Page:EB1911 - Volume 19.djvu/446

 of nerve-stretching in some forms of neuralgia, notably sciatica, is sometimes successful. It consists in cutting down upon and exposing the nerve, and in seizing hold and drawing upon it so as to stretch it. Such an operation is obviously justifiable only in cases where other less severe measures have failed to give relief. The employment of electricity, in long continued and intractable forms of neuralgia, proves in many instances eminently serviceable. In the severest forms of tic doloureux complete relief has followed the extirpation of the Gasserian ganglion.

NEURASTHENIA (Gr. , nerve, and  , weakness), the general medical term for a condition of weakness of the nervous system. The symptoms may present themselves as follows: (1) general feeling of malaise, combined with a mixed state of excitement and depression; (2) headache, sometimes with the addition of vertigo, deafness and a transitory clouding of consciousness simulating petit mal or migraine; (3) disturbed and restless, unrefreshing sleep, often troubled with dreams; (4) weakness of memory, especially for recent events; (5) blurring of sight, noises or ringing in the ears; (6) variable disturbances of sensibility, especially scattered analgesia (partial and symmetrical) affecting the backs of the hands especially, and in women the breasts; (7) various troubles of sympathetic origin, notably localized coldness, particularly in the extremities, morbid heats, flushings and sweats; (8) various phenomena of nervous depression associated with functional disturbances of organs, e.g. muscular weakness, lack of tone, and sense of fatigue upon effort, dyspepsia and gastric atony with dilatation of the stomach and gastralgia; pseudo-anginal attacks and palpitation of the heart; loss of sexual power with nocturnal pollutions and premature ejaculations leading to apprehension of oncoming impotence. Objective signs met with in organic disease are absent, but the knee-jerks are usually exaggerated.

According to the complexity of symptoms, the neurasthenia is more particularly defined as cerebral, spinal, gastric and sexual. The cerebral form is sometimes termed psychasthenia, and is liable to present morbid fears or phobias, e.g. agoraphobia (fright in crowds), monophobia (fright of being alone), claustrophobia (fright of being in a confined place), anthropophobia (fright of society), batophobia (fright of things falling), siderodromophobia (fright of railway travelling). There may also be mental ruminations, in which there is a continuous flow of connected ideas from which there is no breaking away, often most insistent at night and leading to insomnia. Sometimes there is arithmomania (an imperative idea to count). Such cases often exhibit a marked emotionalism and readily manifest joy or sorrow; they may be cynical, pessimistic, introspective and self-centred, only able to talk about themselves or matters of personal interest, yet they frequently possess great intellectual ability, and although there may be mental depression, there is an absence of the insane ideas characteristic of melancholia.

Traumatic neurasthenia is the neurasthenia following shock from injury; it is sometimes termed “railway spine,” “railway brain,” from the frequency with which it occurs after railway accidents, especially in people of a nervous temperament. The physical injury at the time may be slight, so that the patient is able to resume work, but symptoms develop later which may simulate serious organic disease. As in all forms of neurasthenia, the subjective symptoms may be numerous and varied, whereas the objective signs are but few and slight. Many difficulties, therefore, present themselves in arriving at a sound opinion as to the future in such cases. It is desirable not only to study the case carefully, but to obtain some knowledge of the previous history of an individual who is claiming damages on account of traumatic neurasthenia.

NEURI, an ancient tribe placed by Herodotus (iv. 105) to the north-east of Scythia. He says of it that it is not Scythian, but has Scythian customs. Every member of it, being a wizard, becomes a wolf once a year. The position assigned to their district appears to be about the head waters of the Dniester and Bug (Bugh) and the central course of the Dnieper just the region which, on general grounds, place-names, recorded migra tions and modern distribution, appears to be the original location of the (q.v.). The wolf story again recalls the tales of werewolves so common among Slavonic peoples, and there is much probability in Schafarik’s conjecture that the Neuri are nothing but the ancestors of the Slavs.

