NEURITIS.
Treatment depends upon the local or constitutional cause : in many instances where only one trunk is affected (mononeuritis) a careful inquiry will reveal trauma, pressure or compression, as when one or more of the arm nerves become inflamed after a heavy sleep during which the nerve trunks have been compressed against some hard body by the weight of the upper extremity, thorax, or head. It must always he remembered that in such cases the first results are those of neuritis, which afterwards are followed by paralysis and wasting. This is seen in so-called " crutch palsy " and in those cases of tumour pressure and continuous strong muscular action as in hammermen. The treatment consists of absolute rest to the affected limb, the application of dry warmth by light bandaging over a thick layer of cotton-wool, and when the pain is severe the internal administration of an analgesic or the hypodermic use of Morphia. Upon cessation of acute pain, electricity, massage and passive movements will be indicated for the restoration of function.
Where an attack of acute neuritis (perineuritis) follows exposure to cold, especially a stream of cold air playing upon a localised area of the skin, the same treatment is indicated combined with full doses of the usual anti-rheumatic agents, as Salicylates, Aspirin, &e. A good routine is the following: Acid. Acetylsal, gr. x.
Salicin. Pi-erif. gr. viii. Misce.
Fiat pulv. :Mite tales xviij. St. i. ter die post cibunt.
Blistering is clearly indicated in such cases where the symptoms fail to yield rapidly to the above measures.
In very chronic examples of mononeuritis, the inflammatory changes are of an interstitial character, and in addition to the indication for the relief of pain, the wasting of the muscles and loss of power call for electricity and continual gentle massage combined with the internal administration of large doses of Iodides and repeated blistering, as in the treatment of sciatica.
In every case a search must be made for a constitutional cause; thus gout, rheumatism, diabetes, alcoholism, diphtheria, malaria, syphilis, influenza and mineral poisons, like those of mercury, lead and arsenic, may be the underlying causes, though these factors are more liable to lead to the peripheral type of neuritis. The presence of each of these causal elements affords clear indications for treatment. Arteriosclerosis is another well-recognised cause and is an indication for the free adminis tration of Nitrites.
Local treatment of a neuritis involving a single nerve or any of the cords given off by a large plexus, as the cervical, brachial or lumbar. may as a rule be carried out upon the lines laid down for neuralgia, but in the early acute stage of neuritis, heroic massage, very hot applications, the cautery, acupuncture and electricity are certainly contra-indicated Leeching the skin over the trunk of a solitary inflamed nerve near to its exit from a bony foramen or from a fascia] opening is often productive of excellent results, as in acute neuritis of the facial as it emerges from the stylo-mastoid foramen. In acute neuritis of the sciatic nerve in thin patients the leech bites may be covered over by a cupping-glass with advantage.
For the relief of pain locally and constitutionally and for the various means of carrying this out, the reader is referred to the article on Neuralgia. The treatment of the resulting paralysis and muscular wasting will be detailed in the articles on Paralysis.