Loss of muscular power, which may pass, little by little, into complete palsy, also occurs. It is, however, neither constant nor proportionate to the gravity of the case in other respects. Whilst, as a rule, it is developed insidiously, it occasionally shows itself with suddenness. In the latter case it is usually preceded by some acute complication, and may disappear as quickly as it came. At first it is a mere feebleness, which, beginning in the fingers, extends to the hands and arms. It may after a time manifest itself in the feet. More or less muscular paresis is invariably associated with the tremor above described.
Alcoholic Paralysis.—The earliest account of alcoholic paralysis is that of James Jackson,42 who designated the disease, from its most prominent symptom, arthrodynia. He attributes it to ardent spirits, and chiefly observed it among women. “This arthrodynia comes on gradually. It commences with pain in the lower limbs, and especially in the feet, and afterward extends to the hands and arms. The hands may be affected first in some instances, but in all cases in the advanced stage of the disease the pain is more severe in the feet and hands than in the upper limbs. The pain is excruciating, and varies in degree at different times. It is accompanied by a distressing feeling of numbness. After the disease has continued a short time there take place some contraction of the fingers and toes and inability to use these parts freely. At length the hands and feet become nearly useless. The flexor muscles manifest, as in other diseases, greater power than the extensors, and the whole body diminishes in size, unless it be the abdomen; but the face does not exhibit the appearance of emaciation common to many visceral diseases. The diminution is especially observable in the feet and hands. At some time the skin of these parts acquires a peculiar appearance. The same appearance is noticed in a slighter degree in the skin of other parts. This appearance consists in great smoothness and shining, with a sort of fineness of the skin. The integument looks as if tight and stretched, without rugæ or wrinkles—somewhat as when adjacent parts are swollen. The skin is not discolored. In this disease there is not any effusion under the skin, and the character which it assumes arises from some change in the organ itself.”
42 New England Journal of Medicine and Surgery, vol. xi., 1822, “On a Peculiar Disease resulting from the Use of Ardent Spirits.”
Since Jackson's day, Huss, Lancereaux, Leudet, and others have described various forms of paralysis due to alcohol. Wilks43 under the term alcoholic paraplegia described a form of alcoholic paralysis of which he had seen numerous cases, especially in women addicted to alcoholic excesses. The symptoms are severe pain in the limbs, especially the lower ones, with wasting, numbness, anæsthesia, only slight power of movement or total inability to stand. The symptoms are not unlike those of ataxia. Wilks regarded the disease as due to degeneration of the cord and thickening of the membranes. Several of the cases terminated in recovery in a comparatively short time after the abrupt and complete withdrawal of alcohol. Since that time a number of cases have been reported by various observers.44
43 Lancet, 1872, vol. i. p. 320.
44 See, in particular, Hun, American Journal of the Medical Sciences, April, 1885, “Alcoholic Paralysis.” This paper contains a valuable résumé of the reported cases up to that time. Consult also Dreschfeld, Brain, July, 1884, and January, 1886.
Hun concludes that alcoholic paralysis may be regarded as a special form of disease with the following symptoms: “Neuralgic pains and paræsthesiæ of the legs, gradually extending to the upper extremities, and accompanied at first by hyperæsthesia, later by anæsthesia, and in severe cases by retardation of the conduction of pain. Along with these symptoms appears muscular weakness, which steadily increases to an extreme degree of paralysis, and is accompanied by rapid atrophy and great sensibility of the muscles to pressure and to passive motion. Both the sensory and motor disturbances are symmetrically distributed. The paralysis attacks especially the extensor muscles. In addition to these motor and sensory symptoms, there is also a decided degree of ataxia. The tendon reflexes are abolished, and vaso-motor symptoms, as œdema, congestion, etc., are usually present. Symptoms of mental disturbance are always present in the form of loss of memory or transient delirium.”
Lesions of the cord are absent, but degenerative processes in the peripheral nerves have been discovered in a number of cases. The symptoms are those of multiple neuritis, and the essential lesions consist in degenerative changes in the peripheral nerve-fibres. The associated mental derangement, tremor, and ataxia have been ascribed to changes in the cerebral cortex.
Dreschfeld has divided the cases, according to the more prominent symptoms, into two clinical groups—alcoholic ataxia and alcoholic paralysis.
The ataxic form represents a milder type. The symptoms are lancinating and shooting pains in the lower extremities, sometimes in the upper, with areas of anæsthesia and retarded sensibility. The muscles are painful upon pressure, and atrophy may be moderate or absent altogether. Inco-ordination is marked. The tendon reflexes are absent. Shooting pains down the legs to the toes of a paroxysmal character, and followed by a sense of numbness, also occur. Eye symptoms are wanting.