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swollen ; next, he experienced an unbearable tingling, but what occasioned
him the greatest suffering was acute pain in the calves. He described this
pain as being in the bones. In the meantime movement, and especially
walking, had become difficult. On the 13th December he was admitted
to hospital at Batavia. The swelling of the legs diminished rapidly, the
paræsthetic symptoms lasted a few days longer ; the pain disappeared as
long as he remained quiet, but re-appeared if he attempted to walk. He
was not quite paralysed, and never had been, but his walk was tottering.
" The patient stated that he had never had any fever, nor had he had
any difficulty in obeying the calls of nature ; he ate, drank, and slept well.
" Condition on 31st December.—The patient is strongly built and mus-
cular, and does not look as if suffering. There is no apparent anæmia or
blueness of the mucous membranes. He enters with interest into what
is going on around him, and describes his condition from the commence-
ment of his illness with considerable vivacity. Pulse 94, rising to 116
after very little exertion, moderately tense ; neither sharp nor dichrotic.
Eespiration 26, of abdominal type, The heart's impulse is strong, and can
be made out as far as the 5th intercostal space in the nipple line. The
heart's dullness extends beyond the left border of the sternum, but does
not reach the middle line. The sounds of the heart are sonorous, and
pure, with reduplication of the second sound and intensification of the
pulmonary disastolic sound.
"No other abnormalities could be discovered in either the thoracic
or abdominal organs. His face is doughy and somewhat puffy, but
does not pit on pressure. Along the crest of the tibia the skin
pits distinctly, but the ankle is not œdematous. The pupils act promptly,
and evenly, both to direct light and for convergence. The higher senses are
unaffected. He sees well, hears the tick of a watch at a long distance, and
distinguishes at once between salt and sugar. Organs of motion.—The
muscles are well developed, hard to the touch. Some of them, for example,
those of the calf, are very tender on pressure, and seem to have become more
resistant ; when they contract, one meets with circumscribed swellings ;
mechanically, they were not irritable to the stroke of the percussion hammer.
They present no ideomuscular contraction.
" Most movements, whether active or passive, can be performed.
However, when the patient is on his back, he cannot flex the ankle, and
plantar flexion can be easily prevented.
" If the patient rise, considerable locomotor disturbance is observable.
He lifts his foot with difficulty from the ground, raises it high ; he cannot
stand upon one leg, nor raise himself on his toes. If he try to crouch,
he does so clumsily, and is in danger of falling. When lying on his back
he can bend and extend the trunk, and perform all movements of the upper
extremities, as well as those of the eyes, face, and tongue. When
standing with closed eyes, he totters, but no distinct disturbance
of muscular coordination can be made out. Lying with the eyes closed,
he can place the toes of one foot on the other knee slowly, but without
blundering."
Allowing for the different ways of describing similar facts
incidental to the advance in the methods of medical inves-
tigation that has taken place during the interval of more than
fifty years which has elapsed between the dates at which the
two descriptions were written, I do not think that any one can