334 DISEASES OF THE PERIPHERAL NERVES. 



came only in winter, as well as from the generally favorable course 

 and good result of treatment, it seems probable that this disease most 

 frequently results from catching cold. Diseases of the vertebrae also 

 appear to induce this form of neuralgia, in some few cases, by pressing 

 on the veins as they pass out of the vertebral canal ; and swollen lym- 

 phatic glands, deep in the neck, may cause it by pressing on the cervi- 

 cal plexus and the occipitalis major. 



In cervico-occipital neuralgia, patients also complain of a continued 

 dull pain, limited to small spots, which is, from time to time, accompa- 

 nied by attacks of very severe lancinating pain shooting out in various 

 directions. According to Valleix, these isolated painful spots are : 1. 

 An occipital point located below the occipital bone, between the mas- 

 toid process and the first cervical vertebra, corresponding to the point 

 where the nervus occipitalis major [posterior occipital] perforates the 

 complexus muscle and becomes subcutaneous. 2. A superficial cervical 

 point, somewhat above the middle of the neck, between the trapezius 

 and sterno-cleido-mastoid muscles, corresponding to the point of exit 

 of the chief cervical nerves. 3. A mastoid point, lying behind the 

 mastoid process, corresponding to the occipitalis minor and auricularis 

 major nerves. 4. A parietal point near the parietal protuberance. 5. 

 An auricular point in the auricle. In the attacks the pain darts from 

 these points toward the occiput, the posterior, and upper part of the 

 neck, anteriorly to the face, and, occasionally, downward, toward the 

 shoulder. Cervico-occipital neuralgia is not unfrequently complicated 

 with prosopalgia and neuralgia of the brachial plexus. The attacks 

 Bometimes occur at irregular intervals, sometimes from movements of 

 the head, or other slight causes. They are rarely so severe as the at- 

 tacks of tic douloureux. Disturbances of nutrition in the territory of 

 the cervical nerves are exceedingly rare, if they ever occur. Cervico- 

 occipital neuralgia is far less obstinate, and is rarely so permanent as 

 facial neuralgia. 



In this affection division of the nerves has not been tried. In 

 recent cases blisters are recommended, particularly by Valleix } as well 

 as MegUrfs pills and all other remedies that are used in prosopalgia. 



CHAPTER VII. 



CERVICO-BRACHIAL NEURALGIA. 



BY cervico-brachial neuralgia we mean a neuralgia located in the 

 sensory twigs of the brachial plexus, which is composed of the lower 

 four cervical and the first dorsal nerves. 



This form of neuralgia has perceptible causes far more frequently 



