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In the dropsical variety the picture in the later stages is characteristic. The tissues are all water-logged, and there is general edema. The face is swollen and bloated, the eyes closed owing to edema of the lids, and the skin over the abdomen is puffy. There is a

There is a purplish cyanotic look. All the parts pit on pressure and there is anesthesia to a varying extent. The patient is unable to move with any freedom and in point of fact takes to bed." He suffers from dyspepsia, from palpitation. The heart acts irregularly, and there is a weak, soft and perhaps intermittent pulse. His faculties are unclouded. He may have a slight cough from oedema of the lungs. The tongue is clean, the digestive functions unimpaired though there may be present a watery diarrhea. The tem- perature does not become elevated. The functions of the kidneys shew no signs of being interfered with, the urine being normal in amount and in constitution. lies a dropsical water-logged mass incapable of locomotion and very helpless.

He

On the other hand in the atrophic variety the picture is equally characteris- tic in the later stages. The pronounced emaciation, the steady, gradual and progressive wasting of the muscles especially of the lower extremities, the wasting of the connective tissue over the body, the loss of the reflexes. particularly the knee-jerks, the gradually increasing and spreading anæthesia rendering him finally bedridden, present a picture which is diagnostic. The organic reflexes are not interfered with, and the body temperature keeps at the normal or perhaps may run a degree or more under the normal. The cardiac muscle apparently under- goes a progressive wasting and atrophy pari passu, leading to weakened action, and a feeble, soft and compressible pulse. When the disease reaches its worst point, death may occur either from the extreme general atrophy or from some intercurrent pulmonary affection to which such cases are specially liable, or re covery takes place very gradually. In the latter cases the muscles recover them- selves soonest but the anaesthesia continues and is prolonged. Gradually strength comes back and the muscles slowly, very slowly, regain their functions, and as the leg muscles were the earliest to manifest weakness, so are they the earliest to recover themselves. The patient tries to use his legs with the aid of crutches at first, and be balances himself on them being unable to secure the as- sistance of his legs. Then gradually he is able to

is able to move the legs, to flex the thighs and to raise the feet off the floor instead of scraping his toes on the floor as he walks. Then he slowly acquires control of his feet, and from letting it fall purposelessly on the floor be is able to draw up his foot and to plant it flat-but he still drags it along after him and feels as if he were walking on cotton wool or paper. In the next stage he discards crutches and takes to the assistance of a stick, and so with returning power and returning feeling he gradually comes to use his feet in a normal manner. Con- valescence is slow but is steady, nornial sensation returning last.of all. When recovery occurs in the dropsical variety its progress is slow-gradually the dema of the extremities and of the body becomes resolved, the turbulent action of the heart is regulated, sensation becomes normal, and power of locomotion is regained. The last returns most slowly of all.

In the atrophic form the first sign that shews itself is a sensation of weakness in the legs accompanied by shooting pains in the front of the legs and calves, and there is tenderness in the calf muscles. This pain is striking, because on examina- tion of the skin over the affected muscles and the other part of the leg large areas of partial or total anaesthesia are met with. This weakness is accompanied with inco-ordination of the gait which may become so pronounced as to lead to the necessity of keeping in bed. Weakness of the muscles of the hand also sets in so that the grasp is lost and there may be tremulousness. Later the finer move- ments of the hand are impaired and anesthesia to greater or less extent sets in. Then actual wasting of the muscles of the legs and arms occurs, and a typical picture is presented. An extremely emaciated man is seen lying helplessly-able to perform some of the coarser muscular movements, but unable to stand or walk: he has wrist drop and also aukle drop-the knee reflexes are lost, but the organic reflexes remain intact. The tongue is clean, the appetite good, the breathing is quiet and regular, and the pulse is normal. Sometimes a degree of anæmia may be co-existent when hæmic murmurs may be heard at the base of the heart. mental faculties are not impaired. Gradual recovery may now. take place with slow convalescence, or death may take place from progressive atrophy or from some intercurrent complication.

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