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 AN ESSAY 
 
 ON 
 
 NEURALGIA 
 
 SECOND VICE-PrISs 
 MEMBER 
 
 BY J OM&*t. t JB; MURRAY, A. 31. 
 
 ifl^TP^ 1 THE AMERftWjfry^lft 
 
 r ofV( 
 
 PIAN SOCIETY, ANI> 
 OLTJMBIA COLLEGE. 
 
 NEW-YORK : 
 
 fRINTED BY J. SEYMOUR, No. 49 JOHN-STREET. 
 
 1B1G, 
 
A 
 
 /m 
 
AN 
 
 INAUGURAL DISSERTATION 
 
 ON 
 
 NEURALGIA, 
 
 SUBMITTED TO THE PUBLICS EXAMINATION OE THE 
 
 TRUSTEES OF THE COLLEGE OF PHYSICIANS AND SURGEONS, 
 
 OF THE UNIVERSITY OF THE STATE OF NEW-YORK, 
 
 SAMUEL BARD, M. D. PRESIDENT, 
 
 THE DEGREE OF DOCTOR OF MEDICINE; 
 
 MONDAY THE SIXTH DAY OF MAY, 1816, 
 
I 
 
 TO 
 WRIGHT POST, M. D. 
 
 PROFESSOR OE ANATOMY, PHYSIOLOGY, AND SURGERY, IN THE COLLEGE 
 OF PHYSICIANS AND SURGEONS ; 
 
 VALENTINE MOTT, M. D. 
 
 PROFESSOR OE THE PRINCIPLES AND OPERATIONS OE SURGERY ; 
 
 DAVID HOSACK, M. D. F. L. S. 
 
 PROFESSOR OE THE THEORY AND PRACTICE OE PH YSICK, AND OF MIDWIFERY ; 
 
 SAMUEL L. MITCHILL, M. D. F. R. S. Ed. 
 
 PROFESSOR OE NATURAL HISTORY ; 
 
 WILLIAM JAMES M'NEVEN, M. D. 
 
 PROFESSOR OE CHEMISTRY AND MATERIA MEDICA \ 
 
 JAMES S. STRINGHAM, M. D. 
 
 PROFESSOR OF MEDICAL JURISPRUDENCE : 
 
 NO LESS IN ADMIRATION OF THEIR ABILITIES AND LEARNING, 
 
 THAN IN GRATITUDE FOR THEIR NUMEROUS DISPLAYS OF PROFESSIONAL 
 AND PERSONAL KINDNESS, 
 
 THIS 
 
 INAUGURAL DISSERTATION 
 
 IS 
 
 RESPECTFULLY DEDICATED, 
 
 BY THEIR MUCH OBLIGED PUPIL, 
 
 JOHN WILLIAM BOYLES MURRAY, 
 
Q 
 
 A^ j*. 9: Mz^,. 
 
 
 ^&CJ$3(A 
 
M18TOMY, 
 
 The disease which the French first called Tic 
 douloureux, and which has been generally styled 
 by that name., in preference to Dr. FotherguTs 
 more undefined appellation of u A painful 
 affection of the face/' has been scarcely noticed 
 by ancient writers. It w r as so little heeded by 
 modern physicians, that when that excellent 
 practitioner invited the attention of his brethren 
 to its existence, he was considered as its first 
 describer. 
 
 Much doubt has been expressed concerning 
 the meaning and origin of the word tic. Sau- 
 sages has a species Trismus equinus gallice le 
 Tic. Sic dicitur quia equi hoc affectu labo- 
 rantes dentibus prcesepium impetunt et sonum 
 Tic referunt*. Under the eighth species, Tris- 
 mus hypochondriacus \ he observes, hue referri 
 potest distortio musculorum genets, oculos Sf 
 maxillam moventium involuntarid et pravo 
 usu assueta, quae vulgo Tic dicitur. The 
 same explanation of the term is given in the 
 
 * Nosologia Methodica, Class IV. ii. 6. 
 
£ 8 
 dictionaries of the Academy, Boiste and Cham- 
 baud. The singular affection of horses, during 
 which they strike' their teeth together while 
 biting at the manger, and the unseemly habits 
 of twisting the face, eyes, and lower jaw, in 
 which some persons indulge, are therefore the 
 roots of this expression. The term tic doulou- 
 reux is the ingenious application of forcible 
 expressions used in common life to an acute 
 disease, which to the superficial observer seems 
 to partake of two analogous affections. 
 
