TUBERCULAR NEURITIS, RHEUMATIC NEURITIS, SEPTICZMIC NEURITIS, DIA BETIC NEURITIS, and many other forms are spoken of by writers. Their nature is sufficiently indicated by the name.
Functional Disorders.
Varieties.—The functional disorders of the peripheral nerves may be classed as motor, sensory, and mixed forms.
The motor functional neuroses of pe ripheral origin are:— (a) "Recumbent palsy," "night-palsy," or "waking numbness," characterized by temporary paralysis of one or more ex tremities, is noticed after lying still for a time or upon awakening in the morning. The symptoms are much the same as those seen when a nerve is compressed, as when a limb "goes to sleep"; but are not caused by pressure, and s.hould not be confounded with the pressure paral yses. It is a rare condition, occurs in neurotic subjects, and its causation and pathology are unknown.
(b) Spasm and tremor, occurring from overuse of muscles and frequently asso ciated with some form of "occupation neurosis." The peripheral sensory neuroses are:— (a) Neuralgia, elsewhere described.
(b) Parmsthetic neuroses, an affection closely akin to and sometimes associated with the waking numbness above men tioned. It is a condition of little practi cal importance.
The mixed peripheral functional neu roses are:— (a) Erythromelalgia, characterized by neuralgic pain and congestion in the feet occurring after severe exertion or as a sequel of wasting disease. Some form of neuritis may be associated with it.
Acroparmsthesia, resembles erythro melalgia only because of the presence in both of parmstliesia and hypermsthe sia. In no other particulars are these conditions similar. Acroparmsthesia is associated with numbness and falling asleep of the fingers and formication. There are but few objective sensory dis turbances; oftener there are none. There are no vascular symptoms; there is con siderable motor weakness; if there is change in the color of the fingers, they are pale, not red; the hands a,re abnor mally cold; in some cases the tempera ture is reduced from 1/2° to 2° C. Fric tion, walking, and movement of the parts reduce the discomfort, while in erythromelalgia these aggravate the torture. There is greater intermission in the symptoms in acroparmsthesia, while in erythromelalgia they finally be come continuous; in erythromelalgia the reflexes are exaggerated, while in acro parfesthesia they are normal. The vas
cular storm is absent in the latter; de cidedly in evidence in the former. Of 162 cases of acroparmsthesia, 150 were women; only 12 were men. The major ity of cases of erythromelalgia are found in men. Acroparmsthesia affects anmmic, cachectic, and overworked adults; in middle life and women at the climacteric, particularly those who work in cold water. In erythromelalgia there are, be sides the predilection of the disease to attack the lower extremities, complica tions referable to the digestive system with far-reaching central, spinal, or pe ripheral changes in many cases. H. L. Elsner (Med. News, Mar. 16, 1901).
Acroparmsthesia, erythromelalgia,, and the other many and varied vasomotor symptoms have certain features in com mon: 1. They are nnich more frequently met with in the female sex—something like 90 per cent. of these cases occur in the female patients. 2. Vasomotor con ditions appear to be due to some in herent and very often inherited tendency in the patient, for they recur again and again in one form or another during the life of an individual. Thus, a patient may have migraine at one time, severe flushings at another, and syncopal at tacks at another, though there is a tend ency to a, recurrence of the same dis order. There are, moreover, two epochs of life which are specially prone to their development, namely: puberty and the climacteric. 3. The onset of the symp toms, whatever they may be, is always more or less sudden. 4. They are in all cases paroxysmal: i.e., they occur in the form of attacks. There is a sudden rise, when the symptoms soon reach their acme, followed by a gradual descent. In severe cases the attacks may be so fre quent as to resemble a continuous mal ady, but close observation will show that there are well-marked exacerba tions. 5. In the great majority of the patients flushes or flush-storms occur from time to time during the patient's life; should. these be absent there are generally other evidences of vasomotor instability. 6. A great many of them— particularly of the vasodilator kind— are amenable to treatment by bromides, which relieve them, at any rate, for a time. T. D. Savill (Lancet, June 1, 1901).