KM IMIYSIOMKJY 



i her. may he some exaggeration df these reflexes accompanying the diminished tone. 

 The loss of tone is easily perceived on lifting up the leg and letting it drop, or 

 on taking the fore-arm and shaking the hand. The knee-jerk in these circumstam -es 

 di ttcis from the normal jerk in the absence of the tonic contraction which ordinarily 

 follows and continues the short sharp contraction ; the leg thus falls after the jerk, 

 instead of being held up for a short time by the continued contraction of the quadriceps 

 muscle. 



Associated with this atonia is a loss of voluntary power asthenia which is generally 

 more marked in the arm than in the leg. The initiation and the execution of voluntary 

 movements are slower than normal, and the end of the movement is delayed, so that 

 i here is a tendency to over-action of the muscles. Sustained effort is diftieiill. the eon- 

 trait ions becoming intermittent, or giving place to coarse tremor so-called axta-via. 

 There may be defective maintenance of equilibrium in walking, so that a staggering gait 

 is produced, closely resembling that of a drunken man. There is a tendency to fall or 

 deviate to the injured side, but this defect is not nearly so marked as in the case of the 

 dog, already described. 



Kvcn wh'-n the eerebellar gait is not marked, there is always some ataxy of the arm 

 or hand muscles; .the usual co-operative antagonism of opposing muscles is faulty, 

 and these may contract together instead of alternately, or the wrong muscles may be 

 used. When, for instance, the man tries to approximate one finger to the thumb, he 

 tends 'to move all the others. 



Speech is often slurred, drawling, or ' scanning ' in character, and the difficulty ex- 

 perienced by the man in articulation frequently gives rise to explosive utterance. 

 The head is generally inclined towards the injured side and rotated to the opposite 

 side. Abnormal position of the eyes is always a prominent symptom. Both eyes 

 are deviated to the opposite side, and there is nystagmus owing to the difficulty 

 experienced in moving the eyes towards the side of the lesion. When a patient with a 

 lesion on the right side attempts to look towards the right, the eyes move slowly towards 

 the right and then drop back rapidly towards their position of rest, to be slowly moved 

 up again towards the right. The movements are similar to those which may \ 

 in any person looking out of the window of a rapidly moving train. 



There is no loss of sensation or of muscular sensibility. 



