(b) Raynaud's disease, a symmetric ally occurring affection of fingers or toes, niarked by angiospasm, coldness, pain, mottling, swelling, and eventually gangrene. It is a rare disease, is usually associated with ancemia or soine form of tomumia, and may be complicated by neuritis. lt has by some been regarded as a neuritis, but the weight of evidence is against this view, and in the present state of our knowledge the disease may properly be included among the func tional neuroses.
Neoplasms.
Tuinors growing in or upon the nerve trunks are either true neuromata—i.e., tumors composed of inedullated nerve fibres or other nerve-tissue—or are false neurornata,—i.e., composed of other than nerve-tissue. The "false" nenromata are usually of secondary, origin; that is, . • I iv tient. from adjacent struet t: (Allmon kinds being 1, sarcoma, and the .1 ,ind tubercular growths. They ..t.t. ! be considered here, attention ,i.z rectLd onl‘ to the true nerve '. .r-.
Nt-t-tw \IA occurs singly or in num . naching into the thousands. When Itiple- they arc ustmlly small, and rti snot-like, but quite painful, nod tii,khr the skin. When few in num thev are apt to be larger in size, htin occasionally an inch or more in d,anik.ter. Tile causes of neuroma are, the multiple form, hereditary predis i os;tion, and, in the simple form, in juries to the nerve-trunk from blows, surgical operations, etc. The knob-like masses which develop upon the ends of the nerves of the stump after amputa tion offer a good example of this form :f neuroma.
The symptoms of neuroma, beyond the presence of the tumor, are often ni/. In some instances, however. there is pain, parfesthesia, or paralysis in the affected nerve-area. Occasionally the pain is in tense. distressing, and nenralgic in char acter. as is seen in post-amputation neu romata.
In neurofibromatosis the tumors are both cutaneous and connected with nerves. They are of variable consistency and resemble mollusca. Usually tbe face is spared, also the palms of the hands, soles of the feet, and the genitals. Often they are distributed along a nerve-trunk like a string of beads. Pigmentation is frequently in small spots, but large colored areas may be seen. The pa tients often have loss of memory and show some difficulty in comprehension.
Slowness of movement, tremors, and epi leptiform seizures are noted among the motor disorders; and vague anmsthesia and parmsthesia, with painful cramps, among the sensory disorders.
The disease is sometimes congenital, but may appear in adult life or ad vanced age: Feindel (Jour. de med., Mar. '97).
Treatment.—No treatment is called for unless there is pain or other inter ference with nerve-function, when sur gical measures, usually- a total excision, arc called for and give relief.
When examined microscopically true neurornata are found to consist of nerve fibres, mcdulluted or non-medullated, with occasionally a few ganglion-cells interspersed, these nerve-elements being mixed with some fibrous tissue. When the fibrous tissue is abundant the growth is spoken of as "fibroneuroma." Diseases of Special Nerves.
The several conditions of general dis ease above described may, when involv ing special nerves, give rise to well defined clinical symptom-groups merit ing brief description.
Diseases of the nerves of special sense —the olfactory, optic, auditory, etc.—are dealt with by specialists and are, to a large extent, devoid of general interest. The affections of the optic nerve, of which neuritis is the most important, are of value in the diagnosis of intracianial lesions.
Disease of the 3d, 4th, and 6th pairs of cranial nerves leads to abnormalities of ocular movement, whose consideration falls within the domain of the eye spe cialist, although the lesions are often of value in diagnosis of brain diseases.
Up to the present date there have been twenty-seven eases of recurrent paralysis of the third pair. The affec tion usually begins with violent pains, localized in one side of the cranium, nausea and vomiting, and contractions. The paralysis then becomes established; pto.sis, external strabismus, mydriasis, paralysis of accommodation, and crossed diplopia develop, with very intense, per sistent, unilateral pain, with frequent irradiation toward the base of the head and upper portion of the neck, being greatest in the supra-orbital region. P. Darquier (Jour. de Med. et de Chir. Prat., July 25, '94).