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                 NEURALGIA
                    AND
       THE DISEASES THAT RESEMBLE IT.

                    BY

      FRANCIS E. ANSTIE, M.D., LONDON,

FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS; HONORARY FELLOW OF KING'S
COLLEGE, LONDON; SENIOR ASSISTANT PHYSICIAN TO WESTMINSTER HOSPITAL;
LECTURER ON MEDICINE IN WESTMINSTER HOSPITAL SCHOOL; PHYSICIAN TO THE
BELGRAVE HOSPITAL FOR CHILDREN.

              [Illustration]

                NEW YORK:
      BERMINGHAM & CO., UNION SQUARE.
                  1882.

           W. L. MERSHON & CO.,
   _Printers, Electrotypers and Binders_,
              RAHWAY, N. J.




PREFACE.


I believe it will not be disputed that there was considerable need for
an English treatise dealing rather fully with the subject of Neuralgia,
and therefore I hope that the profession will be willing to give me a
hearing. The present work, moreover, does not profess to be a mere
compilation of standard authorities corrected down to the present time,
but puts forward a substantially new view of the subject--at least, a
view that has been only briefly sketched by me in an article that
appeared, three years ago, in Reynolds's "System of Medicine." My
principal object, in writing this volume, was to vindicate for Neuralgia
that distinct and independent position which I have long been convinced
it really holds, and to prove that it is not a mere offshoot of the
Gouty or Rheumatic diatheses, still less a mere chance symptom of a
score of different and incongruous diseases. In order to set the
diagnosis of true Neuralgia from its counterfeits in the clearest light,
it seemed advisable to draw separate pictures of each of the latter (at
least of as many as are of real importance) and present them separately,
as a kind of gallery of spurious neuralgias, and this I have done in the
second part of the volume. No one who had not tried to do it would
imagine how difficult this latter kind of work is. It was necessary for
the sketches to be very brief (unless my book was to become unmanageably
large), and yet to be as truthfully characteristic as possible; and it
was necessary also that only those diseases which so much resemble
Neuralgia as practically to lead medical men astray in diagnosis, should
be dealt with. The selection of the subjects, and the execution of this
part, took a long time, though it only covers about fifty pages. Then,
as regards Neuralgia itself, it became necessary to completely recast
the chapters on "Pathology" and on "Complications," on account of some
of the polite criticisms which Dr. Eulenburg directed (in his recent
"Lehrbuch der Nervenkrankheiten") to my argument in the article above
referred to, since it was obvious that a too brief statement of my views
had caused them to be partially misunderstood by the German physician.
These chapters (Part I., Chapters II. and III.) are certainly the most
important portion of my book, and I would particularly direct attention
to them, in order that their contents may be affirmed or corrected: the
reader will at any time find that they contain a kind of investigation
never before systematically carried out with regard to Neuralgia. The
causes above mentioned, together with others over which I had no
control, have kept back the appearance of this work so long beyond the
date for which it was originally announced, that I feel I ought to
apologize for an amount of delay that would seem hardly justified by the
moderate size of the volume.

16 WIMPOLE STREET, LONDON, _October_ 1, 1871.




CONTENTS.


    INTRODUCTION--ON PAIN IN GENERAL                7


                 PART I.

             _ON NEURALGIA._

    CHAP.                                        PAGE

       I.--CLINICAL HISTORY                        12

      II.--COMPLICATIONS OF NEURALGIA              79

     III.--PATHOLOGY AND ETIOLOGY OF NEURALGIA     96

      IV.--DIAGNOSIS AND PROGNOSIS OF NEURALGIA   142

       V.--TREATMENT OF NEURALGIA                 149


                 PART II.

     _DISEASES THAT RESEMBLE NEURALGIA._

    CHAP.

       I.--MYALGIA                                196

      II.--SPINAL IRRITATION                      200

     III.--THE PAINS OF HYPOCHONDRIASIS           207

      IV.--THE PAINS OF LOCOMOTOR ATAXY           210

       V.--THE PAINS OF CEREBRAL ABSCESS          213

      VI.--THE PAINS OF ALCOHOLISM                215

     VII.--THE PAINS OF SYPHILIS                  218

    VIII.--THE PAINS OF SUBACUTE AND CHRONIC
              RHEUMATISM                          225

      IX.--THE PAINS OF LATENT GOUT               227

       X.--COLIC, AND OTHER PAINS OF PERIPHERAL
              IRRITATION                          229

      XI.--DYSPEPTIC HEADACHE                     231




INTRODUCTION.

ON PAIN IN GENERAL.


Although it is, in a general way, unadvisable to introduce abstract
discussions into a treatise which should be strictly practical, it is
almost impossible to avoid some few general reflections on the
physiological import of Pain, as a preliminary to the discussion of the
maladies which form the subject of this volume. This whole group of
disorders is linked together by the fact that pain is their most
prominent feature; and, with regard to most of them, the relief of the
pain is the one thing required of the physician. It seems, therefore,
very important that we should ascertain, at least approximately, in what
the immediate state consists, which consciousness interprets as pain. It
is not necessary to enter at this stage into any inquiry as to the
pathological causes of the phenomenon; what we know of these, and it is
unfortunately too little, will be discussed in detail under the headings
of the several affections which I shall have to describe.

The question before us now is this: What is that functional state of the
nerves which consciousness interprets as pain? Is it, or is it not, an
exaltation of the ordinary function of sensation?

The latter question is generally answered affirmatively, without much
thought, by those to whom it casually occurs; but indeed there is