915 
4. he is unable to walk without a stick, because he often feels suddenly dizzy. 
5. he cannot look quickly sideways, without losing his equilibrium. 
6. when looking suddenly sideways (especially to the right), he cannot recog: 
nize the objects standing beside him, at least not immediately. 
_ For the rest the patient declares that his hearing was bad since long. Eating, 
drinking and sleeping are all right. No disturbances in the deposition of the urine 
or in defecation. 
Status praesens. A strongly built man, average height, good nutrition, well-fed. 
Colouring of the skin and mucous membranes healthy. 
The left arteria temporalis is visibly crumpled, its wall has surely doubly 
the thickness of that on the right. To the touch it seems to be tense, 
The tongue is moist, not coated. Nowhere any swelling of glands. 
Pulse 90 per minute, regular and equal. 
Breathing abdominal, 24 per minute, regular. 
Heart under percussion normal, under auscultation a slightly accentuated dia- 
stolic sound in the aorta. Lungs normal both under percussion and auscultation. 
No irregularities are to be stated in the abdomen. Urine: acid reaction — no 
albumen, no glucose. 
The local sense of J. P. is good, he knows that he is in the Binnengasthuis, 
is aware too of the right date. His surroundings do not however interest him much. 
His memory is good. A number of six figures is correctly reproduced after a 
lapse of five minutes. Simple and even somewhat more complicated arithmetical 
questions are correctly solved mentally, e.g. 13 14 = 182. 
The internal speech is unimpaired. 
The external speech is rather monotonous, lacking articulation. 
‘The voice is hoarse. 
Reading presents no difficulties, neither does writing, which is done in a very 
neat hand. 
The hair-covering of the head is normal, as are likewise the boundaries of the* 
hair-growth. The head is ever kept turned somewhat to the right. The face is 
asymmetrical. The left cheek is thicker than the right one, it feels hotter to the 
touch and is injected. The left regio temperalis is salient. The left orbital fissure 
is nurrower than that to the right. The left bulb is slightly directed upward. 
The circumference of the head is 59 cm. 
Not unfrequently an involuntary movement may be observed, by which the 
head is thrown to the right. The eyes then are turning first to the left and 
afterwards follow slowly the movement of the head to the right. 
The nerves of the brain: 
I. Olfactorius. The patient states that his sense of smelling was enfeebled long 
before his illness. To the left he recognizes neither Eau de cologne nor anisseed-oil. 
Il. Opticus. Visus (after correction of the hypermetropy + 3D) on both sides I. 
The fundus is normal on both sides, as is likewise the field of vision. 
lll, IV, V. Movements of the eye. The pupil on the left side is somewhut 
narrower than that on the right, the latter is of normal width. On both sides 
the pupils are reacting on light and on convergency. The orbital fissure to the 
left is narrower than that to the right. The left bulbus is slightly protruding. 
The position of the bulbi is somewhat diverging. When in rest, sometimes 
nystagmoid movements appear, usually to- the left and in horizontal direction. 
