DISSEMINATED SCLEROSIS.—This dis ease can be eliminated by the absence of head rhythmical tremors, spastic paraly sis, and hyperalgesia, which occur in alcoholic paralysis with nystagmus.
From SPECIAL ATROPHIC PARALYSIS by the absence of pain in the non-alco holic. From Landry's acute ascending paralysis by tie legs being affected first, the arms next, and then the trunk (if at all), and the foot-drop, there being no foot-drop in Landry's, and in the latter the trunk being affected immediately after the legs; besides, Landry's has no muscular atrophy and no alcoholic elec trical reaction of degeneration.
From PROGRESSIVE MUSCULAR ATRO PHY by the presence of pain and the alcoholic degeneration reaction; so also from chronic anterior polipmyelitis.
From TOXIC HYSTERICAL PARALYSIS by the suddenness of the hysterical onset and cessation.
From CEREBRAL HEMIPLEGIA in that hemianTsthesia is rarely met with in that disease. From various nervous affections of a mixed character.
Etiology.—Alcoholic neuritis is more common in women, and in those who have drunk quietly for a long time. It is especially due to the inordinate use of spirits and alcoholized wines, such as sherry, etc.
One hundred and twenty cases of al coholic nervous affections, of which only nineteen could be classed as polyneu ritis. The motor form was the more fre quent, and the ataxic second. Freyhan (Deutsches Arch. f. klin. Med., vol. li, p. 6, '94).
Child, years old, who, after a large drink of whisky, went into stupor vary ing in depth and lasting more than two months; had a large number of convul sions, partly general and partly limited to the left side; developed right-sided paralysis, which was especially marked in the arm; extreme contractures, espe cially of the left side, and loss of faradic irritability with wasting, and during the first two months had pupillary symp toms, strabismus, and repeated vomiting. Daring six weeks there were the signs of complete consolidation of the right lower lobe. Recovery. Herter (N. Y. Med. Jour., Nov. 7, '96).
Case of alcoholic multiple neuritis fol lowing prolonged debauch. In the spinal cord very marked lesions were found in the anterior horns, the posterior horns, the columns of Clarke, and the nucleus of Stilling, and in the ganglion-cells, the changes being especially marked by their great variety. The most common was central chromatolysis. There were also distinct degenerative changes in the cor tex of the brain. Fatal alcoholic mul tiple neuritis causes grave changes in the ganglion-cells characterized by extreme polymorphism. J. II. Larkin and Smith Ely Jelliffe (Med. Record, July S, '99)_ Pathology. — Until recently (1881), when Clarke discovered a softening of certain portions of the spinal tissue, the post-mortem appearances seen had been peripheral. Eichhorst found a few dis eased patches in the middorsal region besides disease of smaller vessels through out, and increase of the connective tissue in the lateral column. Schiffer, Payne, and Sharkey found ganglionic inflam matory changes and degeneration. Pal noted degeneration of Lissauer's poste rior root-zone in the lumbar region and general involvement of Goll's columns; in another case degeneration of Goll's columns in cervical region, less marked in the dorsal, appearing again in the lumbar. Thomson found disease of the
nuclei of some of the cranial nerves in the pons and medulla oblongata. Hun and Kojewnikoff observed slight degen erative changes in the ganglion-cells of the cortex cerebri. Dejerine and Sharkey have described disease in the vagi and phrenic nerves. Congestion of pia mater has been noted. Campbell also noted these ("Trans. Path. Sec. Liverpool _Med. Inst.," vol. xxiii, _No. 2, '93). The prin cipal changes have been met with in the periphery, generally limited to the finer nerve-terminations, the morbid intensity diminishing with the distance from the periphery. These degenerative changes are generally symmetrical in the upper and lower limbs, the latter being most frequently involved. This peripheral in flammatory degeneration is parenchyma tons, the inflammatory process being secondary to strangulation of the nerves higher up. Sometimes the part affected is swollen; at other times the microscope alone reveals the lesion, disclosing a dull appearance from fatty myeline degener ation. The degenerated cloudy portion gradually separates till the segments surround the axis-cylinder as fatty par ticks. In the sheath and intestinal tissues there is a great increase of the nuclei of the sheaths and infiltration with leucocytes, with thickening of the perineurium. Finlay found wasting of the fibres of the wrist extensors, leu cocytes and nuclei crowding the inter stitial spaces. In peripheral neuritis are found peripheral lesions; in alcoholic insanity and dementia the lesions are central: brain shrinkage and softening, shallowing of interconvolutional fur rows, tortuous atheromatotts vessels, and ventricular effusion.
In the optic nerves the interstitial tissue is first affected; there are found many healthy fibres, which is the oppo site of what occurs in the optic neuritis of locomotor ataxia, and which explains the clinical aspect of alcoholic ambly Opia.
Most important effects of alcohol on the tubular neurin are shrinking and hardening, transmission of impulses being impaired; on vesicular neurin the disso lution of phosphorus, protagon, and lec ithin, with selective affinity for the neurin of the cerebellum. Wilkins (N. Y. Med. Jour., Sept. 22, '94).
[Statement as to hardening of the neurin and other tissues by alcoholic in gestion requires further corroboration. Frequently microscopical appearances are deceptive. NORMAN KERR, Assoc. Ed., Annual, '96.] Prognosis. — Complete recovery may be obtained in the great majority of cases if alcohol be completely renounced. In very grave cases, especially when the patient is not seen in time, total paral ysis, and even death, may supervene. The amyatrophy of alcoholic neuritis may become extremely marked, and end in the formation of fibrotendinous re tractions.
Treatment. — Alcohol must be given up at once and always. Electrotherapy; cold, tepid, hot, or Turkish baths; sponging, and strychnine preparations are recommended. So also are arsenic, nux vomica, cinchona, and the iodides. The food must be easily assimilable.
Alcoholic paraplegia in a woman 30 years old, who was completely cured by combined galvanization of the spinal cord and the paralyzed muscles. Later fara dization was employed. Massy (Jour. de Mild. de Bordeaux, Apr. 23, '93).