GEN. VI. Neuralgia. Germans is denominated gemeingefühl, or general feeling. Nerve-ache. Dr. Hubner published an inaugural dissertation on this subject in 1794, in which he enumerates its properties at some length*. I have never seen this treatise, but Sir Alexander Crichton, who has, describes it as a very ingenious production. Species of disease appertaining to the present genus seated in these nerves. It is these nerves of general sensibility that seem to constitute the seat of disease in the three species we are now about to enter upon, and consequently indicate that the present is their proper place in a system of physiological nosology. SPECIES I. NEURALGIA FACIEI. Nerve-ache of the Face. SPEC. I. LANCINATING PAINS SHOOTING FROM THE REGION OF GEN. VI. THIS is the trismus maxillaris, or t. dolorificus of M. de Synonyms. Sauvages, for it is not necessary to make a distinction between them, as Sauvages himself has done; by Dr. Fothergill it is denominated dolor crucians faciei. As the French give the name of tic to trismus or locked-jaw, they distinguish this first species of neuralgia, affecting the nerves about the jaw, by the name of tic douloureux, by which term the disease is, perhaps, chiefly known even in our own country in the present day. I shall have occasion to observe more at large, under the genus TRISMUS, * Commentatio de Canesthesi Dissert. Inaug. Medica.-Auctore. C. F. Hubner, 1794. GEN. VI. Neuralgia Nerve-ache that the word tic is commonly supposed to be an onomatopy or a sound expressive of the action it imports; derived according to some, from the pungent stroke with faciei. which the pain makes its assault, resembling the bite of of the face. an insect; but, according to Sauvages and Soleysel, from Tic douthe sound made by horses that are perpetually biting the loureux, manger when labouring under this peculiar affection. We meaning of do not, however, appear to be acquainted with the real the word tic. origin of the term. what. of this species sufficiently indiand nature. Seat and cate its seat course From the symptoms by which this complaint is distin- Symptoms guished it is not difficult to decide concerning both its seat and nature. The character of the pain is very peculiar, and its course corresponds exactly with that of the nerves. The second branch of the fifth pair is, perhaps, more frequently affected than either the first or the third. But described. the portio dura of the seventh pair, which is distributed Diagnostics. more extensively upon the face, under the name of pes anserina, is more frequently the seat of affection than any of the branches of the fifth pair seem to be; which is a matter of no small regret, as it is difficult for any operation to reach this quarter effectually, although it is a difculty which we shall presently find has in one instance, at least, been encountered and surmounted. When, however, the disease is seated in the seventh pair of nerves we can be at no loss to decide concerning it, in consequence of the course and divarications of the pain, which commences with great acuteness in the fore-part of the cheek towards the mouth and alæ of the nose, sometimes spreading as high as the forehead, and ramifying in the direction of the ears. At other times the forehead, temple and inner angle of the eye on the sidefected, and even the ball of the eye itself, form the chief lines of pungent agony, while from irritation of the lachrymal gland the affected. eye weeps involuntarily. In this case we may reasonably suspect the disease to be seated in some part of the superior maxillary nerve, constituting the second branch of the fifth pair. And it is hence obvious that the radiation of the pain must vary according to the nerves or nervous twigs that are affected. changes as Line of pain the different branches of nerves are GEN.VI. Neuralgia faciei, Nerve-ache of the face. The disease has been occasionally mistaken for rheumatism, hemicrania, and tooth-ache: yet the brevity of the paroxysm, the lancinating pungency of the pang, the absence of all intumescence or inflammation, the compaDisease has rative shallowness, instead of depth, of its seat, and its invariable divarication in the course of the facial nerves or their offsets, will always be sufficient to distinguish it from every other kind of pain. been mis taken for various others. How distinguishable. Cause little known. Some times local. Exemplified. Of its exciting causes we know but little. It seems sometimes to have been produced by cold, and sometimes by mental agitation in persons of an irritable temperament. But it has been found in the robust as well as in the delicate, in the middle-aged as well as in the old. In a few cases the irritation has been local, of which Mr. Jeffereys has given a very striking instance in a young woman who, when only six years old, fell down with a tea-cup in her hand, which was hereby broken, one of the cheeks lacerated, and a fragment of the tea-cup imbedded under the skin. The wound healed, though slowly and with difficulty; the buried fragment of the tea-cup was not noticed, and consequently was not extracted. From an early period a violent nervous pain returned nightly, and one side of the face was paralytic. These dreadful symptoms were endured for fourteen years: at the end of which time an incision