Neuralgia and the diseases that resemble itAnstie, Francis Edmund
Science
Neuralgia and the diseases that resemble it
Anstie, Francis Edmund
Neuralgia
(_c_) The class of cases for which merely hypnotic remedies are of much
value is limited; nevertheless, in the milder kinds of migraine and
clavus, especially when they have been brought on or are kept up by
mental worry or hysterical excitement, these remedies will sometimes
prove very useful. In former days, before we knew chloral, I used to
employ camphor for this purpose; three or four grains being administered
every two hours: and in hysterical hemicrania of a not very severe type
this not unfrequently produced a short sleep, from which the patient
awoke free from the pain. But chloral infinitely transcends in value any
agent of this kind that was known before. Perfectly valueless for the
really severe neuralgias, it is of the greatest possible use as a
palliative in migraine and clavus, where the great object, for the
moment, is to get the patient to sleep. A single dose of twenty to
thirty grains will often effect our object: it may be repeated in two
hours if sleep has not been induced; it should be given as soon as the
pain has at all decidedly commenced.
And here I wish to make some special remarks on the subject of
"palliation," and the relation it bears to "cure." Nothing is more
common than to read serious admonitions, in medical works, about the
folly of trusting to remedies which only palliate for the moment but
leave the root of evil untouched; and, of course, there is a certain
respectable modicum of the fire of truth behind all this orthodox smoke.
In the case of neuralgia, however, it is most important to understand
that mere palliation, that is, stopping of the pain for the moment, may
be either most useful or highly injurious, according to the way in which
it is done. The unnecessary induction of narcosis for such a purpose,
doubtless, is most reprehensible; but if it were possible simply to
produce sleep from which the patient should awake refreshed, without any
narcotic effects, then, certainly, that sort of palliation must be good.
That is precisely what the judicious use of chloral does; and I may
mention, as resembling though not equalling it, the action of Indian
hemp, which has been particularly recommended by Dr. Reynolds. From
one-fourth to one-half of a grain of good extract of cannabis, repeated
in two hours if it has not produced sleep, is an excellent remedy in
migraine of the young. It is very important, in this disease, that the
habit of long neuralgic paroxysms should not be set up; and if the first
two or three attacks are promptly stopped, by the induction of sound,
non-narcotic sleep, we may get time so to modify the constitution, by
tonics and general regimen and diet, as to eradicate the neuralgic
disposition, or at least reduce it to a minimum. But I would decidedly
express the opinion that such remedies as either opium or belladonna are
mostly unsuited to this purpose. If the migraine of young persons does
not yield to chloral, to cannabis, or to muriate of ammonia (in twenty
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