Neuritis

“ When spasm or tremor has been observed in acute neuritis of mixed nerves, it is a matter of doubt whether it is not to be explained by reflex action of the cord excited by irritated centripetal fibres. Various trophic symptoms may show themselves, as herpes zoster or acute œdema. Erythematous streaks and patches are sometimes observed upon the skin along the course of the inflamed nerve-trunks. In chronic neuritis, into which acute neuritis generally subsides or which arises spontaneously, the symptoms above described are very much modified ”

“ For this reason it is important that the treatment of the disease be solely the province of the physician; for only the carefully trained in all the requirements of diagnosis can differentiate the pseudo from the real, the innocuous from the disastrous.
False or nervous neuritis may feel like real neuritis (the result of poisons in the blood) , but it gives itself away when it localizes itself in parts of the body where there is no nerve trunk. The exhaustion of neurasthenia sometimes seems extreme enough to be the result of a dangerous physical condition ”

“ The nerve does not always present the appearance of continuous inflammation, but the evidence of neuritis may be seen at points along its course which are separated by sound tissue. These points of predilection are usually exposed positions of the nerve or near joints. Often the nerve appears to the naked eye normal, and the characteristic changes of neuritis are only revealed by the microscope. ”

“ The above case is accordingly exceptional in its association of a severe peripheral neuritis with the optic neuritis. Typically, after six months to a year in the factory, the cramps and formication of the legs are felt, and the gradual diminution of vision with transient blindness, finally leading to inability to read, sets in. The green blindness, the accommodative paresis, and diminution of central vision, the concentric contraction of the visual fields, are the usual story. At first the eye grounds are normal; there is then an edematous neuritis, and finally a white atrophy. ”

“ Counter-irritation, heat, cold, electricity, may all be tried in vain, and as a last resource against pain, ulceration, and perverted nutrition we may be obliged to resort to nerve-stretching, or neurotomy. Under the head of Neuritis much must be said of treatment applicable to the inflammation, acute and chronic, resulting from nerve-injuries. ”

“ One subject to rheumatism or neuritis, even in small degree, should take care not only not to take cold but not to overdo in laboring; cold, wet and over-exertion cause the majority of the acute attacks. But some are caused by diseases, such as diphtheria, typhoid fever, etc., and a great many cases of neuritis following these and other infectious diseases can be avoided if proper care is taken during and after these diseases. Such care can easily be taken. Keep your rooms warm and comfortable, and the patient in bed or in a comfortable room until all danger is past. ”

“ The pathological consequences of pregnancy, as far as they affect the nervous system, take the form of neuralgia and of peripheral neuritis of various nerves, of chorea, of disturbances of the sense organs, and of actual psychoses.
Peripheral neuritis in pregnant women affects chiefly the lower extremities, but has been observed in the arms also; it is characterized by muscular wasting with reaction of degeneration, by trophic disturbances, and by disorders of sensation. ”

“ In some of these cases where it has been difficult to distinguish between neuritis and neurosis, a change of occupation or some strong diversion of mind for a considerable period or a change of residence has proved the beginning of a cure. I have seen what was considered by experienced physicians to be a chronic low-grade neuritis of quite intractable form clear up completely as the result of the young woman being compelled to take up a wage-earning occupation, when it had always seemed before as though life was going to be smooth and there was no necessity for her to labor. ”

“ We may well ask ourselves, also, whether there is not some likelihood that a peripheral irritation, which stops short of producing an actual neuritis migrans capable of centripetally exciting a myelitis, may not, by a lower degree of centripetal irritation, give a bias toward certain forms of non-inflammatory atrophy in cells of posterior nerve-roots which are congenitally of weak organization. ”

“ These are again subdivided into a definition, conduction, and physiology of pain. In treating of the pathology of pain no effort is spared to render lucid neuritis, or inflammation of the nerves, multiple neuritis, chronic alcoholic neuritis, that of consecutive influenza, of beriberi, and the neuritis of leprosy. Under definite nerve areas, neuralgia is dealt with exhaustively and at length ”

“ All of these lesions of the nerve-fibres may be recovered from by a process of regeneration, the fibres showing a remarkable tendency to recover their normal structure and function.
SYMPTOMS OF NEURITIS.—When a mixed nerve is the seat of an acute neuritis, with hyperæmia of its blood-vessels, it becomes swollen by inflammatory exudation, and can be felt as a hard cord amongst the surrounding tissues. It is not only highly sensitive to direct pressure, but muscular exertion, or even passive movement of the part, excites pain. ”

“ In ten out of the one hundred cases the patient recovered completely from the headache and general cerebral symptoms and regained perfect health, but the optic neuritis was followed by atrophy and complete blindness. In the face of this terrible termination we cannot help thinking that simple trephining of the skull and the removal of bone, without any interference with the brain, as suggested and practiced by Mr. Victor Horsley for the relief of optic neuritis and pressure symptoms, is a method of treatment worthy of more frequent trial when vision is failing markedly. ”

“ Local causes, such as involvement of the nerve in a scar or in adhesions, may afford indications for operative treatment.
Multiple Peripheral Neuritis.—Although this disease mainly comes under the cognizance of the physician, it may be attended with phenomena which call for surgical interference. In this country it is commonly due to alcoholism, but it may result from diabetes or from chronic poisoning with lead or arsenic, or from bacterial infections and intoxications such as occur in diphtheria, gonorrhœa, syphilis, leprosy, typhoid, influenza, beri-beri, and many other diseases. ”

