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An attempt has been made from the clinical particulars provided of the 130 cases to group them
into one or more of the three levels in which the lesions would appear to be located—
I. The upper level—Cortical, 12 cases.
II. The middle and lower levels—Mid-brain and cranial nuclei, 112 cases ; cerebellum, 5 cases;
lower levels and spinal ganglia, 37 cases.
Grouping of the symptomatology of the 130 cases from the clinical features supplied showed
the following particulars:—
Lethargy was present in 126 cases; fever in 80 cases; paralysis or weakness of ocular muscles
(squint or diplopia) in 68 cases. These symptoms were manifested in combination as follows :—
Fever, lethargy and ocular palsies—65 cases.
Lethargy and ocular palsies—27 cases.
Fever and lethargy—16 cases.
In addition, other ocular manifestations were noted—viz,, ptosis in 29 cases; nystagmus in 27
cases ; paralysis or inequality of pupils in 6 cases ; blindness or dimness of vision in 2 cases.
Weakness or paralysis of facial muscles on one or both sides was noted in 30 cases, and of the
tongue in 5 cases; deafness supervened in 3 cases; difficulty in swallowing (3 cases); mask-like expression
(9 cases); speech—slow or scanning (48 cases); aphonia (6 cases). Other conditions were hemiplegia
(8 cases); monoplegia (9 cases); paraplegia (9 cases); foot drop (2 cases); tremors, muscular twitchings,
involuntary and choreiform movements (myoclonus and paralysis agitans type) affecting muscles of
one or both limbs, face or abdomen, in 31 cases;; catatonia of limbs (5 cases); chorea (2 cases);
paralysis agitans (2 cases); muscular rigidity—(i) of neck or with head retraction (5 cases), (ii.) of limbs
(13 cases).
Reflexes recorded: Knee jerks normal in 4 cases, absent in 3, diminished in 5, and exaggerated
in 5 cases ; plantar extensor response absent in 4 cases and present (flexor) in 2 cases; Babinski's sign
present in 2 cases ; Kernig's sign present in 5 cases. Skin eruptions in the form of general erythema,
macules, petechias, were noted at the onset of illness in 3 cases. Incontinence of urine or faeces, or both
(25 cases).
The distribution of pain an early symptom, and usually severe, was recorded as follows :—Head
(66 cases); neck and back (14 cases); chest and abdomen (5 cases); joints (7 cases); arms (9 cases);
legs (3 cases).
Other conditions noted at onset or during the course of illness were vomiting (24 cases) ; delirium
(35 cases ; 2 maniacal); giddiness (12 cases); staggering (1 case); convulsions (4 cases, one being
violent and epileptiform)— one case was definitely associated with epilepsy ; anaesthesia is also recorded
as occurring in three cases, affecting the whole of the right half of the body in one case, and one or both
legs in two cases.
Laboratory
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in diagnosis