 Besides the terms tic douloureux and pain- 
 ful affection of the face of Dr. Fothergill, it 
 has been yariously styled by different writers, 
 Trismus dolorificus , Tic convulsif., Morbus 
 nervorum faciei crucians^ Prosophalgia, 
 Aerophobia, 8$c. But since these expressions 
 by no means specify the seat nor nature of the 
 disorder, the generick term neuralgia, recom- 
 mended by Professor Chaussier, is certainly 
 the most correct, classical, and comprehensive. 
 According to its situation in the system, it may 
 be specifically distinguished as Neuralgia faciei, 
 brachii, digiti, <fyc. Banishing the unscientifick 
 language hitherto employed, with the approba- 
 tion of many learned and eminent physicians, 
 the disease should henceforward be designated 
 and acknowledged only as neuralgia. 
 
 In detailing the records of Neuralgia, after 
 giving due credit to the more ancient writers. 
 
the medical men of the present day seem to 
 consider Dr. John Fothergill" as its principal 
 discoverer. The notices of Neuralgia anions 
 modern physicians have been numerous, but 
 none have given a sy sterna tick view of it, 
 specifying all the methods of management, 
 and especially, as connected with the various 
 surgical operations now recommended for its 
 relief. 
 
 The Greeks are perfectly silent concerning 
 it ; but it is said to have been mentioned by 
 Rhazes, the celebrated Arabian, whose descrip- 
 tion he acknowledges to have been derived from 
 Simion Seth, physician to an Eastern Emperor, 
 during the eleventh century. " Subsequent to 
 this period, Ebr Sina, of the same nation, de- 
 scribed the disease, more fully and with more 
 precision 6 ." From the investigation which 
 has been bestowed on this subject, it appears 
 that, John Hartmann Degener, a physician of 
 Nimeguen, in 1724, is next entitled to the dis- 
 tinction of having given the most circumstantial 
 account of Neuralgia'. Dr. Siebold^ whose 
 
 a Med. Observ. and Inq. vol. v. 
 
 b New England Journal of Medicine and Surgery, vol. ii. p. 115. Dr. Jack- 
 son on Tic douloureux. 
 
 c Acta Naturae Curios. u De dolore quodam perraro acerboque maxillae 
 •sinistra? partes occupante, et per paroxysmos recurrente." vol. i. 347. 
 
 d Doloris Faciei, niorbi rarioris atque atrocis observationibus Olastrati 
 adurnbratio Diatribe I. qua exercitationes clinicas in nosocomio juliaeo, ha- 
 bendas indicit G. Ch. Siebold, Dr. Med. Prof. Wirceburgi 1795. Diatribe II. 
 1797. Translated in the Medical and Phvsical Journal. No. SO. 
 
 2 
 
10 
 
 research has been practical and laborious, meti-* 
 tions that in 1673, observations on this disease 
 were published by Dr. Daniel Ludwig e . Pos- 
 terior to these publications, N. Andre/, a surgeon 
 of Versailles, in his observations on the diseases 
 of the urethra, has some remarks on Tic clou- 
 loureux ; to him this appellation is traced, 
 and it has been adopted in common parlance 
 and formal treatises since his time. In the 
 edition of Sauvages 7 Nosologia Methodica, 1763, 
 that illustrious physician gives a character of the 
 disease under the title of Trismus dolorificus, 
 particularly notices the deceptive nature of its 
 symptoms, and prescribes caustick or division 
 of the nerve, as the certain cure. 
 
 As before stated, the philanthropick Fother- 
 gill embellished the subject by his clear and 
 practical description of the disease, of which 
 he professed to know no more than what had 
 occurred to him in his private practice. The fond 
 national partiality of his countrymen emblaz- 
 oned Dr. FothergiU's reputation as the disco- 
 verer of a new disease, and with his brief his- 
 tory, the inquiry in England rested, The im- 
 possibility of obtaining the works in which the 
 labours of his predecessors are registered, is my 
 
 e Misc. Nat. Cur. Dec. i. Ann iii. Observ. 252. " De dolore superciliari 
 acerbissimo. 1 ' 
 
 / Diagnos. Med. et Recueil period, de la Soc. de Med. de Paris, 1756, tome 
 iv. p. 318. " Observations pratiques des maladies de l'urethre et sur les plusiers 
 faits convulsifs." 
 
n m 
 
 apology for the imperfect condition in which 
 this inquiry is necessarily relinquished. Fol- 
 lowing Dr. Fothergill are many writers, among 
 w 7 hom, the principal are Messrs. Thouret, 
 Andry, Pujol, and Richter. Pujol's essay is 
 said to exhibit a very learned and laborious 
 investigation into ancient authorities, for the 
 purpose of ascertaining the extent of ancient 
 knowledge and observation. 
 
