Hillis claims to have recognised a motor weakness in the prodromal stage of the disease, and considers that the nerves are already affected with the leprous virus. Such a weakness referable to a neuritis of the motor nerves we have not noted previous to the macular eruption and the onset of the anæsthesia. If there are, in the prodromal stage, muscular weaknesses, we are inclined to regard these as symptoms of the general weakness; according to our view, the skin affection is the _first_ definite symptom of the disease. The muscular affection may always be definitely recognised as a secondary symptom by the atrophy, and the altered electrical reactions. Different degrees and varied extent of the muscular affection may be noted; trivial paresis with only very slight atrophy, which, along with the anæsthesia, may completely disappear, if the neuritis passes off without destroying the nerve fibres; and almost complete paralysis with great atrophy of the muscles. Paralysis with atrophy is most marked on the hands and forearms, feet and calves, and on the face. [Illustration: PLATE V.] The interosseous muscles, of the hands and feet atrophy, so that the interosseous spaces appear as furrows. The thenar and hypothenar muscles also disappear, and the first interosseous space becomes a depression. The muscles of the forearms and calves also atrophy and lose their power, but complete paralysis is never developed; the patients can always move their hands and walk. In the face, all the muscles atrophy and lose their power, and thus all expression is lost. The masseter muscles occasionally, though very rarely, become so atrophic, that the lower jaw drops, and must be retained in position by a bandage. Paralysis of the _Orbicularis Oris_ leads to dropping of the under lip, and to extreme difficulty in closing the mouth, and consequent escape of saliva. (See _Plate V_--a case of maculo-anæsthetic form completely cured and anæsthetic. The maculæ were developed in 1857, and the patient is still alive.) Paralysis of the _Orbicularis Palpebrarum_ renders the closure of the eyes impossible, and paralytic ectropion of the lower lid is developed. The results of this on the eye we will refer to later. The muscular atrophy is by no means always symmetrical; one hand may present marked atrophy, while the other is tolerably useful. This indicates the peripheral development of the paralysis, as does the fact that the muscular sense is preserved, and in particular that no ataxic symptoms appear. The patients can do fine knitting and needle-work with their paretic hands. Their gait has a peculiar character, from the difficulty with which the weakened muscles raise the feet, but they can both stand and walk quite well with closed or bandaged eyes. As we shall see later, this clinical observation corresponds with the results of the anatomical examination of the cord.