GEN. VI. SPEC. I. Nerve-ache preparation, in twenty-four hours, in divided doses: but as he grew better acquainted with the effects of the medi- Neuralgia cine, he gave a drop for a dose at first, and then increased faciei. the dose to two drops, repeating it three times a day. In of the face. one or two instances he has carried the quantity, by a gradual augmentation, to twenty-four drops a day, in the course of a month's use: and very often to five and six drops a day, by adding a drop to every day's account *. Time alone must determine whether the cures thus obtained will prove as permanent as those affected by the tonic power of the subcarbonate of iron. To induce ease, however, under any circumstances, and for any period of time, in the midst of so much torment, is an invaluable blessing. 66 cine to be radical cure In effect, neither narcotics, nor tonics, nor any other No mediclass of medicines that has hitherto been employed, can depended be in every case depended upon for a radical cure, though upon for a some of them, and particularly the subcarbonate of iron, in all cases. are worthy of high commendation. My father," Case from says Dr. Perceval of Dublin," in his manuscript Perceval. comment on the present author's Nosology, was subject to neuralgia faciei for several years, and used a variety of medicines without relief. He was worse in close damp weather, and much worse when his mind was occupied. At length he had an issue inserted in the nucha, kept his bowels free with James's analeptic pills, and exchanged a town residence for the country. In this situation he soon threw off the disease, from which he was free for a considerable time before his death." Change of scene, a Occasional palliatives transfer of morbid action, and a recruited cheerfulness of spirits are valuable auxiliaries in the present as in every found: other nervous affection: but I much question whether these alone have ever operated a cure. A spontaneous time alone cure is the work of time alone; and time, though often a natural cure long and tedious period is requisite, will generally accom- if worked plish it, and probably did so in the case before us. The fact is, that the nervous system in every part, and every * Edinb. Med. and Surg. Journ. July 1823. may be works a at all. GEN, VI. SPEC. I. Neuralgia faciei. Nerve-ache ramification, becomes gradually torpefied by excess of action; and as the eyes grow blind and the nostrils inolfacient by strong stimulants applied to them, so the nervous of the face. twigs of every kind, after a long series of irritation from the present disease, become exhausted of power and obtuse in feeling and it is probably by hastening this state that the most active stimulants, and the warmer tonics, produce whatever benefit is to be ascribed to them. Acupunc ture. Chief radi cal cure to be found in the affected nerves. case related by Darwin. How far acupuncture or needle pricking, the zin-king of the Chinese, which we have already described under chronic rheumatism, might be useful, has not yet been determined. It has, at least, a fair claim for experiment, before having recourse to a curative attempt by the knife. This radical cure consists in a division of the af This fected branches, provided they can be followed home. Dr. Haighton completely succeeded, some years ago, in a case in which he divided the sub-orbital branch of the fifth pair; and Mr. Cruickshank and Mr. Thomas more recently in a case of considerable complication, and where the affection was evidently not confined to the different branches of any single nerve. Interesting last case is given by Dr. Darwin, whom the patient had intermediately consulted, in the second part of his Zoonomia, and is one of the most interesting sections of the work. The patient, a Mr. Bosworth by name, was between thirty and forty years of age. When he first applied to Dr. Darwin he complained of much pain about the left cheek-bone. Dr. Darwin suspected the antrum maxillare might be discased; and, as the second of the grinding teeth had been lately extracted, directed a perforation into the antrum, which was done, and the wound kept open for two or three days without advantage. Afterwards by friction about the head and neck with mercurial unguent, he was for a few days copiously salivated, and had another tooth extracted by his own desire, as also an incision made in such direction as to divide the artery near the centre of the ear next the cheek, which gave also a chance of dividing a branch of the affected nerve; but without success. Internally opiates were Disease at first mistaken : and medi eines tried in vain. SPEC. I. administered in large quantity when the pain was exceed- GEN. VI. ingly violent: bark being used freely in the intervals, but without effect. Neuralgia faciei. Nerve-ache of the face. Progress of the disease. The pain spread in various directions from a point in the left cheek a little before the ear, sometimes to the nose, and forepart of the lower jaw, and sometimes to the orbit of the eye on the same side; the under part of the tongue being at times also affected. It returned on some days many times in an hour, and continued several minutes; during which period, it is well worth observing, as showing the connexion between an irregular sensitive and an