In  the  case  of  every  female  drinker,  deception  should  be  considered  not  only
possible,  but  probable.  Servants  are  corrupted,  and  alcohol  is  often  taken
in  secret,  and  absolutely  denied.  When  a  case  does  not  present  the  improve-
ment that  might  reasonably  be  expected,  this  influence  will  generally  be
found  to  be  at  work.  Hence  it  is  of  great  importance  that  these  patients
should  be  under  the  immediate  care  of  trained  nurses,  and  not  of  their  own


ENDEMIC   NEURITIS.  119

servants  or  relatives.  The  special  treatment  of  the  disease  is  the  same  as
that  for  inflammation  of  single  nerves  already  described.  Warm  poultices
or  fomentations  should  be  applied  to  the  limbs,  and  a  daily  warm  bath,  for
twenty  minutes  or  half  an  hour,  is  often  of  great  service.  The  general  rules
already  mentioned  govern  the  use  of  counter-irritation  and  electricity.  A
very  gentle  voltaic  current  may  be  applied  to  those  muscles  which  present
indications  of  nerve  degeneration,  but  not  until  the  most  acute  stage  of  the
disease  is  over.  Rubbing  is  very  useful,  and  may  be  employed  almost  from
the  first ;  in  the  early  period  it  should  be  very  gentle ;  afterward  attempts
should  be  made,  by  passive  movement,  to  lessen  the  tendency  to  contractures.
The  extreme  sensitiveness  of  the  skin  and  muscles,  and  the  intolerance  of
the  patients,  often  render  local  treatment  very  difficult.  Attention  to  posture
will  do  much  to  prevent  the  occurrence  of  contractures,  but  it  is  often
impossible  to  induce  the  patient  to  lie  in  any  other  position  than  that  which
favors  the  occurrence  of  shortening  of  the  muscles.  These  contractures
hinder  progress  during  convalescence.  Tenotomy  is,  however,  seldom  needed.
It  is  remarkable  how  much  muscular  shortening  will  gradually  give  way.
