Mar.14

Benedikt calls attention to recurrence of endemic supra-orbital neuralgia in Vienna, at the period between the end of winter and the beginning of spring. He has noted this for thirty years. In most cases the disease appears in the form of peripheral neuritis.

FIG. 5.-ENLARGED VIEW OF A PORTION OF FIG. 4.

a, normal nerve-fibres; b, altered nerve-fibres. Numerous nuclei occupy the space between the fibres.

The pain is continual during the attack. The malady has been very common and violent, affecting chiefly people who live near the Danube. The ordinary treatment by quinine, antipyrin, and

FIG. 6.-OBLITERATED ARTERY FROM THE CONNECTIVE TISSUE SURROUNDING
THE NERVE AND FORMING ITS SHEATH.

a, external limit of artery; b, muscular coat, evidently altered; c, fenestrated membrane. The mass
forming the centre of the artery is fibrillated and contains a number of nuclei, and is continuous with the
remaining coats of the artery where the fenestrated membrane seems broken through, and also at other points.
Other arteries in the neighborhood of this one, all of them of large size, are in a similar condition.

antifebrin gave some relief, but it caused the attack to be more violent in the end. The specific treatment seems to be the giving of iodine salts. Galvanization, also, is of great benefit. Immerwahr finds that methylene blue is, under certain circumstances,

Oct.8

(Medical News.)

FIG. 8.-SECTION OF NERVE SHOWING SLIGHT DEGENERATION. (Medical News.)

a valuable agent in relieving neuralgic pain. In sciatica it appears to be of no value, nor is it suited to other than nervous pain. He gave the drug in two 5-grain (0.32 gramme) doses, inclosed in gelatin capsules, three times a day. After prolonged use some strangury occasionally sets in, which soon yields to small doses of powdered nutmeg. Malherbe reports 2 cases of facial neuralgia. He commends subcutaneous injections of cocaine in the treatment. Le Diberder, reports 2 cases of extreme neuralgic pain in the tongue with ulceration of the tongue, in which he suspected a malarial taint. Both were cured by doses of quinine. Lumbago.-Latta studies the diagnostic differences between lumbago and lumbar sprain, which he tabulates as follows:

Nov.

MYALGIA LUMBALIS.

Duration, five to ten days.
Onset, sudden.

Cause Predisposition; rheumatic or gouty diathesis; exposure to cold and wet; overfatigue or slight strain of muscles in one having a predisposition.

Pain: Tearing or aching; confined to a single or group of muscles; aggravated by

movement.

No outward signs.

Rarely painful to touch; pinching af fected muscle may elicit pain.

No particular decubitus.

Heat aggravates.

Constitutional symptoms not common.

100 Mar.10

127

Sept.

LUMBAR SPRAIN.

Duration, fourteen to twenty-eight days.
Onset, instantaneous.

Cause: Injury by twist, fall, direct force, or from overlifting.

Pain: Acute, lancinating, and diffused; slight movement causes agony.

Local heat; swelling, ecchymosis, and discoloration.

Excessive local tenderness.

Decubitus on either side, with knees drawn up toward chin. Heat is grateful.

Constitutional symptoms nearly always

present.

Sciatica.-Charcot reports a case of double sciatica, with degenerative atrophy of the muscles supplied by the external and internal popliteal. In this case he was able to exclude cancer or other disease of the vertebræ, poisoning, diabetes, or any injury of the sacral plexus; and he concludes that there may be a primary double sciatica, which is not symptomatic of any other affection, and is susceptible of cure. Mettler argues that sciatica is distinctly not a neuralgia, but a neuritis of the sciatic nerve. Potts 112 reports a case of double sciatica, which he thinks due to malarial poisoning and which yielded to appropriate treatment. Lebon relates a case in which there was a spasmodic contracture of the muscles of the leg, with an irregular tremor in the leg, and devi

Mar.

152

Jan.16

Apr. 4

was atrophy of the mus

73

Lamy reports 2 more

Jan.10

ation of the vertebral column. Charcot, describes a case due to overuse of the sewing-machine. There cles supplied by the popliteal nerve. cases in which a lateral deviation of the inclination being toward the side of the spasmodic character. Massalongo points out that Vanzetti had observed the deformity of the trunk in sciatica as far back as 1850, although his observations were not published.

1 July 25

July

3 Oct.21

spine was observed, the sciatica, which was of a

3

Oct.14

report cases in with the beginHolmes re

117

July

Eliot Jy suggests that a large proportion of the cases of sciatica are due to neuritis. He commends salicylate of sodium and iodide of potassium as curative agents, and for the more purely neurotic drugs which afford considerable benefit gives aconite, belladonna, and gelsemium. Lépine on and Debove which polyuria was a marked symptom, coming on ning of the trouble and disappearing as it ceased. ports a case, without autopsy, in which sciatica supervened in a case of lymphadenoma, and which led to a fatal termination. Derasse cites a case of traumatic sciatica, caused by the application of obstetric forceps. Charvot has obtained good success from stretching of the nerve in 3 cases of sciatica. Weir Mitchell1013 once more returns to the importance of rest by a splint and the application of dry cold over the affected nerve, sometimes associated with the actual cautery, in the treatment of sciatica. Liégeois has tried solanine without any success.

3

Apr.22

99

Apr.

33

July

Metatarsal Neuralgia.-Bradford calls attention to this form of neuralgia, first described by Morton. The pain is slight at the base of the fourth toe, but in severe cases radiates up the leg. It may be of dull character, or extremely severe. It is aggravated by local pressure over the metatarsal or by squeezing the foot. The affection is due to a neuritis caused by pinching or bruising the nerve by the fifth bone. Lateral pressure brings the

head of the fifth metatarsal and the little toe into direct contact with the base of the first phalanx and the head and neck of the metatarsal of the fourth toe, and by lateral pressure the nerve may readily be affected. The affection is readily detected by lateral pressure, which increases the pain. The most satisfactory treatment is by an appropriate shoe, which will put no lateral pressure upon the foot. In the severest cases an operation may be required, the excision of the head of the fourth metatarsal bone.

138 Sept.

75 May

Treatment of Neuralgia.-Ehrmann notes the occurrence of severe facial neuralgia after the administration of iodide of potassium. Eliot advocates the improvement of the general condition, especially of the nervous condition. Immediate relief is given by hypodermatic injections of morphine and similar drugs. An appropriate specific remedy, if the disease be of rheumatic or syphilitic origin, is of advantage; in other respects he recommends the use of the neurotics aconite, belladonna, and gelsemium, and the external application of counter-irritants and anodynes. Steiner claims that the use of a spray of chlormethyl upon the affected part is preferable to the use of drugs. The application is made daily, the spray being directed on the affected part from a copper siphon, in which the chlormethyl has been subjected to a pressure of four atmospheres. The pain is relieved at once, and, after the first week, does not return.

1 Oct.31