the patient eats sparingly. The amount of urine is generally very much reduced— to a few ounces even.
In this patient, therefore, there are the same signs of peripheral neuritis and of dilatation of the heart as in the other case. In addition, there is a some-what firm œdema, which is not altogether cardiac, but, as its character and the circumstances in which it is found suggest, is probably connected partly with lesion of the nerves regulating urinary excretion, and partly with the play of transudation and absorption in the connective tissues.
Mixed paraplegic and dropsical cases.— In the next bed to this patient there lies, perhaps, another case which looks like a mixture of the two preceding. There is œdema generally somewhat firm— particularly of the shins and feet, about the flanks, sacral region, and, very generally, over the sternum and root of the neck. There is numbness of the shins, there is some ataxia, there is muscular weakness and hyperæsthesia— particularly of leg and thigh muscles, there is absence of knee-jerks, there is probably a cardiac bruit and reduplication of sounds, and there are signs of dilatation of the heart and relaxed arterial tension. Just as in the other cases, the general health of the patient is unaffected, the tongue is clean, the urine though scanty is otherwise normal, and there is no fever.
Great variety in degree and combination of symptoms.— All through the wards of the hospital similar cases may be encountered. Some are so trifling that they are up and moving about with more or less freedom; and others are so severely smitten that they lie like logs in their beds, unable to move a limb or perhaps even a finger. Some are atrophied to skeletons; others are swollen out with dropsy; and some show just sufficient dropsy to conceal the atrophy the muscles have undergone. Although the cranial nerves above the seventh are very rarely involved, in some it will be noticed that the laryngeal muscles are paralysed, the patient being unable to speak above a whisper or to produce an explosive cough. In one or two cases the
