P'ATHO LOGY. 
308 
aflually dead, and were juft ready to leave him. This 
continued about half an hour. By nine o’clock in the 
morning, in autumn, as we were going away, we obferved 
fome motion about the body, and upon examination 
found his pulfe and the motion of his heart gradually re¬ 
turning; he began to breathe gently and l’peak foftly. 
We were all aftonilhed to the laftdegree at this unexpe&ed 
change; and, after fome further con verfation with him and 
with ourfelves, went away fully fatisfied as to all the parti¬ 
culars of this fa£t, but not being able to form any rational 
fcheme how to account for it. He afterwards called for 
his attorney, added a codicil to his will, and calmly and 
compofedly died about five or fix o’clock that evening.” 
/ 3 . A. particulars ; confined to particular parts of the 
arterial fyftem. “Over the whole fyftem except the heart, 
which pulfated violently. Beggi in Pachioniopp.—Con¬ 
fined to the arteries of a fingle arm. Camerar. Memorab. 
Cent. ii. p. 54.” It is fometimes the refult of aneurifm 
or partial paralyfis. This is by no means rare, certain ir¬ 
regularities with regard to particular arteries being often 
remarked. 
7. Entafia fyftremma, cramp. (Tetanus dolorificus, 
Darzvin.) Sudden and rigid contraction and convolution 
of one or more mufcles of the body ; moftly thofe of the 
ftomach and extremities, vehemently painful, but of 
fhort duration. Chiefly produced by a Hidden chill, as 
that of the night-air, or of water when fwimming in it; 
often occafioned by an uneafy pofition, or undue dilten- 
tion of the mufcles ; and hence frequently attacking in 
fleep. Found alfo, as a fymptom, in cholera; and occa- 
fionally in pregnancy and during labour. 
Cramp, or fpafm, is one of the moft painful difeafes we 
are liable to ; at the fame time it is the leaft dangerous. 
Change of temperature, and agents which increafe the 
tranfmiffion of nervous impulfe to the cramped part, 
readily effeft a cure. Of courfe this does not apply to 
fpafms arifing from diftant irritations (for thefe latter 
mult then be removed), or to the fpafms of the partu¬ 
rient ftate, which are induced by preffure on nerves or 
blood-veflels. 
Genus II. Neuralgia, [from nvpov, a nerve, and aAyo?, 
pain.] Contraction and diflortion of a particular mulcle 
or group of mufcles, with partial trepidations, and 
acute lancinating pains in the courfe of the principal 
nerves ; paroxyfm fhort, recurring at irregular periods. 
There are two fpecies defcribed by Dr. Good, which 
however are perfectly analogous. 
1. Neuralgia faciei, tic douloureux: contraction and 
diftortion feated about the ala nafi and upper lip; pains 
fliooting to the orbit; often to the ear, and over the 
cheek, palate, teeth, and fauces. 
a. Neuralgia pedis : racking and intolerable pain feat¬ 
ed about the heel; tremuloufly fhooting in irregular di¬ 
rections towards the ancle and bones of the tarfus. This 
fpecies is defcribed from a very marked cafe which oc¬ 
curred to Dr. Good in a gentleman, otherwife of good 
health, about forty-five years of age, who had been long 
a victim to it. The pain during the paroxyfm was fo fe- 
vere as nearly to make him faint, and was generally com¬ 
pared by him to that of fcalding verjuice poured over a 
wound. Here the tibial branch of the ifchiatic nerve 
feemed to be affeCted, and perhaps the peroneal. 
In this difeafe (we fpeak chiefly of the firft fpecies), 
the pains vary in their degree of intenfity; at one time 
exciting the moft piercing cries, and diftraCted writhings 
and motions, in the miferable patient ; while at another 
they are more bearable. When at the acme of their 
violence, the parts affeCled are often convulfed, and fome¬ 
times various contortions and grimaces are obfervable. 
Thefe are to be diftinguifhed from the convulfive twitch- 
ings of the mufcles with which the difeafed nerves com¬ 
municate, and which are occafioned by irritation from 
the excefllve pain ; while the contortions and grimaces 
are voluntary, being caufed by the patient’s writhing and 
willing from the agony of his torture, and may be pre¬ 
vented by a firm refolution to refill any impulfe of ftirink- 
ing from the attack. 
