bursts of high-voltage delta activity in all right-sided leads with phase-reversal in the right temporal region. From the time of admission for four weeks there was a slow, steady deterioration, the ptosis becoming complete and the eyes Aixed except for some downward movement.Bilateral total paralysis of jaw, facial, palatal, and pharyngeal muscles resulted in inability to hold her mouth closed or to lift her head off the pillow. She was unable to swallow or to speak, and deafness was marked. The remainder of the body appeared unaffected and her mental state was quite clear, though to a casual glance she appeared moribund. Nasopharyngeal secretions had constantly to be sucked out, but she would often attend to this herself. She was fed by oesophageal tube twice daily, and the constantly threatening inhalational bronchopneumonia was combated by full chemotherapy and penicillin.After remaining in this state for three weeks, with numerous episodes of respiratory obstruction, each thought to be her lest, she made an indistinguishable sound, and three days later to our astonishment could enunciate recognizable words, while some movement returned to the eyes. After a week she was able to speak sentences, in 10 days was able to swallow fluids, and solids four days later; eye movements were limited only on upward gaze.There was a slow and uninterrupted improvement, but as she became more mobile it was apparent that, though eye movements were normal, and all the motor 'weakness had disappeared, she had developed a Parkinsonian facies with tremor of the head, ,and mild cogwheel rigidity of the limbs with tremor. The cerebrospinal fluid on March 31 was normal apart from the Lange curve, which read 4322100000.Her further progress was followed in the out-patient department, and the Parkinsonian features gradually disappeared. By February, 1950. there was slight immobility only of the face, and six months later she was in all respects quite normal.Comment.-On admission the sensory, cerebellar, and mild pyramidal signs were all on the same side, and, with the gross defects of conjugate ocular movem,nts, pointed to the main lesion being in the tegmentufi of the midbrain, with evidence of involvement of lower centres developing later. It was striking how, at the height of the illness, when the patient was unable to see, speak, swallow, or expectorate the secretions which could be heard rattling in her throat, her mental state was perfectly clear and the power in her limbs excellent. She was very eager to listen to the wireless, and her deafness necessitated its being extremely loud. It was an unforgettable sight to see an apparently moribund patient, her wireless set at full volume, occasionally turning on the motor of the sucker to clear her own nasopharynx.Case 2A male 36-year-old 'works inspector had a history of general malaise and recurrent frontal headache for seven days, and increasing drowsiness for two days during which both lids tended to droop. On March 21,
