NEURITIS, Peripheral.
This is usually of the multiple degenerative type, and commonly caused by alcoholism alone or in combination with arsenic, as in the memorable Manchester epidemic of 19oo, but other causal factors, as diabetes, rheuma tism, influenza, malaria, syphilis, gout, gonorrhoea, diphtheria, erysipelas, beriberi, leprosy, mineral poisons, as copper, lead, arsenic, mercury, carbon disulphide and dioxide, naphtha, &c., may be present. The condition has been observed to follow typhoid and other exanthematous fevers, mumps, puerperal fevers and various forms of tuberculosis.. The above causes should be sought for, especially as multiple peripheral neuritis of an intractable type may in any given case arise from a combina tion of any two or even more of these causal factors, treatment being unsuccessful till the removal of all the primary elements has been accom plished.
Whilst treatment of an eliminatory character suitable to each primary toxxmic condition is being pursued, the patient should be placed at rest in bed. The limbs, generally the lower ones being first and chiefly affected, may be enveloped in a thin layer of cotton-wool and a light bandage, and where a marked degree of heat does not exaggerate the pain and dis comfort, the wool may be covered in by a layer of oiled silk. Warm fomentations are often soothing, but hot baths and all forms of counter irritation, friction, massage and electricity in the early stages of pain and tenderness are distinctly contra-indicated, as sloughing may be readily excited by these agents. In advanced cases first coming under obser vation, a water-bed should be procured, and from the first attention should he directed to correct by suitable and well-padded splints any faulty position of the limbs caused by the contraction of unopposed muscles.
During the early stages of treatment, the dietary and general hygiene are those indicated in the treatment of chronic alcoholism, and as the condition of the digestive organs is unhealthy, catarrh of the stomach being nearly always present, a great difficulty arises in combating the nausea, anorexia, vomiting and craving for stimulants. It is unnecessary to say that alcohol in every form must he strictly prohibited; rectal feeding may be necessary. (See under Alcoholism.) severe pain rarely calls for Morphia, and the danger of establishing another drug habit must never be lost sight of. This remark also applies to the treatment of the insomnia which is almost always present, and which must be relieved by simple hypnotics. Trional is frequently employed
for this purpose, but the writer has several times observed a type of peri pheral neuritis develop under the continuous use of this hypnotic when employed for the relief of insomnia in other conditions; hence, if adminis tered during alcoholic neuritis, it should only be given occasionally. Bromides in large doses or Paraldehyde may be safely given to induce sleep.
The pain may be relieved by small doses of Antipyrine, Phenacetin, Aspirin, or any of the analgesic drugs mentioned in the list under 'Megrim. One of the best routine combinations for most cases is the following: B. Phenazoni 31.j.
Ext. Coca Liq.
Tinct. Capsici Glycerini et Aqua ad 5iv. Alisce.
Fiat mistura. coch. min. ter in die ex aquti.
Salicylates are always useful; in addition to their slight analgesic action they act as diuretics and aid in the elimination of the toxins by the kidney and skin, and are clearly indicated in all rheumatic and gouty types of neuritis. Iodides are valuable in all forms of the disease, and constitute the best routine in the treatment of the neuritic following lead. copper, mercury and arsenical neuritis, and are especially indicated in syphilitic and rheumatic cases.
As soon as local pain and tenderness have been overcome by the above measures gentle massage and passive movements may be commenced, and graduated voluntary exercises may be permitted as the patient gains the power of his limbs.
In chronic and neglected cases, in those examples of dual forms of the disease arising from the operation of more than one causal factor, and in the peripheral neuritis following prolonged and inveterate alcoholic excess which fails to respond to abstention and rest, mu€h wasting and a high degree of paralysis result, often with contractures of muscles and deformity of limbs and secondary arthritic complications. The treatment of such cases resolves itself into active Faradisation of the affected muscles long con tinued and perseveringly employed, large moistened electrodes being used with a current strong enough to produce mild contractions of as large a number of fibres as possible in the partially degenerated muscles. Strych nine, which is contra-indicated in the early stage, may be injected deeply into the centre of the muscles. Hot air or the electro-thermic bath or Tallermann's apparatus may be employed where there is much rigidity before beginning massage, passive movements, Schott's or Swedish exercises. Surgical procedures may be necessary to divide tendons and overcome adhesions.