. A treatise on the nervous diseases of children : for physicians and students. ith another accident; hefell from a carriage and was badly fright-ened. The first symptoms he noticed werepains around the left ankle, then a shak-ing of the left leg. Soon thereafter thearm began to shake. Five months laterhe noticed the same symptoms on theright side of the body. On my first examination of the boy,three years after the accident, I foundhim well nourished ; the muscles in goodcondition, the color of the skin normal,but considerable vasomotor disturb-ances. He exhibited the mask-like ex-pression of
. A treatise on the nervous diseases of children : for physicians and students. ith another accident; hefell from a carriage and was badly fright-ened. The first symptoms he noticed werepains around the left ankle, then a shak-ing of the left leg. Soon thereafter thearm began to shake. Five months laterhe noticed the same symptoms on theright side of the body. On my first examination of the boy,three years after the accident, I foundhim well nourished ; the muscles in goodcondition, the color of the skin normal,but considerable vasomotor disturb-ances. He exhibited the mask-like ex-pression of the face, and his speech, aswell as the rhythmical tremor of thehands, legs, and head, were exactly thoseof a patient suffering from paralysis agi-tans. Soon another set of symptoms ap-peared, which proved to me that this senile disease, when occurring in ayoung individual, was subject to peculiar modifications, which allied it muchmore closely to multiple sclerosis, a disease common in earlier life. While under observation he developed characteristic nystagmus, scanning,23. Fig. 88.—Patient with Paralysis Agi-tans, who also exhibited some Symp-toms of Disseminated Sclerosis. 354 THE NERVOUS DISEASES OF CHILDREN. and tremulous speech. All the reflexes became greatly exaggerated. Thetypical tremor of paralysis agitans, involving the head, lips, and tongue, andthe extremities, remained unchanged. He still exhibits the propulsive move-ment so characteristic of paralysis agitans. The hands have the position ofshaking palsy, and the contractures are much like those seen in the senile is almost impossible, and with the symptoms pointing in part tomultiple sclerosis, and in part to paralysis agitans, he presents a very unusualappearance.* Prognosis.—Like many other chronic disorders of thecentral nervous system, multiple sclerosis is not a rapidlyfatal disease. It may run a continuous course for years with-out seriously endangering life, but any intercurrent disease i
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