Part 9 (1/2)

[19] _Journal de la Physiologie, v._

[20] ”Ernahrungsstorungen der Augen bei Anaesthesie des Trigeminus.”

Mitgetheilt von Dr. v. Hippel in Konigsberg in Preussen. Archiv f.

Ophthalm. Band. xiii.

[21] Zeitsch. f. rat. Med., 1867. There is corroborative evidence, from independent sources, of the truth of Meissner's views. His own observation only proved half the case; but he quotes an observation of b.u.t.tman's in which the exact converse of his own experience happened, the external fibres being affected without the inner band, and anaesthesia without trophic changes being the result. Moreover, Schiff (Gaz. hebdom., 1867) obtained experimental results (in operating on cats and rabbits) which coincide with Meissner's.

[22] London Hospital Reports, vol. iii., p. 305.

[23] Wegner, loc. cit.

[24] Archiv f. Ophthalm., xv., 1.

[25] ”Deutsches Archiv f. klin. Med.,” ii., 2, 1866. I am not aware whether Piotrowski has at all altered his opinions since the (subsequent) observations of Ludwig and Cyon upon the ”depressor” nerve.

[26] ”Functional Nervous Disorders.” Churchill, 2d edit., 1870.

[27] ”Prize Essay of the New York Academy of Medicine.” New York: Wood & Co., 1869.

[28] Volkmann's Sammlung klinischer Vortrage, No. 2. ”Ueber Reflex Lahmungen,” von E. Leyden. Leipzig, 1870.

[29] ”Cases of Urinary Paraplegia,” Med.-Chir. Trans., 1856.

[30] Wurzburg. Med. Zeitsch., iv., 56-64.

[31] Med. Cent. Ztg. 21, 1860.

CHAPTER IV.

DIAGNOSIS AND PROGNOSIS OF NEURALGIA.

_Diagnosis._--This subject is much simplified and shortened, in regard to our present purpose, by the plan of the present work, which, by separately describing (in Part II.) the other disorders which resemble neuralgia, and are liable to be confounded with it, avoids the necessity for stating here the negative diagnosis of neuralgia itself. We are only concerned here to give a clear picture of the positive signs which it is necessary to verify before we can suppose disease to be neuralgia. The special modes of searching for these are interesting, and in some respects peculiar;

(1) The first and most essential characteristic of a true neuralgia is, that the pain is invariably either frankly intermittent, or at least fluctuates greatly in severity, without any sufficient and recognizable cause for these changes.

(2) The severity of the pain is altogether out of proportion to the general const.i.tutional disturbance.

(3) True neuralgic pain is limited with more or less distinctness to a branch or branches of particular nerves; in the immense majority of cases it is unilateral, but when bilateral it is nearly always symmetrical as to the main nerve affected, though a larger number of peripheral branches may be more painful on one side than on the other.

(4) The pains are invariably aggravated by fatigue or other depressing physical or psychical agencies.

The above are characteristics which every genuine neuralgia possesses, even in its earliest stages; if they be not present, we must at once refer the diagnosis to one or other of the affections described in Part II. of this work.

Supposing the above symptoms to be present, we expect to find--

(5) In by far the largest number of instances that the patient has either previously been neuralgic, or liable to other neuroses, or that he comes of a family in which the neurotic disposition is well marked.

Failing this, we are strongly to doubt the neuralgic character of the malady, unless we detect that there has been--

(6) A poisoning of the blood by malaria (but this very rarely causes neuralgia, save in the congenitally predisposed); or--