Physical examination at this time showed ptosis of both upper eyelids, dilatation of the right pupil, sluggish reaction to light of both pupils, apparent paralysis of the internal rectus of the left eye, normal retina, inability to raise the head, control apparently having been lost of the muscles of the neck, inability to swallow, absence of taste. The tongue was heavily coated and the throat was covered with a viscid whitish mucus clinging to the mucous membrane. The soft palate could be raised but was sluggish, particularly on the right side. The exudate on the right tonsil was so marked that it resembled somewhat a diphtheritic membrane. The seventh day there was some change in the condition; occasional periods occurred when swallowing was more effective, and there was less tendency to strangle. On the eleventh day there was some improvement of the eyes, still strangling on swallowing, sensation of taste was keener, and the general condition improved. The twelfth day the patient was able to move her head, but was unable to lift it except when she took hold of the braids of her hair, and pulled the head forward. The eyes could be opened slightly, speech was less nasal and more distinct, and improvement in swallowing was marked. At the end of two weeks the patient was able to take soft diet freely, and at four weeks she was up in a chair for a couple of hours complaining only of general weakness and inability to use her eyes. At the end of five weeks she was able to leave the hospital and return to her home and later to resume her regular work. In all cases the nervous system is strikingly affected in this form of food poisoning. Dizziness, double vision, difficulty in chewing and swallowing, and other symptoms of nervous involvement occur with varying intensity and may persist for a long time after the first signs of the attack. Temperature, pulse, and respiration remain practically normal. In contrast with the traditional type of food poisoning gastro-intestinal symptoms may be slight or altogether lacking. Freedom from abdominal pain is usually noted; diarrhea is the exception and constipation the rule; vomiting sometimes occurs, but may be absent. In the cases described by Sheppard there was "an entire absence of the usual gastro-intestinal symptoms from first to last, no pain or sensory disturbance and no elevation of temperature." The visual disturbances are very characteristic. Stiles relates his own experiences as follows: