﻿410 MITJRA. 



4. Paresis of the muscles of the extremities. 



According to Gerlier there may also be added neuralgic radiating pains 

 to the back of the neck, back and to the periphery (such as forehead, 

 shoulder and arms) ; more seldom an increase of the secretions of the 

 nose, tear ducts and salivary glands is observed. Cramps, anaesthesia, 

 hypersesthesia, and disturbances of the organs of sense, or of the bladder 

 and large intestine are always lacking. 



To begin with, the symptoms observed in the eyes, obscureness of vision 

 and ptosis, are the most important. The first of these begins with a 

 blurring of the contours of objects which are observed: the patients state 

 that they see everything as if it were surrounded by a fog. Some remark 

 that they see near objects indistinctly, with others it is the reverse, still 

 others have impaired vision both for near and far objects. In addition 

 to the dimness of vision, ptosis is a frequent symptom and one which is 

 more easily shown in an objective manner. This can exist in a slight 

 degree even at times when the patient is otherwise apparently free from 

 the disease. It appears in different degrees; it may be so slight that it 

 only gives the patient a sleepy appearance or it may be so pronounced 

 that only a hair-like slit is seen between the lids. It is brought about 

 by a paresis of the levator muscles of the upper lid and is generally 

 bilateral. Diplopia is less frequent and according to my observation is 

 caused by a paresis of the rectus internus muscle. G-erlier, in addition, 

 mentions photophobia, photopsia and disturbances in the color sense. 

 Eperon, Sulzer and I demonstrated hyperemia of the papilla, the optic- 

 nerves and their surroundings, during the attack. 



Disturbances of speech, of the movements of mastication and deglu- 

 tition are only seen in severe cases. During lengthy conversation the 

 speech gradually becomes more and more indistinct and difficult to 

 understand, because of increasing weakness of the tongue and lips. The 

 muscles participating in mastication and deglutition at the same time 

 lose their normal strength, so that the patient soon is unable strongly 

 to bite on a finger thrust into his mouth, and finally he is unable even 

 to swallow water. It is therefore not a rare occurrence that a person 

 suffering from kvbisagari loses all his food from his mouth during a 

 meal, instead of swallowing it. 



The paresis of the muscles of the back of the neck, back and extremities 

 is observed most frequently when the peasants are working in swampy 

 rice fields bent over their work, as occurs in planting rice and in weeding. 

 Under these circumstances they first observe pressure and heaviness in 

 the back of the neck, the head sinks forward and can only be raised with 

 difficulty, so that in these cases a bandage is tied over the forehead and 

 fastened by a string to the belt, in order to allow the sick one to work. 

 The paresis of the muscles of the loins is manifested by the fact that the 

 sufferer finds difficulty in raising himself to an erect posture after bending 

 forward, and he must support himself by this hands on his thighs or hips ; 



