466 
REPORT OF CASE. 
to me that No, 12 was very sick. Hurrying to the hospital, I 
learned that a short time after my previous visit the patient had 
assumed the recumbent position, as usual on the left side, remain¬ 
ing there quietly until nearly ten o’clock, when he got up, began 
to sweat and to breathe rapidly, then to lie down and get up 
repeatedly as in spasmodic colic. Being greatly surprised at the 
sudden change, I made a critical examination of the patient with 
the following result. He was lying on the left side, steaming 
with perspiration, nostrils widely dilated and the mucous mem¬ 
brane bright red, respiration rapid and accompanied with a 
groan, occasional straining as if to avoid faeces, and frequent clonic 
spasms such as are seen early in poisoning from strychnine. The 
patient on being made to arise, stood with the back arched, the 
head held low, the hind feet well advanced and moved only on 
compulsion. When locomotion was attempted it was seen that 
the left hind leg was losing some of its power, for although the 
leg was advanced fully as well as the opposite member it was 
irregularly placed on the ground and would knuckle over at the 
fetlock; in fact, I was forcibly impressed with the resemblance 
which the leg bore to that of a person attempting to walk with 
one leg ‘ c asleep.” An examination of the leg revealed nothing, 
neither did a rectal examination, the feces being soft, the bladder 
empty and the circulation of the iliacs perfect. 
I could not make a diagnosis, for sensation was perfect in all 
parts of the body and no lesion could be detected in the lame leg, 
so I determined to treat the most prominent symptom—extreme 
physical suffering—and to this end administered a two ounce dose of 
tr. of opium with one ounce of sweet spirits of nitre. After a 
time the patient became more quiet and again rested on the left 
side. Repeated inspections of the left leg revealed a decreasing 
temperature of all the parts below the middle third of the tibia. 
This loss of temperature increased until the lower part of the leg 
became cold as dead flesh. I believed now that I had a solution 
to the difficulty, for the pulse could not be felt in the digital 
arteries, while it was perceptible as ever in the iliacs; no appreci¬ 
able ingress of the blood to the cold parts took place; the functions 
of the foot were entirely suspended, while the upper parts of the leg 
