The patient, A. R., a farmer, when first seen Jan. 19, 1895, was 42 years of age. He had never suffered from any serious disease, had led a moderate life and denied syphilis. His hair was almost white but his complexion clear and unwrinkled. Four months previously (September 1894), he began to be troubled by numbness in the toes and fingers, which became worse after the first of December, 1894. His condition when first examined January 19 was as follows: He complained of numbness of both legs and of the body up to the manubrium. There was a subjective sense of numbness of the left arms and in a slighter degree of the right, ill-defined, but felt to and above the elbows.
There were girdle pains in the lower abdomen, slight swaying on standing, but no staggering when walking; and a decrease of sexual desire. The knee-jerks were active, and
MITCHELL JK, RHEIN JHW. CASE OF PRIMARY COMBINED COLUMN DISEASE. JAMA. 1898;XXX(16):911–915. doi:10.1001/jama.1898.72440680031001j
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