 The ingenious Dr. Haighton 5 has distinguish- 
 ed himself by the interesting view which he has 
 taken of Neuralgia, and of its surgical treatment. 
 Dr. S. Fothergill has also written a systematick 
 treatise on the disease, so ably illustrated by his 
 lamented uncle. 
 
 To the unfrequent appearance of Neuralgia, 
 are w T e to ascribe the slight acquaintance which 
 many physicians of eminence have acknow- 
 ledged concerning it. Excepting the Italians, 
 according to Dr. Siebold, writers of all nations 
 have seen cases of Neuralgia. " Dr. Fother- 
 gill met with sixteen instances of it ; Dr. Thi- 
 lenius, a German physician, saw it but tw T ice 
 during a most extensive practice of twenty 
 years ; Dr. Aepli, a Sw T iss physician, only 
 once in twenty-seven years." In America, 
 of late years, many cases have been recorded. 
 Professor Hosack has seen six cases ; Dr. Jack- 
 
 g Medical Records and Researches. 
 
\ 
 
 12 
 
 "3on details his treatment of four patients ; and 
 Professor Mott^ within a very few years, has- 
 been instrumental in relieving five sufferers. 
 Other respectable practitioners in different parts 
 of the union have borne testimony to its occur- 
 rence, and likewise to its tractability , when pro- 
 perly and actively treated. 
 
 As to the greater liability to this disease ex- 
 hibited by either sex, some contrariety of opi- 
 nion exists. In England, females have been 
 afflicted with Neuralgia in the proportion of 14 
 to 1 male ; while in Germany, the comparison 
 of frequency is 21 men to 13 women. In 
 America, the law of nervous irritability exposes 
 females to the occurrence of this bane of com- 
 fort, to a greater degree than the hardier sex. 
 All Dr. Jackson's cases were ladies ; but Dr. 
 Mott's experience inclines rather to the opposite 
 opinion : only two of his patients were females, 
 It is evident, that the history of Neuralgia is 
 still very imperfect; and indeed for practical 
 purposes the preceding details are of little value, 
 except they be employed to convince the skep- 
 tical, or confirm the doubting. 
 
 Dr. J. Fothergill is inclined to believe, that 
 the disease is rather an attendant on advanced 
 life, than on an earlier period. " On review- 
 ing the cases mentioned by different authors, 
 we observe, that they were for the most part 
 
13 d 
 
 confined to the period of age between the 
 thirtieth and eightieth year; and instances of 
 the disorder being met with at an earlier 
 period of life have but rarely occurred." — - 
 " Fortsmann, a German writer quoted with 
 great respect by Heurteloup\ says, that he 
 has seen the disease in young girls of twenty, 
 and even of nine years." Heurteloup also 
 gives a long and minute account of a Corsican, 
 w r ho was under thirty years of age 1 . Dr. Dar- 
 win, in his Zoonomia, relates a case unusually 
 severe, and of great extent, in which the patient 
 was between twenty and thirty years of age. 
 
 Connected with the irregularity of appear- 
 ance as to age and sex, is the uncertainty of the 
 temperament, in which a practitioner may ex- 
 pect to meet with Neuralgia. Indeed no habit 
 of body nor of life seems exempt from its 
 attacks : the laborious and the indolent, the 
 phlegmatick and the nervous, the rigid fibre 
 as well as the lax 5 the thin equally with the fat, 
 the delicate and the robust, are exposed to the 
 excruciating torments of neuralgick affections. 
 
 The season of the year is also equally inca- 
 pable of regulating its occurrence. 
 
 h Recueil de la Soc. de Med. de Paris, Tome iv. p. 20a. " Cette disser- 
 tation de Fortsmann est savante, pleine d'erudition, et merite de tenir place 
 parmi les bons ecrits sur le tic douloureux de la face. On y trouve des ex- 
 emples de jeunes filles de neuf et de vingt ans attaquees du tic douloureux." 
 
