﻿KUBISAGARI OR VERTIGE PARALYSANT. 411 



he also complains of weakness in the body. Paresis of the extremities 

 is manifested by dropping objects from the hands, or the patient moves 

 painfully with a cane or along a wall or similar support. As the ptosis 

 and dimness of vision is in these cases generally intense, the patients 

 are usually compelled to keep quiet and await the passing away of 

 the attack. All the motor disturbances first appear in muscles which 

 are exerted, especially in cases of repeated, identical movements, as for 

 example, during mowing with a scythe, pumping, marching, chewing, 

 writing, etc. 



The symptoms given above do not appear simultaneously nor with equal 

 intensity in all cases, but one more generally finds them together in severe 

 attacks; in the lighter ones there is either only ptosis with dimness of 

 vision, or in addition only weakness of the muscles of the back of the neck. 



The length of the attack is generally short, it rarely exceeds ten or 

 fifteen minutes, but it reappears readily as soon as the customary work 

 is continued. 



The patients are well in the intervals between the paroxysms. They 

 are neither anaemic nor nervous ; the liver, spleen and other organs show no 

 abnormalities, the blood contains no parasites either during the attacks 

 or in the interval, the corpuscular elements are also not materially altered. 

 Only patients who have suffered from repeated, severe attacks are left 

 with a certain degree of ptosis and weakness of the muscles of the back 

 of the neck, trembling of the hands, uncertainty of gait and speech 

 (Gerlier) as well as increased reflexes. 



Causative factors of the attacks are bodily exertion, notably labor in a 

 stooping position, and repeated, uniform motions, especially on an empty 

 stomach or after the ingestion of food difficult of digestion. Writing, 

 reading, steady attention, mixing with crowds of persons and similar 

 circumstances .also act in a similar manner. On the other hand, the 

 attacks are diminished or stopped by rest and change of location. This 

 fact renders the study of the disease in hospitals almost impossible. 



In regard to differential diagnosis, in the first place myasthenic para- 

 lysis must be taken into consideration as in this disease also, generally 

 by repeated movements, the muscular strength gradually diminishes. 

 On the other hand, in kubisagari there is sometimes a weak indication 

 of the myasthenic reaction, but kubisagari is distinguished from the 

 above-named disease by its endemic-epidemic character as well as by 

 its sudden appearance, by the dimness of vision and by the rapid and 

 more general extent of muscular weakness, etc. It is scarcely necessary 

 here to enter upon a more exact discussion of the differential diagnosis 

 between the disease and neurasthenia (ordinary paroxysmal lameness.) 



The etiology of this peculiar disease is obscure. The superstitious 

 peasants in Japan have thought of a supernatural influence of the 

 wandering spirits of the dead who have found no resting place. 

 The Swiss peasants believed in witchcraft. Ladame contends that 



