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.
Heart: The heart was clinically not enlarged. The cardiac sounds
were feeble, there was no accentuation of the second sound in the
aortic area, nor were any cardiac murmurs audible. There were no
vascular changes observable in the vessels of the fund). There was no
evidence of cedema or of congestive heart failure.
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.
DISCUSSION:
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.