During the last ten years massage of the peripheral nerves * has become much more extensively used, since the diagnosis of neuralgia is so often replaced by that of neuritis, for which the benefits of massage are obvious.

Insterstitial neuritis of rheumatic or other origin, with inflammatory increase of connective tissue, but with unaltered or almost normal nerve fibres, is that which best lends itself to massage, and is extremely common, usually as a bye-product of processes which have spread by contiguity to other parts, especially to the muscles.

Sometimes, especially in the case of the nerves of the face, and particularly with the supra-orbital nerve, one is able by means of palpation to feel the thickening of the nerve + as a result of interstitial neuritis, so that it either feels thickened in the whole of its length, or localised swellings lead one to diagnose a "neuritis nodosa disseminata." The easiest method of examination is first to knead the surface with a lubricant, then by palpation with the tips of the fingers glide forwards and backwards over the nerve trunk at right angles to the axis, then carefully compare the result of palpation with the normal nerve trunk on the healthy side. If one thus succeeds in changing the more general diagnosis of "supraorbital neuralgia" or "facial cramp" to the more satisfactory one of "supra-orbital or facial neuritis" or "perineuritis,"one works most during massage treatment by frictions over the changes present, but without neglecting to treat the nerve in its whole length by other manipulations, even where palpation gives only a negative result. One lays greater stress on working over those parts where the nerve emerges from an opening in the bone (e.g., the supra-orbital foramen), or where it passes through a muscle {e.g., where the great occipital nerve becomes cutaneous by piercing complexus behind the mastoid process), or where it perforates fascia (e.g., where the lateral branches of the intercostal nerves become superficial in the intercostal spaces). It is in such places, corresponding to the "puncta dolorosa" of Valleix, that we generally find the most marked evidence of chronic inflammation felt as small swellings.

* Massage of peripheral nerves was mentioned at least as early as 1758, when Fordice wrote, in reference to hemicrania: "Compressio vel frictio nervi, qui cranium supra oculi orbitam perforat, aliquando dolorem lenit, nunquam delet." Cotunni spoke of massage of the sciatic nerve. Balfour of Edinburgh used nerve massage about 1820, and many other historical references exist.

+ Reinhardt Natvig of Christiania has collected earlier accounts of pathological changes in the nerves . We find, among others, that Tournilhae-Beringier in 1814 found the sciatic nerve thickened to three times its volume in a case of sciatica, and that Astley Cooper found the infra-orbital nerve atrophied in a case of neuralgia.

In many cases one cannot feel the nerve by palpation, but must rely in the treatment on one's knowledge of topographical anatomy, and if there is reason to suspect an interstitial process the nerve should be treated in as large a part of its area of distribution as possible by frictions, the most important manipulation in cases of interstitial neuritis. This should be followed by the ordinary nerve massage, vibrations, and effleurage.