Toxic Polyneuritis

of Ten Cases Presenting Some Unusual Features By R. S. ALLISON, M.D., M.R.C.P.(LOND.), AND W. H. PATTERSON, M.D. NEURITIS is a common complaint and a term often loosely used to describe indefinite sensory symptoms. Polyneuritis or peripheral neuritis is, however, a definite entity and much less common. Harris (1) classifies its causes into four main groups (a) Caused by the absorption of poisons introduced into the body. (b) Due to auto-.toxamia or to poisons developed primarily within the body. (c) Due to infection of an organismal nature. (d) Occurring in cachetic states. It is unnecessary to detail the various well-knowvn causes in these groups, such as lead, a'cohol, (liabetes, and diphtheria, but some recent additions are of note. A few years ago a form of polyneuritis occurred epidemically in America from the drinking of a patent preparation known as Jamaica Ginger or "Jake" (2). Tlhe neuritis was not caused by the alcohol content, as might be expected, but bv a chemical adulterant tri-orthocresyl phosphate, which was found in some of the samples of the preparation examined. In Europe a similar type of polyneuritis has been observed in women. Carillo and Ter Braak (3) investigated an epidemic of this in Holland. They noticed that those affected had been taking apiol, an extract of parsley seed which has antipyretic properties. In their cases, however, the apiol had been clearly used to produce abortion. Furthermore, they were able to produce a polyneuritis in chickens by adding it to the food. They found that apiol also contained triorthocresyl phosphate, but state that the polyneuritis produced by this substance differs from that due to pure phosphorous poisoning. It deserves, therefore, to be added to the list as a separate condition. Apart from the above well-defined causes of polyneuritis, there occur, from time to time, cases in which the disease appears spontaneously and unrelated to any obvious poison or infection. Osler(4) gave the name of 'acute febrile polyneuritis' to this type, and under the heading of etiology mentioned "cold, over-exertion, or spontaneous onset." Bradford, Bashford, and WVilson (5) described a series of 30 similar cases, and Gordon Holmes (6) reported cases in soldiers during the Great War. Harris (1) suggests that the title 'toxic polyneuritis' should be reserved only for those cases in which the infective agent or source of the poison is not clearly established. In 1932 ten cases were seen in the North of Ireland which appeared to fall into this group-toxic polyneuritis. It is thought that this comparatively large number of cases is worthy of record, because of the infrequency of the disease, and because unusual features were present in many of the cases. It is propos'ed to describe first a typical case, and then discuss the mode of onset, clinical course, and etiology of the group considered as a whole.