irregular irritative power in the same muscles, the patient, says Dr. Darwin, seemed to stretch and exert his arms, and appeared to have a tendency to epileptic actions, so that his life was rendered miserable to himself to support, and to his friends to witness. The complaint gradually grew worse, and Mr. Bosworth removed to London for the purpose of again putting himself under Mr. Cruickshank's care, and of submitting to any opera- Patient put tion he should recommend. The pain was now intolerably acute, and almost unremitting; and opiates afforded him Cruicklittle or no relief though taken to the quantity of six tea- and Thomas, spoonsful of laudanum at a time. The operation of dividing the diseased nerve was therefore determined upon. under the care of shank, "As the pain", says Mr. Thomas in his letter to Dr. Darwin, after its completion, "was felt more acute in the left ala of the nose, and the upper lip of the same side, we were induced to divide the second branch of the fifth and operated upon pair of nerves as it passes out at the infra-orbital foramen. with partial He was instantly relieved in the nose and lip; but towards success. night the pain from the eye to the crown of the head became more acute than ever. Two days after we were operations obliged to cut through the first branch passing out at the submitted supra-orbital foramen: this afforded him the like relief to. with the first. On the same day the pain attacked, with great violence, the lower lip on the left side, and the chin; this circumstance induced the necessity of dividing the third branch, passing out at the foramen mentale. During Farther GEN. VI. SPEC. I. Neuralgia faciei. Nerve-ache of the face. Additional division of nerves, the whole period, from the first division of the nerves, he had frequent attacks of pain on the side of the tongue ; these, however, disappeared on division of the last nerve. "The patient was evidently bettered by each operation; still the pain was very severe, passing from the ear under the zygoma towards the nose and mouth, and upwards round the orbit. This route proved pretty clearly that the portio dura of the auditory nerve was also affected, at least the uppermost branch of the pes anserina. Before I proceeded, continues Mr. Thomas, to divide this-Mr. Cruickshank had operated hitherto -I was willing to try the effect of arsenic internally, and he took it in sufficient quantity to excite nausea and vertigo, but without perceiving any good effect. I could now trust only to the knife to alleviate his misery, as the pain round the orbit was become most violent; and therefore intercepted the nerve by an incision across the side of the nose, and also made some smaller incisions about the ala nasi. To divide the great branch lying below the zygomatic process, I found it necessary to pass the scalpel through the masseter muscle till it came in contact with the jaw-bone, and then to cut upwards; this relieved him as usual. Then the lower branch was affected, and also divided; then the middle branch running under the parotid gland. In cutting this, the gland was consequently divided into two equal parts, and healed tolerably well after a copious discharge of saliva for several days. 66 "I hoped and expected that this last operation would have terminated his sufferings, and my difficulties; but the pain still affected the lower lip and side of the nose, and upon coughing, or swallowing, his misery was dreadful. This pain could only arise from branches from the second of the fifth pair passing into the cheek, and lying between the pterygoideus internus muscle and the upper and ultimate part of the lower jaw. The situation of this nerve rendered the operation hazardous, but after some attempts it was accomplished." This finished the series cure. of operations, and restored the afflicted patient to perfect health. Nerve-ache I have dwelt the longer on this interesting case, because faciei. it seems to show, first, that there is occasionally no certain of the face. cure but in the use of the knife; secondly, that a delay in General performing the operation only affords time for the disease remarks. to spread from one branch of the affected nerve to another, and even to different branches of nerves in a state of contiguity and thirdly, that the disease betrays the spasmodic character of the diathesis when minutely watched, even in cases in which this character is most obscure. Dr. Darwin objects properly enough to arranging this disease as a trismus, "since no fixed spasm," says he, "like the locked jaw exists in this malady." He adds, indeed, that in the few cases.he has witnessed, there has not been any convulsion of the muscles of the face; but in Mr. Bosworth's case he has expressly noticed the morbid stretching of the arms, and the tendency to epileptic actions. Its proper place, however, seems to be where it is now arranged. SPECIES II. NEURALGIA PEDIS. Nerve-ache of the Foot. RACKING AND LANCINATING PAINS RANGING ABOUT THE SPEC. II. THIS is the neuralgia plantaris of Professor Chaussier: GEN. VI. who mentions a very decided case of it, to which Dr. Synonym Marino, a physician of Piedmont, had been long subject. It commenced, he tells us, in early life; was relieved by the mineral waters of Vivadio; and still more by the exemplified. |