SKIN: Scar 2 inches long extending across the forehead and downward between the eyes and across the bridge of the nose The skin of the groin is macerated bilaterally as a result of being constantly moistened with urine.

EYES, EARS, NOSE AND THROAT: No marked abnormalities.

LUNGS: Hyper-resonant throughout with moderate enlargement of the chest cage suggesting the presence of mild emphysema.

CARDIOVASCULAR SYSTEM: Apex of heart palpable at a point I cm medial to the left mid-clavicular line. No evidence of right heart enlargement could be detected Pulse 80 Blood pressure 130/75 Pulse full and regular except for an occasional skipped beat The distal palpable arteries in the wrist and ankles were markedly sclerotic.

MUSCULO-SKELETAL SYSTEM: Both legs and arms were slowly moved by the patient although all movements of the extremities were associated with moderate spasticity The patient was unable to stand alone or walk when he was held upright.

NEUROLOGICAL SYSTEM: Pupillary reaction to light normal. Deep tendon reflexes in arms and legs were normal. Normal reaction to plantar stimulation.

GENITO-URINARY SYSTEM: Incontinence of urine was noted at the time of examination. Genitalia appeared normal. A prostatic examination was not made.

GASTRO-INTESTINAL SYSTEM: Abdominal examination was normal. Incontinence of the bowels was noted at the time of the examination.

4. IMPRESSION AND PROGNOSIS: It is the impression of the undersigned that this man is suffering from far advanced generalized arteriosclerosis which is progressive and that he has already suffered from repeated small apoplectic strokes It is believed that this condition has already developed to the point where this man has lost all capacity for memory, reasoning or understanding of statements made to him and that transporting or doing anything which might excite him might endanger his life.

/ s / PAUL F. CHESNUT
Capt., MC
Surgeon