AMAarchives of neurology & psychiatry . culty in l)ecame laliored and difficult. There were no chills, fever orvomiting. On readmission, the patient appeared acutely ill. I)reathing with difficulty,with the accessory muscles brought into play. Double ptosis w-as noted, alsoclonic-like elevations of the eyebrows. The pupils were widely dilated andfixed, the fundi normal; there was no paralysis of the extrinsic ocular muscles (JLOBCS-STRA CSS—EPIDEMIC EXCEPHALITIS 127 or nystagmus. There was no sensory disturbance. The deep flexes werenormal. The abdominal reflexes could not
AMAarchives of neurology & psychiatry . culty in l)ecame laliored and difficult. There were no chills, fever orvomiting. On readmission, the patient appeared acutely ill. I)reathing with difficulty,with the accessory muscles brought into play. Double ptosis w-as noted, alsoclonic-like elevations of the eyebrows. The pupils were widely dilated andfixed, the fundi normal; there was no paralysis of the extrinsic ocular muscles (JLOBCS-STRA CSS—EPIDEMIC EXCEPHALITIS 127 or nystagmus. There was no sensory disturbance. The deep flexes werenormal. The abdominal reflexes could not be elicited. There was a masklikeexpression of the face. The patient could not protrude her tongue, nor moveit from side to side; it was atrophied. She could not swallow; fluids wereregurgitated. The palatal reflexes were lost. There was marked dysarthriawhich gradually led to complete loss of speech. The temperature remainednormal. Her condition declined rapidly, and after two days in the hospitalshe died from respiratory Fig. 2.—Gray sulistance. lateral to the aqueduct of Sylvius; medium sizedvessel, showing early adventitial changes, such as formations of elements of perivascular infiltration are still in evidence. Smalllymphocytes, glial cells, granular cells and fibroblasts are among them. Case 3.—History.—M. P., a woman 22. married, developed pain in the lowerpart of the abdomen and slight vaginal bleeding five months previous toadmission. Ectopic gestation was suspected and a laparotomy performed. Abicornate uterus and evidence of early pregnancy in one horn were followed. After discharge from the hospital, the patients conditionremained below par. She complained of frequent headaches and blurred visionfor four months preceding the onset of acute symptoms. Two weeks before 128 iRciiiriis or xinROLOcy A admission she suffered from coryza and cough but remained up and about for afew days, when she had
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