PATHOLOGICAL  ANATOMY.  1227

is  the  only  manifestation  of  the  disease.  When  the. palate  alone  is  affected,
it  usually  recovers  in  two  or  three  weeks,  but  if  the  limbs  also  suffer,  the
paralysis  of  the  palate  may  last  a  much  longer  time. ,  Loss  of  power  in  the
limbs  always  endures  longer  than  the  affection  of  the  palate  or  eye  ;  it  rarely
passes  away  in  less  than  two  months,  and  may  last  for  four  or  six  months.
When  definite  improvement  has  commenced,  it  often  proceeds  rapidly,
although  the  paralysis  may  have  been  severe  and  of  long  duration.  Thus,
in  one  case,  paralysis  of  the  limbs  commenced  in  the  seventh  week,  slowly
increased  until  the  twelfth  week,  remained  almost  complete  until  the  twen-
tieth week,  when  improvement  commenced,  and  in  four  weeks  more  all
trace  of  weakness  had  passed  away.  As  power  is  regained,  the  electric  irrita-
bility of  the  muscles  becomes  normal.  The  loss  of  the  knee  jerk  is  the  last
symptom  to  pass  away,  and  often  continues  for  several  weeks  after  good
power  has  been  regained.     Ultimate  recovery  is  almost  always  perfect.*

Death  may  occur  during  the  course  of  the  paralysis  from  other  sequelag
of  the  primary  disease,  especially  from  renal  mischief.  The  palsy  is  fatal
chiefly  by  three  mechanisms  :  (i)  Syncope  from  paralysis  of  the  heart.  (2)
Asphyxia  from  paralysis  of  the  muscles  of  respiration.  (3)  Exhaustion  in
consequence  of  inability  to  take  sufficient  food,  due  to  paralysis  of  the
pharynx,  or  to  the  anorexia  and  the  repugnance  to  food  produced  by  the
liability  for  it  to  get  into  the  larynx.  The  third  mechanism  is  effective
especially  in  children.
