. They are also
consciously engaged with the practices and professional identities
that the film investigates and celebrates, finding an amplified
account of the “showgirl” as complex professional identity and
physical and intellectual praxis assists academic engagement with
the film’s dense account of a historic moment in its history. The
collection therefore folds into its fandom and appreciation of the film
the wisdom afforded by a renewed interest in workplace sexual
dynamics, race and ethnic presence, and the insights of
antihomophobic theory alongside the documentation of experiential
and historical presence in the showgirl zone. But they all share one
thing: they are written from outside the zone of equivocation that
has characterized writing on Showgirls in the past. Instead, they
perform the kinds of fandom they explore, putting in plain view
intellectual, affective, and libidinal investments in this extraordinary
film.

MELISSA HARDIE is Associate Professor of English at the University of

Sydney. Her recent work appears in Australian Humanities
Review, Textual Practice, Film Quarterly, and Angelaki. Her most
recent book chapter (with Amy Villarejo) is on the 1978 Briggs
Initiative and the television drama Family, in Television Studies in
Queer Times. She is editor of the Oxford University Press series
Approaches to the Novel.

MEAGHAN MORRIS is Professor of Gender and Cultural Studies at the

University of Sydney. She is author of The Pirate’s Fiancée:
Feminism, Reading, Postmodernism; Too Soon Too Late: History
in Popular Culture; and Identity Anecdotes: Translation and Media
Culture.

KANE RACE is Professor of Gender and Cultural Studies at the

University of Sydney. He is author of Pleasure Consuming
Medicine: The Queer Politics of Drugs; The Gay Science: Intimate
Experiments with the Problem of HIV; and (with Gay Hawkins
and Emily Potter) Plastic Water: The Social and Material Life of
Bottled Water.

References
Alter, Ethan. “‘Showgirls’ at 25: Gina Ravera Discusses the Cult Movie’s Most
Controversial Scene.” Yahoo!Entertainment, September 23, 2020.
 https://www.yahoo.com/entertainment/showgirls-gina-ravera-controversial-
scene-paul-verhoeven-220338697.html.
Bersani, Leo. “Is the Rectum a Grave?” October 43 (1987): 197–222.
Bonnaud, Frédéric. “The Captive Lover—An Interview with Jacques Rivette.”
Translated by Kent Jones. Senses of Cinema 79 (September 2001). First
published in French, 1998. http://sensesofcinema.com/2001/jacques-
rivette/rivette-2/.
Breckon, Anna. “The Erotic Politics of Disgust: Pink Flamingos as Queer Political
Cinema.” Screen 54, no. 4 (2013): 514–33.
Fassbinder, Rainer Werner. “Six Films by Douglas Sirk.” In Douglas Sirk, edited by
Laura Mulvey and Jon Halliday, 95–106. Edinburgh: Edinburgh Film Festival,
1972.
Film at Lincoln Center. “‘Showgirls’ Q&A: Paul Verhoeven & Gina Gershon.”
YouTube, March 1, 2017. https://youtu.be/vj7JB_Otn3A.
Godard, Jean-Luc. “Tears and Speed.” Translated by Susan Bennett. Screen 12, no.
2 (1971): 95–98. First published in French, 1959.
Hardie, Melissa Jane. “Loose Slots: Figuring the Strip in Showgirls.” XText 1
(1996): 24–35.
Keeling, Kara. Queer Times, Black Futures. New York: New York University Press,
2019.
Maltin, Leonard. Leonard Maltin’s Movie & Video Guide 2002. New York: Signet,
2002.
Marsh, Calum. “Starship Troopers: One of the Most Misunderstood Movies Ever.”
The Atlantic, November 7, 2013.
https://www.theatlantic.com/entertainment/archive/2013/11/-em-starship-
troopers-em-one-of-the-most-misunderstood-movies-ever/281236/.
Martin, Adrian. Mysteries of Cinema: Reflections on Film Theory, History and
Culture 1982–2016. Perth: University of Western Australia Publishing, 2020.
———. “The Offended Critic: Film Reviewing and Social Commentary.” Australian
Quarterly 27, no. 2 (2000): 10–16.
McHale, Jeffrey, dir. You Don’t Nomi. XYZ Films, Grade Five Films, 2019.
Nayman, Adam. It Doesn’t Suck: Showgirls. 2nd ed. Toronto: ECW, 2018.
Sandler, Kevin S. “The Naked Truth: Showgirls and the Fate of the X/NC-17
Rating.” Cinema Journal 40, no. 3 (2007): 69–93.
Sirk, Douglas, and Jon Halliday. Sirk on Sirk: Interviews with Jon Halliday. London:
Secker and Warburg for the British Film Institute, 1971.
toofab. “Elizabeth Berkley Embraces ‘Showgirls’ 20 Years Later.” YouTube, June 29,
2015. https://youtu.be/tk8XR3U71D0.