 NEURITIS (Gr. , nerve), a term applied to the inflammation of one or more bundles of nerve fibres. Two varieties are known, the localized and the multiple. The localized form frequently follows on exposure to cold and may attack a single nerve. Facial paralysis (Bell’s palsy) is commonly seen following a neuritis of the facial nerve. Neuritis may follow blows and wounds of a nerve, injuries involving stretching of a nerve or long continued pressure such as may occur in a dislocation of the elbow joint, or the nerve may share in the extension of a neighbouring inflammation. The first symptom of a localized neuritis is pain of a boring character along the course of a nerve and its distribution, the part being sensitive to pressure. There may be slight redness and oedema along the course of the nerve, movement becomes painful in the muscles to which the nerve is distributed, numbness may follow and the tactile sense be impaired, finally the muscles atrophy, and degenerative changes may take place in the nerve or nerve sheath. Slight cases following cold or injury may pass off in a few days, while severe cases such as those following the pressure of an unreduced dislocation may last for months.

Multiple neuritis or polyneuritis is a disease which may affect many of the peripheral nerves symmetrically and at the same time. For the pathological changes see. The difference in these changes is due mostly to the difference in the aetiology of the neuritis. The causes may be divided as follows: (1) The toxins of acute infective diseases, such as diphtheria, influenza, typhoid fever, malaria, scarlet fever and septicaemia. (2) Acute or chronic poisoning by lead, arsenic, mercury, copper and phosphorus. (3) General disorders: gout, rheumatism, tubercle, carcinoma. (4) The local action of leprosy and syphilis. (5) Endemic disease: beri-beri. (6) Alcohol, the most common.

Alcoholic neuritis occurs as a result of constant steady drinking, particularly in those who drink beer rather than spirit. The earliest symptom is numbness of the feet and later of the hands, then painful cramps in the legs appear and there is pain on moving the limbs, or the patient complains of deadness, tingling and burning in the hands and feet, and superficial tenderness is occasionally present. In other varieties of the disease the earliest symptoms are weakness of the legs and extreme fatigue, leading to a characteristic “steppage gait,” or marked inco-ordination of movement may occur and the gait become ataxic. Trophic changes soon appear, in some cases early and rapid muscular wasting occurs, the skin becomes dry and glossy, the nails brittle and the hair thin. In time actual contractures takes place, the hip and knee-joints become flexed and the foot dropped at the ankle. In cases that recover there may be permanent deformity. Should the case progress the patient may become bedridden and powerless, and degenerative mental changes may take place, loss of memory, irritability of temper and emotional instability. Various complications such as bronchitis, fatty changes in the heart, albuminuria and a liability to pulmonary tuberculosis, tend to carry off the victim of chronic alcoholic neuritis. Cases seen early in the progress of the disease, who can be placed under supervision, may recover under treatment, but those in whom the attacks have recurred several times and in whom there is much mental impairment rarely make a complete recovery. The treatment consists in putting the patient to bed, with the administration of strychnine hypodermically, and attention should be paid to the position of the limbs so as to avoid the development of contractures, cradles being used, the limbs kept in the correct positions by sandbags, and gentle massage being employed as soon as possible. Should contractures have already formed) some mechanical device adapted to stretch the contracted muscle must be resorted to. Biers’ hyperaemic suction apparatus is very useful in the painless stretching of contracted joints, or old-standing adhesions may have to be broken down under an anaesthetic, extension apparatus being afterwards worn. In the later treatment the galvanic and faradaic currents combined with massage are useful in helping to restore the wasted muscles, and hot-air baths and warm applications are appreciated.

Arsenical neuritis mostly affects the lower extremities, as contrasted with lead, which mainly paralyses the fingers and wrists; recovery is even slower than in alcoholic neuritis, the treatment being on the same lines, with the removal of the cause of the disease. In the neuritis of chronic lead poisoning a fine tremor of the hands is an early symptom and sensory symptoms are usually absent; the muscles affected are the extensors of the wrists, thumb and fingers