“ The PROGNOSIS of multiple neuritis is in the great majority of cases not grave, so far as life is concerned, even when there is extensive paralysis. Death may occur early in the acute form of the disease or it may take place at the end of chronic cases. When the disease proves fatal, it is from paralysis of the diaphragm and the other muscles of respiration. Where the paralysis and atrophy have been great, showing profound alteration of the nerves, a long time is required for recovery, and more or less paralysis, contracture, or defective sensibility may permanently remain. ”

“ The detection of optic neuritis is of the greatest importance in the diagnosis of cerebral affections. Nevertheless, in certain cases of double optic neuritis with headache considerable caution is necessary before coming to a conclusion as to the exact nature of the disease. Though these two symptoms are present in the majority of cases of brain tumor and are so frequently due to this cause they are also met with in other diseases. In some cases of granular kidney, for example, the patient comes under treatment for headache and failure of vision ”

“ Multiple neuritis is a painful generalized inflammation of the peripheral nervous system and arises in many toxic conditions of the blood; among the most important are lead, arsenic and chronic alcohol poisoning. ”

“ ETIOLOGY.—Traumatic and mechanical injuries of nerves are the most common and best understood causes of neuritis. Not only may it be occasioned by wounds, blows, compression, and other insults to the nerves themselves, but jolting and concussion of the body, and even sudden and severe muscular exertion, have been recorded as giving rise to it. ”

“ Pain in this region, often due to neuritis, may accompany acute and chronic thoracic disorders, and may be the precursor of herpes zoster. [p. 1235] Caries of the vertebræ and meningitis should be thought of, and cancer if the neuralgia is very persistent, even if it is paroxysmal in character.
TREATMENT.—Besides the general indications for treatment referred to above, it is worthy of special note that nerve-stretching has been successfully tried for intercostal neuralgia. ”

“ Pain is not always present, nevertheless, and cases not infrequently occur which run a painless course. In some cases which have come under the writer's notice spontaneous pain did not occur until some days after the disease was fully declared by other symptoms. More constantly present, and more characteristic of multiple neuritis, are the disturbances of sensation which show themselves in subjective feelings of numbness, tingling, pins and needles, coldness, burning, and other paræsthesiæ, which appear at its outset and continue to be present more or less during its course. ”

“ II. Localizing Symptoms (A) To the non-excito-motor frontal region (anterior frontal) . Headache tends to be localized to the frontal region, vomiting is seldom a conspicuous feature, and optic neuritis is not only rather later in development, but also less progressive than when the tumour is placed in other situations. If the tumour occupies the orbital aspect of the lobe, primary optic atrophy (from pressure) may be existent on the affected side with optic neuritis of the contralateral fundus. ”

“ It is probable that many ill-defined, so-called rheumatic pains which are so frequently complained of are the result of obscure chronic neuritis. Anæsthesia and various paræsthesiæ are often more prominent symptoms than pain. Sometimes there is a hyperæsthesic condition of the skin, in which touching or stroking the affected part causes a peculiarly disagreeable nervous thrill, from which the patient shrinks, but which, however, is not described as pain. ”

“ The liability to confound the affection with a neuritis more centrally situated, but the pain of which is referred to the periphery of the nerve, is to be obviated by a tracing of the nerve along its course to the nerve centre so as to identify any centre of tenderness, and also by the implication of all the peripheral branches coming off ectal of that point. ”

“ But my partner will be home tomorrow, and I’m relinquishing my place to him. It is really his case.”
“I refuse to be anybody’s case. I’ve heard from the best authorities that no one knows anything about neuritis and that it is practically incurable. One has to suffer and suffer. Even Almroth Wright has not found the anti-bacilli. Nepenthe gives me ease; that is all the doctoring I want—ease!”
“It is doing you a lot of harm. And what makes you think you’ve got neuritis?”
“What ailed your Margaret?” ”

“ There is chronic inflammation of the stomach, which is characterized by morning vomiting; there is often hardening of the liver, trembling of the hands and tongue; the memory is weakened and judgment and will as well, especially until a stimulant has been taken; often the person is irritable, careless, with loss of moral sense and in extreme cases dementia. Peripheral neuritis is more common in men than in women. It begins with sharp pain and tingling in the feet and hands; paralysis affects the lower extremities, then the upper, and is most marked in the further muscles of the limbs. ”

“ Gowers thinks that this is an over-estimate, but admits that optic neuritis occurs in four-fifths (or 80 per cent.) of all cases of cerebral tumor. In considering this question we cannot too carefully keep in view the facts so well stated by Hughlings-Jackson,177 that optic neuritis is essentially a transient symptom, and that, although it often occurs early in the disease, it may in some cases be developed only in the latter stages of the complaint. ”

“ In some cases the neuritis thus excited by exposure to cold attacks the nerve after it has issued from the bony canal, and then the resulting injury to the fibres is much less grave. Although in some cases there are prodromal symptoms, as stiffness or pain in the face, generally the paralysis occurs suddenly, very often being first observed upon awaking. The patient may be first made aware of the paralysis by an inability to drink without the fluid dribbling from the affected side of the mouth or by the overflow of tears from the eye of the same side. ”

“ It is characterized by paralysis and fatal effusion, also neuritis, which is an inflammation of the nerves. It seems to be undecided among the medical profession as to whether the disease is infectious or not. Some claim it is brought on by the eating of bad rice or certain raw fish. Young men in those climates seem to be most susceptible to beri-beri. ”

“ Even in cases where actual neuritis has developed, or where there have been changes in the intermuscular planes bringing considerable disability, the aches caused by these will be much more bearable if the patient's mind is set at rest as to the real significance of the condition. No condition should be called rheumatic unless at some time in the history of it there was an acute inflammatory condition with Galen's classical symptoms—tumor, color, rubor and dolor. Pain alone is never sufficient to justify the diagnosis. Painful disability is usually due to local causes. ”