SYMPTOM A TOLOGY 



may become quite distressing to the patient, who, upon quickly 

 rising from a sitting or a lying posture, may even fall to the 

 ground. The muscular power may now be diminished, and the 

 patient may no longer be able to do his work; tremblings in various 

 parts of the body, but more especially in the head and arms, 

 may be noticed, and the legs seem scarcely able to support the 

 victim, who now shows decided melancholic symptoms, avoiding 

 his fellows, becoming highly emotional, and perhaps threatening, 

 or actually committing, suicide, often by drowning in water. 



Pains are felt in various parts of the body, but especially in the 

 head, the stomach, and the feet. A most unpleasant symptom 

 is the burning sensation complained of by the patient after retiring 

 to bed at night. So severe is this that patients have been known 

 to strip off all their clothes and lie naked on their beds. By this 

 time the unfortunate victim will have learnt by bitter experience 

 that sunlight is deleterious to his condition, and will try to avoid 

 it as much as possible. 



Again, as winter approaches, the symptoms will diminish and die 

 away, and the patient will feel better; but this time the skin does 

 not recover itself, but remains thickened and pigmented in places, 

 and thinned, whitened, and atrophic in other places. 



Again, there may be only an interval till the next spring or 

 autumn, or the succeeding spring, or there may be a longer interval, 

 and again mild or severe symptoms may appear. 



With repeated attacks the skin changes become marked, the 

 mind becomes often permanently affected, and melancholic or 

 maniacal symptoms are often observed. 



Pain is often complained of in the back, and tenderness is found 

 on pressure over the spinal nerves on either side of the- dorsal or 

 lumbar portions of the vertebral column. Muscular weakness is 

 noted, especially in the legs. The knee-jerk is at first exaggerated, 

 but later is diminished, and finally lost. Ankle clonus and wrist 

 clonus are rare, and only occur when the knee-jerk is exaggerated, 

 when there is tenderness on both sides of the dorsal and lumbar 

 cord, and when abdominal and epigastric reflexes are also increased. 



There is no special gait, but there is a tendency to fall backwards 

 or forwards, and hence, though the patient walks with the legs well 

 apart, in a very bad case he can only take a few steps without 

 falling down. There may be tremors in the legs and tongue. The 

 bladder and rectum are not as a rule affected until the end, but 

 there are exceptions to this, and contraction of the limbs does not 

 take place till bedridden; but moderate rigidity of the muscles of 

 the arms and legs, associated with stiff and at times irregular spas- 

 modic movements, has been recorded as occurring early in rare 

 acute cases. A sudden rigidity of the body associated with re- 

 traction of the head has also been observed. These attacks last only 

 a short time, but are recurrent. Trophic lesions, such as bedsores, 

 are of rare occurrence. Hyperaesthesia may occur in different parts 

 of the body, and pains (even of a lightning nature) may exist in the 

 head and back, and be associated with cramps. 



