39 Klinik des Rückenmarkskrankheiten.
3. Disorders of the Peripheral Nerves.—Magnus Huss found no change in the peripheral nerves in five cases in which they were carefully examined. Lancereaux discovered degenerative changes in the peripheral filaments in alcoholic paralysis. Leudet found hypertrophy of the neurilemma and alterations in the cubital nerve in an individual suffering from chronic alcoholism in whom this nerve was paralyzed. Dejerine40 observed in two fatal cases of alcoholic paralysis neuritis of peripheral nerves with integrity of the nerve-roots, the spinal ganglia, and the cord. In one of Dreschfeld's cases of alcoholic paralysis,41 in which the cord was found perfectly normal, the “sciatic appeared thin and grayish, and was surrounded by a great deal of adipose tissue. Vertical sections showed, when treated with perosmic acid and stained afterward with picro-carmine, a moniliform appearance of the nerve-tubes, due to breaking up of the myelin; the nuclei were increased, and there was also some interstitial cell-infiltration. Transverse sections showed in some few places an increase in the diameter of the axis-cylinder, and again the interstitial infiltration.”
40 Archives de Physiologie nerv. et patholog., No. 2, 1884.
41 Brain, Jan., 1886.
Disorders of General Sensibility.—Disorders of general sensibility are among the earliest of the nervous phenomena of chronic alcoholism. They occur in the following order: hyperæsthesia, dysæsthesia, and anæsthesia. Disturbances of sensibility manifest themselves, quite independently of hallucinations, as sensations of malaise, of discomfort, of chilliness, of cramps, or of abnormal warmth or cold. Sometimes they amount merely to momentary discomfort, at other times to extreme pain. They are usually limited, often to the feet and legs, sometimes to the hands and arms; again, they are experienced in the trunk, and especially in the back. They are most common during the evening; less frequently they are induced by the warmth of the bed; and, again, they are experienced on rising. They are apt to be associated with occipital or frontal headache.
Among the most frequent nervous phenomena of chronic alcoholism are disturbances of sleep. Sleep is light, uneasy, and disturbed, difficult to obtain, troubled with dreams, and unrefreshing. More or less complete insomnia is by no means rare. It is more apt to occur, however, after acute exacerbations of alcoholism than in the ordinary chronic condition.
Hyperæsthesia manifests itself as an increased sensibility to pain, to mere contact, to temperature, and in an exaggeration of the muscular sense. Two general forms may be distinguished—the superficial and deep. The former usually manifests itself by an exaggerated sensibility of the skin, especially along the course of the superficial nerves and at their points of emergence from the deeper structures. The latter consists in a more or less intense sensation of pain, often diffuse, sometimes almost unbearable, and associated with a sensation of heat or cold, which is most commonly experienced in the lower extremities. It is often referred by the patient to the deeper muscles or to the bones and joints, and is increased by movement or pressure.
Anæsthesia is a much more common occurrence. It is usually developed during the later period of chronic alcoholism, and may implicate the skin, the mucous tissues, or the deeper structures. It presents all degrees from mere impairment to absolute loss of sensation. In the latter case, contact, pain, temperature, and electrical stimulation equally fail to excite sensation. In the deep anæsthesia of alcoholism pressure and electro-muscular sensibility are alike impaired. The muscular sense is also enfeebled or abolished. The regions which are the seat of anæsthesia are, as a rule, of a lower temperature than those in which sensation is normal. The anæsthesia may extend to the conjunctiva, and even to the cornea and to the mucous membrane of the mouth and throat. It has also been observed in the mucous membrane of the genitalia and at the verge of the anus.
Disorders of Motion.—Disorders of motion consist of tremor, subsultus, spasm, convulsions, muscular paresis, and palsies. Tremor is a very frequent phenomenon in chronic alcoholism. It consists generally of a series of rapid rhythmical movements. Sometimes the extent of the movement is increased and their rhythm irregular. They are then choreiform. The tremor may be continuous; much more frequently it only appears in the morning. The subject has then some difficulty in dressing himself, particularly in buttoning his clothing, in shaving himself, and in raising a cup to his lips. This symptom commonly ceases after the ingestion of a certain quantity of alcohol, only to return on the following morning or after a considerable period of abstinence. Voluntary movements intensify the tremor. It most commonly affects the upper extremities, next in frequency the muscles of the face, and finally the lower extremities. In rare cases it affects the muscles of the whole body. Alcoholic tremor affecting the hands and arms renders the subject awkward and interferes with his ability to work; affecting the lower extremities, it gives rise to an embarrassing, irregular gait; affecting the lips and tongue, it produces hesitation of speech or stammering, and when it is of a high degree articulation may be so imperfect that conversation is impossible; affecting the muscles of the eyes, it gives rise to nystagmus. Tremor is not infrequently associated with subsultus tendinum, spasmodic contractions, and cramps. These phenomena are usually localized, and affect by preference the muscles of the face and those of the lower extremities.