“The carpenter with whom he lodged had not been always on the best terms with him; Woodville said he should wish to [p346] let the man see that he died in peace with him, and as he never had much occasion to employ him, desired he might be sent for to come and measure him for his coffin. This was done; the carpenter came, and took measure of the Doctor, who begged him not to be more than two days about it; ‘For,’ said he, ‘I shall not live beyond that time;’ and he did actually die just before the end of the next day. He got between one and two thousand pounds by his Medical Botany, and with the money bought a small estate, which he left to his natural daughter, being all the property he possessed.”
We happen to know this fact, and moreover, that the Doctor was playing at chess when the carpenter was introduced to measure him for his wooden surtout. “Mr. ——,” said the Doctor, “you come at the proper season, for my game is nearly finished!”
The work is embellished with three etchings, which remind us that Mr. Wadd not only uses the pen, but the pencil, with facility and taste. His published works afford ample proof of his power of illustrating morbid anatomy, but we happen to know of some unpublished folio proofs of equal merit. To his fair fame as a surgeon, by the works we have just noticed, he may add the reputation of being one of the most vivacious literary illustrators of his art.
On Tic Douloureux. [◊]
SIR,
PRESUMING that popular and domestic medicine may occasionally find a niche in your Journal, I beg to offer a few remarks upon the above complaint, which has lately become, as it would appear at least, singularly prevalent; and as I address myself to general readers, I shall avoid all learned terms of art, and minute descriptions requiring them. The genuine tic douloureux is usually considered as a morbid affection of the nerves of the face, very commonly attacking the circumference of the orbit, and producing frequent and violent paroxysms of excruciating pain; the disease, however, varies considerably in intensity, and sometimes bears the same name when attacking other parts; it frequently occurs under the integuments of the head, and may or may not be attended with external tenderness. Though opiates relieve the pain, they are ineffectual as to its cure. Peruvian bark, in [p347] various forms, has sometimes afforded relief, and preparations containing the metallic tonics, more especially the oxides of iron, have been regarded as giving more permanent and beneficial assistance. Local remedies are of very uncertain utility, and electricity and galvanism have generally done more harm than good. The division of the nerves has been resorted to, but never with permanent, and often not even with temporary benefit. The cause of the disease is unknown, and though sometimes organic derangement would appear to excite it, no plausible source of the mischief can usually be discovered. The patient’s principal solace is that the disorder frequently wears itself out, and as far as my experience goes, the less we rely upon individual remedies, the better—the main thing being strict attention to the general health, and especially to the state of the stomach and bowels. These remarks apply to the genuine Tic Douloureux; but it has of late years been the fashion in physic to give that alarming name to a variety of painful affections, resulting from very various causes, by which much needless uneasiness has been given to the patient, and which has often led to erroneous and even mischievous systems of practical treatment. As cases of this kind are of every day occurrence, a short notice of them can scarcely be inappropriate to a Journal, the chief object of which is to familiarize every branch of science.
Rheumatic affections of the head and face often put on the appearance of Tic; like it, they come on at short intervals, and are limited to a small space; there is, generally, more or less of external tenderness, sometimes confined to spots upon the face and scalp, not larger than a shilling; at others, more diffused. More or less of this is usually attendant upon habits subject to chronic rheumatism, and it not uncommonly is the leading feature of the complaint. The internal use of opiates and sudorifics, especially small doses of Dover’s powder, warm fomentations, and keeping the head, especially at night, wrapped up in flannel, are sovereign remedies.