Notes
Another random document with
no related content on Scribd:
lesion is in the cerebellum, so that, if continuous, it is not likely to
mean that anything worse is coming. It has been said to be strongly
significant if occurring without the digestive derangements or
circulatory disturbances likely to cause it, and be unconnected with
disease of the ear. Unfortunately for diagnosis, but fortunately for the
patients, the so-called vertigo a stomacho læso, may arise in cases
where the stomach trouble is very difficult or impossible to detect,
and it often continues for weeks or months after the most careful
regulation of the diet, and yet is followed by no cerebral lesion.
Although a vertigo for which every other cause can be excluded
certainly justifies a suspicion of cerebral trouble, the tendency to
exaggerate its prognostic importance should not be encouraged by
the physician, as it may exist a long time, and disappear without
another sign of the catastrophe which has been keeping the patient
in dread.

Among the more significant and immediate symptoms are to be

reckoned paræsthesiæ of the side about to be paralyzed, such as
numbness or tickling. Headache of great severity is often, but not
invariably, present. It has nothing characteristic about it, except that
it may be different from those the patient has been in the habit of
having, or may be of unusual severity, so that the patient says it is
going to kill him. Such a headache in a person in whom there is good
reason, from age, interstitial nephritis, or other symptoms, to suspect
the existence of vascular lesions is likely to be an immediate
precursor of a hemorrhage. Persistent early waking with a slight
headache, which passes off soon after rising, is said by Thompson29
to be a somewhat frequent premonition. Vomiting is hardly a
premonitory, but may be an initial, symptom, especially in
hemorrhage of the cerebellum.
29 N. Y. Med. Record, 1878, ii. p. 381.

Reference is had in these statements chiefly to the ordinary form of

cerebral hemorrhage. Of course if, during a leucocythæmia or
purpura, large hemorrhages occur elsewhere, it may be taken as a
hint that possibly the same thing may take place in the brain.
These signs of arterial disease must be considered as of the highest
importance among the (possibly remoter) premonitory signs, not only
of cerebral hemorrhage, but of the other lesions treated in this
article. Atheroma and calcification of the tangible arteries place the
existence of peri-endarteritis among the not remote possibilities.
High arterial tension has already been spoken of in connection with
etiology, and its presence should be sought for. An irregular and
enfeebled cutaneous circulation has been spoken of as an indication
of value.

OCCLUSION OF THE CEREBRAL ARTERIES may take place from several

causes other than those which concern us here, as from the
pressure of tumors or endarteritis, usually syphilitic. Thrombosis and
embolism are grouped together from their great anatomical
resemblance and their frequent coexistence, but the symptoms
produced, although ultimately the same, are often different enough
to make it necessary to bear in mind the fact that there is a
distinction—that is, that embolism is rapid and thrombosis is slow.

A cerebral artery may be occluded from the presence of a plug of

fibrin more or less intermixed with the other elements of the blood.
This plug may have been formed in situ, and is then somewhat firmly
attached to the walls of the vessel, and partly decolorized at its
oldest portion, while on each side of it, but especially on the side
away from the heart, it is prolonged by a looser and darker clot of
more recent origin. This is a thrombus.

When the plug has been transported from elsewhere it is embolus.30

It may consist of various substances, as described in the article on
General Pathology, but is usually of fibrin which has formed a
thrombus or vegetation elsewhere, and, having been broken off, is
carried by the blood until it comes to a place too narrow for it to pass,
or where it lodges at the bifurcation of a vessel. The piece of fibrin
thus lodged has a strong tendency to cause a still further deposition
—that is, a secondary thrombus—which may progress until it comes
to a place where the blood-current is too strong for the process to go
on any farther. It may in such cases not be obvious at the first glance
whether the whole process is thrombosis or whether it started from
an embolus.
30 The Greek word εμβολος (εν, in, and βαλλω, to throw) signifies the beak or rostrum
of a ship of war. Εμβολον signifies wedge or stopper, and would certainly seem the
appropriate form to be adopted for anatomical purposes. As uniformity of
nomenclature, however, seems more to be desired than etymological accuracy, the
writer has conformed in this article to the general usage.

