Of internal remedies, strychnine, which was first warmly recom mended by Henoch, is still the most useful. It is given hypodermi cally in doses of 0.0005 to 0.001 to 0.002 Gm. per diem gr.). If there is any objection to giving strychnine hypodermically in children, tincture of nux vondea 2.0: 10.0 Gm. (30 gr.: 21 dr.) (of bitter tincture) 5 drops (to a child of 3), 15 drops (to a child of 5) or 20 drops two or three times a day, to be followed by milk. Electricity should be tried in every case. If there is paralysis of the pharyngeal muscles, a local application of an electrode in the shape of a catheter (with a faradic current, or the stabile cathode), or stroking movements with the cathode applied to the throat, increasing the strength of the current until a deglutition move ment is elicited. In paralysis of the extremities faradization or massage of the paralyzed muscles is recommended.
Recently injections of large doses of antitoxin, repeated several days in succession, have been administered in cases of postdiplitheritic palsy and, it is said, with very good results.
(b) Alcoholic Neuritis In the child alcoholic intoxication manifests itself by cerebral, more often than by peripheral symptoms. In acute cases convulsions, irregularity of the respiration, delirium, coma or even sudden death are observed; in eases of chronic intoxication, increased irritability (as evidenced for example by excessive restlessness during the exami nation) insomnia, ill-temper, mental dulness, and epileptiform attacks.
Only a few cases of peripheral alcoholic neuritis in children are found in the literature (T,escynski, Jacob, Campbell, Zappert, ete.). In every case there is a history of long-continued indulgence in alcoholic beverages. It seems that beer, which can be taken for a long time in small amounts without producing any immediate symptoms, is par ticularly apt to cause peripheral neuritis.
The symptoms of alcoholic neuritis in the child are practically the same as in the adult. It is first noticed that the patient tires easily when walking, and this is soon followed by paresis of the legs and com plete inability to walk. Ataxia is usually present and is most notice able when a child which has been completely paralyzed in the leg begins to regain the power of walking. The deep reflexes of the legs arc usually abolished, the reaction to electric stimuli is variable. Later in the course of the disease weakness of the arms and muscles of the trunk develops. An important symptom is pain along the nerve trunk, which the patient sometimes complains of spontaneously and which may be accompanied by hyperalgesia of the skin. The muscles also are sometimes sensitive
on pressure. (Edema of the skin is occasionally observed. Other 11C1'1'011S disturbances, such as palsies of the ocular muscles, are rare in eases oc curring during childhood. In children who are confined to bed on account of some other grave effect of alcoholic intoxication (heart, liver), the symptonis of polyneuritis may be quite overshadowed by the other symptoms present jeampbell).
The course and prognosis in alcoholic neuritis are not bad unless the primary disease itself brings with it dangerous complications. Recovery is slow and may require many weeks or even months.
Something is known of the pathologic anatomy of alcoholic neuritis in children since one case (Campbell) ended fatally. The pathologic findings in the adult form the subject of a monograph by Heilbronner. With regard to the peripheral nerve changes, which predominate in the pathologic picture, and the spinal lesions, they have already been dis cussed in connection with polyneuritis.
It is evident that these cases should be a warning against giving alcohol to children: although, considering how rare they are compared with the frequent use of beer in childhood, the exploitation of these cases by the opponents of alcohol for purposes of agitation does not seem to be entirely justified. The treatment consists in withdrawing the alcohol, rest in bed, and faradization.
(c) Lead Neuritis Neuritis due to lead poisoning has been described more frequently in childhood than alcoholic neuritis (about 35 to 40 cases). The causes are exposure to lead in the workshops of lead workers, playing with toys or bits of silk containing lead, lead enamelled drinking vessels, swallowing various foreign bodies eon taining lead, ingestion of the metal in medi cinal preparations. etc. The possibility of blood poisoning of the cerebral variety) resulting from the use of diachylon ointment (Hahn) should be borne in mind, and we may also mention a strange case (reported by Anker) of hereditary lead poisoning in the child of a man who was suffering from that disease.
While referring the reader for the other symptoms of lead poisoning to the chapter on the intoxications. we shall here confine ourselves to a discussion of the nervous symptoms. These are somewhat different in children than in adults, the legs being regularly attacked by paralysis first. especially the peroneal muscles.