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%’print: The Medical Fortnightly, Saint Louis, U. S. A. Reprinted from The MEDICAL FORTNIGHTLY, St. Louis; April 15, 1892. 
A Case of Athetosis Bilateraiis. 
By Frank Parsons Norbury, M. D. 
JACKSONVILLE, ILL. 
Assistant Physician to Illinois Central Hospital for the Insane; formerly Assistant Physician to Pennsylvania 
Institution for Feeble Minded Children, Elwyn, Pa. 
Reported for the fledical Fortnightly. 
JV., aged 43; farmer; married. Admitted to the Illinois Central Hos- 
pital for the Insane 1886; said to have been insane then for two years; 
cause, “brain fever.” Mother was insane; father intemperate. Patient 
was an alcoholic, and had been so for several years. When admitted he 
was excitable, full of delusions of persecution, very nervous; physical health 
much impaired. Complained of severe pains in his stomach, which he 
claimed were aggravated by loud noise; believed he heard voices in his 
stomach. Had slight staggering gait, frequent nocturnal seminal emissions. 
For two years he improved somewhat physically; mentally was much 
better for some time; he interested himself in light work about the premises. 
He was subject to sudden attacks of uncontrollable nervousness; muscular 
spasm appeared in the peripheral ends of extremities, viz, in the fingers and 
toes, about two years ago, and gradually the hands, arms, neck, face andl 
tongue were involved. The lower extremities were implicated very early in the 
progress of the-disease. The movements from the beginning have been 
characteristic, being gliding, not quick or jerky, and are regular and continu- 
ous. They can be controlled only by placing one leg across the other, fold- 
ing the arms and compressing the chin on the breast. The opening of the 
mouth causes facial distortion, spasm of the tongue, and, if under great ex- 
citement, inability to swallow. 
Aphasia has gradually developed, until now he can only utter one word, 
“bully,” which he says when coming out of the bath. His mind is now 
very much impaired, although at one time he was quite intelligent. The 
dementia appeared and increased with the athetosic'movements. The gait 
is peculiar; it is not jerky, as in adult chorea, nor is it staggering, as im 
locomotor ataxia, but it is straddling, the stride being slowly made, the toes. 4 
touching the floor first. He can walk in a straight line. Walking, however, 
excites the athetosic movements to such a degree that he will not walk very 
far or very often. Reflexes are present but normal in intensity. Sensation 
is somewhat inhibited. There is no motor paralysis, no anaesthesia, no pain. 
Such is the history of this most interesting case. From a study of the 
symptoms, his family history and his habits before becoming insane, 1 am 
led to diagnose the case as one of athetosis bilateralis. The lesion is no 
doubt spinal as well as cerebral, for it is frequently the case in double athe- 
tosis, that degeneration will be found in both. In this case the spinal symp- 
toms appeared first, followed sometime later, by the cerebral. The degen- 
eracy may then be ascending spinal-cerebral. 
No doubt atrophy will be found involving the cerebral cortex, for it is a 
frequent lesion in alcoholic insanity. This patient has been a hard drinker; 
his so-called brain fever was, in fact, acute delirium and the sequences of his 
alcoholic excesses, associated with his hereditary entailment, are shown in 
the insanity and the athetosis with which he is now afflicted. This case 1 
deem worthy of reporting because of the scarcity of such cases, and further 
to show that all cases of double athetosis are not associated with congenital 
imbecility. Hammond’s original case of athetosis, was an alcoholic; this 
case of double athetosis is likewise an alcoholic and I attribute the lesion in 
both to pathological results of the habit. 1 have seen hemiathetosis of syph- 
ilitic origin, and am now studying a case which I attribute to syphilis.