It is probable that a thrombus forming at one point in a cerebral

vessel may break to pieces and its fragments be carried farther
along, forming a number of small emboli. (See Capillary Embolism.)
Embolism or thrombosis may take place anywhere in the brain or
body generally, but has certain points of preference. Of these, the
most usual in the brain is in the neighborhood where the internal
carotid divides into the anterior and middle cerebral, or in either of
these arteries, especially the middle, beyond this point. The plug
may be situated in the carotid just before this point, or even as low
down as its origin from the common trunk. Emboli lodge in this
region, somewhat more often upon the left side. The brain is said to
be third in the order of frequency with which the different organs are
affected by embolism, the kidneys and spleen preceding it. It has
been found that small emboli experimentally introduced into the
carotids are found in much larger numbers in the middle cerebral
than elsewhere. It is the largest branch, and most nearly in the direct
line of the carotid. Position undoubtedly influences the point at which
an embolus lodges, as it probably moves slowly along the vessels
and along their lower side. It has been remarked that, on account of
this course of the embolus, it is doubtful whether it can get into the
carotid when the patient is standing, but it certainly can do so when
he is sitting up; which, so far as the direction of the carotids is
concerned, is the same thing. The frequency with which a
hemiplegia is observed when a patient awakes in the morning may
perhaps be accounted for by the position favoring the passage of an
embolus into the carotid, which otherwise would reach organs more
remote.
The vertebrals and basilar are not infrequently affected.

The sources whence cerebral emboli may spring are various, but
cannot be found outside a certain range. They may, in the first place,
be torn off from vegetations upon either the mitral or aortic valves;
and this source is probably the most common. The appendix of the
left auricle may furnish a plug from the thrombi formed among its
trabeculæ, or the aorta from an aneurism or from parietal thrombi
formed, upon spots roughened by atheroma. The pulmonary veins
are occasionally the source of the embolus, though this is not very
common.

It is rather doubtful whether an embolus can find its way from the
systemic veins through the lungs to the brain, but it is possible that
small emboli may do so, and increase in size from the addition of
fresh fibrin when floating in the blood-current. The occurrence of
pyæmic abscesses in the brain would suggest the possibility of this,
though it is, on the other hand, possible that the brain abscesses are
secondary to older ones in the lungs. In some cases, however, a
careful examination does not disclose the source of the embolus.

In the blood-current the embolus may give rise to no symptoms

whatever, and even after its arrival in the cerebral circulation it may
lodge in such a way as not entirely to obstruct the current. In most
instances, however, it does not stop until it plugs the vessel
completely and arrests the current of blood beyond it for a moment.
Whether it shall completely deprive the portion of brain to which it is
distributed depends upon its situation as regards anastomoses and
upon the formation of secondary thrombus. Hence the knowledge of
the distribution of the arteries supplying the brain—that is, the two
carotids and two vertebrals—is of more importance in reference to
embolism and thrombosis than to cerebral hemorrhage, where the
effusion takes place from quite small branches.

The anterior portion of the brain, including the anterior and posterior
central convolutions and the first temporal, are supplied with blood
by the two terminal branches of the internal carotid, the anterior and
middle cerebral, the ganglia underlying these portions of the cortex
being supplied, as already stated, by small branches arising near the
origin of these two trunks, and principally the second. The anterior
cerebrals of the two sides are connected by the anterior
communicating, which is a short and usually wide vessel. Sometimes
one anterior cerebral branches in the longitudinal fissure, and
supplies a part of both sides. Hence in plugging of one internal
carotid which does not reach its bifurcation a collateral supply may
be received from the other side. If, however, an embolus or thrombus
has penetrated beyond the origin of the middle cerebral, this vessel
can no longer receive a supply from the anterior.

The posterior communicating arteries are two small vessels which

connect on each side the posterior cerebrals and either the carotid,
just as it gives off its two chief cerebral branches, or else the middle
cerebral close to its origin. These arteries may be of quite unequal
size, that upon the right usually being the larger, and sometimes so
large as to give the appearance of being the principal origin of the
posterior cerebral. When this happens the part of the posterior
cerebral which arises from the basilar may be reduced to a minute
arteriole, and the basilar, almost entire, goes to supply the left side of
the brain. This condition of the posterior communicating may exist to
some extent on both sides in the same brain. It is probable that in
many cases these arteries are too small to be of great value in re-
establishing the circulation in the anterior portion of the brain when it
is suddenly interrupted by an embolus.

When the large trunks leave the circle of Willis to be distributed upon
the surface of the brain, after giving off from the first centimeter or
two of their course the nutrient arteries for the deep-seated ganglia,
they break up into several branches which ramify upon the surface,
but, as Duret has shown, undergo very few anastomoses. Instead of
forming, as was once supposed, a richly inosculating network, small
branches penetrate into the brain-substance perpendicularly from
the superficial vessels, but these do not communicate freely with
each other by vessels larger than capillaries.
From these anatomical conditions it happens that when a vascular
territory is deprived of its normal supply by an embolus, it cannot be
supplied with blood from surrounding districts. A certain limited
amount of collateral supply is possible through the capillaries and the
rare anastomoses, but it is only around the edges, and the centre of
the territory becomes destitute of circulating blood. Thus an embolus
does not in the brain produce, as it does in other organs with more
abundant collateral supply, a large hemorrhagic infarction.

Small hemorrhages may, however, take place around the edges of

the softening, and when a number of small emboli are present, so as
to afford a number of overlapping areas with their borders of
congestion, a red softening may be the result. When the emboli are
very small, and at the same time not numerous enough to occlude all
the ultimate ramifications of a trunk, the vascular compensation may
be rapidly completed.

The change produced in the cerebral substance from cutting off its
supply of blood is known as anæmic necrosis, and includes what has
been known as white softening, with probably some yellow, and
possibly a little red softening, the latter in case where simple
softening has been complicated by hemorrhage.

When the circulation ceases the substance that should have been
nourished loses its firmness and acquires a custard-like consistency.
The gray and white substances are no longer so distinct in
appearance, the latter losing its milky-white color, the whole surface
of a section becoming of a dirty yellowish-white, somewhat shining,
and looking as if it contained more moisture than normal. When a
considerable portion of the interior of the hemisphere is thus
affected, the brain outside, with its membranes, bags down, looks
swollen, and feels to the fingers as if there were present a sacful of
fluid. The boundaries of such an area of softening are marked off
from the healthy substance with some distinctness, though less than
that of a hemorrhage. There may be some hemorrhage around the
edges or into the cavity, so that the presence of a little blood-pigment
is no proof that the original lesion was not softening from occlusion.
In the further progress the contents of the cavity become more fluid,
and finally a somewhat distinct cyst is formed, not unlike that from a
hemorrhage, with an internal areolar structure from the remains of
connective tissue, and contents of a slightly yellowish or brownish
color, or often of a chalky white. These cysts have little to distinguish
them, when old, from similar ones left by hemorrhage, except the
much greater amount of pigment in the latter. The smaller spots of
softening may after a time lose their fluidity, and remain as yellowish
patches as firm as, or firmer than, the surrounding brain. The region
of the brain involved becomes atrophied, the convolutions shrink,
and the membranes become filled with serous fluid, to compensate
for the sinking of the surface.

The microscope shows gradually increasing fatty degeneration,

disorganization of the nervous tissue, and degeneration of its
elements. The pyramidal cells are sometimes distinctly recognizable
by their form, and show gradual transition into the indeterminate
round granulation-corpuscles. The vessels exhibit fatty degeneration
of their coats, as well as accumulation of fatty granules between the
vessel and the lymphatic sheath. The clot which blocks the artery
becomes adherent to its walls, and the vessel with its contents forms
a round solid cord.

In a few instances the thrombi have become perforated through the

centre, so that a channel is formed for a renewal of the circulation.
There is no reason to suppose that this takes place soon enough to
be of any advantage in restoring the nutrition of the necrosed
portions of brain.

The region involved in softening depends upon the artery which is

plugged and the location of the obstructing body. The place of
election seems to be the carotid near its separation into its large
branches, or these branches after the separation, especially the
middle cerebral, this being peculiarly liable because it is the largest
branch and is the continuation in a direct line of the carotid. It is more
frequent upon the left side. Cases have been observed where the
whole of one hemisphere was softened from obstruction of the
carotid at its bifurcation; which may be accounted for, as Charcot
suggests, by an unusual distribution of the arteries, as described
above, the posterior cerebral as well as the other two being derived
almost entirely from the carotid. In a case recently observed by the
writer the whole right cerebral hemisphere, with the exception of the
tip of the frontal and tip of the occipital lobes, was softened to the
consistency of custard, a thrombus extending from the bifurcation of
the common carotid into all the ramifications of the middle cerebral.
The most common form, however, is where more or less of the brain
around the fissure of Rolando and fissure of Sylvius, with or without
the underlying ganglia, is softened. This happens from a lodgment of
the embolus in the middle cerebral. If the obstruction be close to the
origin of the artery, the corpus striatum suffers, from the mouths of its
small nutrient arteries arising in this part of its course being stopped,
while if it have passed along a little farther, these remain open, and
the cortex, to which the larger branches are distributed, alone is
softened.

The anterior cerebral is not infrequently affected, either alone or with

the middle, and in these arteries as well as the posterior the
embolus, if of small size originally, may penetrate so far as to give
rise only to quite a limited anæmia. The basilar is an artery not very
rarely occluded, though more commonly by thrombus than embolus.
This occlusion may be so limited as to affect only the nutrient
arteries of the pons and cause a very limited softening, the parts
before and behind it being supplied by the unobstructed portion or by
collateral circulation from the carotids. Occlusion of the cerebellar
arteries and softening of the cerebellum are among the rarer forms.
The vertebrals themselves are sometimes plugged. A thrombosis
has been observed in the only inferior cerebellar artery which
existed, causing softening in both lobes. There was atheroma of the
heart and arteries, and a thick calcareous plate in that which was
occluded.31
31 Progrès méd., 1876, 373.
In a general way, it may be said, with many exceptions on both
sides, that thrombosis and embolism tend to affect the cortex, and
hemorrhage the central ganglia.

