In 1877, Wilks, of Guy's Hospital, London, published the report of a case of "Bulbar Paralysis without Anatomical Changes." "The patient, a girl, could scarcely move about, spoke slowly and had strabismus. For a month she remained in much the same condition, then all the symptoms became aggravated and in three days they assumed the characters of bulbar paralysis. There were indistinctness of speech, difficulty of swallowing and inability to cough. Respiration became increasingly difficult, and death rapidly supervened." The next year Erb reported three cases in which the chief symptoms were a striking paresis of muscles, especially of mastication, of the neck and the eyes (ptosis), less of those of deglutition, the tongue and extremities. During the twenty years that have passed since Wilks reported this interesting condition, 62 cases have been reported, including our own, most of them (46) from the continent of Europe—10 from England and 6