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when not sleeping, patient complained of conflicting warm continuous bath and tincture of opium were indistinguishable voices that sound like those of her effective. quarrelling relatives. For the first two weeks the Diagnosis.- Manic Depressive Insanity, Manic patient was partially unclear, and the stream of Phase, precipitated by and following influenza and thought was frequently incoherent. Replies and pneumonia. The patient was discharged as recoverremarks were frequently irrelevant such as: “I had ed about two months after admission. a suit case. My tooth-brush is here. Why did they The chief point of interest here is that we put a comb in my bed?” During this period there
are dealing with a true psychosis, precipitated were delusions of unreality. She was sure her baby by an infectious disease, and not a post-infecwas dead and troublesome auditory hallucinations continued. These disappeared suddenly on the fif
tious mental condition. Diagnosis further conteenth or sixteenth day after admission. At the firmed by personal history of two or three hyposame time all disturbances of memory and thinking manic attacks annually for the past several also subsided. With this change the patient's mood became slightly elated, and self-accusatory ideas
years. (which had formerly been present) disappeared, and
Case VI. E. H. Psychiatric Service 2573. Male, the patient seemed eager to adjust difficulties at
Age 35. Steam Fitter and Plumber. home and to resume her domestic duties.
Family History.-Denied or unknown. Father is Diagnosis.—Toxic delirium, associated with an
reported as having a high blood pressure but able infectious disorder, probably influenza, in an in
to work daily. Steadily but moderately alcoholic. dividual of hysterical temperament.
Several uncles on both sides of the house steadily
alcoholic. Comment.-In view of the family situation Make-up.--Somewhat retiring and seclusive alprior to the acute illness and in view of the un
though he is a member of a number of fraternal
organizations; rather sensitive and difficult to beclear state, and sensory disturbances, there is a
come acquainted with, although for a few individ. suggestion of simple hysteria with unclearness ; uals he shows extreme attachment; steady worker; on the other hand the probability of an infec- moderately but steadily alcoholic from seventeenth tious somatic disorder complicates the diagnosis.
to thirtieth year. Married at 33. This is favored by the fact that the patient's physical illnesses or operations. About a year ago
Previous Medical History.-No history of serious mental condition cleared up so rapidly after the patient expressed paranoid ideas thinking that admission to the hospital, and all symptoms of his employer in the Ford Eagle Plant regarded him a toxic disorder disappeared. The inter-rela
as a German spy. This idea was retained for a
long period of time. tion between the physical disorder that had ex
Present Trouble.—Last December the patient had isted, and the previous difficult family situation
influenza, lasting about two weeks. He returned had its evident psychic effect and consequently to work before fully recovering from the effects gives us a mixture of two conditions noted in
of this illness. While at work he complained of the diagnosis.
indefinite pains in his head and lungs and the feel
ing of fear and tremor referred to the sternal reCase V. Psychiatric Service 2474. Male F. R. gion. Since this illness unstable emotionally and Age 24. Transferred to us from Contagious Ward inclined to romancing over supposed serious accibecause of over-active conduct.
dents at the plant where he was working. Recently Family History.-No previous serious illness. At
auditory hallucinations and ideas of reference. He tended school in Manilla, Philippine Islands, where
has heard mysterious knockings on the walls, and
would sit in the corner of a street car because he he received his credentials for admission to the University of Michigan in October, 1918.
