336 DISEASES OF THE PERIPHERAL NERVES. 



duced brachial neuralgia, neurotomy proves triumphant, particularly 

 in recent cases, and when the neuralgia has not become " habitual." 

 Besides other remedies that we have already mentioned, the internal 

 administration of oil of turpentine has some reputation ; we shall refer 

 to it again when speaking of sciatica. 



CHAPTER VIII. 



INTERCOSTAL NEURALGIA. 



WE designate as intercostal neuralgia the morbid excitement of 

 one or several spinal nerves, particularly of those which as intercostal 

 nerves pass along the upper intercostal spaces to the sternum, and 

 along the lower spaces to the epigastrium. 



Intercostal neuralgia is among the most frequent forms of neural- 

 gia. It is met more frequently in women than in men, shows a sur- 

 prising predisposition for the sixth, seventh, and eighth intercostal 

 nerves. We have already spoken of the shrewd explanation that Henle 

 gives for this peculiarity. The fact that the inferior intercostal nerves 

 are chiefly affected, that is, the ones that empty then* blood into the 

 hemiazygos vein, supports the view that one of the chief causes of niter- 

 costal neuralgia is dilatation of the venous plexus, which most readily 

 occurs at these places, and exercises pressure on the roots of the spinal 

 nerves. In some cases the dorsal nerves are pressed upon, where they 

 pass through the intervertebral foramina, by inflamed vertebrae, or, after 

 they have passed through, by carious ribs and swollen glands. Inter- 

 costal neuralgia not unfrequently occurs after recovery from pleurisy. 

 Within a year I have seen two cases which undoubtedly had this 

 origin. It is doubtful what anatomical changes in the neurilemma or 

 in the parts surrounding the nerves, during a pleuritis or the reabsorp- 

 tion of the pleuritic exudation, have occurred in these cases. The 

 same is true of those cases of intercostal neuralgia that occasionally 

 accompany tuberculosis of the lungs. Lastly, as the disease is par- 

 ticularly liable to occur in hysterical women with chronic uterine dif- 

 ficulty, it has also been referred to a propagation of the morbid excite- 

 ment from the nerves of the uterus through the spinal medulla to the 

 brachial plexus (Bassereaii). 



In intercostal neuralgia, the three painful points mentioned by 

 Valleix are more frequently observed than in most other forms of 

 neuralgia. The first or vertebral point is in the posterior part of the 

 intercostal space, somewhat outward from the spinous process, and 

 about on a level with the point of exit of the nerve from the interver- 

 tebral foramen. The second or lateral point lies in the middle of the 



