A Case of Alveolar Carcinoma with Metastases in Brain and Adrenal Gland

His family, history was good. He stated that he had no serious illness, that he had served in the Army-during the Great War, and that he had been in his present employment for several years. OIn the morning of 29th February, 1936, he said, he fell when handling a sack of coal, and struck his left elbow on the ground; his forearm " tingled right down to the fingers," but he was able to continue his work. Some hours later he was having a meal in his ownI1 homiie when his wife said to him, " IVhat are you doing ith N-our left hand?" He looked down and saw that he was twvitching or moving his left hand, but had not been aware of it. Soon afterwards he consulted his doctor, who advised him to go to hospital. He attended at Doctor Lewis's outpatient departiinent, aild was shortly after-wards admitted to Ward 6. In appearance lhe was a slim, dark-haired man who looked younger than statedl age; he had a rather sallow, bronzed skinl. He exhibited a continuously repeated, involuntary, purposeful movemenit of the left upper limb, involving arm, forearm, and hand, occurring about every fifteen seconds, but varying in time and intensity. Briefly, he appeared to be continuously striking his own upper abdomen. These blows were so forceful that sooIn the Ward Sister had to pad his abdomen with gamgee tissue to protect it. He also lurched about in the bed, trying, as he said, to stop these movements. He volunteered the information that he could throw a fit if he breathed very deeply, and proceeded to demonstrate this; after eleven deep breaths his left arm went into clonic contractions, his head and eyes turned towards the right, his face became cyanosed and his neck rigid. The "fit " lasted about thirt) seconds, after which the left arm was apparently paralysed of mlovement, but the reflexes could be easily elicited. After two minutes the tic-like movements of left arm and hand began again, gradually increasing in intensity until the usual height was attained. Consciousness was maintained throughout. He was not encouraged to repeat this performance. At this stage his pulse and temperature were normal. His appetite was very variable; for some days he could not be coaxed to take food, and then for a day or so he would eat quite hungrily. Physical examination revealed little or nothing: his …