 « Essay on Tic douloureux, by Dr. Jackson. New-England Journal, 1315. 
 
w M 
 
 Nor is Neuralgia confined to one part of the 
 body. Professor Siebold, of Wurtzbourg, enu- 
 merates the following seats, as met with in 
 authors : 
 
 1. In one single part of the face, viz. at the 
 inner canthus of the eye, Fothergill ; in the 
 orbita, the same ; at the super cilia of the right 
 eye, Pujol ; in the joint of the jaws, Selle, 
 Pujol ; in the maxilla inferior, at the passage 
 of the nervus infra-maxillaris, (the entrance or 
 exit?) Lentin; in the ossa temporum, Fother- 
 gill ; in the nervus infra-orbitalis, Albinus, 
 Van Wy, and many others ; in the ala nasi, 
 Vogler and Thouret ; at the margin of the 
 tongue, Lentin. 
 
 2. In one half of the face, Fothergill and 
 others. 
 
 3. In both cheeks, Pujol. 
 
 4. In both sides of the maxilla inferior, at 
 the exit of the nerve. 
 
 5. In the whole head and face, Lentin. 
 
 6. In one foot, Lentin. 
 
 Mr. AbernethyV remarkable case shews its 
 existence in the ring finger of the left hand, ex- 
 tending in its progress up the nerves of the arm. 
 Dr. Kelly l witnessed its occurrence in the fore 
 finger of the left hand, and Mr. Home 771 has 
 
 k Surg. Observ. vol. i. p. 244. 
 
 I Dissertatio Inauguralis de Neuralgia. Edinb. 1810. 
 
 m Phil. Trans, for 1801. 
 
15 . * 
 
 met with it in the thumb. Dr. Hosack men- 
 tions one lady whose fore finger of the right 
 hand, and another whose second toe of the left 
 foot, was affected by Neuralgia. " In the Edin- 
 burgh Medical and Surgical Journal", a case 
 is recorded by Dr. Verpinet, as occurring in 
 one of the nerves of the fore arm, the conse- 
 quence of a wound with a knife'." 
 
 The face, however, is most subject to attacks 
 of Neuralgia, which has been satisfactorily tra- 
 ced to a morbid affection of some of the large 
 nerves which render that portion of the body so 
 susceptible of impressions. The portio dura of 
 the seventh pair, forming the pes anserinus, and 
 the nervus communicans faciei. The frontal 
 nerve, being the termination of the ophthalmick 
 branch of Willis, or first branch of the trige- 
 mini; the ultimate disposition of the second 
 branch of the fifth pair, the infra- orbit ary nerve; 
 and lastly, the mental nerve, the third branch 
 of that important trunk, are the sources of pain 
 and suffering. The tongue, the tonsils, the 
 radial, ulnar, and anterior tibial nerves, have 
 been occasionally affected by the disease. 
 
 n Vol. iii. p. 14. 
 
 o American Medical and Philosophical Register, vol. iv. No. li, 
 
CH^LBmACTMRm 
 
 The character of this affection, as given by 
 Sauvages, under the name of trismus dolorifi- 
 cuSj is as follows : Est difficultas maxima et 
 valde dolorifica os aperiendi aut movendi cum 
 uberi ptyalismo, pervigilio, et musculorum 
 vicinorum continua et convulsiva agitatione. 
 Dr. Darwin p has criticised this location and 
 description, objecting, that it has not a fixed 
 spasm like the locked jaw. But certainly the 
 convulsion of the face, the tetanick (though 
 temporary) closure of the low r er jaw r , and the 
 tremulous agitation of the jaw and lips, are 
 points in the description dwelt upon by many 
 writers. Trismus is defined by Sauvages to be 
 convulsio vel tonica vel clonica maxillce infe- 
 rioris. Therefore, without approbating the 
 ideas of the great French nosologist, Dr. Dar- 
 win might well have spared his criticism, and 
 have omitted remarks which have tended to 
 weaken the authority of his illustrious prede- 
 cessor. 
 
 The following character may be less exposed 
 to exception than many which I have seen: 
 Neuralgia is marked by an acute pain gene- 
 
 p Zoonomia, CI. I. % 4. 12. 
 
