16
consciousness was unable to feed himself, and his legs were feeble and unmanage-
able as at present. He was discharged from the Jain Hospital towards the end
of May ; the bubo, which was in the right groin, having cicatrized. He never
had syphilis, but had a mild attack of small-pox fcur years ago.
He was brought on a stretcher to the ward : nutrition is good ; the facial
expression is vacant and stolid, all the muscles are quite toneless ; he lies on his
back and finds great difficulty in turning from side to side or sitting up ; he is
unable to perform any movements with steadiness and precision. When sitting
up, movements of the arms and legs are made with sudden jerkin ess and with
wider range than normal. The pulso is regular, 52 per minute, of fair volume
and tension ; respiration 20 per minute, jerky and irregular in rhythm.
The muscles are fairly nourished, but relaxed. Electrical reactions are
normal ; the feet are rather flat ; and the hands are held as seen in drop-wrist.
Superficial reflexes are present ; the planter reflex elicits a sudden and forcible
movement. There is marked inco-ordination of the muscles in general. The
head falls forwards and is moved from side to side, instead of being turned to
look at objects. On attempting to get out of bed the legs are extended with sud-
denness, and then thrown outwards with a forcible jerk ; he sits holding on to the
edge of the bed to maintain his balance; stands with the feet widely apart and
leans forwards so as to see their position. The muscles are tremulous, and move-
ments markedly exaggerated, the legs crossing one another, when a step is taken,
and thrown forward with a sudden jerk, the toes being brought to the ground
forcibly, and the body swaying like that of a drunken man. The movements of
the hand are exaggerated and unsteady, the right being worse than the left.
When the hands are at rest, the fingers tremble irregularly. Simple movements
of the hand are accomplished by spasmodic jerks, and fine movements are most
clumsily attempted and imperfectly finished, as is seen on carrying a spoon to
the mouth or tying a string. He is unable to maintain his balance in any
position.
The acts oí swallowing, defoecation and urination are properly performed
but delayed.
There are no lightning pains, nor formication of the extremities. He does
not complain of giddiness, or of gastric or rectal crisis. He has not suffered from
vomiting or girdle sensation. Sensibility to touch is delayed but not actually
diminished, and the patient is unable to recognise how often he has been touch-
ed or by how may fingers. His sense of feeling amounts to something being
brought in contact with his body, but he is unable to recognise what it actually
is. Sensibility to pain is somewhat diminished, a forcible pinch giving him pain
after a little time. Sensation to heat or cold is not affected. A hot tube passed
along the course of the spine gives a burning sensation at the 1st, 2nd, 3rd and
4th dorsal vertebra?. No spinal nor cranial percussion tenderness is present.
Cerebral, mental, vaso-motor and nutritive functions are not in any way altered.
There have been no trophic changes.
Articulation is slow and deliberate ; individual syllables are pronounced
separately and forcibly, laying great stress on the final part of the word. The
answer to any question put to him takes time, and the act is deliberate. He is
intelligent and understands all that is said to him»
Taste is normal; hearing is somewhat diminished in the right ear, but he does
appreciate after a time the character of the sound: smell normal.
There is no nystagmus. The left eyeball does not move outwards to the same
degree as the right ; besides this deviation in the axis, there is nothing peculiar.
Pupils are moderately dilated and the Argyll Robertson phenomenon is not
present ; pupils react to light and accommodation. In both eyes there is a well
defined area of old choroiditis between the optic disc and yellow spot. This is quite
symmetrical in jroth eyes.
All other systems were examined and found normal. The patient has been
under observation for some time and has as yet shown no improvement. The
symptoms present exactly resemble those seen in many severe cases of plague after
the second day.