s 8 ATF-SLKY MILLS ON 



with her let! haud, aud likes to be very lightly covered. The eyes are three i)arls closed 

 during the day and completely closed at night. The face sometimes becomes (lushed. 

 She never speaks, aud in tact has spoken but once in eleven years or more, and that was 

 quite recently (1890), when she .said " I am not asleep." lier appetite has been better 

 since she has been in the long sleep than it was before, and she eats things she would not 

 touch when awake. At least once during the present attack she has, unassisted, got out 

 of bed, and there is reason to believe she has done the same thing several times, but not 

 withiu three years, as her physical condition renders it impossible. Several times the 

 nurse fancied the patient was moving about the room at night, but for some time could 

 not actually prove that such was the case. At last, however, a fall was heard in the 

 middle of the night, aud the patient was found lying fast asleep at the bottom of the 

 stairs, down which she had fallen. 



During the present attack she has fasted on several occasions, aud once went fifteen 

 days without food. It must be remembered that the nurses were si^eaking of the last 

 attack and at a time when the patient had been in a state of lethargy for more than 

 eleven years. 



In September, 1890, I saw the patient with Dr. Clarke. This was my first, but Dr. 

 Clarke's second visit. We found the patient, an old woman, in bed. She was lying on her 

 back with her eyes half closed. Her face when we first entered was somewhat flushed 

 and respiration rapid. When respirations were closely observed it was noticed that they 

 were most irregular, and at times ceased for several moments. They averaged 22 per 

 minute. Pulse was 104, fairly strong aud regular, arteries almost free from rigidity. 

 Axillary temperature, 98§ . The nurse stated that ordinarily the patient's bowels moved 

 but once in three days, but latterly she had developed a tendency to diarrhoea, and since 

 that had evinced a sense of discomfort until the bowels were relieved. This sense of dis- 

 comfort was evinced by whining like a dog. Ordinarily she would not give any indica- 

 tion that she wished to relieve herself, but the presence of the bed pan would excite the 

 reflexes. She does not soil the bed. The statement of the nurse in regard to the amount 

 of urine passed every day was, that a little more than half a pint would be a fair average. 



A physical examination of the patient was made. The lelt foot was drawn as if there 

 were a contracted Tendo-Achillis ; right foot drawn down but not in such a marked man- 

 ner as the left. Marked rigidity of the right knee aud leg ; left leg and knee not rigid. 

 Right ankle easily moved ; left rigid. Patellar reflexes absent. Tickling the soles of the 

 feet did not cause any evidence of sensibility. Each great toe was drawn under the 

 second toe, this condition being especially marked in the left foot. When the soles of 

 the feet were tickled it wag thought that the respirations were slightly deepened, l)ut on 

 account of the irregularity of the breathing it was difficult to determine this point, and 

 it was considered undecided. Patient's hair gray ; nails healthy and not abnormally 

 brittle. Facial reflexes better than reflexes in any other part of the body. Orbicular re- 

 flexes good even with air ; at the same time it was noticed that flies crawling over the 

 face did not excite the reflexes. Pupils responsive to light. Small bed sores found on 

 hips and evidence of former deep-seated bed sores plainly visible. 



While we were present the nurse endeavoured to arouse the patient and tried to get 

 her to take some food. A feeble protest was made (whining), the patient winked for a 

 few moments, and then went off to sleep again. Bread was put in her mouth, but re- 

 mained there without any effort being made to swallow. 



