On Arsenical Paralysis. 7 



Reflexes. 



1) Skin reflexes. Sole reflexes do not occur. Slight gluteal and 

 interscapular reflexes occur whereas no abdominal or epigastric reflexes. 



2) Tendon reflexes. There is no patellar reflexes. No foot- 

 clonus exists. 



3) Bladder and rectal reflexes are normal ; no disorders of urina- 

 tion or defaecation. 



4) The pupils are a little enlarged but of the same size, expand 

 moderately and react to light. 



Trophic disorders. In both arms, particularly the fore-arms and 

 hands, the muscles feel atrophied, the fore-arms are flat; dorsal metacar- 

 pal interstitial spaces appear to be especially hollow and thenar is in both 

 hands sunk in. Fossae supra- and infraspinatae are somewhat more than 

 usually hollow. The muscles of the legs in particular the lower-legs are 

 reduced in comparison with that of the trunk. 



The skin of the arms is darker than normal and dry, on the legs 

 dark-spotted. 



Vasomotoric disorders. The fore-legs and feet, particularly the 

 latter are somewhat swollen and the skin here is pale; on the other part 

 of the foot a hoUovy is left after pressure. 



About the back there is nothing to remark; the patient is not 

 tender any where to pressure on the spine. 



Abdomen. About the navel the patient is rather tender to pressure 

 but nothing abnoimal can by palpation be observed. No abdominal 

 distension is perceptible. 



In the other organs there is nothing to be noted. 

 Daily notes. 

 April 21. Two epileptic fits in the evening. 



» 22. Weakness, headache. One epileptic fit 3 p.m., a less se- 



vere one at 9 p.m. 



Pricking ache in fore-leg, more severe than usual. 

 Diarrhoea. 

 17 — 18. Ache in the left shoulder (joint). 

 Diarrhoea and colic pains. 



» » » 



Dead. Latterly strongly developed hyperaestesia, extending 

 over the extremities; urine and faeces passed involuntarily. 

 Difficulty in speaking and swallowing was experienced the 

 last days. 