felt passengers were gazing at him. Within the past
five weeks delusions that his wife and mother were Present Trouble.—About Christmas time 1918,
trying to poison him. He has taken drugs from patient contracted influenza which was later com
the house to local pharmacists to ascertain their plicated by pneumonia. He was treated in the Con
nature. tagious Ward. After the fever subsided the patient
Course Here.-Physical Examination: Negative made steady recovery. Then he began to show
except for certain sounds in the right pulmonary extreme restlessness and confusion. He was un
apex, somewhat suggestive of pulmonary tubercuclear, over-active, and apparently hallucinated. There
losis. X-ray, however, is reported as negative for were intervals of apparent normality. He
tuberculosis. transferred to this ward and the case was first re- Neurological Examination.—Left pupil slightly irgarded as a post-influenzal psychosis. Examinations regular; right pupil reacts slightly to light; bilateral physical and neurological, could not be made be
conjunctival anesthesia: marked intention tremor of cause of the patient's extreme over-activity. Labor- the hands, fingers and arms on the F. F. T. Marked atory Examinations all negative. Mental Examina- hypalgesia of the entire body amounting almost to tion and Observation on the wards later left no
an analgesia over the forearms. Laboratory Exdoubt that we were dealing with a true psychosis. aminations all negative. The chief symptoms were increased psychomotor Mental Condition Here. On admission the paactivity, pressure of speech, Alight of ideas, and tient was somewhat suspicious in his attitude and distractibility. He was frequently decorative, at accessible although he was apparently superficial other times denuding or destructive, and frequently in his narrative, and evasive. His manner sug. exhibited emotional instability. There were occa- gested either an intellectual deficiency or the unsional mild expansive delusions and irritability. The naturalness so frequently seen in cases of Dementia
Praecox. His manner was frequently light as well rooms, one like a court room, the other a bright as his mood, and both out of harmony with the room where people were dancing and having a high situation, and seemed to be an over-compensation old time. I have the power of seeing things for what he was apparently trying to cover up. at a distance. In the court room I saw Joe and Closer interview and questioning confirmed this, and. Charlie get out and go away into the dancing room. brought out the following content of thought: In the dancing room I looked in at the door and Chiefly marital infidelity on the part of his wife, and only saw a crowd of people. At home I have seen earlier ideas of reference and persecution; personal two people leaving at day-break." The patient says ability to "see things at a distance." The patient he is sure she has been unfaithful to him. asked for an interview a number of times but seem- This note on the patient's mental condition was ed to get nowhere. Finally he said, “I have a secret made on May 15. The physician suggested to the I wish to tell you. While at the Receiving Hospital patient that he leave the case in the physician's hands in Detroit I kept everything from the staff and and allow him to handle the situation, and if there have been doing the same thing here, but I am was anything in it the physician would find it out afraid I cannot carry it through. My wife was Since that time the patient has been visited twice unfaithful. My evidence is, just before coming here by his wife. On the first visit he was still someI called her up over the telephone, and without what suspicious, but on he second visit this had recognizing my voice she said, “Is this Joe or apparently disappeared. Charlie?' One is a Ford man. That sort of thing Today, June 9, he states that from the moment had been going for about two months. I got evi- the physician said he would handle the situation he dence but not enough for court proceedings. I told was sure that his wife had stopped all of her queer her things were not right and she said, 'I'll put you actions, and he wishes to look upon the things as where the dogs wont bother you.' She meant completely of the past and forgotten. where nobody could get into touch with me. She He has enough insight to see that his father and lised to stand at her window and look down with mother are taking the part of his wife and be bethe shades of her window drawn. I could see lieves it would be unwise to pursue the matter any what she was doing through a mirror but not to further. whom she was signalling. Her actions even during The manner of the patient is still somewhat unthe day time showed that something wrong was natural. He laughs rather light-heartedly in refergoing on. She was pink under the eyes. You know ring to certain things. Will not quite admit that he what that means (sexual significance). I had no does not still have the power to "see things at a other kind of evidence. We broke up housekeeping. distance" but believes that he had better "cut out She had a sign at the window marked for sale.'
that stuff.” It was taken down when I came back. I thought she was selling out everything and 'beating it with Comment. The case first looked like a simJoe or Charlie."
ple post-infectious psychosis following influenza, The patient is evasive when asked if anybody but on close study of the case, particularly with tried to poison him. He admits sending a bottle
reference to the patient's paranoid ideas for a to the Board of Health. This was not returned to him. “At times I heard her in the kitchen stirring
vear preceding his influenza, and because of the things in a pitcher. She never did that before, she persistence of this paranoid tendency, particuwas always prompt at meal time."
larly with reference to his wife, we seem rather The patient then asks the physician to go with to have a psychosis, not post-infectious, but a him to Detroit to get his brother-in-law on the tele.
frank psychosis precipitated by a physical letphone where he has a switch-board, and then permit him, (the patient) to call up his wife. “She
down. The features are those of paranoid Dedoesn't know my voice. She thinks I am here. I mentia Praecox, which is suggested by the parawill represent I am Charlie or Joe and thus have a
noid tendency existing long before the influenza, chance to make a date ‘on the going to bed stuff,'
and by the ideas of marital infidelity and teleand see if she falls for it. I'll then get a woman
pathić ideas, which the patient still insists he detective and let her run it down. If I don't get it straightened, in time it will ruin me. I'd like her has. This diagnosis is also confirmed by the if she wou'd cut out this monkey stuff. My father patient's general manner. Alcoholic paranoia was against the match but I don't want her family
is with difficulty ruled out because of the history to know anything except the brother-in-law I spoke
of long standing and steady alcoholism; this of. It would kill her oldest sister who thinks the sun rises and sets in me."