The pain does not always confine itfelf to the feat of 
the difeafe, but darts with the rapidity of lightning to 
the neighbouring parts, fliooting in different directions 
like radii from a centre. It rarely gives warning of its 
approach, and often the firft fign of an attack, is the 
patient’s llarting up in a ftate little fhort of phrenfy. 
In this condition, fome patients beat the part with 
violence, or forcibly rub it wnth fome rough fubftance till 
excoriation takes place ; and, in fome inltances, they 
have fucceeded in thus diminilhing the intenfity of the 
pain. 
The pains are more frequent during the day than in 
the night, probably from there being fewer caufes of ir¬ 
ritation during the latter feafon ; and they are more fre¬ 
quent during converfation than in filence; and Hill more 
lo at the time of maftication, when the attacks often fuc- 
ceed each other with fuch rapidity as to appear like one 
continued paroxyfm, with fcarcely an interval of cefla- 
tion. The eye at times is red, inflamed, and watery, as 
we fometimes obferve in fevere tooth-ache ; in other 
cafes it is particularly dry; and in fome patients a co¬ 
pious flow of faliva fucceeds a paroxyfm. In general, 
only one fide of the face is affeCted with this dreadful 
malady ; but, as there are cafes recorded in which both 
fides fuffered at the fame time, we cannot lay it down as 
a certain charaCteriftic of the difeafe. Fouquet obferved 
at Montpellier two women who had both cheeks affeCted 
at the fame-time ; and Pujol knew a lady, who, for feveral 
months, had the pain in one cheek, which after a while 
was free from pain; but the other cheek was immedi¬ 
ately attacked in the correfponding place, the pain con¬ 
tinuing for two months, and then refuming its former 
pofition. 
When the difeafe continues for a great length of time 
with increafing violence, the patient can neither obtain 
reft by night nor by day, and his appetite fails. The 
complaint ufually terminates without any apparent caufe, 
leaving the patient for a time to enjoy the comforts of 
life. But whoever has had one attack may with confi- 
derable certainty anticipate another ; and, though he is 
to-day well, and free from all pain, to-morrow’s dawn 
may ufher in a renewal of his torment. So varied is the 
duration of this affeCtion, and fo limited is our knowledge 
of it, that we can aftign no determinate or even probable 
period for its continuance ; and, unlefs a cure iseft'eCled, 
it returns at intervals more or lefs frequent, and with 
increafed violence, till the great final cataftrophe, which, 
however, it does not feem to accelerate. For, though 
Dr. Banfch is faid to have died of it, we can place little 
reliance on the report; and fubfequent cafes and obfer- 
vations do not corroborate fuch a fuppofition. 
This malady is confined to the nervous fyftem, the pa¬ 
tient feldom difplaying fever or acceleration of the pulfe. 
It is moft generally remarked in perfons who have an 
unufual degree of nervous irritability in general, and more 
efpecially when this nervous temperament is joined to 
bilious and gaftric difturbance. It is increafed by all cir- 
cumftances which impair the tone of the digeftive organs, 
or by any local irritation ; in fome cafes even by the tri¬ 
fling one of {having. 
A variety of fpecifics for neuralgia have come in and 
gone out of fafhion. They have generally been medi¬ 
cines of the narcotic and fedative clafs; as cicuta, bella¬ 
donna, See. and might have deceived their employers lefs 
often than has been the cafe, had their exhibition been 
preceded by medicines which aft on the alimentary canal, 
and its collatitious vifeera. Indeed the ftate of_ the di- 
geltive organs is the firft thing to be attended to in neu¬ 
ralgia, as in fo many other difeafes. Mr. Abernethy is 
faid to have cured many patients by this alone ; and, 
when it does fail to cure, it never we believe fails to mi¬ 
tigate. We fliould therefore urge moft ftrongly the ftridl 
regulation of the digeftive organs in tic douloureux. 
As the local detra&ion has a fedative operation on excited 
nerves 