What has just been written applies to the simple mechanical action
of emboli. If, however, they have a septic origin, as notably in cases
of ulcerative endocarditis, the region in which they lodge becomes,
instead of a simple spot of necrosis, a septic focus or abscess, with
its results of compression or irritation. In such a case there are likely
to be abscesses of similar origin in other organs, and the cerebral
lesion is only a part of the general pyæmic condition.

ETIOLOGY.—So far as the lodgment of an embolus in an artery is

concerned, it can hardly be said that there is any etiology, for the
detachment of the plug from its place of origin is purely a matter of
accident, and may take place at any time. As to its origin in the form
of fibrinous deposit on the valves of the heart or a roughened spot on
the aorta, we must refer to the article on General Pathology. The
most important condition for embolism is disease of the valves of the
heart, rheumatic or otherwise. Next comes arterial disease,
producing roughening of the inner coat and subsequent deposition of
fibrin. So far as we can tell, the causes leading to endarteritis or
atheroma are essentially the same as those which produce the
periarteritis described in connection with cerebral hemorrhage, and
we may therefore put down old age, alcohol, and strain as among
the causes of cerebral embolism. Injuries of the lungs leading to
thrombosis of the veins may be considered as possible sources for
the formation of an embolus, and we might suppose that phthisis and
pneumonia would furnish plugs which would lodge in the brain,
though as a matter of fact they seldom do so.

Experience shows that embolism, unlike hemorrhage, is not specially

a disease of advanced life, but is distributed over different periods,
with preference for old age less marked than with hemorrhage.
Andral gives the ages of patients with softening—which, however,
includes thrombosis as well as embolism—as follows: the average
would undoubtedly be displaced in the direction of youth if
thrombosis could be taken out of the list:

Andral: Andral: Cases (with autopsies) of

Beginning of softening Death with softening embolism, thrombosis, and
in 27 cases. in 153 cases. softening—25 cases.
17–20 4 15–20 10 20–30 4
27 2 20–30 18 30–40 3
30–37 2 30–40 11 40–50 3
43–45 2 40–50 19 50–60 1
53–59 4 50–60 27 60–70 5
63–69 7 60–70 34 70–80 2
76–78 6 70–80 30 Young 1
80–89 4 Middle-aged 1
Old 5

In the etiology of cerebral arterial thrombus there seem to be two

factors of prime importance, although there are cases which seem to
demand a third, and Charcot32 suggests the possibility of some
hæmic dyscrasia favoring the formation of a thrombus, and relates a
case of thrombosis of the middle cerebral, with three others of the
same process in other arteries, occurring in patients with uterine
cancer, where all the usual sources of emboli were explored with
negative results. The first of the two is disease of the cerebral
arteries, not necessarily extensive, but sufficient to form a starting-
point on the inner wall for the deposit of fibrin. In this respect the
etiology of thrombosis may be various. Syphilitic endarteritis, for
instance, may very easily give rise to this lesion, but it is likely to be
accompanied by others, and has a symptomatology more or less
peculiar to itself. It is not, of course, to be included with the form we
are considering.
32 Comptes Rendus Soc. de Biol., 1865, p. 24.

The second factor—one which is perhaps capable of giving rise to

coagulation of the blood or deposit of fibrin without any arterial
disease—is weakness of the heart, connected or not with anæmia.
The causes of this condition may be manifold, and are likely to lead
to many other consequences than cerebral thrombosis. A thrombus
may form upon a very small basis of atheroma. Several of these
points are illustrated in the following case: A lady, aged about sixty-
five, had had for many months vague symptoms of want of strength,
fatigue, want of appetite, and so on, with complaints of distress and
fulness in the abdomen, for which no special cause could be found.
On one occasion she was unusually long in dressing, and her
expression was noticed to be changed and her voice altered for a
few moments. The pulse was habitually 60 or less, and at times
irregular, but nothing abnormal could be detected in the sounds or
position of the heart. Fatty degeneration was suspected. One
morning, after going to bed in her usual health, she was found on the
floor of her room unconscious and with left hemiplegia. She lived
about thirty-six hours. The autopsy showed nothing abnormal in the
abdomen except a considerable accumulation of fat; and in the
thorax the heart appeared normal, and was not fatty. There was very
little atheroma. In the end of the internal carotid artery was a
thrombus, of which the lower and firmest part was connected with a
very small spot of roughening just at the point where the artery
comes through the base of the skull. It extended just beyond the
origin of the middle cerebral artery, which was of course occluded.
The corresponding region of the brain was converted into a vast
mass of softened tissue.

