NEURALGIÆ.
The great variety of causes that may give rise to neuralgia, precludes the possibility of any specific for this symptom. In discussing its electro-balneological treatment, I would observe a primo that I cannot, in the light of my personal experience, agree with those who claim for electrical treatment good results in a majority of cases.[16] On the other hand it cannot be denied that, either as a palliative or curative measure, electricity, employed in an appropriate form and manner, is of inestimable value in many cases, and frequently succeeds where all other remedies are of no avail. Where we know the cause of a neuralgia, it is of course comparatively easy for us to determine whether or not electricity promises to avail anything. But even where the nature of the cases appeared to indicate its use, the failures, in my hands at least, have outnumbered the successes. The brilliant results—sometimes almost instantaneous—that we obtain now and then, should not lead us into overlooking our failures. Undoubtedly the circumstance that most of the cases that have come under my observation were of a very obstinate nature, referred to me by other physicians after varied unsuccessful treatment, has much to do with the formation of my views as expressed above, and future experience may perhaps lead me to modify them.
Speaking still from my own experience, I will state that the cases that have proven the most amenable to treatment were, first, those of rheumatic origin; second, hysterical neuralgiæ, and, third, cases where no assignable cause could be elicited. The most obstinate varieties were those of a malarial type (even when quinine in large doses or arsenic were employed in conjunction with galvanism) and those that depended on some form of chronic inflammation—neuritis, periostitis, etc. Of central neuralgiæ, I have had excellent results in the sympathetic variety and in the pains of posterior spinal sclerosis, while in the neuralgiæ of cerebral origin (diffuse cerebral sclerosis, tumors, etc.) I have never met with any appreciable success.
Where, then, we are able accurately to diagnose a case, there cannot be much doubt as to the appropriateness or not of electrical treatment, and in cases whose origin is obscure, which may be considered practically functional and therefore treated more or less empirically, electricity holds out as much or more hope than any other remedy. Whether electricity should be employed locally or in the form of baths, must depend on the features presented by each individual case. In neuralgia of the fifth pair—excepting those reflex cases where the point d’origine is to be sought for somewhere in the trunk or extremities, and those that depend on cerebral hyperæmia or anæmia, where the equalizing effects of the baths on the circulation are frequently of great benefit—these are generally useless. Of other neuralgiæ, I have found the baths less successful in those of the superior than in those of the inferior spinal nerves. Lumbo-abdominal neuralgia and sciatica have yielded much more readily than brachial or dorso-intercostal neuralgia, etc., etc.
The mode of administering the baths in neuralgiæ does not possess enough of uniformity to render suggestion in this respect of any value. I will state however that, as a rule, the best results have been obtained from the descending galvanic current.
In chronic cases the baths should be administered daily, and should not be discarded as unavailing until at least a dozen have been successively taken.
Case XX. Sciatica. Mr. R., a middle aged man, mechanic, was sent by Dr. Arcularius Nov. 9th, 1874. Had post-rheumatic sciatica of some six weeks’ standing. There were no remarkable features about the case, which however was sufficiently severe to disable him from pursuing his avocation. He took his first bath on the date above-mentioned. Another bath was administered next day, and three more every alternate day. He was then almost well. On Nov. 25th he returned, there remaining still some traces of the affection. Four more baths, the last of which was administered on Dec. 4th, sufficed to complete the cure.
Case XXI. Sciatica. Mr. G., aet. about 35, saddler, was sent by Dr. Waechter, March 6th, 1875. Had suffered from sciatica without discoverable cause for several years. For one year prior to his visit had been unable to work, and was confined to bed a great portion of the time. There was slight atrophy of the affected limb. He had had considerable medical (including local electrical) treatment, without avail. The baths were faithfully and persistently tried in this case, effecting however but slight improvement. Subsequent hypodermic injections, first of strychnia, then of atropia and finally of chloroform, the latter in doses ranging from 30 to 60 minims, gave him only temporary relief. The patient was finally discharged uncured.
Case XXII. Lumbo-abdominal neuralgia. Mr. W., aet. about 40, was brought by Dr. Marvin S. Buttles in June, 1875. He had been in poor health for a number of years, and was then in a very cachectic condition. There was considerable gluteal atrophy on the affected side. At Dr. B.’s suggestion he took a course of electric baths, with the happiest result. He improved steadily, and on the occasion of a late inquiry after I had not seen him for some months, Dr. B. told me that the patient had entirely recovered. His general condition as well as the neuralgia had been very favorably modified by the baths, and he is now in far better health than he has been for many years.
Case XXIII.—Lumbo-abdominal neuralgia. Mr. G., aet. 40, came to consult me in October, 1875. He had suffered from neuralgic pains, more particularly in the renal region of both sides, but also in the neighboring parts, for only one week. The case being so recent, I entertained a very favorable prognosis, which subsequently was amply verified. A bath on the 12th of October and one on the 16th sufficed to effect a complete cure.