be made, but the patient responded to pin-prick, deep pressure and muscular movement throughout the body.
4. Cardio-vascular Examination:
Pulse: Rate 100, rhythm irregular. The irregularity was due to extra-systoles. The radial arteries were just palpable, without evidence of pathological thickening or tortuosity. Blood pressure: systolic 130 mm. of mercury, diastolic 80 mm. Of mercury.
5. Respiratory Examination:
Chest movement satisfactory. There was no impairment of percussion noted. Auscultation revealed no impairment of air entry, no alteration in the breath sounds, and the absence of any adventitious sounds.
6. Alimentary-renal Examination:
There was slight distention of the abdomen, due to increase in the gaseous content of the intestines. There was no evidence of ascites. The spleen was not palpable, nor was there any evidence of glandular enlargement. The liver was just palpable, one finger's breadth below the right costar margin, but there was no evidence of enlargement upwards. Urinalysis: no sugar or albumen present.
7. Skeletal Examination:
The patient's rigidity limited the examination of joints. There was limitation of movement of the neck due to muscular hypertonus. The hypertonus was so marked in the lower dorsal and lumbar region as to produce rigidity of the spine. Attempts to move the joints passively stimulated involuntary contractures of the muscles. There was evidence of crepitus in both knee-joints.
The clinical record presented by this patient is that of an organic cerebral disorder, with predominant involvement of the frontal lobes and basal ganglia. The mental disintegration of the patient renders him incapable of comprehending his environment, and of reacting normally to it. He remains uniformly apathetic and disinterested, intellectually retarded to a very marked degree, and shows no evidence of spontaneous activity.
Last modified: October 10, 1998