was confined, however, to beer drinking, on an The patient then reverts to his suspicions dating average of a glass or two a day. While the
paback to over a year ago when he imagined he was tient's reactions do not appear to be those of being taken for a German spy, and says that he alcoholism it is difficult to rule out the influence has had no other trouble except with his wife, and
that it may have on the general picture. While that his one desire is to know who Joe and Charlie are. He then returns to his residence at
on the whole it looks like a case of Dementia the Receiving Hospital where he says, he was play- Praecox this should by no means be regarded as ing a part. "I had to do this or kill my own goat." an absolute diagnosis.
The patient then makes a more bold statement saving. “I know she has been keeping up relations CASE VII. Psychiatric Service 2528, H. T. Fewith Toe and Charlie since I have been here. I was male, Age 27, Occupation, Housemaid. presented with the sensation that there were two Family History.-The father and mother separat.
ed. Mother is a prostitute and a bad woman in 2. All movements, as well as speech, are slow, every respect according to the anamnesis furnished either the result of psychomotor retardation or of by the State Industrial Home for Girls at Adrian. blocking. Occasionally she replies to a question On one occasion she threatened the prosecutor and several minutes after it has been asked, and seems herself.
especially eager to reply if the examiner prepares Personal History. The patient was admitted to
to leave the room, the State Industrial School in 1904 and discharged 3. Sleep: The patient complains of not sleeping in 1910. She was reported as willful and vicious well. She reports frequent dreams, but when quesat times, and attended school only when compelled tioned as to whether she is sure they are dreams to do so. This was before admission. Her record she hesitates and says, "Perhaps
I think at the State Industrial School is that of a good I thought it last night.” Her "dreams” are of great girl unusually quiet, capable and trusty. significance. The following is typical: "I dreamed She had
the usual diseases of childhood I went somewhere and saw men and automobiles. with good recovery. She had frequent phar- One man had dark eyes and was a German. I saw yngitis and tonsillitis during childhood. Head- two babies; one was asleep, and the other wasn't; aches about once a month to the twenty-fifth , one was crying and the other had its eyes open. year. For the past seven years there has been Then I went into the house and I seemed to have pain over the right ovary at the beginning of the blue eyes and light hair (the patient has dark hair menstrual periods. Two and a half years ago she and eyes) and I was glad and happy about it.” It had a severe attack of tonsillitis, lasting about three is this dream (?) that she thinks she "thought." days with elevated temperature. Two years ago 4. Comprehension: is not disturbed, but the pawhile working at the Belding Silk Factory the pa- tient's attention frequently lags seemingly because tient became very nervous. As this “worked on she is lost in her own abstractions, her" it affected, according to her own account, her 5. Stream of thought shows almost as typical right knee so seriously that she could not keep up a blocking as it is possible to see. She starts to her work. The knee "bothered" her for nearly a reply to a question, seems to have forgotten it, hesiyear and a half. The pains in the knee suddenly tates, begins again, sighs, and when the examiner got better, but became more intense in the right asks another question she replies to the first. It inguinal region. She came to the Homeopathic frequently resolves itself into an ambitendency or Hospital for treatment for this condition on Feb. ambivalency. This will be seen in the narrative of ruary 23, 1919. Two days later she insisted on leav- the patient. It is the same in respect to purposeful ing the Homeopathic Hospital against advice, wan- moveinents. She begins, then stops. At times she dered about the town for several hours and was has had a retention of urine. When taken to the finally brought back by a Y. W. C. A. worker. The toilet she sits for a long time, says she cannot pass patient had fifty dollars on her person when she her water, but wishes instead to be allowed to defeleft the hospital. It was gone upon her return. A cate, few days later she developed more marked mental The Content of Thought shows two interestsymptoms, was referred to the Psychopathic Hos
ing features: auditory hallucinations, and desire. ital and admitted on March 14.
as she puts it, "to have a man." About this desire Course Here. Physical Examination.-Negative "to have a man" is woven an extremely interesting except for apical abscess of a right molar which
sexual fantasy. In her own words. “A year or two developed two weeks after admission.
ago I used to masturbate. I felt sorry afterwards Gynecological Eramination.-Negative except for and thought it was wrong. : Then I used to think pruritis vulvae.