But the most common cases of painful affections, mistaken for Tic, are those which occur in nervous and irritable persons, and especially amongst men of business, statesmen, lawyers, merchants, over-studious persons, and all whose minds are [p348] occasionally exercised beyond their powers, who are subject to reverses of fortune, or sudden changes in the posture of their affairs, and who are constant objects of public attention, praise, or censure. For a time, the constitution, if a good one, bears up against such wear and tear, but as you advance, one or other symptom of a shattered nervous system appears, and this, more quickly and certainly, where the body has been pampered by too good living, false spirits excited by indulgence in wine, and fatigue relieved by narcotics, instead of sleep. Among the host of disordered affections to which such persons are liable, violent local nervous pains are most common, but they are invariably relieved by such means as contribute to quiet the mind and invigorate the body. Abstinence from business, retirement into the country, regular hours, plain food, moderate exercise, and avoiding excitement, are here certain remedies, and indeed the only ones, but they are unfortunately not always easy of attainment, and sometimes altogether unattainable. I have, however, mentioned these cases, to enjoin an early attention to the overhanging evil, and to criticise its improper treatment. I would, upon the first point, enjoin early attention to the first symptoms, and when they appear let the individual seriously ask himself whether it be worth while to gain a little more money, glory, or honour, or renown, at the expense of all future comfort, and a painful, wearisome, and probably shortened existence; or whether such apparent advantages had not better be at once conceded, and the host of evils, which will almost certainly ensue, warded off by a timely retirement? I could illustrate this subject by reference to many individuals, especially in the legal and medical professions, some of whom are harassing themselves to death by over-exertion, whilst others (I regret to say but few) are preserving a healthy constitution, by sacrificing a certain share of fame and emolument: the exceeding folly, too, of persevering in business, when neither mental nor bodily powers are adequate to the exertion, might here be animadverted on, but I must, for the present, waive such topics, and return to the treatment of those nervous pains called Tic Douloureux, which are of such common occurrence in the cases alluded to. These will certainly give way under [p349] that quiet and retirement which has been above recommended; but it is really provoking to see such means so commonly neglected, and the unfortunate patients tormented by blisters, fomentations, and galvanism, and their already debilitated stomachs further overpowered by gigantic doses of powdered bark, rust of iron, and other (in such cases) equally ineffective and hurtful medicines. I write to warn against them.
I have spoken of Peruvian bark as a remedy in tic douloureux. Where the painful affection so called, let it arise from what cause it may, assumes an intermitting form,—and nothing is more common than to have it coming on at stated periods, generally one violent attack in the twenty-four hours,—in such, as in other similar cases, bark has often been effective; but of late, sulphate of quinine has very properly been substituted for it; and as this extremely curious and valuable medicine is now in every one’s hands, and even finding its way into family medicine chests, a few words respecting its use, or rather abuse, may not be here misplaced. I would first remark, that it is too commonly given in over-doses: it then produces thirst, and a white tongue, and, what is remarkable, it excites in most people that uneasy sensation of fulness about the stomach, which is generally complained of after a large dose of powdered bark, and ascribed to the indigestible nature of the large quantity of inert and insoluble woody fibre in which that substance abounds. For these reasons sulphate of quinine is too often laid aside in cases where, if properly and judiciously administered, it might prove of important service; instead of three or four grains, or even more, repeated every four or six hours, let a grain be given once a day; and if it agree, and occasion require, let this dose be repeated twice or thrice daily, either in the form of pill or solution. I prefer the latter; two drachms of tincture of orange-peel being used as the solvent, and diluted afterwards with half a wine-glass of water. It is not meant here to insinuate, that in obstinate agues, and other disorders, large doses of quinine are always improper, but to enforce the occasional mischief which they produce, and by which the medicine is unjustly brought into distrust and disrepute.
Decayed teeth are fertile sources of pains and twitches [p350] about the facial nerves and muscles, analogous to Tic; and great irritation from inflamed membranes of some cavity in the upper jaw has also occasioned them. I knew a person who suffered six months from such an attack, and for whom a physician prescribed, in the course of that period, some pounds of carbonate of iron. Symptoms then ensued, for which a course of sarsaparilla was ordered, but it was of no avail. Mercurials were then given, with manifest mischief. The extraction of the second grinder effected a permanent cure; its roots were connected with a cavity of fetid discharge, which had no sooner vent, than all the symptoms disappeared.