The SYMPTOMS of the lodgment of an embolus in the brain may

closely resemble, or even be precisely the same as, those of
hemorrhage. Unless, however, an embolus makes a pause on its
journey, giving rise to a partial obstruction before there is a complete
one, or unless the obstruction is not absolute until after the formation
of a secondary thrombus, the attack may be absolutely sudden.

A thrombus, however, is slower in its formation, and may produce

gradually increasing anæmia of the region of brain supplied before it
is absolutely complete, with a gradually increasing paralysis and loss
of consciousness slowly approaching. Thus we may have the early
symptoms in the form of headache, vertigo, heaviness, and
drowsiness, peculiar sensations in the limbs about to be paralyzed or
in the head, delirium of various kinds, or hysterical manifestations.
Prévost and Cotard33 lay special stress upon the importance of
severe vertigo (étourdissement) as a prodrome or warning of
softening, especially in the aged. It is dependent upon anæmia of the
brain, and this, in its turn, upon atheroma of the arteries, and
sometimes at least upon feebleness of the circulation, both of these
being conditions likely to cause the deposit of a thrombus. As,
however, the thrombus does not necessarily result from these
conditions, and as the vertigo may arise from other sources, as
stated under the head of Cerebral Hemorrhage, it is to be looked
upon with special suspicion chiefly in those cases where other
symptoms might lead in the same direction, and when other causes
can be excluded.
33 Mémoires de la Soc. de Biol., 1865, p. 171.

The same authors also speak of less defined symptoms, like delirium
and stupor, occurring among the inhabitants of the Salpêtrière (old
women), with intervals of comparative health, as being premonitory.

It is possible, however, for the symptoms of thrombus to be

developed rapidly when, as in the case last described, the thrombus
begins to form in a place which does not entirely interrupt the
current, but afterward reached the mouth of a large vessel, which it
closes.

The loss of consciousness, coma, and all the phenomena of the

apoplectic attack, with the possible exception of early rigidity, may be
as fully developed from occlusion of the cerebral vessels as from
their rupture; but it must be said that it is more common to meet with
them in cases of large hemorrhage than with either embolism or
thrombosis.

The general functions are even less disturbed than with a

hemorrhage producing an equal extent of paralysis. The temperature
follows nearly the same course as in hemorrhage, except that the
initial fall, if present—which is not always the case—is said to be less
than with cerebral hemorrhage. To this succeeds a rapid rise, which,
even in cases which are to terminate fatally, gives place to a fall to
the neighborhood of normal, and another rise before death. These
are the statements of Bourneville. The rise is said not to be so high
as with hemorrhage.

The annexed chart is from a man (W. I. W.) who was in the hospital
with ill-defined nervous symptoms, and was suddenly attacked with
convulsions, vomiting, and unconsciousness. He had a small tumor
at the point of the right temporal lobe, and softening of the left corpus
striatum. The apoplectic symptoms occurred on the 15th—that is, as
will be seen by the chart, one day after the temperature began to
rise. The pulse and respiration show no characteristic changes.

FIG. 40.
It is much more common for the embolus or thrombus to give rise to
a set of symptoms less severe than a fully-developed apoplectic fit.
During such a fit—or, more clearly, as it is passing off—we find more
or less marked paralytic symptoms, but these are quite as frequently
present without the loss of consciousness. The patient states that he
waked up and found one side of his body helpless, or that he was
reading the paper when it fell from his hand, and upon trying to walk
found that he could not do so. Loss of speech may be an initial
symptom. It has been spoken of as premonitory, but it is probable
that it is in reality only the beginning, which, in some cases may go
no farther, but is usually succeeded by more extensive paralysis,
which makes its meaning unmistakable. These symptoms may be
hours or even days in developing, with occlusion as well as with
hemorrhage. Very slight attacks may occur which hardly excite
attention, and lesions are found after death in many cases to which
there is nothing in the history to correspond.

Improvement may begin very rapidly in some cases where the lesion
is small, a sufficient amount of collateral circulation being developed
to prevent the structure from being disorganized. In others a
specially favorable anastomosis may preserve even a larger area,
but in others still it is not easy to account on entirely anatomical
grounds for the amount of improvement which takes place.

From this point onward the history of hemorrhagic and of embolic

and thrombotic paralysis is essentially the same, and the description
of the principal phenomena and progress of hemiplegia will apply to
all.

SYMPTOMS AND PROGRESS OF HEMIPLEGIA DEPENDING ON CEREBRAL

HEMORRHAGE OR OCCLUSION OF THE CEREBRAL VESSELS.—The cerebral
cortex represents the centres for many of the higher nervous
functions, spread out in such a way that they may be more or less
separately affected, while the corpora striata and internal capsules
are the regions where the various conductors are crowded together,
so that embolism, when affecting small vessels and limited areas of
the cortex, more frequently gives rise to narrowly-defined groups of
symptoms than hemorrhage, which, taking place oftener in the
central ganglia, is able to cut off the communication from large
masses of cerebral tissue at once. This is a general remark, tending
to explain why aphasia, for instance, is often spoken of as especially
a symptom of embolism, while it is in reality common to all the
lesions that affect the proper locality.

