It is not very common. The etiology is not clearly understood, but there is a growing unanimity of opinion to the fect that the disease is clue to a toxic infection, the specific nature of which, however, is as yet undetermined. It oc casionally follows the infectious fevers. In at least one case seen by the writer, which presented a classical picture and ended fatally on the eleventh day, gross alcoholism was the cause.
Neither climate nor season is known to be etiologically important, nor is hered ity a factor.
Landry's paralysis is nothing but the second and third stages of a chronic multiple neuritis that affects the cord by continuity. Here it spreads rapidly, generally upward, sometimes downward, causing death by involvement of the vital centres of the medulla. The out break usually follows an attack of some infectious disease. Clinically the pro gressive character of the paralysis is characteristic; the direction of its spread, however, is not. Pathologically, Landry's paralysis is a subacute chronic polyneuritis and an acute diffuse de generative myelitis. Krewer (Zeit. f. klin. Med., B. 32, '97).
Pathology.—The pathology is as yet an unsolved problem, though the solu tion seems happily not far distant. The results of many autopsies in the past have been negative. Inconstant and widely varying lesions were reported or no determinable lesions whatever could be found, the latter result being the rule until within recent years. The theory of a profound and fulminant molecular disorganization of the anterior-horn mo tor cell is less than plausible, even as a theory. The doctrine of an identity with poliomyelitis, differing in the acuteness and severity of form only, has been en tertained and is based upon much quasi supportive evidence. That the disease is a pure form of fulminant myelitis is no longer accepted, although it is admitted that the resultant symptom-picture may closely simulate Landry's paralysis. The consensus of present-day neurological belief is that the disease is quite prob ably a special form of multiple neuritis affecting the lower motor neurons, with secondary changes in the anterior horns and muscles resembling or identical with those observed in poliomyelitis. Ross,
Pitres and Valllard, Eisenlohr, Nauwerk, and many others are among those who have adduced evidence in support of this theory. Pending the final decision and following a well-established precedent, the disease is considered here among the affections of the spinal cord.
Prognosis.—The prognosis is grave al ways, but the disease is by no means necessarily fatal. Many recoveries have been reported. Should the disease not terminate fatally within two or three weeks the patient will probably recover. In those who recover there is no residual paralysis, the functions of the affected nerves being usually restored to the nor mal. A special susceptibility to subse quent attack is said to remain, but the statement lacks verification in general experience. The danger to life is, of course, far greater in those in whom the functions of cardiac action and respira tion are affected; but even in such cases recoveries are said to have occurred.
Treatment.—The treatment, as might be inferred from the indefinite etiology, is more or less empirical. The patient should be put to bed at once and kept absolutely quiet. The limbs should be enveloped in lambs' wool fleece or the hot wet pack. Ergot in V,- or 1-draehm doses every four hours has been em ployed. Quinine in full doses with or without sodii salicyl. may be used. Small and frequently-repeated doses of mer cury or inunctions of mercury are indi cated. In plethoric subjects moderate venesection followed by warm saline transfusion suggests itself as a rational procedure. Serum-therapy may prove an aid ultimately. For the late stages of the protracted disease potassium iodide, strychnine, and electricity are indicated. Oxygen has been employed with symp tomatic relief in the dyspncea from re spiratory involvement.
Hereditary Ataxia.
Synonyms. — Friedreich's ataxia, or disease; family ataxia.
Definition.—It is a distinctly, though not necessarily a directly, hereditary de generative disease of the spinal cord, af fecting the posterior and lateral columns and the bulbar region, usually beginning in childhood. with symptoms of ataxia. curvature of the spine, defects of speech. talipes, choreiform movements, vertigo, and ultimately paraplegia.