were partially flexed, and similarly the elbows, the latter being pressed firmly against the trunk. There was generalized muscular rigidity, due to hypertenus of an extra-pyramidal tract lesion.

On the physicians' entering the room, the patient fixed his gaze on them, and replied to their greeting with "Guten Tag," and gave his hand when they offered theirs to him. He shook hands normally, but he could not relax his hold or remove his hand, and continued to squeeze the physician's hand; this was due to the presence of a forced grasp-reflex, which was more marked in the left than in the right hand. When asked how he felt, he replied "Gut," but to all further questions he gave no reply at all. He was silent and showed no reaction to, or comprehension of, other questions, and simple commands, such as "Open your mouth," "Put out your tongue," "Look this way." Only painful and disagreeable stimuli produced any reaction, and then it was merely a facial expression of discontent, sometimes accompanied by grunts of disapproval.

The disturbance of verbal response was not due to dysarthria, because the patient was able to pronounce such words as he did use, quite distinctly. Neither was it due to motor aphasia, because the few words he used were used correctly, and he never exhibited the jargon responses of the true aphasic when attempting to answer questions.

The patient was indifferent, apathetic, and was not in good rapport with the external world, lacked initiative, exhibited paucity of emotion. He uttered no spontaneous speech, and his reaction to painful stimuli was primitive.

Neurological examination showed the following additional abnormal findings: There was a right facial weakness of a supranuclear origin. The pupils reacted promptly to light, and appeared normal, save that the left was slightly larger than the right. Ophthalmoscopic examination of the fund), limited by lack of cooperation from the patient, showed clear media and normal retina and retinal vessels. The right disc, the only one visualized, appeared normal. Extra-ocular movements could not be tested; there was no obvious strabismus. All deep reflexes in the arms and legs were present and very brisk. Clonus was not elicited. The planter reflexes were flexor. Abdominal reflexes were absent, except for the right upper. There was incontinence of urine and feces, of the type associated with senile dementia. There was an associated minimal degree of intertrigo. Owing to lack of cooperation of the patient a full sensory examination could not