On Arsenical Paralysis. 3 



stand and walk the feet turned on the sides. About the same time or 

 two daj^s later, cramp commenced in the fingers, first one then another 

 finger would involuntarily become crooked without connexion with the 

 others. A few days after the beginning of the illness without itch or 

 fever a rash suddenly appeared on the legs which in one day spread 

 all over the body with the exception of the hands and feet. It consisted 

 of discrete rather closely sitting blisters, thin and containing clear w^ater, 

 largest on the legs, where they mesured about 5 — 10 m.m. in diameter. 

 'The blisters burst after a couple of days (if there were pus in them or 

 not, cannot be ascei'tained) and dried to crusts, which fell off a fort- 

 night's time. 



During this time and subsequently the patient continually lost 

 flesh especiall}^ on the arms and hands, her streught at the same time 

 diminishing. The arms and hands finally became so weak that she had 

 to be fed. By degrees her strength returned but with no increase of 

 muscle in the arms and hands, and she could, although uncertain and 

 weak, execute light work with the latter. 



The fingers had attained a peculiarly bent position and became 

 «0 stiff that the patient could not quite bend them. 



Simultaneously with the increase of strenght sensation in the fore- 

 arms and hands became lessened. Paraesthesia appeared in the hands 

 (feeling of an egg rolling backwards and forwards); and with this a 

 slight pricking sensation was felt in the same. 



The condition of the feet however remained unchanged so that the 

 patient was obliged to be in bed. The pricking sensation under the soles 

 of the feet disappeared and instead chiefly at night a faint ache in the 

 knees and foot joints commenced, sometimes a more prickly pain in the 

 fore-leg right to the toe-tips. The sensation in the feet and lower- 

 leg disappeared so that she felt as if they were thick lumps stuck to 

 the legs; she also thought the foot was swollen and was astonished to 

 find that it was as thin as before. At first movements in the knee 

 and hip-joints were effected without difficulty, but afterwards the leg- 

 could not be outstretched on account of contractions. At the end of 

 march the feet and lower-leg began to swell a little and have ever since 

 ■continued to do so. 



Previous to the outbreak of the illness the patient had not been ex- 

 posed to any fall or damage to the spine, nor felt any pain in the back 

 or waist, stiffness in the arms, legs etc. 



