The paralytic form is usually associated with atrophy, affecting chiefly the extensors of the fingers and toes. The paralysis and atrophy in some cases come on acutely, in others more slowly. When the patients come under observation they are usually unable to stand or walk, and it is therefore not easy to make out whether or not the paralytic stage has been preceded by a stage of ataxia. As the sensory phenomena in these cases are the same as in the first group, it is probable that pseudo-ataxic symptoms have preceded the slowly oncoming paralysis. Paralysis and atrophy of the extensors of the fingers and toes, with paresis of the other muscles, are associated with the sensory phenomena above described. Tendon reflexes are absent; the superficial reflexes are much diminished. Recovery takes place in a considerable proportion of the cases upon the withdrawal of alcohol. The atrophy and paralysis pass away altogether, the tendon reflexes are restored, and the disturbances of sensation disappear. In the greater number of these cases persistent delusions are present.
Lancereaux45 describes alcoholic paralysis as symmetrical, affecting either the upper or lower extremities and gradually extending toward the trunk. The lower extremities are invariably more affected than the upper, and the extensor than the flexor muscles. There is diminished reaction to electricity, and anæsthesia is present. The brain and spinal cord are normal, but the peripheral nerves show extensive degenerative changes.
45 Gazette des Hôpitaux, No. 46, 1883.
4. Disorders of the Special Senses.—a. The Sight.—Disorders of vision are among the most frequent and the earliest symptoms of chronic alcoholism. Phosphenes, scintillations, sensations of dazzling, muscæ volitantes, and streams of light are often complained of. These phenomena may be constant or transient. Diplopia and other visual disturbances of the most irregular and annoying character also occur. Sometimes there is dyschromatopsia; the colors are confounded: red appears brown or black, and green appears gray, etc. In the more advanced stages amblyopia may occur. The acuity of vision rapidly diminishes, sometimes to the point that the patient with difficulty distinguishes the largest print. Objects appear as seen through a fog, and their outlines are distinguished only after repeated and close effort. Again, blindness almost absolute occurs for the course of some minutes—passes away rapidly, only to return again at intervals. Not infrequently the sight is better in the morning and evening than during the day. Achromatopsia, characterized by enfeeblement, and not infrequently by the momentary loss of the power to recognize colors, and particularly the secondary tints, also occurs. Cases of Daltonism occasionally seem to depend, to some extent at least, upon alcoholic disturbances of vision. Impairment of the power to distinguish colors must not, however, be confounded with the difficulty experienced by many alcoholic subjects in recognizing different colors successively presented to the eye with some degree of rapidity. Such individuals are able to distinguish colors when sufficient time is permitted them. Their difficulty depends upon tardiness of perception, such as is often experienced by neurasthenic subjects in recognizing faces in a crowd, rather than upon any failure in the power of recognizing colors. As a rule, the disorders of vision are not permanent, at least in the beginning. Later, they are of longer duration, and alcoholic amblyopia occasionally degenerates into irremediable amaurosis. Ophthalmoscopic examination reveals at first no appreciable lesion, and the disturbance of circulation, venous stasis, and peri-papillary infiltration thus observed appear to be inadequate to explain the visual disturbance. Atrophy of the optic nerve occasionally occurs as a direct result of alcoholism. Nystagmus has been frequently observed. The state of the pupils is variable and without constant relation to the acuity of vision. The pupils are not infrequently uniformly dilated, contracting slowly under the influence of light. More rarely they are permanently contracted; occasionally they are unequal. These modifications are often without demonstrable relation to anatomical lesions.46
46 Vide this System of Medicine, Vol. IV. p. 803.
b. The Hearing.—The disturbances of hearing encountered in chronic alcoholism are in many respects analogous to those of sight. Patients complain of curious subjective sensations, which are described as humming or whistling sounds, the ringing of bells, music, or the murmur of a crowd. At times the sense of hearing is so exquisite that the least noise causes pain. On the other hand, hearing may be greatly impaired, diminishing by degrees until it becomes in some cases, without recognizable lesion, almost or completely lost.
c. The Taste.—As a rule, the sense of taste is impaired in chronic alcoholism; occasionally it is wholly lost.
d. The Smell.—The sense of smell is in most cases to some extent, and in many cases greatly, impaired, the most powerful odors being scarcely perceived by old topers.
Alcoholic Epilepsy.—Alcohol, and especially that combination of alcohol with oil of wormwood and aromatics known as absinthe, is capable of producing convulsive seizures resembling epilepsy. Certain forms of alcoholic convulsions can scarcely be distinguished from ordinary epilepsy. Acute alcoholism may be an exciting cause of the convulsive seizures in an epileptic. Alcoholic epilepsy is, however, peculiar to chronic alcoholism, and particularly in individuals in whom there is an hereditary tendency to nervous disorders. Once established, alcoholic epilepsy may continue even after the alcoholic habit has been discontinued. The attack is usually followed by marked mental disturbances. These vary from profound dulness to stupor or mania; they last from some hours to several days, and present the characters of similar conditions following non-alcoholic epileptic paroxysms.