TIC DOULEUREUX. 



Hartenkeil, Hildebraude, and Baldinger, and fome other 

 Germa " rehte cafes of what they call fc d-l^X 

 w^ch, though in fome particulars, they "^-ble tha 

 affeaion, in others differ moll materially. 1 he hrlt ot 

 antcxioii, , , ., . V havinc been very prevalent at 



d^efewnters <^^^ ^^'J^;^,di.A, relurring gene- 

 ba^tzburgh. li"; "^fo^j^^^P a„d fometimes, though 

 rally once in twenty-iour numa, C,,,^;,! 



rarely, once in twelve hours ; often remanung for fcveral 

 S at a time, and then fuddenly departing Thefe, 

 however were obvioudy cafes of hemicran.a ; for that has, 

 i, ma. y inllances, been obferved to attack the pat.ent. 

 perbdically, and to yield to bark. See Hemicrania 

 ^ The prUjpoJi„g caufe of th,s djfea e would feem o 

 be a cerfain period of life, when the llrength begnts to 

 fail, the functions to be impaired, and the whole corporeal 

 frame to feel the firft iigns of approaching decay. We 

 rarely find it commence before the faftieth year, though 

 two or three cafes of an earlier date are recorded. Women 

 do not feem to be more liable to the complaint than men ; 

 though Dr. Fothergill, having a great proportion of female 

 patients, imagined they were more prediipofed to it ; as 

 likewife did Pujol, from their greater feniibihty. The 

 latter author (in his Effay, p. 14-) fays, " we generally 

 obferve in fuch people as are fubjeft to tic douleureux an 

 excefs of mobility, which renders them more or lefs dif- 

 pofed to hyllerical and hypochondriacal afFedions. Expe- 

 rience, however, teaches us, that people very far removed 

 from excefs of fenfibility are equally liable to the difeafe ; 

 that women are not more Uable to it than men ; and that 

 the predifpofing period of life is that when the fenfibility 

 or mobility of fibre is moft defeftive. 



The exciling caufes are, cold applied to the face in a 

 ftream, whether of air or of water ; particularly when the 

 patient is fatigued by previous exhauftion. Expofure 

 then to ftormy, damp, moiil, windy, and tempelluous 

 weather, frequently excites an attack ; alfo external in- 

 juries, as blows or contufions on the face. Paffions of the 

 mind, as excefs of anger or of grief. 



The difeafe being once eftablifhed in the fyflem, the 

 Dighteft caufes in fome individuals will bring on a paroxyfm ; 

 fuch as eating, drinking, and talking, or indeed any motion 

 of the facial mufcles, or the gentleft touch with a hand- 

 kerchief, or any other fubllance to the nofe, lips, cheek, &;c. 

 of the affcfted fide. Shaving is an operation moil par- 

 ticularly fhunned and dreaded by the unhappy patiesit ; and 

 often cannot be endured till after a confiderable interval of 

 eafe. Blowing the nofe is abfolutely impracticable ; or, if 

 attempted, a moll pungent and dillrafting torture attends 

 the performance. M. Andree, in a work entitled " Ob- 

 fervationes fur les Maladies de I'Uretre," mentions a very 

 obftinate cafe of tic douleureux, which he attempted to 

 cure by dellroying the nerve that he fuppofed to be the 

 feat of the difeafe. He began by laying it bare, and was 

 aftonifhed to find, that every time he touched the denuded 

 nerve, he immediately excited fymptoms of the diforder ; 

 the paroxyfm ceafing in the ufual time, and recurring when- 

 ever the nerve was touched. This fatt is very clear and 

 decifive as to the part affefted by the difeafe, and hence 

 we readily perceive, why the leall touch or motion on the 

 furface of the fliin produces a paroxyfm. 



