Neuralgia and the diseases that resemble itAnstie, Francis Edmund
Science
Neuralgia and the diseases that resemble it
Anstie, Francis Edmund
Neuralgia
(_b_) The commencing hypodermic dose of atropine should be one-one
hundred and twentieth grain; it is not often that so small a quantity
will do any good, but it is necessary to use this agent with great
precaution, as we occasionally meet with subjects in whom extremely
small doses provoke most uncomfortable symptoms of atropism, as dry
throat, dilated pupil, delirium, and scarlet rash. Commonly we shall
find ourselves obliged to increase the dose to one-sixtieth,
one-fiftieth, or one-thirtieth of a grain; and in a very few cases it
may be necessary to go even as high as the one-sixteenth or one-twelfth.
In my experience such instances are excessively uncommon; and I cannot
but suppose that the practitioners who use the high doses frequently
must inject in such a manner as to fail to get the whole dose taken up.
[Absolutely inexplicable to me is the statement of the illustrious
Trousseau--that hypodermic remedies are "less active" (!) than gastric
remedies--except on his hypothesis.]
The most remarkable effects that I have seen from hypodermic atropia
were obtained in cases of peri-uterine neuralgia, especially
dysmenorrhoeal neuralgia. Speaking generally of atropine, it must
undoubtedly be counted far inferior to morphia as a speedy and reliable
reliever of neuralgic pain, but for all pelvic neuralgias it appears to
me on the whole to surpass morphia. And besides this, in other
neuralgias, where opiates altogether disagree (as with some subjects
they do), it is not uncommon to find that atropia acts with
exceptionally good effect. And to some extent I am inclined to confirm
Mr. Hunter's opinion, that, where atropia does stop neuralgia, it does
so more permanently than morphia.
There is another special use of hypodermic atropine which I have not
seen mentioned by any one but myself, but which is probably very
important, namely, in ophthalmic neuralgia where acute iritis, or
especially glaucoma, seems coming on. I may be mistaken, but I believe
that in three cases I have succeeded, by prompt injection of sulphate of
atropine (one-sixtieth to one-fortieth of a grain), in saving a
neuralgic eye from damage, and possibly from destruction, from impending
glaucoma.
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