As cases of acute ascending paralysis are of somewhat rare occurrence, and as the following case differed in some of its features from the type described in text-books, I venture to think that a short account of it will interest some readers of THE LANCET. S. S-. a man fifty years of age, came to hospital on Oct. 19th, 1886, complaining of pains about his shoulder blades and in the back of his neck, attended occasionally with a slight degree of fever. Little importance was attached to what

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... red to be a case of muscular rheumatism. No symptoms of nervous disease declared themselves until five days after his admission-viz., on Oct. 24th, when, on rising in the morning, he found that he could not in walking lift the right foot clear of the ground ; he either dragged the foot, or else. to avoid doing so, had to swing the entire limb outwards f:.om the hip. Sensation in this leg was uneected; the right patellar-tendon reflex was exaggerated. The left leg was free from nervous symptoms of any kind. The pains in the upper part of the back mentioned above continued. On Nov. lst a rather large vesicle (" bulla") appeared suddenly on the front of his left patella, and burst on the same day, leaving a purple, discoloured base. On the 3rd he noticed that he sometimes passed urine unconsciously in bed, and at other times that, although conscious that he was about to pass urine, he was yet unable to restrain it if a urinal was not brought quickly. On the 6th a second bulla appeared behind his left thigh. Up to this date the left leg had continued free from paralysis, but that of the right had so far increased that he was now unable to move it when walking, or to draw it up when lying in bed. On the 7th both motor and sensory paralysis began to appear in the left leg. On the 9th his state was as follows :-Tactile sensation was entirely absent on the left side from the toes to a point half an inch below the nipple; while on the right side it was absent from the toes to a point four inches below the nipple. There was a band of hypersesthetic skin at the upper limit of these areas of ansesthesia. Sensibility to pain was absent throughout both lower limbs, and as far upwards as the iliac crests on both sides. A current from fifty Leclanché elements was, however, painfully felt throughout both legs. Paraplegia was absolute; the legs were drawn up upon the thighs, and these towards the abdomen. Both urine and faeces were passed unconsciously. The patellar-tendtn reflex was lost on both sides. The disease seemed to be of syphilitic origin, as he had contracted syphilis two years before, which was followed by sore-throat and an eruption. On Nov. 7th the man was put upon a course of bichloride of mercury, with iodide of potassium. This specific treatment was soon followed by a marked improvement. On Nov. llth, being the eighteenth day since the onset of paralysis, tactile sensibility had returned to both sides of the chest and abdomen, but not to the legs; the knee jerk was still absent on both sides. About this time he began to complain of acute pain in the skin over the right hypochondriac region, and this unaccountable symptom persisted for nearly a fortnight. On Nov. 12th two bedsores appeared over the sacrum, one on each side of the middle line. On the l3ch and 14th his abdomen became tensely tympanitic, and his chance of recovery seemed small, as his breathing was much interfered with. This distension, however, yielded at last to assafoetida and enemata. On the 15th sensation returned in both legs, and he was able to move slightly the left ankle joint. On the 17th the motor paralysis of the right leg was still absolute, but the knee jerk on that side had returned, while on the left side it was still wanting. On the 18th, with much effort, he could just move the toes of his right foot. About Nov. 15h his left foot and ankle became oedematous; this oedema, which did not extend above the ankle, disappeared in about four days. On the 19th another vesicle appeared on the outer side of the left leg, about midway between the knee and the ankle. The raw surfaces left by previous vesicles had all become ulcers. which had extended both in depth and area. The mercurial treatment was partly suspended for a few days in consequence of what appeared to be threatening salivation, but as a partial relapse ot all, or nearly all, the nervous symptoms. ensued, the treatment was resumed in full. On Nov. 26th the knee jerk had returned on the left side also. From this date onwards he continued to regain motor power in both legs. On Dec. 16th, having been fifty-three days in hospital, the patient was sent to his home; he was then able, unassisted, to move himself in bed from a lying to a sitting position on the side of it, but could not stand up; he was also sensible of impending evacuations either of rectum or bladder, and able to provide against them, although not able to postpone them. On Feb. 24th, four months after his seizure, 1 heard that he was able to walk slowly with th6 support of a stick. .ReMMAs.—That this disease was caused in some way by syphilis is proved, I think, by the history, by the early and rapid improvement under mercurial treatment, and by the temporary arrest of this improvement during a temporary diminution of the dose of bichloride of mercury. The imperfect symmetry of the symptoms was remarkable; for example, the right leg was paralysed when the left was still unaffected ; yet the knee jerk disappeared first on the left side, and did not return on that side until a week after it had returned on the right. Again, whereas three bullse and subsequent ulcers appeared on the left limb, none appeared on the right. The two bedsores on the sacrum were, however, symmetrical. Between Oct. 24th and Nov. 2nd there was no elevation of his temperature, but from Nov. 2nd to the 13th there was a daily evening rise averaging 2°, but on two occasions amounting to 5° above the normal. A further discussion of the case would be out of place in a clinical record ; but I would notice, in con" clusion, two variations from the type of this affection as described by Drs. Gowers and Ross-viz., the occurrence of several so-called bedsores and the considerable loss oi sensation. The bedsores had the characters distinctive of those which occur in some diseases of the spinal cord; they appeared suddenly, their contents were dark-coloured, the raw surfaces left when the bullse burst became spreading ulcers, and most of them occupied situations such that pressure could have had no part in causing them. Again, the loss of sensation, although transitory, was well marked. Yet Dr. Gowersl says, regarding the former, there is "no tendency" to their occurrence, and, regarding the latter,. "there is no considerable loss of sensation." With respect to " a malady so rare that experience accumulates slowly," L universal statements can hardly yet be hazarded.