925 



NEURALGIA. 



NEURALGIA. 



920 



has met with another after the application of leeches to the side of 

 the neck. 3. Neuralgia intercostalis (first described by Siebold, and 

 afterwards by Corvisart) occupies either a portion or the whole of one 

 of the intercostal nerves, generally in the lower part of the thorax. 

 1. .V. uralyia cervico-brachialis (first noticed by Professor Fulci of. 

 Catana), is seated in the internal cutaneous nerve, a branch furnished 

 by the brachial plexus. The pain begins at the anterior and internal 

 part pf the shoulder, and descends along the inner side of the arm and 

 fore-arm to the wrist. Sometimes it extends not only to all the 

 branches of the internal cutaneous nerve, but also to those of the 

 external, and then becomes confounded with the following species. 

 5. Xenfaliiia musculo-cutanealis was first described by M. Martinet, and 

 occupies the external cutaneous (or musculo-cutaneous) nerve, another 

 branch derived from the brachial plexus. The pain commences at the 

 shoulder, descends along the anterior external surface of the arm and 

 fore-arm as far as the wrist. 6. Neuralgia, sttpra-scapularis was also 

 first described by M. Martinet, and is seated in the suprascapular nerve, 

 another branch given off from the brachial plexus. The pain begins at 

 the inferior angle of the scapula, passes along its posterior surface, and 

 sometimes descends along the radial border of the fore-arm to the 

 thumb and fore-finger. 7. Neuralgia mamma, first described by Dr. 

 Good as consisting of "sharp, lancinating pains, divaricating from a 

 fixed point in the breast, and shooting equally down the course o the 

 ribs and of the arm to the elbow; the breast retaining its natural 

 size, complexion, and softness." 8, and last, Neuralgia of the facial 

 nene, or portio dura, of the seventh pair, about the existence of which 

 there is great room for doubt ; for as this is a nerve of motion and not 

 of terwation, it is not easy to understand how it should be liable to be 

 affected by a disease which is in general simply and purely painful. 

 However, it is still more difficult to deny the fact ; numerous instances 

 have occurred in which the disease has (to all appearance) been 

 seated in this nerve, and several wherein the pain has not only 

 followed its ramifications with great exactness, but has also been 

 attended by convulsive twitchings of the facial muscles, and even by 

 their paralysis. 



But besides these external forms of neuralgia, the disease has some- 

 times been found to attack various internal organs. This was first 

 suggested by Dr. John Fothergill in 1773, who says (in Vol. v. of the 

 ' Med. Observ. and Enquiries,') " There are few physicians, I believe, 

 who may not in reviewing many cases, which have occurred to them, 

 of anomalous pains in different parts of the body, so as sometimes to 

 counterfeit gouty, bilious, and other internal affections of the stomach 

 and bowels, perceive some analogy between them and the complaint 

 here pointed out ; " but it is only lately that pathologists have begun 

 to enumerate these " anomalous pains," and class them as so many 

 distinct species of neuralgia. Sometimes the central mass of the 

 nervous system is affected, and we find the terms " Cerebralgia " and 

 " Myelalgia " employed by some modern French authors to designate 

 neuralgia of the brain and of the spinal chord. (Raciborski, ' Precis 

 du Diagnostic,' 1837.) Sometimes, instead of the branches of a nerve, 

 the extreme filaments only are diseased, as would appear to be the case 

 in many of those kinds of pain commonly called " rheumatic " (MM. 

 Jolly and Piorry, quoted in Raciborski). To these have been added 

 torticollis, lumbago, angina pectoris, neuralgia of the arteries, gastralgia, 

 enteralgia, hepatalgia, nephralgia, hysteralgia, neuralgia of the heart, 

 testicle, bladder, urethra, diaphragm, &c. (Rociborski, Rowland, Elliot- 

 son, ftc.) It may perhaps be rather fanciful to give the name " neu- 

 ralgia " to all these cases, and it would take up too much space to 

 describe each separately ; but they are all characterised by an increased 

 ility of the nerve, and have the same general character of coming 

 on in paroxysms at regular or irregular intervals. 



Of the remote or predisposing causes of neuralgia very little is 

 known, but it has been supposed to attack females more frequently 

 than males, the rich than the poor, those that live in towns rather 

 than the inhabitants of the country. It is also most common among 

 persons of a nervous temperament, and both infancy and old age are 

 comparatively safe from its attacks. The immediate or exciting causes 

 are very numerous, and sometimes extremely obscure. Among the 

 most common may be mentioned, exposure to wet and cold, mental 

 excitement and agitation in persons of an irritable temperament, and a 

 deranged state of the digestive organs. Local injuries of various kinds 

 are another very frequent cause of the disease ; such as the lodgment 

 of sftiy foreign body in the branch of a nerve, wounds, contusions, 

 cicatrices, the too great distension of a nerve, carious teeth, &c. Sir 

 Henry Halford has published in his ' Essays,' five cases showing that 

 sometimes " the disease is connected with some preternatural growth 

 of bone, or a deposition of bone in a part of the animal economy where 

 it is not usually found in a sound and healthy condition of it, or with 

 a diseased bone ; " and Sir Benjamin Brodie, in his ' Lectures on Local 

 Nervous Affections," mentions several where the pain was occasioned 

 by the pressure of an aneurysmal or other tumour. Another cause is 

 exposure to ma I 'in. This is more especially the case in 



those attacks which are regularly intermittent, and which yield to the 

 same treatment m ague. Puerperal women are also subject to this 

 disease, especially after large floodings during labour. 



