. A text-book of medicine for students and practitioners . y in a comparative-ly few rare cases. Onthe other hand, however,the contrast between themarked ophthalmoscopicchanges and the compar-atively insignificant dis-turbance of vision whichis occasionally found isremarkable. This condi-tion is probably due tothe conservation of theaxis cylinders. Never-theless, on careful exam-ination, we find not in-frequently a contractionand limitation of thevisual field, disturbance^ of color vision, etc. It is very curious thatoccasionally, at the onset of the disease (vide infra), total blindness of on
. A text-book of medicine for students and practitioners . y in a comparative-ly few rare cases. Onthe other hand, however,the contrast between themarked ophthalmoscopicchanges and the compar-atively insignificant dis-turbance of vision whichis occasionally found isremarkable. This condi-tion is probably due tothe conservation of theaxis cylinders. Never-theless, on careful exam-ination, we find not in-frequently a contractionand limitation of thevisual field, disturbance^ of color vision, etc. It is very curious thatoccasionally, at the onset of the disease (vide infra), total blindness of oneeye occurs for a short time, and then disappears again. In rare cases opticneuritis and choked disc have been observed, which are due perhaps to retro-liulbar sclerotic foci. Disturbances of the ocular muscles associated withdouble vision not infrequently occur, occasionally even as the initial ocular palsies are either unilateral or bilateral. Occasionally we findparalysis of associated movements (foci in the pons). Loss of pupillary reflex. Fig. 159. — Pallor of the temporal half of the optic nerve(beginning optic atrophy in multiple sclerosis). MULTIPLE SCLEROSIS OF BRAIN AND SPINAL CORD 329 to light is scarcely ever observed. Disturbances of liearing are much rarer,but I Jiave also repeatedly observed them. Sensory disturbances are hardly ever pronounced in the clinical pictureof multiple sclerosis. Upon accurate examination, however, slight and tran-sitory hypergesthesias cannot infrequently be demonstrated. Marked pain,also, does not belong to the typical clinical picture, but anaesthesia and painfulsensations frequently occur. Severe and even neuralgic pains occur only ina few cases; occasionally they may appear as initial symptoms. Mai-ked vesicaldisturbances are also rare, and generally occur only in tlie terminal stage ofthe disease. Slight vesical disturbances (transitory difficulty in urination,slight incontinence) can, however, be frequently demonstr
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