917 
To the right upper limit of hearing by bone-conduction (monochord STRUYCKEN) 
15!/, (norm. 13—14). 
Upper limit of hearing by air-conduction idem 31 (norm. 14). 
To the left , ef 2 ,», bone-conduction idem 15/3. 
5 yet ve De „ air-conduction idem 31. 
Whispering voice. To the right + 8 cm. 
To the left low zone + 3 cm. 
high zone + 5 cm. 
To the right the patient does hear: 
SCHWABACH shortened. WEBER not lateralized. RINNE to the left +, to the right —. 
VIIIb. The nervus vestibularis. Injection of cold water. 
On the right side it distinctly produces nystagmus to the left. Afterwards 
there is + no deviation to be found in both arms in pointing at a fixed object. 
On the left side there is as distinctly produced nystagmus to the right. The 
pointing experiment made after this shows no deviation for the right arm, but it 
does so for the left arm that is deviating to the right. 
IX, X, XI. The taste has not suffered either to the left or to the right. 
Subjectively the patient declares that his sense of taste has diminished on the tip 
of the tongue. 
The uvula is swollen clubshaped at its end, on its right upperside there is a 
sear. It is deviating towards the right. 
The arcus palatini to the right are placed lower than those to the left. On 
innervation both arches are lifted slightly (a result of the swollen uvula). Insigni- 
ficant Rhinolalia aperta. 
Laryngoscopically (Dr. van Gitse). Epiglottis abnormally small. During phona- 
tion the right vocal cord is passing far over the median line. Of the left 
vocal cord only a small margin is visible, half concealed under the swollen false 
vocal cord. The left vocal cord is entirely motionless, there are neither abductor 
nor adductor motions. 
The motions of the right vocal cord are normal. 
To the left there is tumefaction in the region of the arythenoid-cartilage and 
in the sinus piriformis. 
A complete paralysis of the left N. accessorius of the oblongata is assumed 
to exist. 
The shoulders are lifted without any difficulty. M. trapezoides and M. sterno-cleido- 
mastoidens are not atrophic. 
Swallowing presents difficulties, because according to patient, there is an impe- 
diment io the left. 
XIL The N. hypoglossus. When in repose the tongue is normal, when put 
out it is stretched straightforward. Strong tremor, especially at the tip. Movements 
can be made in all directions. The innervation of the bottom of the month is 
equal on both sides. 
Neck and trunk. The attitude of the head is always turned to the right. For 
the rest no irregularities in the movements of neck and trunk. The vertebral 
column is nowhere painful. The patient is able to raise himself from a declining 
posture to a sitting one without the aid of his arms. 
Sensibility. The tactile sense is undisturbed both to the right and to the left, 
even the slightest contact with a plug of cottonwool or a hair-pencil is instantly 
perceived. 
