1898 Journal of the American Medical Association (JAMA)  
The following brief clinical studies of multiple neuritis embrace only those cases in which were found motor and sensory paralysis of symmetric development, but do not include that form of neuritis which affects only the muscles of the palate or of the nose, as shown by regurgitations of fluids, with nasal voice or those cases affecting only the ocular muscles. Diphtheria is undoubtedly by far the greatest cause of multiple neuritis. Comparatively few cases are caused by the other infectious
more » ... other infectious diseases. Smallpox is not infrequently a cause of the disease, but I have seen no mention made of chicken-pox giving rise to the disease. I, unfortunately, have one case to report of the production of the disease by arsenic given during the course of treatment of chorea. I have twelve cases to report, the causes of which were: arsenic administered for chorea, 1 child; diphtheria, 9 cases; varicella, 1 case, and measles 1 case. Seven children were cured, 5 died. In none of my cases were the sphincters involved; in all cases there were some deviations from the normal mental condition of the child. This last symptom I have seen little stress laid upon. The first symptom noticed was simply a weakness of the extremities, followed rapidly by inability to stand or walk-the motor paralysis appearing first, followed at once by the sensory paralysis, the recovery being first of the sensory and later of the motor paralysis. No allusion was made in medical literature of paralysis following diphtheria until the end of the 16th century, the first mention being made in 1580. Ghisi, in 1747, describes an attack in his own son, and adds that he "left to nature the cure of the strange consequences." The first description of the disease in America was given by Dr. Bard of New York, in 1771. Few authorities describe multiple neuritis in children, although diphtheretic paralysis was described long before the disease was considered to be a neuritis. In looking over the statistics of paralysis following diphtheria, I find no distinction is made, or in only a few instances, of paralysis affecting the throat only and a general multiple paralysis. In the collective investigation of the American Pédiatrie Society, of 189 cases, the paralysis was general in 8 only. They report 3384 cases with 9.7 per cent, followed by paralysis. Various other estimates are given of from 5 to 15 per cent. All authorities agree as to the rarity of death, although one authority thinks physicians are too optimistic in regard to the mortality. Of my 9 cases, 3 were treated during the attack of diphtheria with antitoxin; of these three, 2 died. Five of the 9 children were treated during the attackof diphtheria In 7 cases the Klebs-Loeffler bacilli were found; the other two occurred before the discovery of the bacilli. The ages varied from 23 months to 12 years. Case 1.-Willis S., the youngest child, 23 months, had an attack of diphtheria, moderately severe. One week later there was hoarseness followed by régurgitation of fluids through nose, nasal voice, and internal strabismus of both eyes. At the end of the first week the child was unable to stand alone, or walk, pain over track of nerves, most marked in the lower extremi-ties, anesthesia, as shown by the indifference to prick of pins ; the temperature test was not applied ; the child lacked its normal intelligence. The symptoms increased rather in extent than intensity, the muscles of the neck becoming involved. The rectal temperature varied from 101 to 104.5, with at the end 106. Death occurred in a spasm at the end of the fourth week from the first appearance of the sore throat. Case 2.-Joe S., 4 years ; seen on the eighth day of diphtheria. Klebs-Loeffier bacilli found, nose, pharynx and tonsils involved, moderately severe attack ; throat normal and free from bacilli on the thirteenth day after the first symptoms. Thirtyone days after the first appearance of the sore throat, or eighteen days after recovery from the diphtheria, nasal voice and régurgitation of fluids were noticed, and the child walked with difficulty ; this increased in severity, the child became unable to either stand or walk alone, pain on pressure over the nerves of the lower extremity, with anesthesia. The muscles of the trunk and neck were not involved. The child again began to walk fifteen days after the symptoms of nasal voice and régurgitation were noticed, with complete recovery shortly after. Case 3.-Sara N., had a mild attack of sore throat, according to the history of the mother, from which she recovered. In the fifth week after, nasal voice and régurgitation of food began. The child complained of being tired and disinclined to walk ; this gradually increased, and at the end of four weeks she was suddenly seized with pain in all the extremities, and shortly after was unable to stand, walk, sit or hold head up : marked tenderness and anesthesia in all extremities. The temperature test showed great pain when heat was applied, but she insisted that the cold made her feel much better. The tenderness over the track of the nerves was intense ; the temperature varied from 101 to 104.5; there was gradual loss of intelligence. Five days after she complained of severe pain, the physical signs of broncho-pneumonia were found ; death occurred in the ninth week from the first symptoms of sore throat. Case 4.-John K., 3 years; recovered from a mild attack of chicken-pox about July 1. On the 7th the child was attacked by laryngeal diphtheria. Antitoxin was given, and the child was completely recovered by July 14 ; the bacilli persisted until July 31. August 1 the mother noticed the nasal voice and a very slight régurgitation of fluids-on the 7th the child held the head to one side, staggered when attempting to walk, and fell down frequently ; four days later was unable to stand alone ; anesthesia marked ; temperature test showed heat felt over a part of both limbs-of lower extremities, less on upper and on the trunk. Child at times seemed delirious, intelligence very much below his normal, died suddenly, apparently from cardiac paralysis on the eighteenth day after the first régurgitai ion of fluids. Case 5.-Mild attack of diphtheria, December 30. Antitoxin given ; complete recovery on the eighteenth day. February 7, without previous reguritation of food, child began to limp, and fell down a great deal, complained of pain in the legs ; four days later could walk only by dragging the feet, and at times crossed his legs during locomotion ; could not stand nor walk alone ; marked pain over track of nerves, with marked anesthesia of both legs ; no reaction to cold temperature test. Slight reaction to heat ; upper extremities normal ; could sit alone, but only a few minutes. On the sixteenth day internal strabismus of the left eye was noticed ; on the twenty-first day attempted to walk ; twenty days later completely well. The intelligence of this child was less affected than the others. Case 6. -Annie P., 9 years. Early in November had an eruption on the hands, the nature of which was not known. No attention was paid to this, and about December 1 complained of inability to walk, and régurgitation of fluids and nasal voice. When seen a few days later could neither stand or sit alone ; tenderness over track of nerves, patella reflex nearly absent. The symptoms remained about the same for a month, then marked change in the intelligence, utterly unable to move the lower limbs or hold the head up ; tenderness over track of nerves much more marked, with marked anesthesia. Entire
doi:10.1001/jama.1898.92450210008002b fatcat:vepgodqg75gm7cj3cii4xwmcwm