Neuralgia and the diseases that resemble itAnstie, Francis Edmund
Science
Neuralgia and the diseases that resemble it
Anstie, Francis Edmund
Neuralgia
There are curious differences between the effects of blistering in
trigeminal or intercostal neuralgia and in sciatica. On the whole, it
would appear that blistering in the neighborhood of the spine is less
frequently effective in the latter, and we sometimes, after failing with
this method, obtain immediate success by two or three repetitions of the
flying blister, somewhere over the trunk of the nerve, especially just
outside the sciatic notch. I have one lady patient in whom this series
of phenomena has several times been observed; and I have seen it occur
in a particular attack, in other patients, in whom, nevertheless, on
another occasion the spinal blistering has been promptly effective.
I consider blistering of the posterior branches to be an important, and
usually an essential, element in the treatment of all cases of sciatica
in the middle period of life which have reached some severity and lasted
long enough to become complicated with decided secondary affections.
In all cases where blistering is employed it is advisable to adopt the
simultaneous use of hypodermic morphia or atropine; this combination of
remedies is exceedingly powerful.
Lastly, it must be said of blistering, that, on the whole, it is a
remedy not well fitted to be applied to aged subjects; and in its
severer forms it should never be applied to patients who are greatly
prostrated in strength. For it must be borne in mind that the remedy may
miss its aim of relieving the neuralgia, in which case it is necessary
to remember, more accurately than many practitioners appear to do, what
a very serious element of misery and prostration will be introduced into
the case by the vesication itself.
I am not convinced that any of the other forms of severe skin-irritation
(_e. g._, tartar-emetic inunction, or the use of veratrine-ointment to
such a degree as to produce not the anæsthetic but the irritant effects)
are of any particular value; if blistering failed, I should not expect
to see them succeed.
A milder degree of skin-stimulation is represented by rubefacient
liniments of various kinds, which may be briskly rubbed into the skin
along the track of the painful nerve, without any danger of producing
vesication. Among this class I continue to prefer chloroform diluted,
with six or seven parts of chloroform, to any other; in the milder forms
of neuralgia, especially in young persons and first attacks, it is
surprising how frequently the paroxysm may be greatly relieved, if not
arrested. Still, this can only be regarded as the merest palliative; and
in severer cases such applications are useless. Occasionally, when
chloroform-liniment has failed, a mustard plaster will do good.
Public-domain text, read in full here on John Shaqi.
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