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Related post: in the medulla oblongata or in the upper Cheap Exelon cervical region of
the cord, but these cases were either not acute ascending
paralysis at all, as in the case reported by Leydeii,J or the
lesions were too small l(^ explain the symptoms, as in the
case of Kiiintnel,* or, finally, the lesion was of a very inde-
terminate nature and not found in other cases, as the patches
of exudative matter deeply stained by carmine found by
* Gazelle hcbdomadairc, 1809, pp. 472 and 486.
f Arc/tii'ei) ffeneralcs, I86B, i, p. 123.
t Allff. Zeit»chrl/l /. Pnyeh., 1875.
« ZeilKchrift f. Klin. Med., 1881, ii, p. 273.
Eisenlohr,* and the swollen axis cylinders and minute hiem-
orrhages found by Hoffmann. f
Myelitis of the anterior horns bears a closer resemblance
to acute ascending paralysis, although bulbar symptoms oc-.h
cur very rarely in the former disease. In both diseases^!
there is a widespread motor paralysis with abolition of re-
flexes and without any disturbance of sensibility or of the
ori;anic reflexes ; and the attempt has been made by Petit-
fils,J Bernhardt," and others, to classify acute ascending pa-
ralysis as a form of myelitis of the anterior horns in which,
in consequence of the rapidly fatal termination, the muscles
do not exhibit the characteristic electrical reaction of de-
generation during life, nor do the nerve cells in the anterior
hornsexhibit any definite changes in death. Theseassump-
tions were disproved by \Vestphal,|| who, in several cases of
relatively long duration, found neither lesions after death
nor the electrical reaction of degeneration during life. Since
the publication of Westphal's paper the early ajipearance of
muscular atrophy and that of the electrical reaction of de-
generation have been regarded as diagnostic symptoms, and
are sufficient to distinguish clinically myelitis of the anterior
horns from acute ascending paralysis ; while at the autopsy
of cases of myelitis of the anterior horns a definite lesion is
found sufficient to explain the symptoms observed during
life. Although in most cases there is no prcat difficulty iu
distinguishing these two forms of disease from each other
clinically, yet some cases of myelitis of the anterior horns
simulate the symptoms of acute ascending paralj sis quite
closely, as, lor instance, the cases reported by Sudeykine ■^
and Immerniann. ^
Multiple neuritis bears a very close resemblance to acute
ascending paralysis, and, just as twenty years ago, when
myelitis of the anterior horns was attracting great attention,
the attempt was made to regard Landry's paralysis as a
form of it, so, during the past five years, when multiple
neuritis has been attracting much attention, the attempt has
been made to regard Landry's paralysis as one of its forms,
but neither attempt has been as yet successful. Certainly,
to one who has observed cases of both diseases, Exelon Price there is a '
decided tlifference Buy Cheap Exelon in the clinical picture of Landry's paraly-
sis and multiple neuritis. There can be no doubt that
many of the cases which have been reported under the name
of acute ascending paralysis are really cases of multiple
neuritis; but in every such case in which the autopsy has
revealed a multi[>le neuritis, even of slight degree, the
symptoms of bulbar paralysis were absent or very slightly
marked, J and there was present during life either a decided
disturbance of sensibility, manifesting itself by severe pain
* Viichow's Archiv, 1878, Ixxiv, p. 73.
•f Archiv fur Paychiatrie, 1884, xv, p. 140.
I Cotvndiratians sur Falrophie aigiie den cellvhn molriees, Paris,
1879, p. 93.
» Berl. klin. Woehensehrifl, 1871, No. 47.
II Buy Exelon Arehivf. Pxyrhialrie, Bd. vi, p. 766.
A RhshI: Med., St. Petersburg, 1886. Cirlhl.f. llin. J/ed.. 1887.
^ Pulimnijelilis Anterior Acuta, Subacuia et Chronica. By Charles
Morel. Basel, 1890.
J Dillioulty of respiration due to paralysis of tlie intercostal or
phrenic nerves can not be regarded as a symptom of bulbar paralysis
in tlie absence of any disturliancc in deglutition and speech.
1 l>y extensive aiiwsthesia,* or else a paralysis of the
^jrliincteis, f or else the muscles presented a more or less
wi II -marked electrical reaction of degeneration, and were
t iideron pressure and atrophied J — symptoms which form
If part of the clinical picture of the disease described by
It is true that cases of Exelon Online multiple neuritis present so much
\ariation in the relative prominence of the sensory and mo-
t'T symptoms, in the completeness of the electrical Exelon Cost reaction
ul denjeneration, and in Order Exelon their other symptoms, that it seems Buy Exelon Online
somewhat artificial to insist on separating the complex of
svinptoms constituting Landry's paralysis from the general
' liss of multiple neuritis. But Purchase Exelon if we do make such a sepa-
rition, we can find in medical literature some two dozen
i-es of well-marked Landry's paralysis, while many other

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