The motor paralysis, more or less complete, which has been

described under the head of Hemorrhage continues indefinitely. It
may disappear rapidly, so that motion begins to return in a day or
two, and goes on to complete recovery in a short time. On the other
hand, it may be months before the flexion of a finger or a toe gives
the slightest token of the will resuming its control. The face often
recovers its symmetry before the limbs are fully restored, but the leg
may be used in locomotion before the complete recovery from
paralysis, since the tone of the muscles is sufficient to keep the knee
straight enough for support, as if the leg were all in one piece, while
it is swung around at each step by the pelvic muscles. We may meet
with all degrees of recovery—from that which is absolutely complete
and comparatively rare, through the case where a little want of play
upon one side of the face, a little thickness of speech, a feeble or
awkward grasp of the hand, betrays what has happened, or that of
the man so often seen in the streets with a mournful or stolid face,
the arm in a sling or dangling straight down by the side, and
swinging one leg awkwardly around, to the helpless paralytic lifted in
and out of his chair or lying almost motionless in bed, and living only
to be fed and be kept clean.

Involuntary movements may take place in limbs entirely incapable of

voluntary ones, and may occur under conditions of excitement or
with other involuntary movements, such as gaping. On the other
hand, the patient often moves the well hand while making utterly
ineffectual attempts on the paralyzed side. Involuntary twitching of
the feet may be annoying. Reflex movements, especially of the feet,
are often exaggerated, and in fact the twitching just spoken of is
often excited by some trifling, perhaps unperceived, irritation. A
touch with the point of a penknife upon the sole of the foot may call
out a movement which the patient is utterly incapable of executing by
the force of the will, and the appearance of volition is often increased
by the grimace or exclamation of pain or annoyance.

Epileptiform attacks may be a sequence of hemiplegia, occurring at

irregular intervals, and not of great severity. Sometimes the patient
seems depressed or less talkative for a day or two previously, and
relieved after the fit has occurred, as in true epilepsy.

Comparatively little attention has been given to the condition of

sensation in hemiplegia. In the more complete apoplectic stupor it is
apparently abolished, like nearly all the functions above those of
respiration and circulation, but it often happens when the patient is
unable or unwilling to make any voluntary response to the voice, and
lies apparently perfectly indifferent, that any moderate irritation like a
pinch will bring out evidence of sensation. It is often stated that in
hemiplegia the sensation is not at all affected; and this is probably
true of many cases, but a more attentive examination will often
disclose a decided diminution on the affected side. Broadbent, who
has tested with pricking, touch, the compasses, and hot substances,
says that it is frequently diminished, and often greatly so, and not
only in the limbs, but in the face, chest, and abdomen. Tripier34 says
that a lesion of the larger part of the fronto-parietal region determines
at the same time a paralysis of motion and a diminution of sensibility;
and one may conclude that this region holds under its dependence
sensitive as well as motor phenomena intimately connected with
each other. The zone called motor, of which the limits are difficult to
fix, may with more reason be called sensori-motor.
34 Revue mensuelle de Méd. et Chir., 1880, p. 18.

Anæsthesia probably in most instances disappears more rapidly

than motor paralysis, which accounts for its being frequently
overlooked. The more common location of lesions causing motor
paralysis—i.e. the corpus striatum and the motor portion of the
cortex—is one not likely, unless extensive, to concern sensation; but
there are cases where a very complete hemianæsthesia, including
the special senses, may be found; and when, in such cases, the
motor paralysis is slight, a picture is presented almost identical with
that of hysterical hemianæsthesia with great diminution or abolition
of the special senses, hearing, taste, smell, with concentric
diminution of the field of vision and of the color-field, or complete
color-blindness on the affected side.

A man aged thirty-five while at work suddenly felt a prickling

sensation upon his left side, and became unconscious. The
bystanders say he was convulsed. On returning to consciousness
after three hours he had lost his speech, which, however, was rapidly
recovered, and his left side was not so strong as his right, though
there was no distinct history of paralysis. Two or three days
afterward it was noticed that sensation was much diminished upon
the left side, two sharp points of the æsthesiometer being felt as one
at two inches on the forearm and three-quarters of an inch on the
tongue. He could feel the touch of a spoon, but could not tell whether
it was cold or hot. Odors were not recognized upon the left side of
the nose, except faintly ammonia and chloroform, and a watch was
heard on that side only when in contact with the ear. The field of
vision was much diminished and color-blindness was almost
complete. A few days later the field of vision had increased, and
there was color-sense, the field of perception for the different colors
being arranged almost exactly as laid down by Charcot, vision for
red being largest, but not so large as for simple perception of
objects; those for blue, green, and yellow nearly the same and
smaller; and that for violet limited to a small space in the centre of
the field.