I wanted to get married, but I never found the right Neurological Examinations.--Negative.
man. Some wanted me, but I didn't like them. BeLaboratory Examinations.-Negative except for a fore my knee hurt me at Belding I decided to go number of W. B. C. in the urine, probably from West: I felt nervous. I thought I would go and get the pruritis. Blood count at the Homeopathic Hos
I went to Colorado, Denver, and worked pital February 23, 1919, 13,600 WBC. Blood count at a restaurant. One day a man came in. I cared here negative.
for him, perhaps he cared for me. He didn't say llental Examination. Ever since admission to the anything, but he wrote me after I came back. I hospital the patient has had the appearance of being thought I wanted to marry him. I liked the looks perplexed, apprehensive and unclear. In view of of him. I thought he was 36, but he was really 51. this attitude and of the subjective account of “knee Now, that is strange, isn't it?” trouble" it was at first thought that we were dealing At another interview the patient states that eight with a
case of post-infectious psychosis following and a half years ago her father used to come to articular rheumatism. Communication with the her and place his genitals against hers, but never Homeopathic Hospital and with the family physi- made intromission. She would handle his parts. cian elicited no history, however, of any recent ill- Ihree years ago she did the same thing with a ness or febrile condition. Routine mental exam- cousin, and again for three or four times with her ination brought out the following points:
father last September. (Gynecological examination 1. General appearance that of mild apprehension shows imperforate hymen). and slight unclearness. The patient tries to co- While at the Homeopathic Hospital the patient operate, however, at all times. She is quite re- made a suicidal attempt. When asked the reason spectful, and accessible, though slow in her move- she answered, “Because I was afraid I couldn't see ments and in her speech. She frequently looks at my father again. I wanted to tell him I was sorry." the examiner in a perplexed way, gazes about the Also, while at the Homeopathic Hospital she says room as if hallucinated, and appears to be in a dream she heard the voices of girls saying, “You like your state.
father, you slept with him, and I thought that was
wrong because that is the way married folks do. going to do in the window, but I wasn't. There I said strange things such as "Father pissed going to put the window up. I hear someone say in it, and mother shit in it.” My father was there 'throw it,' 'throw it.'" (Throw what?) “A touch when I said those things. That is why I want him of passion I guess. I don't understand that very to come, to tell him I am sorry.”
well. A touch of passion I guess. I don't underAt this hospital she has heard voices say, "You
stands that very well. A touch of passion for chilcheated, because you liked your father." Then the dren, I guess.” When questioned about her somatic patient says in comment, “I liked my father be
complaints she states that she now feels more like cause I liked everyone, I guess." Then she looks
herself than when she came into the hospital. She questioningly at the examiner asking "That's all
has no pains in the side, “No pains anywhere." right to like everyone?" Then breaks off rather
For the past two months there has been no noticeabruptly and says, “But you can't like everyone.
able change in the patient's condition unless it is a Then the voices said they were going to cheat me;
slight deterioration. Her manner is more frequently they meant they were going to prevent me going
silly and there is frequent unmotivated laughter. out with a gentleman friend, Americans I guess, not
She insists that she still hears voices. There is Germans.” When asked how one can hear voices
still evidence of blocking. Her replies when she is she replies, “I hear voices in my mind. I don't
interviewed come with abruptness and in a choppy know as I hear voices, but I think I hear them." manner, with long intervals between questions and
answers. 7. Orientation. The patient is oriented for per
The answers are frequently explosive.