17 4fe, 
 
 rally following the ramifications of some 
 principal nerve, uncertain in its time of at- 
 tack, short in its duration, frequent in repe- 
 tition, accompanied by a convulsive action of 
 the neighbouring muscles. 
 
 BJESCJR1JPTIQJV* 
 
 In the commencement of Neuralgia faciei, 
 the correctness of the old appellation is per- 
 ceptible ; for the absence of swelling or any- 
 other external mark of disease, induces the 
 by-standers to reprove the patient, for his ridi- 
 culous and disgusting contortions of the face. 
 But while the Chorea Sancti Viti is frequently 
 unattended by any other distress^ than what 
 proceeds from the unnatural positions of the 
 body resulting from it, Neuralgia is invariably 
 calculated to draw forth the deepest commise- 
 ration. Its first symptoms, sometimes, are oc- 
 casional irregular twitchings of the muscles sup- 
 plied by the diseased nerve. In other instances, 
 its strong; resemblance to toothach has caused 
 the fruitless sacrifice of many teeth. By de- 
 grees its genuine nature developes itself; the 
 
 3 
 
lb 18 
 
 spasmodick actions increase in frequency and 
 acuteness, and a distressing and embarrassing 
 train of symptoms is noticed. The pain is very 
 irregular, and fickle as to its hour of acces- 
 sion. The patient's rest may be disturbed night 
 after night, as well as his comfort destroyed 
 during the day. The most trifling and opposite 
 occurrences give rise to the spasms, which by 
 their severity overcome the stoutest resolution^ 
 and force forth loud and involuntary screams of 
 anguish. Washing the face, moving the hand 
 or a handkerchief lightly over the face 7 , eat- 
 ing, drinking, speaking, hawking and spittings 
 sneezing, coughing, and blowing the nose, will 
 either of them in a moment awaken the most 
 poignant and acute pain. Even touching the 
 face with a finger, slightly rubbing the forehead^ 
 putting on a pair of spectacles, or even only 
 opening the mouth, will excite a return of the 
 pains. Taking into the mouth any thing hot, 
 cold, or acid, will produce the effect, perhaps 
 with aggravated violence. Combing the hair? 
 shaving, reading aloud, or any thing that gives 
 the slightest motion to the muscles of the face, 
 will be likely to occasion in the part a throb- 
 bing, which seems to begin like the vibration of 
 a musical cord, extending its effects to the cheeks, 
 the eye j the nose, up to the scalp on the affect- 
 
 q Dr. Gardner Jones' own case. Phil. Med. Museum, new series. Vol. I. 
 No. 2, 
 
19 J 
 ed side ; or from the corner of the mouth down- 
 wards to the base of the jaw., agitating the mus- 
 cles of the chin ; after continuing a few seconds, 
 sometimes a few minutes, and in aggravated 
 cases even fifteen or twenty minutes, it will 
 cease, and the part which had been affected will 
 enjoy an interval of perfect ease. When the 
 paroxysm comes on, the patient s whole body is 
 convulsed from the excess of agony ; the eyes 
 are intensely closed ; the tears trickle down the 
 cheek; the mouth is distorted, and, with the 
 whole cheek, quivers ; the body unconsciously 
 waves backwards and forwards, and the foot of 
 the diseased side is involuntarily moved, in con- 
 formity with the flexure of the body. Some- 
 times, the pain seems as if a heated knife, or a 
 sharp instrument was piercing or screwing into 
 the flesh ; at others, as if red hot pincers were 
 tearing or twisting it from the bone. The in- 
 terruption to every enjoyment, and even every 
 common occupation of life, as admirably describ- 
 ed in the eloquent letter of Dr. Jones, descrip- 
 tive of his own sufferings, is only equalled by 
 the degree of misery, with which these pa- 
 roxysms are attended. The wretchedness of a 
 neuralgick person seems to approach the ex- 
 treme of human misery ; being such as " nei- 
 ther words can describe, nor the imagination 
 easily conceive." 
 
w 20 
 
 The preceding delineation is applicable to a 
 confirmed case, involving most of the facial 
 nerves. In many instances, the operations of 
 the disease are more confined, and give rise to 
 a deception in the diagnosis. The first case 
 recorded by Sauvages, was mistaken by him for 
 Odontalgia, and treated accordingly. This mis- 
 take has been often repeated, as the obstinacy 
 of the patient points to the gums, or a carious 
 tooth, or the antrum highmorianum , as the seat 
 of the disease. With this view the gum has 
 been divided in various directions, many teeth 
 have been unnecessarily extracted, and useless 
 perforations have been made into the cavity of 
 the upper jaw. 
 
