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some slight improvement but the Headmaster eventually reported
the boy's progress as unsatisfactory. He has now left school some
time, and is doing nothing. He is a nice gentlemanly boy to look
at, but in some respects is irresponsible.
Case No. 4.
M. 52. Boot repairer. Onset 3/9/22. Notified 8/9/22.
Was removed to Fulham Infimary on 5/9/22.
Initial symptoms—patient has been ill two years and has
wasted. 2/9/22 complained of severe abdominal pains with vomiting
and frequent evacuations. Had been constipated for one week
before. Transferred to West London Hospital on 3/9/22. Next
day began to talk strangely and his articulation was defective.
Shouted incoherently and waved his arms about. Transferred to
Fulham Infirmary 5/9/22. Patient very emaciated, skin dry and
pigmented. Tongue furred. Some emphysema of lungs. Otherwise
nil abnormal in lungs or heart. Temperature normal. Urine
s.g. 1013. Slight trace of albumen. Pupils dilated, react to
light—equal. No squint. Fundi normal. Abdominal reilexes
normal. Knee jerks absent. No ankle clonus. Muscles of legs
hypotonic. No facial paralysis.
Patient flexing fingers of right hand rhythmically with abduction
of thumb, flexing and extending elbow. Similar movements
of less range in left arm (movements resemble those of a
cobbler sewing a boot).
Patient pays no attention questions. Tongue dry and
lying in floor of mouth. Patient will not protrude it. Incontinence
of urine. Bowels not open.
6/9/22. Patient semi-comatose. Lumbar puncture-C.S.F.
clear under moderate pressure.
8/9/22. More conscious. Answers simple questions. Slight
ptosis both eyes.