She has been erotic at all times. She continually son and place, but only partially oriented for time, missing the day and date, but giving the year and
says she wants a man to sleep with her and asked
the physician if he would not do so. When asked month.
why she laughs when she is touched on the arm 8. Narrative. This was given in the form of
she replies, “Because it gives me pleasure." There the patient's own anamnesis. When questioned about
have been one or two brief episodes of exciteincidents of the day when she left the Homeopathic
ment when she has imagined that the Germans Hospital, she states that she left the hospital about
and Catholics are against her. 11 a. m. and walked steadily until about 2 p. m. It seemed as though the doctors were after me to
Diagnosis.—The diagnosis in this case is one of
the most difficult of all the cases considered. She see how far I could walk to test my heart. I went to the Ann Arbor restaurant for dinner. Once I
seems to present a picture and difficulties quite sim
ilar to one or two of the seven cases presented by went into a shoe store to send a telegram; then to
Hoch and Kerby in the April number, 1919, of the a grocery store; I was looking for the depot to send
Archives of Neurology and Psychiatry under the the telegram to my father. When questioned about
caption, “A Clinical Study of Psychoses Characterher money, she says she gave it to her father. She
ized by Distressed Perplexity.” The principal featbecomes somewhat confused at this point, knowing
ures in these cases are: her father was not in the city, but insists that she gave it to no other man. After lunch she returned
1. Perplexity in facial expression and utterances. to the Y. W. C. A., and says while there she felt 2. Marked distress accompanied either by restsick, as though she were going to die. It was after lessness or phenomena of inhibition. this that she was returned to the Homeopathic Hos- 3. A feeling of guilt which the patient cannot pital.
formulate; which is projected in the form of ac9. Insight: Is not perfect. She knows she is cusatory hallucinations against which the patient nervous and worried, but she has no complaint ex- protests, that is, does not accept. cept "a pain in the side." When asked why she 4. There is often a constitutional basis and the looks about the room in so strange
psychosis is frequently of apparently short duration. answers, “I feel as if something were on my head Quoting Hoch exactly: "As to the clinical position drawing it, a machine of some kind." She then of these cases, it was shown that the reaction as looks at her hands and says, “I am not clean, yes I such has a certain relationship to the manic deam clean, but I am not clean inside. My blood is pressive reactions, that features of it, and possibly gone. Sometimes I have quite a bit, and then I the pure clinical picture, may occur of a toxic indon't have very much. I think it is caked.” (Do fectious etiology, and also in typical form. It has you feel changed?) “Not until last night when I occurred in a case whose further course was that thought I had light hair and blue eyes, but I liked of Dementia Praecox.” It was pointed out that them last night. I thought she was a German girl." the same is true in the case of the manic and stupor 10. Ward Notes, April 9, 1919.
reactions. The patient is clear, well oriented, knows that Hence the case before
lie the physician has been away a week; gives the day between a depression with perplexity; a toxic inand month correctly; misses the date by two days. fectious psychosis with perplexity, and a dementia She states that the feelings of her head of being praecox with perplexity. It is rather hazardous to drawn as if by a machine have disappeared, and risk a positive diagnosis at this stage. The history that things seem more real except when she thinks of unclearness, however, on the day the patient too much. When asked what she thinks she gives wandered away from the Homeopathic Hospital and a reply that is evidence of auditory hallucinations: the evidence of fantasies of a sexual nature, with “I hear them saying that she is going to have a pronounced wish-longings, together with ambivalent dirty rotten baby. I can't see how that is.” She tendencies point somewhat strongly to dementia then looks out of the window in a perplexed way praecox. Whether the perplexity in the case is due and continues, "I saw a soldier this morning and to negativistic and agnostic impulses, or whether the thought I liked the looks of him. He looked as if perplexity produces what appears to be either rehe was waiting for something, to see what I was tardation or blocking, it is hard to determine. Ex
cept for the dream (?) in which the patient con- The case was referred to us March 28, 1919. The ceived herself as having light hair and blue eyes, patient appears apprehensive, restless and slightly there is no positive evidence of disintegration. emaciated. There is a moderate psychomotor retar
However that may be as the case progressed one dation, and marked facial tremors, particularly at could almost see the unfolding of the schizophrenic either angle of the mouth when the patient is speakmechanisms with an effect not unlike the ultra rapid ing. It is a nasalized speech and different, accordmoving picture device which enables one to get the ing to the patient's statement, from what it is when most rapid and complex movements of the athletes' she is well. Handwriting is tremulous. Sleep: The gymnastics. Unlike case six there is no definite patient states that she dreams a great deal. Before evidence yet of progressive deterioration.
coming here she dreamed of her father coming Case VIII. Neurological Service. Courtesy of back to her. She states that she has always liked Dr. C. D. Camp. R. G. Female, Age 40, House, him better than her mother. Comprehension is unwife. Married.
