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.

    7/14 (page 5)
    These examples, I have thought, would prove interesting and valuable, as tending to show what has not yet, so far as I know, been advanced respecting the influence of alcohol, that its effects may appear, not only in the more common form of a gene- ralised paralysis of the extremities, but in lesion of a peculiarly localised character. If 1 am right in the view that these are ex- amples of localised neuritis due to alcohol, it is evident that we shall have in future to bear this possibility in mind when we meet with neuritis of single nerves or plexuses, of the cause of which we do not find a ready explanation. Let us turn now to peripheral neuritis arising from other causes than the influence of alcohol. A week or two after I had pub- lished a work on Paralysis from Peripheral Neuritis the following case came under my observation at the hospital. It is one of multiple neuritis occuring in a patient affected with diabetes mellitus:— J. K., aged 55, carpenter, applied to the National Hospital for the Paralysed and the Epileptic on June 30th, 1886, suffering from loss of power in the lower extremities, which he ascribed to work- ing in the wet. He had been quite well until the previous September, when, after working daily for several weeks out-of-doors in the cold and wet, he began to get pain and tenderness in the front of the right thigh, which extended presently down the leg to the foot. The pain was very severe, and there was so much weakness that his knee often gave way and let him down. A month after the right the left leg was similarly attacked, and in three months from the first symptoms he could not walk at all. AlDout this time he noticed also numbness and pins and needles in both legs, especially in the soles of the feet, and the pains were severe and continuous. The symptoms continued till the end of Febru- ary, when the pains became less severe, and he became able to- walk upon crutches. The improvement in his lower limbs con- tinued, but towards the end of May he began to have a little tingling and slight numbness in the tips of his fingers. At no time was there any difficulty with his bladder, but soon after the commencement of his illness he was troubled with great thirst and noticed that he passed much urine, and, moreover, wasted in flesh a great deal. On examination, the legs were found thin; they could be flexed readily upon the thighs, but extension was imperfectly performed. There was no power of dorsal-flexing the feet upon the legs. There was tenderness on pressure in the soles of both feet, and he com- plained of tingling and numbness from the feet up to the knees— more in the feet, ankles, and front of the legs than in the calves. There was much loss of cutaneous sensibility in the feet and lower part of the legs. The knee-jerks were absent. There was no re- sponse to the strongest induced currents in the anterior tibial group of muscles, and this painful application could be borne without inconvenience in that situation, whilst lower down it was only felt as pressure. It was remarkable,! may note by the way, that some immediate return of voluntary power in dorsal-flexing the feet followed this application, although the electric current Itself caused no muscular contraction. Examination of the urine showed that it contained a large quantity of sugar. The man was admitted as an in-patient a fortnight afterwards Examination then showed the plantar reflex fair on the left, but hardly to be obtained on the right sole; the gluteal fair on the left, not well marked on the right; the cremasteric also better on tne left than the right side. The abdominal and epigastric re- Hexes were present on each side. There was a ready and normal