26 G. H. MONRAD-KROHN. M.-N. Kl. 



I have not seen any clinical signs of gtJi (glossopharyngeal), loth 

 (pneumogastric), or nth (accessorius) cranial nerve lesion. But, as regards 

 the I2th cranial nerve (the hypoglossal nerve), I have found a slight devia- 

 tion (i. e. a unilateral paresis) of the tongue in three cases. 



As regards taste, Armauer Hansen & Looft have already in 1895 

 pointed out that the sense of taste (as well as the sense of smell, as previ- 

 ously pointed out) is frequend}' diminished or entirely lost in advanced 

 cases. I should like to add that as a rule the sense of taste is not totally 

 lost even in advanced cases with complete facial paralysis. 



Articulation as a rule remains quite good. Only when the muscles 

 round the mouth are becoming paralytic is any marked dysarthria notice- 

 able — and even then it is practicall}' only the labial sounds that become 

 fault}'. If one wants to unmask this slight dysarthria one should let the 

 patients pronounce test words containing the letters b, p, or m. Patients 

 with perioral paral^'sis will have difficulty in pronouncing these letters parti- 

 cularlv if there be "ectropion oris". Sometimes they try to close their lips 

 with their hands, and when the difficult letter is at the beginning of the 

 word I have observed this manual help to be very successful. The patient 

 then first closes his mouth entirely with the aid of his hand and can thus 

 pronounce b, p, or m as the ßrst letter of a word, but not where it occurs 

 in the middle of one. As test words I have therefore used th^ following: 

 "bibi", "papa", "mama" for Norwegian patients. For English-speaking 

 patients "bab}'", "papa", "mamma" might be used as standard test words. 



On the whole, however, d3'sarthria plays an unimportant part in the 

 clinical make up of leprosy — and the other bulbar disturbances play an even 

 less significant part. Thev practically never exist. This is, as will later 

 be. shown, a point of considerable diagnostic interest. 



That leprous lesions of the nasal and oral cavities, of the pharynx 

 and larj-nx may cause dysarthria, dysphagia and aphonia, is another matter. 

 In these cases a local lesion can always be discovered to account for the 

 disturbance, which must not be mistaken for one of bulbar origin. 



The Motor System. 



(One of the most characteristic motor disturbances in leprosy — the facial paralysis — has 

 already been dealt with in the preceding chapter I. 



The motor disturbances of leprosy begin at the distal parts of all four 

 limbs, and then gradually and slowh- spread to the more proximal parts. 



The character of the motor disturbance is that of a typical peripheral 

 neuron lesion, i. e. the paresis is accompanied by pronounced atrophy and 

 hypotonia. As the onset is so gradual and the progression so slow, the 

 strophy and paresis seem to develop pari passu ', and one sometimes has 



' In contradistinction to more acute peripheral neuron lesions sueh as acute poliomye- 

 litis, where the atrophy first appears when the parysis or paralysis has existed for 

 some time. 



