Paraesthesias and in particular a burning sensation of the erythematous areas are often noted. Hyperaesthesia of the dorsal and lumbar regions is often noted. Pruritus is at times complained of in the region of the perineum. We have muscular weakness.
Sleeping Sickness.—The deep reflexes are usually exaggerated and the superficial ones diminished or absent.
There is no distinct alteration of motor or sensory function except that of deep hyperaesthesia (Kérandel’s sign). There is usually marked weakness of muscles of locomotion.
Leprosy.—The usual statement is that there is an exaggeration of the deep reflexes. Ankle clonus has been rarely reported.
Anaesthesia is the most important symptom in the diagnosis of leprosy. This loss of sensation is often for pain and temperature with retention of tactile sense (dissociation of sensation—a prominent symptom of syringomyelia). The anaesthesia is not only found in the spots but associated with the leprous neuritis which chiefly involves the ulnar, facial and peroneal nerves. Muscle palsies and atrophies are common and the main-en-griffe appearance of the hand is seen.
In lathryism we have spasticity and an exaggeration of the reflexes.
A very remarkable disease called kubisagari or paralytic vertigo has been observed in Japan. This disease is thought to affect those living in stables. The attacks only last a few minutes and at other times the patient seems normal. An attack shows ptosis and diplopia, speech disturbances and palsy of muscles of back of neck, causing the head to fall forward. There may also be some paresis of muscles of extremities. The disease is not fatal. Cases have been observed in Switzerland.
The Gait
There are no gaits in tropical diseases which can strictly speaking be regarded as special types of gait. In beriberi we often note the designation tripod gait of beriberi. This simply refers to the manner in which a case of the paraplegic type of beriberi uses a stick held by his hands to assist him in dragging along his atrophied and enfeebled legs. The legs are widely separated and the stick placed in front makes the two legs and stick resemble a tripod.