 After lasting a certain time in one portion of 
 the face, if not arrested, every neighbouring 
 nerve will be involved in the malady. In Mr. 
 Bosworth's case reported by Dr. Darw 7 in, the 
 supra and infra-orbitar, and mental nerves, the 
 branches of the pes anserinus, and also the 
 branches of the superior maxillary nerve pas- 
 sing into the cheek between the pterygoideus in- 
 ternus muscle and the upper part of the lower 
 jaw, were successively divided before relief 
 could be obtained. 
 
 Although the sufferings of the patient are so 
 great, it seldom happens that the constitution 
 experiences much deterioration, during the con- 
 tinuance of Neuralgia. The aged most gener- 
 
21 
 
 ally are its victims, and in some remarkable in- 
 stances, other diseases have held their course un- 
 interrupted and unmodified by this formidable 
 attendant. In Mr. Pearson's communication 7 " 
 is a case, however, in which mortification seized 
 the interior of the cheek surrounding the dis- 
 eased nerve, by which the patient's life was 
 destroved. How far this result mav have been 
 connected with the previous mercurial treat- 
 ment, it is impossible to hazard an opinion. 
 
 Neuralgia generally attacks but one side of 
 the face ; instances of both cheeks being involv- 
 ed are very rare. The right cheek appears 
 more liable to its occurrence than the opposite. 
 All Dr. Mott's patients were afflicted on the 
 right side, as were also a majority of the cases 
 recorded, in which the particular cheek is spe- 
 cified. 
 
 r Edinburgh Medical and Surgical Journal, toL 3. 
 
21 
 
 CAUSES* 
 
 The remote causes of Neuralgia are very 
 obscure. In a plurality of cases, no predis- 
 posing nor exciting causes can be detected ; in 
 a few, some local injury is the only assignable 
 cause. Cold ; violent blows, especially on the 
 head and face ; punctures, as in bleeding ; the 
 partial division of a nerve ; a contusion, as from 
 a cannon or musket ball ; cicatrices ; conges- 
 tions ; a delicate skin ; chewing of acrid sub- 
 stances ; excessive talking ; heavy coughing ; 
 long continued sneezing or blowing of the nose ; 
 and preceding tooth ach, are enumerated as 
 having given rise to the complaint. Some of 
 these are evidently mere attendants, and in- 
 competent to its production, while others seem 
 calculated rather to excite a paroxysm than 
 the disease. Some patients have been cured 
 by close attention to the digestive organs ; there- 
 fore symptomatick Neuralgia may be consi- 
 dered as proceeding from and depending upon 
 their derangement. 
 
 As the proximate cause of disease, should be 
 deemed that peculiar condition of the affected 
 organ which gives rise to the characteristick or 
 attendant symptoms, we shall be equally at a 
 
23 
 
 loss in determining the proximate cause of 
 Neuralgia. 
 
 Dr. Fothergill is inclined to believe that a 
 cancerous disposition is the proximate cause. 
 " My subjects were for the most part, if not all., 
 past the time of menstruation. They were 
 generally of a firm and somewhat robust fibre, 
 generally with black hair, and not subject to any 
 particular diseases. Most of them had borne 
 children, and nothing remarkable had occurred 
 about the cessation of the menses. These and 
 other appearances induced me to suspect that 
 the cause of these extreme pains in the face 
 might possibly be of a cancerous nature ; the 
 method of cure, and other circumstances cor- 
 roborated the suspicion 5 ." 
 
 The objections of Dr. Haighton are opposed 
 to Dr. Fothergill's authority, in his own lan- 
 guage. 
 
 " Out of several patients, whom Dr. Foth- 
 ergill attended with this complaint, two only 
 had schirrhous indurations of the breast, or 
 any other symptoms of Cancer. 
 
 " We might ask, out of the considerable num- 
 ber of patients labouring under Cancer, how few 
 of them have pains in the face, unless the Can- 
 cer be seated in that part ? It is well known 
 that local complaints of various kinds may at- 
 tack the same patient, without having the least 
 affinity to each other. 
 