With regard to the seat of neuralgia, there can be little doubt but 

 that it is in tin; nerve itself; but it is equally certain that the part 

 where pain in felt is not always) the part diseased. Tho fact is, neu- 



ralgia of any nerve may be purely the result of irritation reflected from 

 a very distant point of the nervous system. Post-mortem examination 

 throws no light on the state of the nerve, but there is no reason to 

 '< H that it arises from an inflamed or congested state of the nerve 



hi which the pain has been experienced. 



The diagnosis of neuralgia is not in general very difficult, for even 

 when it does not follow the course of a nerve, it may commonly be 

 distinguished from every other disease by the peculiar character of the 

 pain, its excessive violence during the paroxysm, and the absence of all 

 symptoms of fever and inflammation. It may sometimes be difficult 

 at first sight to distinguish neuralgia from rheumatism, inasmuch as 

 the two diseases resemble each other in some of their most prominent 

 symptoms ; but by observing the following diagnostic signs (derived 

 from the general character of inflammation in all parts of the body), 

 the danger of confounding them may be avoided. In rheumatism the 

 pain is continual, as is the case in all inflammations : in neuralgia it is 

 never constant, but is subject to paroxysms and intermissions. In 

 rheumatism the pain is aggravated by the slightest pressure ; in neu- 

 ralgia, on the contrary, it is sometimes alleviated by it. To these it 

 may be added that in rheumatism we shall find the usual attendants 

 of inflammation, namely, heat, redness, and swelling ; while in neu- 

 ralgia (as noticed above) these are rarely if ever present. 



Dr. Inman has recently pointed out that a painful condition of the 

 muscles, ordinarily known by the name of cramp, is frequently mis- 

 taken for neuralgia. This disease, which he calls myalgia, he says 

 may be recognised : 1. By the pain being hot and burning; 2. By its 

 absence in the morning, and increase during the exertion of the day ; 

 3. By its seat in some one muscle, and being increased by the move- 

 ment of that muscle ; 4. It is the result of unusual exertion of the 

 muscle: 5. It is relieved by relaxation, or artificial support ; 6. The 

 pulse is unaffected ; 7. The pain of cramp often comes on suddenly 

 during the night. The distinction between myalgia and neuralgia is 

 of importance, as the treatment of the two diseases might be directly 

 opposite. 



With regard to the treatment of neuralgia, it would appear quite 

 superfluous to say that it must be regulated by the circumstances of 

 each particular case, if it were not notorious that no disease has been 

 treated more blindly and empirically. When any foreign body presses 

 upon the nerve, or when the pain can be distinctly traced to a carious 

 tooth, the removal of the source of irritation will commonly be 

 sufficient to cure the disease, though the practitioner should be espe- 

 cially warned against the danger of confounding neuralgia with the 

 tooth-ache an error that is not unlikely to occur in some cases of tic 

 douloureux, and one that has often occasioned the loss of several teeth 

 to the patient without any good effect. When (as is sometimes the 

 case) the disease appears to be occasioned by the irritation arising 

 from an old cicatrix, it will be expedient to try the effect of appli- 

 cations to the cicatrix itself namely, either the nitrate of silver, or 

 the actual cautery, or a blister, or a crucial incision over the part, or 

 even its removal by the knife. And in the same way, when it can be 

 distinctly referred to any other of the exciting causes enumerated 

 above, the removal of that will probably be followed by the disappear- 

 ance of the disease. But, as already observed, it very frequently 

 happens that the exciting cause cannot be discovered, and in these 

 cases the treatment must necessarily be in a great degree empirical. 

 When the paroxysms are irregular in their duration and recurrence, 

 perhaps the sesquioxide of iron is the best remedy at present kmnvu : 

 it may be given in doses of half a drachm three times a day in twice 

 its weight of treacle. When the pain recurs after certain regular 

 intervals, those medicines which are found to be most efficacious in 

 the treatment of ague may be exhibited with advantage. The disul- 

 phate of quina may be given iu doses of four or five grains three times 

 a day, though this medicine has sometimes been given in much larger 

 quantities, and Sir Benjamin Brodie mentions one case where the 

 patient took as much as half a drachm daily. (' Local Nervous 

 Affections,' p. 28.) The liquor potass* arsenitis is another excellent 

 medicine which may be employed in this form of disease : the dose is 

 i at the commencement four or five minims three times a day, which 

 may gradually and cautiously be increased to ten or fifteen. When 

 there are any signs of inflammation present, that the disease may seem 

 rather to deserve the name of neuritis than of neuralgia, it must be 

 treated accordingly, and the usual antiphlogistic remedies, both 

 external and internal, may be employed. In almost every case of 

 neuralgia it will be advisable to exhibit some preparation of opium, 

 both to relieve the pain and also in order to procure the patient some 

 sleep at night, at which time the paroxysms are often much aggravated ; 

 and especial care must also be taken not only to prevent the consti- 



pation caused by this drug, but also to keep up a free evacuation of 

 I the bowels, as in some cases the disease appears to have been cured by 



purgative medicines alone. 



Among local applications may be mentioned the unguentum veratri, 

 emplastrum opii, and empl. belladonna;, or a lotion (recommended by 

 Dr. Bennett, of Charleston in America), composed of four ounces of 

 the aqua laurocerasi and one ounce of sulphuric ether, either alone or 

 with half or one drachm of the extract of belladonna. The application 

 of an ointment with one or two grains of aconitina to a drachm of lard 

 has also been strongly recommended. Counter-irritants have often 

 proved very efficacious, particularly the application of a common 



