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April 17, 1987

OK, OK, OK: The Facts of Kew—More on Squatter's Palsy

Author Affiliations

Rochester, NY

Rochester, NY

JAMA. 1987;257(15):2033. doi:10.1001/jama.1987.03390150049020

To the Editor.—  Dr Kumaki's1 conclusion that it was probable that his patient's foot drop was causally related to the use of a squat-type toilet should not be included in the facts of Kathmandu without at least some reservation.The patient presented with a history of ten to 15 bowel movements daily. The use of the squat-type toilet was probably maximal at that time, but the foot drop did not appear until eight days later, when the patient's dysentery was improving. Apparently, Dr Kumaki did not consider that the dysentery itself might have caused the palsy. Textbook accounts of severe dysentery caused by Shigella2 regularly mention that one of the unusual complications of this disease may be a palsy—most probably due to toxic neuritis. This possibility must be considered in this patient.Two types of common peroneal nerve palsy have been described—acute and tardy.3 The acute type