Neuralgia and the diseases that resemble itAnstie, Francis Edmund
Science
Neuralgia and the diseases that resemble it
Anstie, Francis Edmund
Neuralgia
I suspect, however, that the most frequent successes with arsenic will,
after all, be made in the cases of more or less anæmic male patients who
are attacked with the neurotic form of angina in the midst of a career
(as is especially the case with some professional careers) that implies
not merely incessant labor, but great anxiety of mind. The drug does
little good, however, if not positive harm, in that form of angina
pectoris minor which is not the result purely of these causes, but of
these, or some of these, plus the morbid action of the alcoholic excess,
to which the patient has fled in order to relieve mental harassment and
the fatigue that comes from overwork, especially overwork at tasks that
are not congenial to his natural disposition; there is usually in such
cases a heightened irritability of the alimentary canal, which is almost
sure to cause arsenic to disagree: the really useful treatment is
quinine for the first few days, and then, when the stomach will bear it,
cod-liver oil in increasing doses, up to a large daily amount given for
a long time together.
On the whole, arsenic, from its singularly happy combination of powers
as a blood-tonic, a special stimulant of the nervous system, and withal
as a special opposer of the periodic tendency, must be regarded as one
of the most powerful weapons in the physician's hands, and (although it
seems to act best in the neuralgias of the vagus and of the fifth) there
is a possibility of its proving the most effective remedy in almost any
given case which may come before us.
2. The narcotic-stimulant treatment for neuralgia includes some of the
most powerful remedies for the disease which we possess. These remedies
have very different properties, but they all agree in this, that in
small doses they appear restorative of nerve-function--in large doses
depressors of the same.
Four very different types, at least, of narcotic-stimulant drugs are
useful in neuralgia: (_a_) There is the opium type, by which pain is
very directly antagonized, and, besides this, sleep is also directly
favored. (_b_) There is the belladonna type, by which pain is also much
relieved, though with far greater certainty in some regions than in
others (_e. g._, much the most powerful effect is seen in cases of pelvic
visceralgia), but sleep is by no means so certainly or directly produced
as by opium. (_c_) There is the chloral type, which is almost purely
hypnotic; it is represented almost solely by chloral itself, which is
resembled by scarcely any other drug. (_d_) There is bromide of
potassium, which stands alone for its powerful action on the cerebral
vaso-motor nerves, and which is useful in neuralgia simply by its power
to check psychical excitement directly (through the circulation) and
indirectly (through the production of sleep).
Public-domain text, read in full here on John Shaqi.
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