28 ‘TURNBULL ON RANUNCULACE2. 
much less, and from the surface under which the disease is actually 
situated being greater than where one spot only is affected, thereby 
affording an opportunity of making the application over a number. 
of affected points at the same time. : ; : 
In cases, too, of long duration, there is more difficulty experi- 
enced in performing a complete cure, than in those of a more recent 
date ; but this does not appear to arise from the ointment having 
less power in removing the existing paroxysm in these instances 
than in others, for it almost always affords immediate relief, but 
from the habit of recurrence at stated intervals which its previous 
long continuance seems to have impressed upon the disease : even 
this, however, may be broken through by a little perseverance ; 
and a recovery be effected, if not as quickly, at least as certainly, as 
in less obstinate cases. 
For those forms of the disease which have been characterised as 
occupying the branches of the affected nerve, an ointment, made 
with twenty grains of Veratria to an ounce of lard, must be rubbed 
during the paroxysm, over the whole seat of the pain for fifteen or 
twenty minutes, or what is better, until the heat and tingling caused 
by the friction have been so great as to produce an impression on 
the feelings of the patient equal to that arising from the disease 
itself ;* and when such an effect has been brought about, the fric- 
tion may be discontinued for a short time, to allow the irritation 
occasioned by it to subside, so as to enable the patient to form a 
judgment of the relative intensity of the pain now, compared with 
what it was before the ointment was had recourse to. In many 
instances the paroxysm will be found to have been cut short ; but if 
any degree of uneasiness remain, the part must be again rubbed with 
the ointment until the peculiar sensations arising from its use again 
show themselves, and this second application will, in general, be 
succeeded by a remission of the pain. Should an instance, however, 
occur of such obstinacy as to resist this repetition, the patient 
should still persevere, until the paroxysm be subdued. 
In the great majority of cases to which this form of treatment has 
been applied, the removal of the paroxysm has been readily effect- 
ed ; and those in which a continuance of the friction, in the manner 
now recommended, is found necessary, are almost without excep- 
tion cases in which the affection has been confined to one point. 
For the purpose of obtaining the full effect of the Veratria as soon 
as possible in such instances, it has been used in the proportion of 
forty grains to an ounce of lard, and this may be done either from 
the very beginning of the treatment, or the quantity of the alcaloid 
may be augmented by five grains in each prescription until it attain 
to that amount. The former method is upon the whole to be pre- 
ferred, because by it an immediate check is put upon the paroxysm 
in severe cases, without the necessity of continuing for a length of 
time the employment of weaker applications. 
* It is of the greatest importance to attend to this caution, as the ointment has 
no ject whatever in removing the disease unless these sensations are induced. 
