78 
severe headache. This feature of the disease is fullv confirmed hv 
%/ 
the testimony of both teachers and parents, who assert that children 
of this class are usually much more backward (and even stupid in 
their studies) than other children not showing the symptoms under 
discussion. 
Dizziness is very commonly mentioned by the patients. This feel- 
ing, which they usually speak of as a "’swimmmg in the headd’ is 
experienced especially upon rising suddenly from a chair or a bed. 
Nervousness does not seem to be so commonly complained of as 
mental lassitude, headache, and dizziness. Still it is more or less fre- 
quently mentioned, more particularly by the girls and women. 
Among girls from about 13 to 20 years of age it was quite notice- 
able that they were more timid and more emotional than were their 
healthier sisters. 
According to Sandwith (1891, pp. 11-12), there is pain in the head, 
generally referred to the temples, while in the knees there is almost 
invariably present great weakness and some pain; occasionally there 
is in addition pain in the shoulders. Giddiness is another very gen- 
eral symptom, and it is this as much as anything else which compels 
the patients to give up work. The worst cases are those which are 
nearly always asleep, and can not be interested in anything when they 
are awake. On the whole, sleepiness is decidedly a symptom. Dense 
stupidity, associated sometimes with reiterated demands for a favor 
alreadv granted, shows that the bloodless brain is afiected in all 
advanced cases, and at least three times Sandwith (1891, p. 13) found 
a condition of weak-mindedness which would have warranted the 
patients being sent to the asylum. 
PATELLAE EEFLEX. 
Absence of patellar refiex is reported in cases of general debility 
and muscular weakness. Sandwith (1891, p. 13) found this reflex 
unaltered in 35 per cent of the cases examined, completely absent in 
18 per cent, decidedly diminished in 5 per cent, and a little exagger- 
ated in 12 per cent, all of which were early cases. 
GEXITAL SYSTEM. 
EXTEEN AL GENITALIA; SEXUAL FUNCTION; MENSTEUATION ; STEEILITY. 
In cases where infection has taken place in early childhood, the 
delayed development of the genital system is very marked. Patients ^ 
of 16 to 22 years of age may not be better developed than healthy per- 
sons of 11 to 15 years. Menstruation may be very irregular, espe- j 
dally in summer. This same condition is insisted upon in many early 
writings on dirt-eating. Mothers frequently ascribe the condition of I 
their daughters to the absence or irregularitv of the menstruation as ; 
IS mentioned also in early writings on dirt-eating. 
