The neuropathy of diabetes mellitus, often a serious disability, may become a crippling handicap if it afflicts a blind diabetic. The sightless diabetic cannot compensate for his loss of position sense. Nor, with his pain sensation impaired, can he readily avoid injury which may lead to ulceration, gangrene, or neurogenic arthropathy in the lower extremities. The hitherto ambulant patient may then become bedridden.
Diabetic neuropathy further disables the blind diabetic if it also affects the upper extremities. This involvement, though less common than that of the lower limbs, is more frequent than generally supposed. Symns1 described it more than 50 years ago, and other investigators have subsequently demonstrated impairment of vibratory perception and of motor nerve conduction velocity as well as other manifestations of sensory and motor nerve pathology of the upper extremities in a number of diabetic patients. The practical implication of these observations became apparent when it