NEURALGIAS OF THE NERVES OF THE LEGS, described as crural, plantar, meta tarsal, etc., present the usual features of neuralgia in general and need not here be elaborated.
Treatment.—The treatment of the in tercostal form of neuralgia, as of the two preceding varieties, is that of neuralgia in general. Especially good results are obtained from counter-irritation, prefer ably the actual cautery.
Treatment of intercostal neuralgia should be either palliative or radical. Among palliative measures may be in cluded mustard poultices. chloroform liniments, blisters quickly removed, dry cupping, or even the actual cautery. Radical treatment should be directed to the cause, since intercostal neuralgia is not a disease, but a symptom. Frank Billings (Chicago Med. Recorder, Sept., '95).
Migraine.
Definition.—A form of severe parox ysmal headache often accompanied by nausea and vomiting. Called also "hemi crania," "neuralgic headache," "sick headache," etc.
Symptoms. — Premonitory symptoms extending over a few hours to a day or two are not uncommon, these being mental hebetude, somnolence, or de spondency, with vague uneasiness or ill defined discomfort. Abnormal visual phenomena are also frequently seen prior to onset of the attack, these consisting of visual hallucinations, pupillary abnor malities, hemianopsia, and indistinctness of sight. Disturbances of other sense mechanisms are more rare, although sometimes shown, such as anTsthetic areas about the head and face, aphonia, and transient mental disorder or con fusion of ideas. Following these pro dromal symptoms more or less closely, or accompanying them in quickly-de veloping cases, we have the characteris tic headache, at first unilateral, located in the temple, eye, or occiput, but spread ing as it increases in intensity until it in volves all of one side of head, or in some cases both sides. The pain is intense, throbbing, and is increased by move ment, noises, light, and any worry or emotional strain. Nausea is usual and vomiting frequent, becoming, in the so called bilious headache, very distressing. This vomiting in occasional cases gives relief, its occurrence marking the end of the attack; but the usual rule is that the pain is increased and rendered more unbearable by the vomiting. The face
is sometimes flushed, sometimes pale; I the pulse is slow and the arteries throb and have a sclerotic feel to the touch. There is great prostration and physical weakness, and complete loss of appetite. Temperature abnormalities arc some times present, but are neither constant nor characteristic. The urine is some times abundant, sometimes almost sup pressed. Constipation at the beginning of the attack is the rule. The duration of the paroxysm is variable, from a few hours to several days. Twenty-four to thirty-six hours of suffering is frequent, and in the severer forms the patient may be kept in bed three or four days. The attacks recur for years, or, in rare cases, through life. In old age they usually cease; and in many women there is complete cessation after the climacteric. The seizures in women are apt to occur at or near the menstrual periods. The attacks subside slowly, as a rule. With the beginning diminution of the pain the patient falls asleep and awakes some hours later free from the pain and often feeling better than before the attack.
Close connection between migraine and other neuroses pointed out. The cortical disturbance which produces mi graine may extend, and so produce other neuroses; thus heiniamesthesia, func tional motor paralysis, aphasia, or alexia may result. In two cases mental dis turbance was noted, in one hallucina tions and loss of memory occurred im mediately after an unustuilly severe at tack of migraine., and IVCIT follotved by ft condition of stupor lasting thirty-six hours; gradual recovery took place. In the other, each attack was associated with maniacal symptoms lasting about an hour and a half, the patient having no remembrance of the attack when it was over. both these cases there was typical migraine with telchopsia. Mi graine is not to be regarded as a special form of epilepsy or hysteria, hitt either of these may succeed it. kralTt-Ebing (Neurol. Centralb., Nov., '95).