Bell's palsy furnishes the most frequent example of neuritis due to cold. The paralysis is sudden and complete, and the wasting of the facial muscles is very rapid. Massage treatment is usually postponed for a month or six weeks from the onset. The theory is that the nerve trunk, being inflamed, should not be subjected to manipulation. Probably this is true, but it is no reason why the nutrition of the paralysed muscles should not be maintained. Moreover, in spite of the fact that the face is affected, it is quite possible to maintain most of the muscles in a state of relaxation. A small hook placed at the angle of the mouth and attached to the top of a similar hook running behind the ear will prove of the greatest assistance. Massage as prescribed for flaccid paralysis should be given, and, during the stage of recovery, exercises should be prescribed while the patient stands in front of a looking-glass. Assistive and even resistive movements can be given with ease. Prognosis depends, as a rule, largely on the duration of the paralysis before treatment is begun. Recovery may take place even after the trouble has persisted for twelve months. Throughout the early stages the region of the nerve-trunk should be avoided. In the later stages vibration over the mastoid process may be used, in the hope of loosening any adhesions that may have formed in the Fallopian canal. This treatment should be postponed till at least six weeks have elapsed since the onset of the paralysis.

Paralysis due to traumatic neuritis of recent origin should always receive immediate treatment. The injury may be due to a blow on the nerve, the ulnar nerve in every-day life, and the facial nerve after the performance of a mastoid operation, affording frequent examples. All forms of crutch and stick paralyses are also due to traumatic neuritis. Again, the nerve may receive a severe contusion without suffering direct injury, as when a bullet passes through the thigh close to the sciatic nerve.

The paralysis is immediate and of the flaccid type, and its completeness depends on the severity of the injury, varying from an almost imperceptible weakness to complete loss of power. Treatment should follow the lines already mapped out for flaccid paralysis; but, if the trunk affected is that of a "mixed" nerve (as is almost invariably the case), treatment may require modification owing to neuritis of the sensory element. The return of the motor power is rapid and complete, provided that complications do not arise as the result of the involvement of the nerve in cicatricial tissue.

Traumatic neuritis of a sensory nerve is often very troublesome to deal with, particularly during the stage of recovery. Soon after the accident treatment should follow the same lines as that mapped out for all recent injury, namely, local kneading to check effusion and to prevent further swelling, followed by the application of a thick pad of wool fastened into position by a tight bandage. General surface stroking concludes the seance.

When effusion has taken place, surface stroking is succeeded by kneading of the limb, the tender area being slowly approached. Over this area a broad grasp with the palm of the hand, and gentle kneading without actually moving the hand on the surface, will be more readily tolerated than local kneading, say, with the two thumbs.

Presuming sensation to have been destroyed, there will be no great difficulty until recovery is taking place. Then the treatment must be regulated by the condition. Some patients suffer a dull, constant, aching pain, and surface stroking will prove to be all that is necessary. Care should be taken to avoid sensitive spots during the earlier stages. These are slowly approached as sensitiveness decreases. Other patients suffer no pain unless the part supplied by the nerve is touched, when even the touch of clothes may be painful. For this type of case stroking is useless, but a firm grasp and firm kneading often afford great relief. In a third type no form of massage can be tolerated, and then the whirlpool bath may prove invaluable.

In the later stages, any time after the lapse of four to six weeks, vibration should receive a tentative trial, particularly if any thickening of the nerve can be detected, or if pressure or tension at any point gives rise to pain. The vibrations should begin some distance away from the painful area and should gradually approach the spot. If the nerve is deep-seated, shaking will have the desired effect. Frictions over any definite nodal swelling will sometimes prove effective when every other movement fails, but the movement should be started very gently and the pressure be carefully graduated.

One cause of brachial neuritis calls for special mention. It is frequently overlooked, and is easily cured by massage, provided too long a time has not been devoted to other remedies. It is a form of pressure neuritis, and is due to carrying the shoulders too low and too far "set back." It is usually accompanied by lordosis. It would appear that the clavicle, being depressed and carried backwards over the first rib, decreases the space, between the two bones, which is occupied by the subclavian vessels and the brachial plexus. There is probably no actual pressure of the nerve trunks against the bones, but the whole plexus is confined within too narrow limits. It may be said at once that all treatment will fail, unless the trapezius and serratus magnus are educated to keep the outer end of the clavicle elevated and the shoulder girdle drawn bodily forwards. Unfortunately long rest in bed has usually been prescribed, and thus the muscles have been allowed to weaken, and only static, not active, means have been taken to relieve the pressure. The result is that, on resuming the upright position, the former conditions, which caused the pain, are restored. Muscular re-education will in such cases usually be attempted too late to do more than alleviate, but it is still possible to confer great benefit. Thus it is always well to consider this possible origin of the trouble whenever called upon to treat an intractable case of brachial neuritis. Manipulation of the cervical spine as a possible cure for brachial neuritis will be considered in the following chapter.