Illustrations of some less-known forms of peripheral neuritis, especially alcoholic monoplegia, and diabetic neuritis / by Thomas Buzzard.

  • Buzzard, Thomas, 1831-1919.
Date:
[1890]
Catalogue details

Licence: Public Domain Mark

Credit: Illustrations of some less-known forms of peripheral neuritis, especially alcoholic monoplegia, and diabetic neuritis / by Thomas Buzzard. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    There is usually a remarkable loss of memory, the patient often saying for instance that she has been out for a walk on that day, when she has not left her room for many -weeks. There is often also a condition as though of complacent indifference and incap- ability of grasping the full meaning of her condition, which seems to be peculiar to a state of chronic alcoholism. If such a case as this should give the opportunity of post-mor- tem examination (a comparatively rare exception) a subacute in- flammatory process will be found affecting the nerve trunks, espe- cially the radial and anterior tibial or the peroneal. The nerves •will seldom show any particular change to the naked eye, but, having been hardened and submitted to section, evidence of parenchymatous degeneration is discovered in them, together with more or less interstitial neuritis. In females affected with alcoholic neuritis I have observed now, during many years, that the catamenia are almost always sup- pressed, and often for many months during the illness. I do not attempt an explanation of this. It seems to me a curious and in- teresting fact when taken in conjunction with the well-known complete, or almost complete, immunity of the functions of the bladder and rectum. Although in the majority of cases it is the nerves of the extre- mities which appear to bear the brunt of the lesion, yet I have seen paralysis of the respiratory muscles and of those subserving deglutition, and in one instance almost complete paralysis of the excernal muscles of the eyeballs. The pneumonia which occa- sionally terminates the scene in cases of this kind is very likely due to lesion of the vagus. I have given an illustration of the more usual symptoms in a ca.ae of multiple neuritis due to alcohol. It is neces- sary to mention exceptional conditions which are found in certain cases. There may be no pains, and but very little or indeed no disturbance of cutaneous sensibility. It seems that in some rare instances it is almost entirely the efferent fibres which suffer. There is often a very considerable amount of oedema of the feet and legs, and the hands may look puffy and sodden. Indeed, I have seen one case in which the brunt of the lesion appeared to fall mostly on the vasomotor system of nerves, and give rise to oedema. In some cases it is chiefly a tottering ataxic gait which is noticeable. This often precedes the paralytic state, which may and often does arrive quite suddenly. Although a dropped condition of the feet is so common as to be highly characteristic of alcoholic paralysis, and should always suggest inquiries into the history, yet I have lately seen a few cases in which the symptom was not present. In these, it is true, the amount of paralysis of the lower extremities was not very great, but as the loss of power in the anterior tibial muscles is commonly an initiatory as well as a very characteristic symptom, it seems worth while to note that it may occasionally fail to occur, at least early in the case. A case which I have seen this winter illustrates some of these exceptional conditions. A gentleman who had greatly exceeded began in September to lose power in the knees and ankles, at the same time complaining of pains in the muscles of his legs. He managed to attend office for a month, then one day when dressed and ready to start, his legs gave way under him and he could not get up. He then began to lose power in the hands, which swelled and were numbed. They remained bad for a short time onlv. When I saw him two months after his attack he had not been able to walk or even to stand. His legs were swollen, he could not