P. A. came to my service in the City Hospital, an emaciated and crippled boy of 12. Physically, he showed pupils that were unequal, irregular and immobile, a coated and tremulous tongue, and a coarse tremor involving the entire body. The speech was hesitating and distinctly ataxic. He was paralyzed from the waist down.
The physical signs showed a spastic paraplegia with the reflexes all exaggerated, and loss of control of both sphincters. There were contractures of both legs so that he lay in bed a helpless paralytic.
Mentally, he showed marked dementia. If touched he would scream, and if given orders he would obey them only after considerable repetition and explanation.
The story that the family gave was that up to about 9 years of age he had been able to attend school. After that he was unable to keep up in his lessons; the teachers found him almost