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



In another case one may find a dissociation between the sensation of 

 temperature and touch on one side and pain on the other — and in yet 

 another case one may find a dissociation between the sensation of heat 

 and the sensation of cold. (This will be exemplified in the sensory charts 

 illustrating this chapter.) 



In short, all kinds of dissociations between the different qualities of 

 superficial sensation may be encountered in leprosy ; but never have I found 

 such dissociations compleie — nor are they to be regarded as the rule. 

 The great rule is that the different qualities of superficial sensation are all 

 affected to approximatively the same extent. 



(The dissociation between superficial anaesthesia and intact deep sensa- 

 tion is, however, the great rule, as will be dealt with below.) 



As regards the distribution, this is as a rule the usual one for any poly- 

 neuritis viz : the distal parts of the limbs show the greatest sensory loss. 

 This extends proximally to a greater or lesser extent. Rarely does the 

 sensory loss extend to the trunk. 



As alread}^ mentioned under the chapter on motor disturbances, it may 

 happen that one nerve is affected earlier and more profoundly than the 

 other nerves. In these cases the distribution of the sensory loss coincides 

 with the distribution of this nerve. It is particularly the ulnar nerve in 

 the upper limbs and the peroneal nerve in the lower limbs that seem to 

 be predisposed for early, isolated affection. 



When in the upper limb the ulnar and the internal cutaneous nerves 

 of the forearm and arm are chiefly affected, the sensory loss has a seg- 

 mental appearance. This segmental distribution ("anesthésie rubanée" ') is by 

 Jeanselme & See claimed to be the initial and the most constant distribution 

 of the superficial sensory loss. Judging from my own cases, I cannot help 

 thinking that they have overestimated the frequency of this kind of distri- 

 bution. It is in my experience, if not rare, yet by no means the most 

 common form of distribution. 



The distribution Just described was found in case No. 60 (L. S.), cpr. 

 fig. 29 — 30 (this case has been described by Prof. Bruusgaard as one ot 

 tuberculoid leprosy — cpr. Norsk Magazin for lægevidenskab, 1921, No. 5, 

 page 359)- 



Apart from the polyneuritic superficial sensory loss just dealt with, we 

 encounter in the maculo-anaesthetic leprosy an anaesthesia more or less 

 corresponding to the maculae. Here great variations occur from one case 

 to another — and also from one macula to another. Sometimes partial disso- 

 ciations are found ; sometimes the border of the distribution of the sensory 

 loss is not identical with that of the macula — the latter sometimes being 

 smaller, sometimes larger, than the hypoaesthetic area. The only generali- 



' The term "segmental" of French authors refers to the segments of the limbs, not to 

 the segments of the spinal cord. 



