History.\p=m-\Acolored boy, aged 6, entered Duke Hospital on Aug. 13, 1933, because of headache, dizziness and unconsciousness. He had been well until two days before admission. At that time, he complained of "stomach ache," which disappeared after catharsis. The next morning his head ached and, shortly afterward, he became dizzy and drowsy, and was too weak to climb into bed. His left arm and leg made spasmodic movements and his right limbs were powerless. Speech was only slightly impaired until later in the day, when he became stuporous. He had taken no food or water for twenty-four hours preceding admission to the hospital. The family history was interesting in that a brother had died several months previously after the onset and course of symptoms similar to those of this patient. A sister, aged 12, had had "rheumatism" for several years and her blood smears showed 25 per cent immediate sickling. Smears of blood from the father and mother did not contain any sickle cells. The patient's past history was unimportant.Physical Examination.-The boy's temperature on admission was 38 C. (100.5 F.) ; the pulse rate was 120; the respiratory rate was 28, and the blood pres¬ sure was 140 systolic and 75 diastolic. The patient was well developed, moderately dehydrated and in a semistuporous state. The skin was dry, and there was gen¬ eral glandular enlargement. The nail beds and mucous membranes were pale, while the sclerae were a deep greenish yellow. The eyegrounds were normal. The tonsils were large, cryptic and moderately injected. The lungs were clear as noted on percussion and auscultation. There was a systolic murmur heard best at the apex and transmitted into the axilla. The right arm and leg were very weak and flaccid. The deep reflexes were hyperactive and the Babinski sign was present on both sides, but remained permanent only on the right side. The cranial nerves were not involved. The spleen was not palpable.Laboratory Tests.-The blood count showed the following : hemoglobin, 9.8 Gm. (64 per cent) Sahli ; red blood cells, 2,740,000; white blood cells, 17,450; polymorphonuclear leukocytes, 80 per cent ; large lymphocytes, 8 per cent ; small lymphocytes, 8 per cent, myelocytes and transitionals, 4 per cent. There was 25 per cent immediate sickling, and 75 per cent within four hours. Bleeding time was one and one-half minutes and clotting time, one minute. Examinations of the stool and urine and intradermal tuberculin (0.1 mg. with old tuberculin), Wasser¬ mann and Schick tests gave negative results.Course.-Immediately after the patient was admitted to the ward, a lumbar puncture was made and bloody fluid obtained. Clear spinal fluid was collected the next day ; however, numerous red blood cells were found microscopically. The From the
