114 A STUDY OF SOME 



toes came down first and sometimes even the heels, so that in ad- 

 vanced ataxia any part of the foot may strike the ground first. 



Regarding the lateral sway of the trunk, it needs no detailed 

 study to tell us that it is much exaggerated. In ataxics who are 

 still able to walk comparatively well this exaggerated sway is al- 

 ways towards the side opposite the advancing or passive leg. How- 

 ever, if the ataxia be increased, as, for instance, in the lower 

 series of Plate 550, the sway may be towards the same side, and 

 then the patient is in danger of falling. 



The Gait in Lateral Sclerosis. 



This gait was studied in Plate 548. The subject was a patient 

 of the University Hospital and was under the care of Dr. Wil- 

 liam Pepper. His history was as follows :* 



" H. S., aged twenty-eight years, single, is an engineer by oc- 

 cupation, and had been working on a railroad in Wyoming Ter- 

 ritory until three or four months ago, when he came to this city. 

 When a child he had diphtheria, which was followed by dropsy 

 and paralysis. Later he was thrown on a hot stove and severely 

 burned, the scar being visible on the epigastrium. When twenty- 

 two years of age he had typhoid fever. He denies having had 

 gonorrhoea or syphilis, although intercourse with loose women is 

 acknowledged. Careful investigation fails to reveal any trace of 

 specific infection. He has used alcohol in considerable quantities, 

 but has never been intoxicated. He uses tobacco in great excess, 

 smoking as many as fifteen cigars on some days, and chewing a 

 large plug of tobacco every twenty-four hours. 



" His occupation has been an exposing one, subjecting him to 

 extreme alternations of heat and cold. He, however, continued in 

 good health until three years ago. In December, 1882, he first 

 noticed a gradual loss of power in the left ankle. He states that 

 five months prior to this he had injured the left ankle and knee 

 by falling from his locomotive. This kept him in bed for seven 

 days, then apparently he became entirely well. The feeling of 

 Aveakness on the left side compelled him to throw most of his 

 weight on the right leg. The trouble gradually grew worse, and 

 in November, 1883, he noticed that occasionally the affected leg 



* See Philadelphia Medical Tiniest, October 31, 18So. Clinical Lecture by 

 Professor Pepper. 



