A schoolboy, aged seven years, was admitted into Westminster Hospital on January 28, 1900, the only history obtainable being that on the previous morning he had been brought home in a “fit,” which lasted the greater part of the day. On admission he was perfectly sensible and talked freely, but on being put to bed he passed into a condition of semi-consciousness which lasted for many days. He took no notice when spoken to, and remained absolutely mute. The face and upper extremities exhibited choreiform movements of a slow and coarse type. These movements were apparently purposive in character, and at times he endeavored to clutch at objects within his reach. Sometimes the arms were widely extended, and then slowly flexed, as if performing the act of embracing. Sometimes the movements conveyed the idea that he was feebly endeavoring to strike those around him. There was no paralysis of the face or of the muscles of the limbs. The movements were, as a rule, bilateral, although sometimes the facial movements were unilateral, but not always on the same side. There was no rigidity of the muscles, retraction of the head, or opisthotonos. There was nothing to indicate that the patient suffered from headache, although at times the brows were contracted and the face wore a worried and anxious appearance. The bowels were open twice a day and urine and fæces were passed in bed. The motions were normal in character. The patient was unable to swallow, and had to be fed by the nasal tube. There was no nystagmus, the pupils were normal in size and contracted well to light. There was well-marked double optic neuritis. The temperature was 99.8° F., and the pulse was 108. There was no tenderness or swelling of the joints, and there was no rash on the skin. No tache cérébrale could be obtained. There was a little cough, but there was no expectoration. The breath and heart-sounds were normal. The urine was acid, had a specific gravity of 1018, and contained neither albumen nor sugar. The spleen was not enlarged. The patient showed no signs of anæmia, but the blood was not examined. There was no wasting of the muscles, and the knee-jerks were present, although somewhat sluggish. The tongue was clean, and presented no sign of having been bitten. The patient would not protrude it voluntarily, and it had to be examined with the spatula.
The condition of the patient remained practically unchanged
for twelve days. The highest temperature recorded was on the
second day, when it reached 100°; on the following day it was
99.8°, and from that time onward it was normal. The double
optic neuritis continued, and the disks were observed to be getting
paler. On February 13 (the seventeenth day of the illness)
the patient was much more sensible, and recognized his mother,
putting his arms round her neck. He was still unable to talk,
although apparently he endeavored to do so, from time to time
uttering a few unintelligible words. On being asked if he would
like an orange he nodded his head, and he showed some signs of
interest in a watch which was shown to him. The incontinence
of urine and fæces continued, but food was taken with less difficulty.
The movements gradually subsided. On the 17th the
patient could say his own name, but beyond that could utter only
inarticulate sounds, and failed to recognize letters or words,
either written or printed. On the 20th he was able to speak
plainly, although incoherently. He endeavored to get out of
bed, and during the night was so noisy that he had to be removed
from the ward. Urine and fæces were still passed under him.
On the 22d he was quieter, and for the first time indicated
that he wanted the bed-pan. The optic neuritis was less marked.
On March 1 the patient was able to get up, and seemed to be
quite well. On the 8th the following note was furnished by Mr.
G. Hartridge, who had frequently examined his eyes during the
course of his illness: “Pupils five millimeters each. React well
to light, to convergence, accommodation, and consensually.
Right vision 6
6, left vision 6
9. Right disk getting white; not much
swelling of the disk; edges clearing. Retinal vessels, specially
veins, very full and tortuous. Left disk pale (less so than
right), dim; edges blurred.” The only medical treatment adopted
was the administration for a few days of 15 minims of liquor
arsenicalis three times a day.