 * Med, Observ. and Inq. vol. v. p. 138, 
 
24 
 
 iC Cancer manifests itself by external appear- 
 ances, as induration, ulcer, &c. This disease 
 produces no visible change in the organization 
 of parts, how long soever its duration may have 
 been. 
 
 " Cancer is seldom very painful on its first 
 appearance. This complaint first announces 
 itself by its acute lancinating pain. 
 
 u In Cancer the pain is not subject to perfect 
 intermissions. In this disease, the intermissions 
 are well marked, though indefinite in their du- 
 ration. 
 
 " Cancer is always aggravated by even a 
 simple incision on the part. This affection has 
 been cured by a simple incision in a proper 
 place." 
 
 Neither sex is peculiarly disposed to Neural- 
 gia, while the habit of females is well known 
 to be obnoxious to cancerous diseases. The 
 early age at which it has appeared in some 
 females, during the continuance of the men- 
 strual flux, and even surviving pregnancy, is 
 adverse to his deductions from the advanced 
 life of his patients. 
 
 Analogy in medical treatment, is a dange- 
 rous and ill-founded plea for identity of nature. 
 The powerful effect of many remedies on va- 
 rious disorders connected with the nervous sys- 
 tem, on this ground, would argue the same 
 proximate cause to exist in all. 
 
who J 
 
 25 
 
 a Almost all the authors who have treated of 
 this subject, agree in assigning arthritic matter 
 as the proximate cause of the disorder, but par- 
 ticularly Dr. Leidenfrost Dr. Degener is like- 
 wise of this opinion, having observed at the 
 affected place, a tumour similar to that in the 
 joints of gouty people. Dr. Siebold saw, in a 
 patient suffering the most violent pains at the 
 supercilia, a node perfectly like that of arthritic 
 limbs ; and Dr. Ludwig fairly tells us, that the 
 patients suffering this disorder became gouty 
 soon after. The disease seems to have an 
 arthritic origin in the cases related by Drs. 
 Bohmer and Lavagan, who found the pain dis- 
 appear when the usual arthritic symptoms re- 
 turned *." Dr. Hosack coincides partially with 
 this opinion, thinking that in one case, Mr. Ap- 
 thorpe's* gout was intimately connected with 
 Neuralgia. Dr. Rush, in his chapter on gout 3 ', 
 expresses his opinion, that Neuralgia is of gouty 
 origin, and the greater frequency of gout in the 
 female sex, according to his ideas, is sufficient 
 to account for their greater exposure to Neu- 
 ralgia. As this hypothesis is not applicable 
 to every case, at least as the gouty diathesis can- 
 not be detected in many instances of Neuralgia, 
 it may be safely pronounced inadequate to ex- 
 plain the mystery. 
 
 t Med. & Phys. Journal, No. xxx. 
 
 wAmer. Med. & Philos. Register, vol. iv.No. 11. p. 299. 
 
 y Medical Inquiries and Observations, vol. 2. 
 
m 
 
 Exanthemata in a few cases have had some 
 influence on the disease, but the irregularity of 
 that influence leaves us equally uninformed as to 
 the probable reason. The disappearance of a 
 miliary eruption in a case of M. Andre's, re- 
 moved the pain, which returned with aggravated 
 violence on the recurrence of the eruption. 
 c: Bonnard and Lavagan relate instances of her- 
 petic eruptions on the arm having preceded the 
 disorder ; and the German translator of Dr. 
 FothergilFs works saw it appear after a retro- 
 grade itch : the pain discontinued when the itch 
 broke out again, but as soon as it was removed 
 by proper remedies, the pain immediately re- 
 turned : and the disease lasted in this way from 
 the nineteenth year of a^e to the twenty- se- 
 venth." * 
 
 Menouret and Selle assign scropulpus acri- 
 mony as the cause of Neuralgia, in two in- 
 stances. 
 
 Venereal poison has been considered the ori- 
 gin of this disease in Mr. Watson V cases, which 
 were cured by the administration of mercu- 
 rials. 
 
 Ci Dr. Lentin relates a case in which a puru- 
 lent salivation preceded the pain, by the ap- 
 pearance of which the paroxysm of the pain be- 
 came less vehement and shorter : in another 
 case the pain succeeded a running of the ears : 
 
 r Journal de Medicine 1793. March. 
 
