ALCOHOLIC NEURITIS.
Definition. — Inflammation of the pe ripheral nerves, especially those of the extremities, due to the excessive use of alcohol.
Symptoms. — The first symptom of alcoholic neuritis consists usually in neu ralgic and tingling pain, especially in the lower limbs, less commonly in the upper limbs. Long prior to these first painful sensations there generally are feelings of debility, lethargy, anorexia, or uneasi ness, with disturbed sleep. The sufferer labors under malaise, cannot tell what is the matter, and rarely seeks medical advice till the pains become severe.
Alcoholic paralysis of the upper limb usually affects the muscles animated by the musculo-spiral nerve, and is often complete, which is the opposite of what is usually seen in plumbism.
Wrist-drop and foot-drop occur from the extensors being more affected than the flexors. The facial muscles and the sphincters may be affected in very rare cases. These pains are usually followed by difficulty in walking, which in turn is due to paresis of the leg-muscles and ataxia.
A distinctive walk, called the high stepping, or pseudotabetic, gait, consists in raising the foot and throwing it for ward, the toes hanging down causing the patient to raise the heel, the sole being visible from behind. This "high-step ping" is seen only when foot-drop is distinct. It resembles the gait of a man meeting obstacles while walking.
When the lower limb is affected, and when the patient is lying down, the foot forms an obtuse angle with the leg, its outer edge is lower than the inner, and the phalanges .are fixed. The patient cannot move his toes or raise the outer edge of the foot. The foot can be ex tended on the leg, but only slightly flexed on it. Usually the paralysis be gins by the extensor proprius hallucis, followed by the extensor communis and the peronei; the quadriceps may be also affected, and may indeed be the only muscle paralyzed. (J. Babinski.) Two cases of paralysis of the left vocal cord due to alcoholic neuritis. In the first case there had been, for fifteen days, such a feebleness of voice that the pa tient, a clergyman, was unable to fulfill his duties. There was no thoracic affec tion and no sign of locomotor ataxia. The left vocal cord was in the cadaveric position. The patient gave a history of recent sciatica in the left leg, but ac companied also by a pronounced anTs thesia of that member. The patient,
although never drunk, was accustomed to drink a quart of strong, English beer at luncheon and dinner, and in the even ing a considerable quantity of brandy. Complete abstinence was enjoined and carried out, and fairly large doses of nux vornica prescribed. By the end of four weeks the voice had completely returned and the vocal cord had regained its nor mal functions. Dundas Grant (Archives de Laryng., Max'. June, '97).
Later on, atrophy of the muscles may be noted, supplemented sometimes by degeneration reaction to electricity. The knee-jerk is lost early in the history of the case. The hands and feet may be come swollen and congested when al lowed to hang down.
Amesthesia of the legs, and even of other portions of the body, is frequent. Indeed, disturbances of the sensibility may be noted when motor disturbances are of little importance; the opposite, however, does not occur. On the other hand, parfesthesia may be present, press ure on the muscles and nerves causing great pain. Cutaneous reflexes are some times diminished in extent and rapidity.
Convulsions and fever rarely occur. Mental symptoms are occasionally pres ent, but they are frequently slight, amounting only to irritability, unrest, and suspicions.
In a proportion of cases there are delirium and extravagant hallucinations resembling those of general paralysis, the most characteristic being a loss of appre ciation of time and place. (Wilks.) Recent events are forgotten, while ancient ones are remembered. The ocu lar disturbances of alcoholism are bilat eral, symmetrical, and affect both eyes equally. They chiefly consist in a cen tral scotoma, ellipsoid in shape, with the longer axis horizontal; red and green are the first colors not seen. Ophthal moscopically, the temporal side of the disk is discolored. Paralysis of the motor externus, ptosis, and external ophthal moplegia have been noted. The pupils may react more slowly than normally to light. (J. Babinski.) Diagnosis.—RHEUMATIC PAINS in the early stages. The failure of sodium salicylate to alleviate the pain, with the temporary lull from opiates, though the pains thereafter persist, soon excludes rheumatism.