Emaciation, reactions of degeneration, and abolition of the patellar and Achilles tendon reflexes are observed in the paralyzed legs. The arms are attacked later and then exhibit typical radial nerve palsy.
As a rule there are no other disturbances to be found except drag ging pains in the limbs. With regard to other symptoms of lead poisoning, extreme pallor and colic are usually present; but the blue line is not always found. Convulsions referable to lead poisoning of the brain have been observed in infants. Other nervous symptoms such as hemiphigia, tremor, spasm of the bladder, optic neuritis, disturbance of the eye muscles and disease of the cranial nerves, are extremely rare in children.
The prognosis of lead neuritis in children is not bad provided the cause is recognized and constant reintoxication with thc metal can be avoided. If the cause cannot be removed, the disease may be greatly protracted. In cases in which the brain is affected, death with convul sions has been described, and in a case of Hahn's the brain was found to contain lead. But even in cases of peripheral neuritis a complete cure cannot always be promised. In one case under my observation there has been for the past two years paralysis of the peroneal nerve. Relapses are by no means rare when external conditions are unfavorable.
The pathologic anatomy is thc same as in alcoholic neuritis.
(d) Arsenical Neuritis After thc ingestion of a toxic dose of arsenic, and especially after a protracted course of medicinal doses of Fowler's solution as, for ex ample, in chorea, poisoning has not infrequently been observed with certain nervous features which may be briefly described.
The symptoms are those of polyncuritis; pain in the distal portions of the extremities and paralyses occupying the foreground in the clinical picture. The paralysis is accompanied by atrophy and the presence of the reactions of degeneration in the muscles; the lower extretnities, par ticularly the legs, are chiefly affected. When the arms are attacked, atrophic paralysis of the muscles of the hand often results. Sometimes ataxia is more pronounced than paralysis (pseudotabes). The patellar reflexes are usually abolished. Painful points are found here and there along the nerve trunk and objective disturbances of sensation are often observed. Trophic disturbances of thc skin in the form of hyperidrosis, glossy skin and pigtnentations are not infrequent. The occurrence of herpes cannot be regarded as a component of the picture of arsenical polyneuritis, since it tnay represent the only sequel of arsenic poisoning.
The course is usually satisfactory. Oppenhchn reports a few cases of contractures in the paralyzed extremities.