. A manual of diseases of the nervous system. sensations, but pains are usually trifling,perhaps because the process is extremely chi-onic. In some cases theremay be severe pain in the position of the nerves or deeply seated inthe limbs. The inequality of the affection of the fibres of the samenerve is shown by the fact that the knee-jerk may persist althoughthe extensors of the knee are partially paralysed. Fig. 62 shows thedistribution of anaesthesia in the hands in a well-marked exampleof this disease which came under my observation some years patient was a Creole of Mauritius, who
. A manual of diseases of the nervous system. sensations, but pains are usually trifling,perhaps because the process is extremely chi-onic. In some cases theremay be severe pain in the position of the nerves or deeply seated inthe limbs. The inequality of the affection of the fibres of the samenerve is shown by the fact that the knee-jerk may persist althoughthe extensors of the knee are partially paralysed. Fig. 62 shows thedistribution of anaesthesia in the hands in a well-marked exampleof this disease which came under my observation some years patient was a Creole of Mauritius, who had come to Englandin early childhood, and presented the first distinct symptoms at * Gerlacb (• Virch. Arch., cxxv, *Neur. Cent., 1891, p. 464) says infection is fromskin, branches of nerves being then affected and finally the nerve-trunks, so thatskin may be seen infiltrated when nerves still remain free. VOL. I. 13 194 MULTIPLE NEUEITIS. twelve years of age—changes in fhe pigmentation of tlie skin, auses- thesia, and muscular They steadily increased during thenext four years, the anaesthesiaextending each half-year fromone finger to another. Therewas also patchy anaesthesia ofthe legs below the knee. Asthe figure shows, the loss ofsensation does not correspondin area to nerve depends on the fact thateven when all the nerves, in- PlQ-. 62.—Distribution of anaesthesia in acase of leprosy. The black areas indicatethe loss. eluding those of the fingers, arediseased, all the fibres may notbe destroyed in any one nerve,so that some sensibility existsin each nerve area. Variousperversions of sensibility, spon-taneous dyssesthesise, ting-ling, formication, and the like,may precede the loss. Thelatter usually occurs gradually,but sometimes so suddenly asto suggest some secondaryvascular lesion, haemorrhage orthrombosis, in the vessels of the nerve that is the seat of the process—a possible result in its early and most active stage. It must berememb
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