In multiple neuritis of septic origin the seat of the disease appears to be very variable; only the forearms or the legs may be involved, or the whole of the limbs, individually or together. Some times the gluteal muscles may be af fected, also the external ocular muscles, and the parts supplied by the vagus. Psychical disturbances is very often pres ent in addition. Hugo Kraus (Wiener klin. Woeb., No. 40, '97).
Case of multiple neuritii and hwma toporphyrinuria following the prolonged ingestion of trional. The cases of trional poisoning are interesting in that they bring vividly before us the etiological relationship existing between the inges tion of another of our synthetized or g,anic drugs and the development of nervous affections. It is a well-recog nized faet that the occurrence of neuritis has notably increased since the introduc tion and general use of the coal-tar prod ucts as remedies.
In personal case the whole amount of trional ingested was about thirty doses of 15 grains each: a total of 450 grains for two months. The onset presented the picture of a case of acute gastro-intes tinal poisoning. Following this there was an acute degeneration of the kidneys and the presence in the 'urine of h;ema toporphyrin: a substance which is usu ally associated with poisoning of sul phonal and trional. The first of the nervous manifestations was a neuritis of the vagus and a subsequent trophic dis turbance in the heart-muscle resulting in dilatation and valvular insufficiency.
The more marked affection of certain definite groups of muscles—e.g., the ex tensors of the wrists and feet—suggests the selective action of trional for certain nerves or groups of cells in the anterior horns of the cord, not unlike that of the metallic poisons.
The nerves recovered their function in the same order in which they were im paired, viz.: first the vagus, next those of the extremities of the left side of the body, and last those of the right side. Stuart Hart (Amer. Jour. Med. Sci., Apr., 1901).
The intensity, rapidity of onset, course, and duration of multiple neuritis vary considerably in different cases. In some the pain is scarcely noticeable, the motor symptoms predominating. In mild cases there may be only slight stiffness or weakness of the muscles, passing off in a few days. In other cases the pains are violent and excruciating, and the paralysis of the muscles is total and long continued, months elapsing before the patient regains use of the paralyzed limbs. Deaths are not infrequent, oc curring during the acute stage from fail ure of respiration or heart-action, and in chronic stage from exhaustion or in tercurrent complications, as pneumonia, pleurisy, or tuberculosis.
With few exceptions the prognosis of peripheral neuritis is good; recovery will be long delayed in severe cases, and in a few acute eases a fatal termination occurs within a few days or weeks.
Bad cases grow worse for weeks or months and then remain stationary for a time. Complete recovery requires several months. Alexander McPhedran (Med. News, Oct. 31, '96).
In cases with involvement of the spinal cord the prognosis is unfavorable.
In all except the mildest cases of neuritis recovery is slow, and is preceded by a stationary period, which lasts one or two months. Some power may be re gained after two or three months, but the average duration of the weakness is six or seven months, and it may be a year before all the muscles recover. C. L. Allen (Med. Rec., Apr. 24, '97).
Out of 49 cases of peripheral neuritis, in 14 cases there was either no recovery or but partial cure. In 22 cases recovery' was complete, while in 13 no mention was made of the termination. ReynoldQ (Brit. Med. Jour., No. 1920, '97).
In cases of multiple neuritis from other causes than acute bacterial infec tion there are few constitutional symp toms: a more gradual onset and a greater chronicity. The diagnosis, also, is easier, since the neural abnormalities are not masked to such an extent by the symp toms of acute disease.
It should be remembered that the characteristic symptoms of multiple neu ritis and those upon which a diagnosis must rest arc the motor, sensory, reflex, and trophic nerve-disorders; the gastro intestinal, cardiac, respiratory, and other occasional features may or may not be present; and to the symptoms of any multiple neuritis may be added the com plicating clinical picture of some acute disease to which the neuritis is possibly due. If the nerve-reactions are tested for, there will be little clanger of error in diagnosis. In the acute cases of sud den onset in which tachycardia and re spiratory distress, with general (edema, yall-r of surfaee. loud heart-murmurs, co „ire pre,ent the peripheral nerve-dis i rdorr, Jre masked and the case is liable fo I c re ,-ard eel as one of acute "heart ;:plitre- or "Bright's disease" unless ,are ful tests are made for neural symp t-ins. chronic cases resemble in many pari,eulars locomotor ataxia; the char acteristic (v.:lit, the lightning pains, girdle sensation, and absence of muscular weak- !less in ataxia ouLlit, however, to render a diagnosis ea:zy.