G. H. MONTAD-KROHN. M.-N. Kl. 



In the lower limbs we meet with exactly the same picture as in the 

 upper limbs viz : an atrophic and flaccid paresis of the feet, slowly ex- 

 tending to the crura and the more proximal parts; but always much more 

 pronounced at the distal parts. 



It is surprising how long these motor disturbances (particularly those 

 of the lower limbs) may exist unnoticed by the patient. 



This flaccid and atrophic paresis of the feet is of considerable diagnostic importance 

 as will be pointed out in a later chapter. 



All lesions of the cervico-dorsal region of the cord maj-, bj^ affecting the p\'ramidal 

 tracts at this level, give rise to motor disturbances of the lower limbs ; but these motor 

 disturbances are of the so called "spatie" or central type, i. e. they are accompanied by an 

 increase of tonus (hypertonia, rigidity) and of typical reflex changes, the most important of 

 which consists in an inversion of the plantar reflex. This is seen in myelitis and meningo- 

 myelitis in the cer\ùco-dorsal region of the cord, in tumours in this region, in am^-otrophic 

 lateral sclerosis, and in many cases, syringomyelia. Only where the lesion extends to the 

 lumbo-sacral region and affects the anterior grey horns at this level, will the lower limbs 

 show the same flaccid and atrophic paresis as the upper limbs. 



The coordination is seldom affected and never to any great degree. 

 The usual tests for coordination are as a rule carried out with great ease 

 and precision. It is surprising to see how deftly the patients use their 

 paretic, atrophic and mutilated limbs at fine needlework. 



The gait is quite steady in most cases, even in those of ver}^ old 

 standing, and even in those where blindness has set in and where extensive 

 mutilations have caused profound deformities of the lower limbs. 



Romberg's sign is, as might be expected from what has already been 

 said, practically always negative. 



This surprisingly good state of all coordination is dependent on the 

 integrity of the deep sensation. This will be dealt with in the next chapter. 



When the flaccid paralysis has reached the crus and the foot cannot be moved, the 

 gait becomes very difficult. On account of the atonia there may be some superficial likeness 

 to tabes, which has struck some observers (Jeanselme & See). But this resemblance is only 

 a superficial one. It will be found that the hypotonia or atonia in leprosy is chiefly due to 

 the flaccid, peripheral paralysis, whilst in tabes it is due solely to a lesion of centripetal fibres 

 (posterior rootsl. The different state of the deep sensation constitutes a fundamental clinical 

 difference between these two conditions. 



The Sensory System. 



As regards the sensory disturbances, we meet in leprosy both subjec- 

 tive and objective sensory phenomena. 



The former vary greatly from one case to another. They may consist 

 in all kinds of irritati\-e phenomena from the lightest paraesthesiae (pins «& 

 needles etc.) to the severest neuralgic pains. They may occur as initial 



