In conclusion one can say that the diagnosis has in this
case been clearly established as a case of encephalitis
lethargica. A study of the case hae not cleared up any of the
mist in which the etiology of the condition is placed, beyond
indicating that the possibility of organismal causation cannot be dismissed.
The symptomatology i3 to be entirely explained in the
light of the pathology - namely an inflammatory reaction
around the cerebral peduncles and the upper part of the pons.
The prognosis in this case while being very good as
regards survival, is guarded, from the point of view of complete recovery.
The treatment is merely palliative.
However if the enquiry into the subject has brought out
any point it has revealed the paucity of our knowledge on
many aspects of the case, and it is quite possible that further
research on the subject may fundamentally alter many of the
views which have been set down in this commentary.
II. A CASE OF ANEURYSM OF THE TRANSVERSE PART OF
THE ARCH OF THE AORTA.
In conclusion one may say that a study of this case
has emphasised the importance of syphilitic infection in
the causation of aneurysm and that when this is combined with
an occupation which involves sudden increases of blood
pressure an open invitation is extended to the formation of
If a vessel is going to give way the part which has gone
in this case, namely the transverse part of the arch of the
aorts is particularly liable, receiving as it does the main
shock of any increase in pressure.
Finally the prognosis is bound up in the patient himself.
The patient of the "don't care" type cannot be given a long
span of existence even with the most diligent treatment
otherwise, but a patient as this one who is intelligent and
will actively co-operate with the physician and who will
submit to a long and wearisome regime of treatment - this
patient although feeling physically very fit, has submitted
to lying on his back continuously for 3 months - can be given
a much better prognosis for one knows that when he leaves the
hospital he will "cut his coat according to his cloth" and
thus will quite probably live a comparatively long and useful
III. A CASE OF PARALYSIS AGITANS
And now, in conclusion, what points have been learned from
a study of this cases: I. Firstly it is now recognised that Paralysis Agitans is
a special type of central palsy due to loss of function
of the Striospinal system; II. Strictly speaking it is not a disease but a special type
of palsy which may result from a variety of pathological
lesions including Senile Atrophy, Vascular degeneration
and various gross lesions of the Corptis Striatum such
as softening, haemorrhage, tumours, and intoxications;
III. There are three varieties of nervous control over
(a) The segmental controlling reflex function and
(b) The Striospinal controlling automatic and associated
(c) The Gortico-spinal controlling discriminated and
IV. The function of the Corpus Striatum, in addition to
controlling automatic and associated movements also
has a regulating influence on muscle tone;
V. Although cure of the condition cannot be expected in
the presenile type - great amelioration of the symptoms
may be expected from the prescribing of certain exercises
and drugs, and more particularly by giving back to the
patient the self-confidence which the slow and progressive
course of the condition has taken away from him.
IV. A CASE OF CHRONIC HYDRAEMIC NEPHRITIS
VALVULAR DISEASE OF THE HEART.
In conclusion only two points are worthy of mention.
The first is well illustrated by this case and that is that
the clinical appearances of a case of nephritis may lead one
very much astray in judging the damage sustained by the kidneys.
The only rational way of finding this is to estimate the
renal function by one or all of the ways mentioned and many
serious mistakes with regard to prognosis will be avoided.
The second point is that which has been brought out
under the heading of treatment - namely the value of a diet
such as that recommended by Epstein which is efficient in
clearing up the gross physical signs and certainly adds much
to the comfort of the patient. It is probable that the lives
of cases of Chronic Parenchymatous Nephritis are cut, short
rather than improved by a continuous regime of an unsustaining
diet and a modified nitrogenous diet improves 3uch cases to
an extraordinary extent both physically and mentally.