impaired but there is a slight distractibility of atFamily History.-Two aunts and uncles have epi- tention. The patient is apprehensive about the outleptic seizures.
come of her illness, frequently asking what is the Make-up.-Eighth grade education at fourteen. nature of her trouble, and when she can go home. Somewhat nervous all her life. Given to day dream
The chief item of interest in the case is the paing as well as night dreams.
tient's narrative. She states that shortly after she Personal History.—Sick headaches all her life, was married (that was 22 years ago) she wondered but not severe enough to confine her to bed. Five if her father would approve of the marriage. years ago they became more severe and have been Shortly after that he appeared to her as in a vision worse in the last two years.
saying “Babe don't worry.” Since that time she has Present Trouble.-Dates back about two years.
not worried about her marriage. She states that Headaches began in forehead involving the back of she has always been sexually frigid, and then repeats neck, and lasting as long as five days at a time. Dur- the account noted by Dr. Camp of fainting spells ing the attack she has photo-phobia; is nauseated
--that they existed for about three years; they are and sometimes vomits. She also experiences numb- precipitated by disconcerting or unpleasant situaness, but has had no disturbance of visions. She tions. Her vomitus is frequently watery. She does sometimes falls backwards; feels herself "going" not lose consciousness, although everything about but cannot talk. These attacks are only momentary.
her seems dark. During these attacks there is The headache ceases after her "falling back.” Astasia Abasia, generalized body tremors, globus
Examination.-Facial expression somewhat epilep- hystericus and gastric complaints. tic. Teeth show pyorrhea. No paralysis. Consid
She gives a history of having an almost complete erable medium tremor of extended hands. The pu- aphonia previous to her present illness; that she pils react somewhat sluggishly. Anesthesia of the had nothing but a whispered voice, even though conjunctivae on both sides. Hearing on the left she was not suffering from an ordinary cold. somewhat obtunded. Optic nerve on the right eye
Last summer, she states, that her mind seemed as pale and deeply cupped.
if it were outside of her body. She tried to say The above history and examination was made on things but could not. On certain occasions she December 11, 1919. Diagnosis—Migraine.
reports what appear to be auditory hallucinations. The patient returned March 20, and states that
She could hear the voices of her son and daughter four weeks ago she was taken sick. Since then when she knew they were out of the house or she has had nasalized speech. She has become weak
asleep and says that she has had tremors of the hands. Neurological Examination for sensory changes She is now so weak that she cannot walk alone. No shows tenderness on pressure over erogenous zones. diplopia. She complains of continual sleepiness,
She has a general hyperalgesia. This appears to being able to sleep at any time and anywhere. The
have come on since her lumbar puncture. husband states that she falls asleep in a chair. The This last case is extremely interesting from face is expressionless, rarely winking. Pupils un
several points of view. First of all clinicians and equal, right being larger than left. Slight bilateral ptosis. She does not draw back either angle of the pathologists are not quite agreed on just what mouth in showing the teeth. The teeth are dry, the term "lethargic encephalitis" denotes. Saint gums sore and red. On sound formation the soft
Martin and Lhermetti* report two cases which palate rises very slightly to the left. There is a
they call "primary poliomesen-cephalitis with marked intention tremor equal on both sides and occasionally a slight tremor at rest. Knee jerks narcolepsie.” They insist that the two fundanegative. Intention tremors in both legs. Pulse mental symptoms in this disease represented by weak, fairly regular, 120 per minute.
these two cases are complete bilateral paralysis Laboratory Examinations.-Lumbar puncture two
of the third nerve, and hypersomnia. For this cells. Carbolic faintly positive. Both phases of the Nonne Apelt test, negative. Reducing substance
reason it is to be differentiated from the acute normal, Blood Wassermann, negative. On two hemorrhagic poliomyelitis of Gayet-Wernicke different occasions Spinal Fluid negative. Gold which show symptoms not found in their cases, Curve 00011100000.
symptoms such as mild delirium, unclearness Ophthalmology reports negative fundus.
with hallucinations, changes in the reflexes, X-Ray.—The head negative.
speech disturbances, mild facial palsies, someGynecology Examination.-Negative. Diagnosis on Second Admission.-Lethargic En
times even hemiphlegias and especially cerecephalitis.
Bull. de la Soc. Med. des Hospitaux, 17 May, 1918.