Pure "parenchymatous neuritis" which is a degenerative process whereby the myelin sheath and the axis cylinder lose their outline and gradually become granular and indistinct, till at last they are destroyed and reabsorbed, differs in many practical respects from interstitial neuritis, especially for the masseur. In examination one cannot always expect to feel the nerve by palpation, nor can one always find a definite tenderness to pressure over its branches. The process has often crept on so insidiously that the changes are considerably advanced before the patient has sought medical advice. He may often have felt in a definite region, generally in the leg, trembling, vibrating pains, which Englishmen call "tingling sensations." In most cases no pronounced motor symptoms are found. The most important treatment in such cases is always simple effleurage, lightly carried out for nutritive purposes over the whole or the greater part of the limb. However favourable may be the conditions for this manipulation, especially in the lower extremities, which are most often affected, such cases seldom give a satisfactory result. Considerable experience, especially in cases of alcoholic, diabetic, and gouty parenchymatous neuritis, has taught me that even in slight early cases, and even when one can remove the cause, as is sometimes the case in alcoholic neuritis, therapeutic results are slowly obtained. When the causes of the disease remain the results are still less satisfactory. When a patient has suffered from diabetes for many years, and begins to experience the unusual symptoms of paralysis of the leg, especially loss of dorsal flexion in the ankle joint, which paralysis is due to neuritis, not to the changes in the posterior horn of the spinal cord present in diabetes, one can retard the development of the process by massage and gymnastics, but the final result, if the patient lives any length of time, is local paralysis.

Pure neuralgia, by which we mean peripheral nerve pains of central origin and other pains for which we cannot discover any peripheral cause, is treated peripherally by effleurage and vibrations (see later concerning Central Nervous Diseases). In these instances, as in many others, we must not neglect the help of electricity and other therapeutic means. Hot-air baths especially are of great value. (The best apparatus is the Bier-Eschemann.)

In nerve injuries massage is used for the same reason as has already been given in speaking of injuries in general, and here again it is effleurage which encourages healing, counteracts inflammation, etc., and frictions which remove inflammatory products. In contusions, where there is a disturbance of sensation and mobility (with marked variations), and not seldom also changes of a trophic nature, it helps to bring the process to a rapid and favourable end. This is often the case after injury where there has been haemorrhage, or after operation, especially after the modern nerve suture (Tillman's). In these cases it is of course necessary to wait until the skin is completely or almost healed before beginning massage, which must be given over the respective muscles as well. Other treatment, particularly electricity, is generally given at the same time. It is evident that one can only expect a satisfactory result when there has been aseptic healing, which gives hope of recovery of conduction. When scar formation takes place round the central and the peripheral stumps of the nerve, and when a considerable space is left between them, no treatment is of any avail except operation and suture of the nerve.

The remarkable "sleep paralysis" which comes on suddenly at night, especially in the area of the musculo-spiral nerve, often in young healthy individuals, probably by pressure or pinching of the nerve, especially where it pierces the external intermuscular septum, disappears in a few weeks or two months under treatment by effleurage, gymnastic, and electrical treatment.

The treatment of supra-orbital neuritis and sciatica may be taken as an example.