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would be unsafe to ride a bike. Slight nystagmus also slight
albuminuria. The following day the tongue was fairly clean.
Patient looked drowsy and somewhat vacant. No alteration in
character. Could then read. The drowsiness entirely passed
away leaving him in his normal condition which was "bright, and
had no idea of bed until midnight."
Recovered completely.
Not seen in consultation.
Case No. 18.
M. 53. Handyman, Building Trade. Onset 23/4/24.
This case was notified and ultimately withdrawn as being a
case of carcinoma of the liver.
The Medical Attendant's notes are as follows :—
14th May-—first seen to-day. For three weeks has felt sick all
day. Sleeps well at night time. "No life" in day time. No
•liplopia. Slightly giddy after stooping. Urine thick. " Stomach
feels choked right up". Bowels open. Tongue slightly coated.
Temperature 98.4. ? Lethargic encephalitis.
17th May—about the same. Sick last night. Sick feeling
after food "Was jolly tired—goes straight to bed when he gets in
Can't eat much. Lost giddiness. "Had a job to carry on to-day."
Could lie down and sleep any time. Has been like it for three
weeks. No pain or shivers or headache or jumps. Not angry,
or irritable—just tired. Pulse 72. Conjunctiva jaundiced, he
says for one week. Motions are light in colour. Urine deep
coloured. Urine contained a little bile and no albumin.
19th May—went for a two mile walk yesterday—had a job to
get home—so tired. Could sleep all day. Slept most of Saturday
and Sunday and well at night time. He read yesterday. No
diplopia. Very quiet—liver reaches down to umbilicus. No
ankle clonus; Knee jerks normal, Flexor plantar reflexes. No
giddiness now. Abdominal reflexes not obtained.