J. R., æt. 26. Diagnosis of mental state—idiocy. Degraded in habits, and of low degree of intelligence. He could appreciate simple orders, and express assent and dissent: speech possessed up to this amount only. The clinical notes of the physical state are unfortunately scanty. They are as follows:—Right arm generally smaller than its fellow, and wasting is more evident in certain places. The forearm forms an acute angle with the upper arm, the flexor muscles being rigid and prominent; passive extension possible only to the extent of a few inches. Muscles of upper arm evidently wasted, but those of the forearm and hand are notably so. The entire limb is held in close contact with the chest; passive abduction to a limited degree is possible. The forearm is held across the chest, with the hand flexed. The fingers, too, are bent upon the palm and thumb, arc compressed, and folded on each other, so that the hand forms a cone. Patient could not use the hand for any purpose, though he could offer some slight resistance to attempts to abduct the arm. When the limb was pricked he showed signs of pain.
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