Vol. 60, 1909 - University of North Carolina at Chapel Hill

266 THE CHARLOTTE MEDICAL JOURNAL
and by tightening it up the amount deemed a true neuralgic pain. At times there is
necessary may be removed. The writer paresthesia. There are often associated
mentions laryngitis and the importance of symptoms in various parts of the body, as
an early diagnosis in laryngeal tuberculosis depression of spirits, mental torpor, uunatand
malignant disease of the larynx. In ural drowsiness, marked susceptibility to
intrinsic cancer of the larynx early diag- cold, torpidity of the liver, iudigestion,
nosis and prompt operation give belter re- painful spasms of tue calf muscles, general
suits than follow the removal of cancer in myasthenia, pyorrhea alveolaris, and hj'perany
other part of the body. Very excellent sensitiveness of the teeth. There is only
results have been obtained since the method one lesion likely to be mistaken for an inof
attacking the disease by the external duration, and that is a gumma. The misoperation
of thyrotomy has superseded the takes to which these rheumatic deposits give
older methods of intralaryngeal removal, rise are numerous. Many cases of cepha-
In extrinsic cancer of the larynx ulceration lalagia are of this variety; involvement of
occurs early and the glands are involved the intercostal muscles has been taken for
much earlier. Even in these cases an effort intercostal neuralgia and pleurisy; in the
should be made to extirpate the disease if abdominal wall they have been mistaken
the condition of the patient warrants it. It for acute and chronic appendicitis, gastric
should be laid down as an absolute rule ulcer, abdominal and pelvic adhesions, calthat
when an adult complains of hoarseness cuius of the kidney, and floating kidney;
or alteration of the voice of several weeks' involvemer.t of the gluteal region for sciatica
duration, the larynx should be carefully and hip joint disease: in the neck they have
examined, and if there is diminished mo- been mistaken for sw^ollen glands: the frebility
of a vocal cord, with or without defi- quently complained of growing pains of
nite tumor, the help of a skilled laryngolo- children he believes are due to this condi-
gist is necessary and should be promptly tion. A number of cases are cited illustraobtained.
ting these mistakes in diagnosis.
Chronic 'Rheumatic" Myositis.—Yaw- The Operative Treatment of Trigeminal
ger in The London Medical Lancet says Neuralgia.— HuUes (Wiener Med. Wochthat
the most frequent cause of the so-called ensch. ) presents an exhaustive review of
gouty pain is a form of chronic myositis, the results obtained in von Eiselsberg's
In a search of literature he had been amazed clinic, comprising 23 cases of neurexaiesis,
to learn of the frequency of the develop- with 22 severe recurrences and no cures;
ment of chronic myositis in muscles other 13 resections at the base of the skull, with
than those of the head and neck, and his 3 cures and 10 recurrences; 10 extirpations
attention has also been attracted to the of the Gasserian ganglion, with 8 cures,
errors in diagnosis to which this condition
had given rise. Among the causes affecting
this condition are heredity, climate, and
From this experience he draws the foUow-
ing conclusions: The medicinal treatment
may alleviate the pain for a time, and even
weather. Temporarily infiltrated muscles cause its disappearance, but permanent rehave
been observed in a child two years old. suits are unobtainable. 2. Peripheral neu-
They may appear at almost any time of life, rexaiesis generally leads to a recurrence,
and are common in old age. It is probable 3. After resections at the base of the skull
that no voluntary muscle enjoys an immu- recurrences are less frequent than after neunity,
but there are sites of predilection, the rexaiesis. 4. Extirpation of the ganglion
most common of which is in the muscles of offers the most reliable chance of a cure,
the head and neck. The gluteal, lumbar, provided it be completely removed. He
and deltoid regions, and calf muscles are suggests that in mild cases medicinal treatoften
involved. The muscles may be in- ment be pursued, since it gives about the
vaded at their points of insertion, or the
infiltrations may appear in the bodies of the
same results as neurexaiesis and does not
subject the patient to the risks of operation,
muscles: at times the infiltration extends to narcosis and infection. The administration
the periosteum to which the muscles are at- of aconitin and intraneural injections of
tached, and also to the fascia. The path- alcohol, repeated when necessary, can be
ology of these diseased muscles is largely recommended. If the disease, however, is
hypothetical. These deposits may develop of severer character and has involved two
in muscles that are overworked, in those of the branches of the trigemiuus, resection
not sufficiently exercised, in those that are
^^ ^j^^ ^ase of the skull is advisable. In
much exposed, and where an injury has .
,
i , it
"^'^'^ ^^^"^'^ ^^^^^- lio^^ver, ni which aU
been sustained. The symptoms are those
of pain, which may be shao-p and cramplike, tl^^ee branches are diseased, resort should
or aching sensation. If the swollen muscle at once be had to extirpation of the gang' iig-
impinges upon a nerve trunk there may be lion.