Neuralgia and the diseases that resemble itAnstie, Francis Edmund
Science
Neuralgia and the diseases that resemble it
Anstie, Francis Edmund
Neuralgia
One of the cases above referred to may here be briefly detailed, as it
shows very completely the clinical history of such affections. C. B.,
aged twenty-four, an agricultural laborer, applied for relief in the
out-patient room of Westminster Hospital, suffering from severe
neuralgic pains of the forehead and face of the left side. Then pains
were felt in the course of the supra-orbital, ocular, nasal, and
supra-trochlear branches, and also in the cheek, appearing, there, to
radiate from the infra-orbital foramen. They had commenced about three
weeks previously to the patient's first visit to the hospital, and about
six weeks after the accident which appeared to have started the whole
train of symptoms. This was a cutting wound, evidently of considerable
depth as well as external size, toward the back of the neck, and so
situated that it must have divided the great occipital nerve of the left
side: and, from the man's account of the numbness of the parts supplied
by the nerve which immediately followed the wound, there could be no
doubt that this had occurred. There was no acute nerve-pain, either
during the healing of the wound, which was rapid, or subsequently, until
more than three weeks from the date of the injury; at this time there
was still a considerable sense of numbness in the skin of the occipital
and upper cervical region; but there now commenced a series of short
paroxysms of pain in the forehead of the same side. These at first
occurred only about twice daily, at regular intervals; the pain was not
very sharp, and only lasted a minute or two. The attacks rapidly
increased in frequency and duration, however, and extended their area.
At the time when I first saw the case the pain was very formidable, it
recurred with great frequency during the day, but would sometimes leave
the patient free for several hours together. The site of the wound was
occupied by a firm cicatrix of about a line in breadth and an inch and a
quarter in length; pressure on this excited only a vague and slightly
painful tingling in the part itself, but severely aggravated the
trigeminal pains, or reproduced them if they happened to be absent. The
regions supplied by the great occipital nerve were still very
imperfectly sensitive. This patient gave me a great deal of trouble. He
continued for many weeks under my care, and I can scarcely flatter
myself that any of the numerous remedies which I administered
internally, or applied locally, had any serious effect in checking the
disorder. The subcutaneous injection of morphia gave some relief, as it
always does, but this seemed to be perfectly transitory; and, although
when the patient ceased to attend the hospital he was decidedly better,
I cannot imagine that there was anything in it except the slow wearing
out of the neuralgic tendency, very much without reference to the
administration of any remedies.
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