1923. No. 16. THE NEUROLOGICAL ASPECT OF LEPROSY. 29 



phenomena only ; but may also exist continuously tor many years. Allusion 

 has already been made to the neuralgic attacks which accompany the acute 

 swelling of certain nerves, sometimes occurring in the course of the disease. 

 It happens that it is this neuralgia of leprous origin which brings the patient 

 to the doctor. (This should always be kept in mind by general practitioners 

 in districts where leprosy exists). 



The objective sensory phenomena consist in 

 I. hyperaesthesia, 

 II. hypoaesthesia. 



In a general wa}- one ma}- say that the former precedes the latter. 

 As a rule, the hyperaesthetic stage is accompanied by irritative phenomena 

 (paraesthesiae, neuralgiae), and often by a tender swelling of the nerves, 

 corresponding to the hyperaesthetic areas. 



As the lesion of the nerves progresses, the hyperaesthesia gives way 

 to sensory loss, hypoaesthesia, — and the case enters the liypoacsthetic stage. 

 These stages, however, may occur at different times in the different areas. 



The study of the sensory loss in leprosy has occupied a great num- 

 ber of clinicians — and the anaesthesia of leprosy has in the eyes of the 

 majority of these clinicians been the neurological manifestation of the disease. 

 To obtain a complete idea of the sensory loss in leprosy, it is necessary 

 to treat the different qualities of sensation separately. 



Here the different qualities will be dealt with in the following order: 



I. Superficial sensation, 



touch — tactile sensation, 

 superficial pain (pinprick), 

 temperature. 



II. Deep sensation, 



joint sense, 



deep pressure pain, 



which latter naturally leads on to the palpation of the nenr trunks and 

 thereby elicited findings. 



As regards the tactile sensation one finds as a rule anaesthesia or 

 hypoaesthesia in the distal parts of all four limbs shading off in degree 

 towards the more proximal parts of the limbs. 



The superficial pain and the temperature sensation will as a rule be 

 found to be affected in the same areas, and, as far as they can be com- 

 pared, approximatively to the same degree as the tactile sensation. 



Yet in some cases various kinds of dissociations are found. In one 

 case the sensation to pain and temperature may be considerably reduced or 

 lost in a certain area, whilst the tactile sensation is only very slightly 

 affected in the same area. This so called "classical dissociation" I have 

 never found complete in lepros}-. 