When the pain has continued with frequent acceffions for 

 a length of time, a moll diilrefling fcene is fometimes 

 witnefTed. The patient, whofe health at the time is 

 generally good, after defifting from eating and drinking, 

 till the keennefs of his appetite, and the intenfity of his 



thirft 



too irrefillibly urgent to be longer unrelieved, 



attacks whatever food is placed before him with maniac 

 fury and hurried precipitancy ; his countenance fuffufed 

 with crimfon, and convulfed and contorted with pain. 

 This horrid conflift does not lafl long ; he foon throws 

 down his knife and fork with defperate violence, obliged to 

 folieit a cefTation of pain by a ftate of inaflion. 



Treatment of Tic Douleureux. — Of the inefficacy of moft 

 medicines in the cure of this cruel difeafe, wc have 

 abundant and melancholy proof. Thofe which have been 

 faid to procure eafe are, opium, cicuta, zinc, ftramonium, 

 belladonna, argentum nitratum, and arfenic. But the 

 inllances in which a cure was effefted by their ufe are very 

 rare ; indeed fome praftitioners, from painful experience, 

 deny their efficacy altogether. All manner of topical 

 applications, from blifters to the fmoking entrails tora 

 from living pigeons, have been in vain applied, and baths 

 and bleeding of all forts. 



M. Watfon, profefTor of chemiftry in the central fchool 

 of Vauclufe, relates two cafes of tic douleureux arifing 

 from venereal caufes. The firft was of an officer in the 

 French army, aged thirty ; the other that of a lady, aged 

 forty. They were both completely cured by a courfe of 

 mercury. Thefe cafes, in fome refpedls, differed from the 

 tic douleureux, but had its moil diftinguifhing charac- 

 teriflic darting pains in the diredlion of the nerves. We 

 learn nothing more from them, however, than that, where 

 the fymptoms of the tic douleureux are excited by the 

 exiftence of a venereal taint in the habit, they will depart 

 when that taint is overcome by the aftion of mercury ; but 

 it is found from experience, that in ordinary cafes, the 

 fymptoms are not in the leall relieved by the life of mercury, 

 Recourfe has next been had to eledlricity, to magnetifm, to 

 adlual cautery, and finally, to the feftion of the affefted 

 nerves. Eledlricity fometimes procures temporary eafe, 

 but as frequently increafes the pain ; though Mr. Blunt, 

 in the Medical Journal, relates the cafe of a lady afflidled 

 with tic douleureux being cured by eledlricity. The 

 pain was chiefly feated in the right temple, and the fymptoms 

 are fo well defcribed as not to be difputed. She was 

 eledlrified twice in the day for feveral minutes each time ; 

 firfl with fparks, then with fliocks, after having previoufly 

 endured a long and ineffeftual courfe of powerful medi- 

 cines. Immediately after the fecond application of eledlri- 

 city fhe ventured to eat, and performed that neceffary 

 operation without any inconvenience. The pains after- 

 wards recurred very flightly ; the eledlricity was con- 

 tinued ; and in the courfe of a fliort time, (lie became 

 entirely free from the complaint. The decided fuccefs of 

 this, though a folitary cafe, iu' fuch a dreadful difeafe, 

 authorifes us to hope, that future trials may be made of 

 the application of eledlricity, which under the diredlion of 

 an able pradlitioner is often a very powerful inilrument in the 

 cure of difeafe, and much oftener fails from want of care and 

 affiduityin the application, than from inefficiency in itfelf as 

 an agent. 



The mode of deftroying the affedled part of the nerves by 

 cauftic has been adopted by fome pradVitioners, and faid to 

 be attended with fuccefs. But, till more experience has 

 better eilablilbed the utility of fuch a cruel operation, we 

 cannot recommend its ufe ; it has not been had recourfe to 

 in this country : and fome cafes are related in which it did 

 not fucceed, and others in which deformity of the face was 

 the confequence. M. Andree, however, has tried it, and 

 recommends its general ufe. In his work will be found an 

 account of the method of operating. 



The 