Less regular forms of anæsthesia may be met with, as well as

hyperæsthesia. These are said to be especially connected with
various lesions of the pons.35 A case is recorded36 of complete
hemianæsthesia in a man, coming on like a blow. There was no loss
of motor power; the face was symmetrical, sight and hearing
unimpaired. Taste was lost and smell doubtful. There was aortic and
mitral disease. Hughlings-Jackson speaks of a man who
experienced a severe apoplectiform attack which it was thought
would be fatal in a few hours. He recovered, however, with almost
complete loss of hearing.
35 Conty, Centralblatt f. d. Med. Wiss., 1878, 571.

36 Med. Times and Gaz., 1871, i. 246.

Neuralgic pains of long continuance are not infrequent

accompaniments of hemiplegia, and may be lasting even after nearly
complete recovery from the paralysis. A peculiar restlessness, a
constant desire for change of position, has been referred to
derangement of the muscle-sense. It is sometimes very distressing,
and causes much annoyance to attendants as well as to the sufferer,
as the patient is no sooner placed in one position, no matter how
comfortable, than he desires to change it.

The mental condition seldom fails to suffer more or less in cases of

hemiplegia, but the limits are very wide between a slight emotional
excitability on the one hand and almost dementia on the other. This
is, of course, applicable to cases where the lesion is a single or
limited one, and not where a hemorrhage or thrombus is merely a
part of a general vascular degenerative change with chronic
meningitis or atrophy of the brain, where the mental decay can
hardly be called the result of any single lesion. In cases of aphasia
the mental condition is harder to make out, from the peculiar inability
to communicate ideas if present. It is very safe to say, however, that
many such patients possess much greater intelligence than would
appear to a casual observer, and yet the apathy with which they
often bear the deprivation of speech and consequent isolation
speaks more strongly in favor of some blunting of the perceptions
than of Christian resignation. A patient whose general appearance is
that of tolerable comfort is likely to cry when attention is called to the
helpless condition of the hand. It is probable that memory suffers in
such cases, if not the reasoning faculties.

Trousseau cites the case of Lordat, who became aphasic, and after
recovery described his own case. The learned professor claims to
have been in full possession of his faculties, and to have arranged a
lecture with the divisions and subdivisions of the subject, and all this
without the thought of a single word passing through his mind.
Trousseau ventures to doubt the possibility of carrying on
complicated mental processes without words, and thinks Lordat may
have overestimated the precision of his mental processes. It appears
in confirmation of this view that after his attack he always read his
lectures, whereas before he had been distinguished as an
extempore speaker.

McCready, in an excellent article in the New York Journal of

Medicine (September, 1857), discusses this subject at length, and
details a number of cases where it was evident that paralytics and
aphasics (who, however, he did not know by that name, nor the
special lesion connected with their condition) possessed not only
ordinary intelligence, but excellent business judgment and ability. He
says that the confusion of mind and difficulty in pursuing a train of
thought of which apoplectics are apt to complain is, to a great extent,
the mere result of diminished nervous energy—that they
comprehend well and judge correctly. It is fair to say that while the
mind is almost certainly impaired, it is not necessarily in exact
proportion to the severity of other symptoms, aphasia included. The
memory, either special or general, is most apt to be impaired.

The testamentary capacity of a person who has had an apoplectic fit

or who is paralyzed at the time of making a will may be called in
question. The only general remark to be made is that these facts
alone are not sufficient to prove incapacity; neither should the
presence of aphasia or agraphia do so without further evidence of
want of comprehension of the meaning of language used by others;
so that if, for instance, a person were seized with hemiplegia and
aphasia between the drawing up of a will and its signature, it should
not be invalidated unless there be further evidence to show that the
testator was incapable of understanding it when read over to him. In
cases of word-blindness, a patient, like one described by Magnan,
may be able to draw up a will with full comprehension of what he is
doing, and yet be unable to read it understandingly. Inability to
signify intelligibly assent or dissent would, of course, entirely
disqualify one from signing a will.

It is seldom that a paralytic attack fails to leave its mark, though

perhaps slight, for years, if not for the remainder of life. An extreme
ease of shedding tears is a very common symptom, and sometimes
laughter comes on very slight provocation.

Among the most interesting groups of phenomena connected with

hemiplegia, and sometimes the sole representative of this condition
—that is, existing alone without any motor paralysis—is that
embracing the means of communicating with the outer world by
means of language spoken or written. Corresponding to, and usually