58 FOTHERGILL'S MEDICAL PAPERS CHAP. 



collection of clear lymph in the ventricle of the brain in several 

 cases, and he suggests tentatively the rupture of a lymphatic 

 vessel from a fall or accident as a possible cause of the dis- 

 order. 1 



Tic DOULOUREUX 



Fothergill was the first to describe clearly that form of 

 facial neuralgia which was afterwards called Tic Douloureux. 

 In his practice down to 1773, the date of his paper, he had 

 met with sixteen cases. He marks the characters which 

 distinguish the complaint from other painful affections of the 

 face, from disorders of the teeth, from rheumatism, from ague 

 in the head (malarial neuralgia), and from those fixed pains, 

 worse at night-time, which are due to syphilis of long standing. 

 The distemper, he says, attacks persons of forty years of age 

 and upwards, and especially women. He describes the site 

 and character of the pain, its paroxysms and how these are 

 excited, and its rebelliousness to treatment full doses of 

 opium relieve, but the remedy becomes as troublesome as the 

 disease. The extract of hemlock, graduaUy increased to a 

 full dose, and persevered in, despite relapses, for many months, 

 appears in his hands most often to bring substantial relief. 

 He has a suspicion that the disorder is allied to cancer. 



His nephew Dr. Samuel Fothergill, published in 1804 a 

 more extended account of Tic Douloureux, describing it as an 

 affection of the fifth pair of nerves and of the portio dura. 

 Success with the use of hemlock was less frequent in other 

 hands than Fothergill's. 2 



HYDROPHOBIA 



Hydrophobia was a very uncommon disease at this period, 

 for Heberden, it seems, had never seen a case ; but it had 

 lately attracted some attention. In one of his papers Fother- 

 gill gives a minute description of a case in which he and 



1 Remarks on the Hydrocephalus internus, read 1768. Med. Obs. & Inq. 

 iv. 40 ; Works, ii. 63 ; Dr. R. Whytt, Observations on the Dropsy in the Brain, 

 1768. A fortnight after Fothergill's paper was read Dr. W. Watson described 

 three more cases, in one of which the symptoms began two weeks after a 

 blow on the head (Med. Obs. etc. iv. 78). Fothergill's paper was published 

 in French : Remarques sur I'hydrocephale interne, traduites par de Vilhers. 

 Paris, 1807. 



2 Dr. J. Fothergill, Of a Painful Affection of the Face, Med. Obs. & Inq. 

 v. 129 ; Works, ii. 179, iii. 163. M. Andr6e of Versailles had alluded to the 

 disease in 1756. Dr. S. Fothergill preferred the name Faciei morbus nervorum 

 crucians : the Germans called it Dolor faciei Fothergilli. 



