Neuralgia and the diseases that resemble itAnstie, Francis Edmund
Science
Neuralgia and the diseases that resemble it
Anstie, Francis Edmund
Neuralgia
As regards the mode of administration, I prefer the use of a solution of
five grains of acetate of morphia to the drachm of distilled water; if
the acetate be a good specimen, this will dissolve easily (and keep some
time without precipitation) without the use of any other solvent. With a
solution of this strength we require nothing elaborate in the form of
the syringe; a simple piston arrangement does well; only it is advisable
that the tube shall have a solid steel triangular point, and a lateral
opening. As regards the place of injection, I must repeat the
opinion[38] which I have already published, that Mr. Hunter's plan of
injection at an indifferent spot is, in the great majority of instances,
fully as effective as the local injection would be; nevertheless, there
is one consideration which in some cases may properly induce us to adopt
the latter plan. Very nervous and fanciful patients will sometimes be
much more readily brought to allow the operation when it seems to go
directly to the affected spot, when they would be sufficiently
incredulous of the benefits of an injection performed at a distance to
indulge their dislike of incurring pain by refusing to submit to it. And
there is one class of cases in which it is likely that there are real
physical advantages in the local injection; in instances of old-standing
neuralgia with development of excessively tender "points," which are
also the foci of the severest pain, it will sometimes be advisable to
inject into the subcutaneous tissue at these points. There is undeniable
reason for thinking that the sub-inflammatory thickening of tissues
around a certain point of nerve delays the transit of the morphia into
the general circulation, and enables it to act more directly and
powerfully on the nerve, which it thus renders insensitive to external
impressions; an important respite is thus gained, during which the
nerve-centre has time to recover itself somewhat. At the same time it
must be remarked that this immediate injection of a tender point is apt
to be exceedingly painful, and it may be absolutely necessary to apply
ether-spray before using the syringe. In early stages of neuralgia,
before the formation of distinct tender points, there is no advantage
whatever (except the indirect one above mentioned) in the local
injection. And, on the other hand, it is often of great consequence not
to run the chance of disfiguring such a part as the face, the neck,
etc., when the injection can easily be done over the deltoid, or in the
leg, or in some other part which even in women is habitually covered by
the dress.
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