IN SEPTEMBER 1946 there was admitted to our service a patient with a bizarre clinical syndrome. He presented the symptoms of well advanced parkinsonism, with masklike facies, open mouth with drooling saliva, cogwheel rigidity of musculature, festination of gait, anarthria and a tremor which was present at rest and which was accentuated on intention. The Babinski response was present bilaterally. Clubbing of the fingers and toes was prominent, the skin showed decided pigmentation of generalized distribution and there was edema of the lower part of the legs. The liver and spleen were palpable. Petechiae were present, and there was constant oozing of blood from the gums as well as intermittent microscopic hematuria. Increased bleeding time, total failure of clot retraction and increased capillary fragility, with a relatively normal platelet count were observed. A striking finding was the intermittently bright red color of the venous blood, which resembled arterial blood.
ZELMAN S, GILBERT T. CYTOCHROME C THERAPY OF TISSUE ANOXIA IN A CASE OF HEPATOLENTICULAR DEGENERATION. Arch Intern Med (Chic). 1948;81(4):485-500. doi:10.1001/archinte.1948.00220220056004