330 DISEASES OF THE PERIPHERAL NERVES. 



The duration of the disease is rarely short, except in the regular 

 intermittent malarial affection; in almost all other forms it usually 

 lasts a long while, even half a lifetime, or more. Among the termi- 

 nations, besides recovery, severe melancholy occurs, which may drive 

 the patient to suicide. Death also occasionally results from the cause 

 of the disease, but not from the disease itself. 



TREATMENT. For the treatment of facial neuralgia we have little 

 to add to the rules given for the treatment of neuralgia in general. 

 Only in a few cases can we cure prosopalgia quickly, by the removal 

 of foreign bodies, tumors, and contracting cicatrices. Extraction of 

 teeth does not often prove of benefit. Usually the unfortunate patient 

 has one tooth after the other drawn, without the slightest relief to the 

 pain. 



In recent cases, caused by catching cold, Valleix urgently recom- 

 mends flying blisters and superficial cauterizations with the hot iron. If 

 the disease be due to malaria, large doses of quinine are almost always 

 of service. The administration of Fowler's solution (four to six drops 

 every three hours) is only indicated when quinine has failed. In de- 

 cided anaemia, we may give preparations of iron, and, when we con- 

 clude that there is some other constitutional disease, whose nature we 

 cannot determine, we may order alterant mineral waters and baths. 



Concerning the employment of electricity, cold, veratrine, and 

 aconite, as well as of morphine, particularly in the form of subcutane- 

 ous injection-, the same is true in facial as in other forms of neuralgia. 

 I have seen two cases of tic douloureux cured by the constant current ; 

 one of them was of thirty years' standing, and in the other eleven 

 operations, some of them severe ones, such as the ligation of the 

 carotid, resection of the superior maxilla, etc., had been performed 

 without benefit. In no form of neuralgia is division of the nerve, or 

 excision of part of it, more frequently done. After this operation had 

 for a time almost gone out of use, Bruns has shown, by a careful ex- 

 amination of the cases where it had been done, that, after excluding 

 the cases where its want of benefit depended on error of diagnosis or 

 operation, and after excluding the cases where the recurrence of the 

 pain was to be regarded as a new attack, not as a relapse, there was 

 a considerable number of cases where the neurotomy caused either a 

 complete and permanent benefit, or at least a temporary one, for a 

 few months or years. According to Bruns, the operation (whose per- 

 formance we will not describe) is indicated when the pain is very 

 limited, and it is probable that its exciting cause is situated at a point 

 beyond which the nerve is accessible to the knife, when other treat- 

 ment has proved fruitless, and when the pain renders the patient unfit 

 for business. There is also an indication to operate when we cannot 



