THE COMBINATION of symptoms referable to the pyramidal system, anterior horn cells, and lower brain stem constitutes the syndrome of amyotrophic lateral sclerosis. The literature contains many case reports of this syndrome in which varied etiologic factors have been determined. Wechsler and associates1analyzed 81 cases of amyotrophic lateral sclerosis and listed dietary deficiency and inflammatory, vascular, and toxic processes as etiologic factors. This clinical symptom complex has been noted following gastrectomy2and polyarthritis,3and in triorthocresyl phosphate poisoning.4It has recently been considered an atopic-stress disorder, and some improvement has been obtained by the use of adrenocortical extracts.5Cord tumors, syphilis, and arachnoiditis may also produce this syndrome. It becomes obvious that the physician in his evaluation of such a symptom complex must seek the clue to the etiology by a careful and detailed search into the patient's occupation, contacts, illnesses, and injuries, since