Although many cases of alcoholic neu ritis have a resemblance to tabes, yet in neuritis muscular weakness and physical disturbances are among early symptoms, %%bile in tabes they usually develop late in the disease. Bernhardt (Berl. klin. Woch., July 14, 21, '90).
The onset and course of acute anterior poliomyelitis is not unlik-e that of acute peripheral neuritis. The fact that the former occurs in children, the latter in adults, and tile absence in poliomyelitis of the marked sensory symptoms of neu ritis are sufficient distinguishing points.
The disease is of frequent occurrence, coming often within the notice of both the neurologist and general practitioner of medicine. The alcoholic, syphilitic, post-febrile, and toxic forms are com mon in all climates. In the southern I-nited States malarial and idiopathic forms are often seen, and two instances of the occurrence of the epidemic variety (beriberi) have been reported, one at Tuscaloosa, Ala., and one at Little Rock, Arkansas, both among insane patients, both epidemics during have to deal in mul tiple neuritis with a general toxwmia or nutrition deficiency in the blood, caus ing degenerative changes in the nerve fibres of the peripheral nerves, associated in some instances with such inflamma tory- changes as were described under simple neuritis. The peripheral ends of the nervc-threads, being farthest re moved from the trophic centre (the cell body), show the first and most pro nounced changes. ln severe cases the entire cell may become involved or be destroyed. The anatornico-pathological changes are similar to those described under simple neuritis.
Case in which the double etiology of alcohol and lead was represented in the production of multiple neuritis for the following reasons: In the first place, the presence of the blue line on the gums and the history of an attack of lead colic are sufficient evidence of the presence of lead in the system in sufficient quantity to produce changes in the nervous sys tem. In the second place, the predomi nance of extensor involvement as exhib ited in the bilateral wrist-drop, with a fair preservation of the grip and all forms of sensation, follows the usual clinical picture of lead palsy of the upper extremities. The evidence in favor of the presence of the alcohol as a factor in the production of the neuritis is found in the predominance of the changes in the pe ripheral, intramuscular nerve-filaments in the lower extremities over the trunk changes. The muscles were very sensi tive to pressure even after the acute symptoms had subsided, while the nerve trunks were only moderately sensitive, and only deep pressure elicited pain.
Sensitive and painful muscles are as rare in cases of lead neuritis as they are common in alcoholic neuritis. Wrist drop, on the other hand, is so frequent in lead netnitis that it is looked on as the typical clinical picture of that dis ease. An intense atrophy coming on rapidly after the development of the neu ritis—less than four weeks—is rare in either form of neuritis, and is practically never inet with in lead. One must look
on it as an evidence of an intense change taking place either in the peripheral nerves or the anterior horn-cells of the spinal cord, or both, induced by the double intoxication. D. J. McCarthy (Phila. Med. Jour., Mar. 23. 1901).
Treatment.—The treatment of mul tiple neuritis should first be directed toward the removal of the cause and the relief of the pain and acute symptoms; after this, measures which hasten re generation of nerve- and muscle- fibres are indicated. In idiopathic cases a full dose of calomel, followed by a saline, is beneficial. Intestinal antiseptics also aid. The pains are controlled by hot applications, dry or moist, and by the coal-tar derivatives and opium. After subsidence of the acute stage, massage and rubbings of affected parts, with dic electricity, give the best resnits in hastening regeneration. Systematic ex ercise should be advised as soon as the condition of the muscles permits of it.
Tonic doses of strychnine and arsenic seem to hasten recovery. In the tressing ease in which tachycardia is a prominent symptom all heart-stimu lants are apt to prove of no avail, the best results being obtained from cold applications to the chest. In the para lytic cases where, after long-continued helplessness, contractures and perma nent deformities are threatened, passive movements and, if need be, fixation of limbs by means of properly-adapted splints may be required.
If the symptoms of peripheral neuritis in pregnancy are very severe, the labor should be terminated. as after delivery recovery sets in. G. Elder (Lancet, July 25, '96).
in treatment of multiple neuritis the cause should first be removed. For the neuritis this is no specific remedy. Ano dynes may be required to relieve the pain. Rest and protect,ion of the parts from injury are of importance. Some satisfactory results from use of strych nine, especially by subcutaneous injec tion: 1/. to V„ grain, twice daily. As soon as the tenderness has abated, mass age and baths will prove useful. In the later stages the rousing of the patient's latent energies and encouraging him to make voluntary use of the muscles, as far as possible, will do more to accom plish the objects in view than any other plan of treatment. A. MePhedran (A1ed. Nem s, Oct. 31, '96).
Case of alcoholic neuritis in a man which \\ as cured by administration of 0.1 grain of strychnine four times daily. E. R. Houghton (Med. Ree., Jan. 14, '99).
The more important varieties of mul tiple neuritis are the following:— ST-PI-Immo NETJRITIS.—ThiS occurs as a result of syphilitic infection. The onset is afebrile and insidious, acute, active symptoms being wanting. The course is chronic. Some cases resemble tabes ("syphilitic pseudotabes").
Treatment.— The cure is effected through removal of the syphilitic poi son by iodides, hot baths, massage, and electricity.