was made through the cicatrix down upon what was then found to be the edge of a hard substance, and which appeared, when extracted, to be the piece of the tea-cup above noticed. From this time the neuralgia and paralysis ceased; the affected cheek recovered its proper plumpness, and the muscles their due power*. It is possible, as suggested by M. Martinet, that, as a symptom, it may sometimes occur in what he calls, and perhaps correctly, an inflammation of the nerves, or a thickening of the neurilemma in some particular organ, of which he has given various examples, accompanied with a reddish or even violet tinge, and studded with minute ec * Lond. Med. and Phys. Journ. Mar. 1823. p. 199. chymoses*. But that this is not the only, or even the ordinary, proximate cause is clear, since in the cases alluded to, pressure upon the part is intolerable, while in idiopathic neuralgia it is commonly consolatory, and considerably diminishes the agony. GEN. VI. SPEC. I. Neuralgia faciei. Nerve-ache of the face. Nature of first pointed out by attacked with success, the disease André and André appears to have been the earliest writer who remarked this painful affection with accuracy; and he succeeded in removing it permanently by applying a caustic to the infra-orbitary, or maxillary branch of nerves in one case in which a previous division of the nerve by the scalpel, as practised by Marechal, had produced only a temporary cure. André, who resided at Versailles, published his account in 1756, whimsically enough intervening it in a treatise on diseases of the urethra. A few unsatisfactory experiments and operations were given to the public in the course of the next fifteen years, chiefly by French practitioners, from which little of real value is deducible. In 1776, Dr. Fothergill, in the fifth volume of Medical Afterwards Observations and Inquiries, communicated a very full scribed by fully deand elaborate description and history of the disease: since Fothergill: which time M. Thouret and Pujol have each published a by Touret and Pujol: valuable paper on the same subject, in the Memoirs of the Society of Medicine of Paris, containing various cases collected and described with great minuteness; and we have already adverted to the more recent publications of Dr. by Meglin Meglin and Professor Chaussier. and Chaus sier. sometimes suspected at the origin of the nerve. It has of late been suspected that in some cases, at Seat of irrileast, of this disease, the seat of irritation might be at the tation origin instead of at the extremity of the nerve; an idea that has arisen from the powerful sympathetic action manifested by the eye and the stomach forming the boundaries of the chain, upon which subject we shall have to speak at large when treating of the genus ENTASIA in the ensuing order. "The nerves," remarks Dr. Parr, "that supply the eye externally, and the slight connexion of the intercostal with the brain, are nearly from the same spot in the cerebrum, and it did not seem improbable, in • Mémoire sur l'Inflammation des Nerfs, &c. 1824. GEN. VI. SPEC. I. Neuralgia faciei. Nerve-ache Hence ar the case alluded to, that the disease may have really been at the origin of the nerve, although felt as usual at its extremity." Dr. Parr was, in consequence, induced to try of the face. arsenic, and in one instance, he tells us, with a decidedly good effect. It is also said to have been since found sersenic tried: viceable in a few other cases. In Mr. Thomas's hands, however, we shall presently perceive that it completely failed. Mercury is also reported to have occasionally proved successful, and especially when carried to the extent of salivation; though in numerous instances it has been tried even to this last effect without any benefit whatever. and mer cury, even to salivation. Acetic ether: zinc. Subcar bonate of iron. When about thirty years ago animal magnetism was a fashionable study in France, it was had recourse to for this discase among others, and had its day of favour as a popular remedy *. Of late, however, neuralgia has been attempted to be cured in France by an external use of acetic ether; while in Germany Dr. Meglin has employed henbane and pills composed of the extract of henbane, and sublimed oxyde of zinc, and according to his own statement with great success. But, beyond controversy, one of the most valuable medicines that have hitherto been tried is the subcarbonate of iron, for the first use of which, so far as I 'know, we are indebted to Mr. Hutchinson†, who commonly employs it in doses of a drachm three times a day. The instances of success appear to be very numerous, though this also, like all other medicines, has often failed. The action of the iron seems to depend upon its tonic power, the most valuable quality we can desire. But there is another energetic medicine which has also a fair claim to attention from a very different property-that of Prussic acid. subduing the sensibility, and this is prussic acid. Mr. Taylor, of Cricklade, Wilts, has made repeated trials of this powerful sedative in various cases, and apparently with more rapid relief than is afforded by the carbonate of iron. He commenced his career with a drop of Scheele's Ediub. Med. and Surg. Journ. July 1823. Cases of Neuralgia Spasmodica, &c. By 3. Hutchinson, &c. 8vo. Lond. |