843 
Lastly after the attack she had been paralysed on the right side, but the lame- 
ness had passed off completely after three weeks. 
Afterwards she often had been giddy, in March, on the 4t of June and on the 
15 of June; but this always happened at the beginning of the menses, which 
were very irregular after the attack. She noticed that after the attack she did not 
see very well to the right: it seemed as if white spots were there. The electric 
light on the market-place seemed to hang lower than formerly to her, and now 
and then it was, as if brown spiders hung in front of the right eye. Since the 
gh of December she sees worse through the right eye. She also often complains 
of headache, vomitting at the same time. Moreover the urine contains 4°/ , 
albumen and many cylinders covered with epithelium of the kidneys. 
On account of these complaints she was brought into my ward of the Univer- 
sity Hospital (Binnen-Gasthuis). 
The patient looks very ill, is a woman of middle height. Anaemic. Much arterio- 
sclerosis. Somewhat enlarged heart. The second tore over the valvula aortae is 
Joud. Pulse 90 - 120. 
Her attitude is active, she takes interest in her surroundings, is well orientated 
in time and in space, sleeps calmly, eats sufficiently. She can walk and makes 
every movement. 
Nowhere on the trunc or extremities any trouble of molility or sensibility is 
to be found Except a lowered abdominal reflex at the right side, all the retlexes 
of the extremities are within normal limits. No sign of Babinski. There are impedi- 
ments in speach. She understands simple commands without an yexception and follows 
them out. Her abundance of words is unlimited but she often misspeaks herself. 
Most of the objects are well named; they are always well recognised. Now and 
then she has to think long over them and after all uses the wrong word for them. 
- She recognises every letter of the alphabet and pronounces them correctly. 
‘Also short words. She can read Joud, but she reads paraphatically and the longer 
words are regularly badly reproduced. She does not comprehend the reading or 
only insufficiently. To comprehend the reading she repeats it several times loudly 
and, then as a rule she does not understand il, she forgets many things. Yet she 
“ean do light work. She manages her little affair in pottery. 
The smell is not affected. . 
The pupils are equally wide, the right one does not react on light as correctly 
as the left. She eannot converge and the reaction of the pupils by convergence is 
not to be seen. 
The vision of the right eye is 1/,; of the left eve U. 
= There is quadrantic hemianopsia in both the tower quandrants of the right 
fields of vision (s. figure). 
Dr. Sir, the ophthalmologist writes about the fundus oculi: “There is no 
trace of papillitis On the right the borders of the papilla are clearly limited, but 
there have been bleedings and there is still some oedema of the retina (retinitis 
albuminurica). On the left the papilla is also clearly limited, but here too are rests 
of haemorrhages. 
There is exquisite hemianopsia in the lower quadrants of the right fields ‘of 
vision. That the macula vision is lost in the right anoptic sector is probably due 
to the bad vision of that eye. 
Tee eye-movements, especially by their turning to the right and more so of 
the left eye, are limited. The left eye deviates to the temporal side. It is impossi- 
ble to direct both eyes to one point. 
