176 
war. They were of rather cheap frame construction, but were very 
practical in arrangement and scrupulously clean, being well adapted to 
the purposes for which they were intended. Every hospital had its 
laboratory facilities, and in several, complete X-ray and photographic 
outfits were seen. 
The three histories sehen to follow. One of them, No. I], is illus- 
trated by a photograph, also kindly furnished by Dr. Nitamuré 
CasE No. I. 
i 
W. S., 22 years old; infantry. The patient comes from a healthy family, has 
always hewn perfectly well, and has never suffered from any disease. About the 
beginning of June, while with the army in Mane thuria, he noticed, without being 
able to assign any special reason for it, a loss of appetite, anorexia, palpitation 
of the heart, and precordial anxiety. After a short time, paresthesia in the tips 
of the fingers and in the region of the thigh was noticed, then paresis of the 
thigh and pain in the calves manifested themselves. The patient entered the 
Tokyo military hospital at Shibuya on August 6, 1905. 
Status praesens: He is a man of medium size, well developed, nutrition fair. 
Pulse 86, full and strong. No fever. Face somewhat puffed, but no true edema. 
Tongue coated; skin dry. Pupillary reaction on both sides normal. Lungs: Ex- 
amination negative. Heart: Upper boundary of the heart’s area of dullness is 
found at the upper margin of the fourth rib, at the left, one finger’s width exter- 
nally to the left mamillary line, to the right, in the midsternal line. The first 
mitral sound is impure. The second pulmonary sound is accehtuated. There is 
no epigastric pulsation. Arterial sound heard indistinetly. The upper margin 
of tne liver dullness is at the upper margin of the fourth rib. Abdomen some- 
what distended; epigastrium somewhat sensitive to pressure. Appetite good. 
Stools, one per day, small in quantity and soft in consistency. 
Disturbances of motion and sensation.—Circular hypesthetic area around the 
mouth. Mouth can not be very firmly closed, and it is especially the upper lip 
which is distinctly paretic. (Such a condition around the mouth, the report says, 
is very rarely seen in kakke.) The entire upper extremities are hypesthetic. The 
senses of touch, temperature, and pressure are equally disturbed. The disturb- 
ances are more marked on the anterior than on the posterior surfaces, and more on 
the left side than on the right one. Both flexion and extension at the elbow and 
wrist are diminished. Flexion of the fingers is possible, but extension is very 
much disturbed. All the fingers are now in a flexed position, particularly the 
middle and the index finger. 
From the umbilicus downward anteriorly and from the gluteal region downward 
posteriorly to the tips of the toes, there is hypesthesia. The latter is more 
marked on the interior surface of the thigh than on the exterior one. The power 
of flexion and extension at the knee joint is diminished, more on the left side than 
on the right one. The dorsal flexion of the feet is decreased; the plantar flexion, 
however, is normal. The muscles of the calf, quadriceps femoris and adductor 
femoris, and the muscles of the anterior side of the forearm, are sensitive to 
pressure. The patellar reflex, the reflex of the tendo achilles and that of the 
muscles of the hand are absent, as is also that of the anterior abdominal wall, of 
the cremaster, and plantaris; however, the adductor reflex is preserved. . 
Therapy: Magnesium sulfuricum, acidum hydrochloricum. 
August 13: Condition of patient improved. Pulse 72. Appetite good. Three 
to four stools a day. Hands and feet somewhat cyanotic. Hypesthesia around 
the mouth is decreased, The motility of the lower extremities is improved, 