27 
 
 and Dr. Thilemus saw a patient who had a kind 
 of gonorrhea, previously to the pain, which be- 
 gan to run again as soon as the pain had 
 ceased/' 
 
 After this detail of opinions and of facts, 
 from which nothing conclusive can be gathered, 
 it would serve no useful purpose to speculate 
 any further on the proximate cause of Neural- 
 gia. The relief produced by an operation seems 
 to confine the morbid action to the nerve af- 
 fected, and the obscurity of nervous pathology 
 and physiology contributes to the mystery which 
 envelopes the subject. 
 
 The effects of the disease on the nerve are 
 by no means ascertained with precision. In 
 two cases, one by Dr. Gilbert of Xew Haven, 
 examination after amputation discovered a 
 condition that resembled a thickening of the 
 nerve. 
 
28 
 
 Bl*AGJVOSI§< 
 
 On referring to the cases of Neuralgia, sus- 
 pected or genuine, which have been submitted 
 to the publick, we can perceive that three dis- 
 eases have been confounded with it. 
 
 Trismus or locked jaw can hardly ever be 
 mistaken for Neuralgia, owing to the involun- 
 tarv and continued contraction of the levator 
 muscles, which widely differs from the spasmo- 
 dick action, violent in degree though short in 
 duration, by which the latter is characterised. 
 
 The other diseases are odontalgia, rheuma- 
 tism of the jaw and face, and hemicrania. 
 
 The age of the patient, condition of the teeth, 
 and direction, nature, and course of the pain, 
 will guide us in the diagnosis. Although, as 
 before observed, young persons have been 
 afflicted with Neuralgia, it is more inclined to 
 fasten itself on the nerves of the aged. If there 
 be any carious teeth, as they may operate to 
 a certain extent on the disease, their extraction 
 being premised, a decided opinion can be form- 
 ed. In odontalgia, the pain is confined to the 
 jaws, extending, by nervous sympathy perhaps, 
 through the alveolar processes of both ossa 
 
29 « 
 
 maxillaria — it cannot be moderated by pres- 
 sure on any particular spot — it is acute, unre- 
 mitting, and often unceasing, until the offend- 
 ing tooth be removed. In Neuralgia, the pain, 
 though often referred to the jaws, is seldom 
 confined to the neighbourhood of the gums ; its 
 direction is in the course of some of the large 
 nerves connected with the integuments and 
 muscles ; it can often be moderated by firm 
 pressure on some principal trunk, and its re- 
 currence by paroxysms will satisfy the dis- 
 cerning physician. In a case reported by Dr e 
 Jackson, u the pain had the most important 
 characteristics of Neuralgia. It was uncertain 
 as to the time of its attack, sudden, coming by 
 strokes, or darting, and excruciating in degree. 
 It was mostly, though not wholly, confined to 
 the portio dura of the seventh pair of nerves. 
 At the same time it is impossible not to ascribe 
 the pain to the tooth, which w r as so long a time 
 retained under the gum." The absence of con- 
 vulsion in the muscles of the face in odontalgia, 
 however, may be considered the chief diagnos- 
 tick symptom. 
 
 More difficulty exists in deciding between 
 Neuralgia and rheumatism. They are both 
 acute diseases; both may produce convulsive 
 actions of the mouth and cheeks ; the parox- 
 ysms of both may become accumulated in fre- 
 quency for some space of time, leaving an inter- 
 
so 
 
 st: be 
 
 val of entire rest ; both may be relieved by pres- 
 sure on the cheek ; both may be excited by the 
 intervention of trivial causes ; and both may be 
 controlled by the same remedies. Where, then, 
 shall we look for a dia<rnostick sign? The warmth 
 of a bed generally heightens the acuteness of 
 rheumatism ; Neuralgia is little affected in de- 
 gree of violence, by the accidental circumstan- 
 ces of heat or cold. The rheumatick diathesis is 
 usually aggravated by a change from a dry and 
 clear atmosphere to damp and rainy weather ; 
 while the other disease, though sensibly affected, 
 does not obey any such law of exacerbation or 
 diminution. In most instances of obstinate 
 rheumatism, swelling of the part affected is a 
 certain consequence ; but in Neuralgia of many 
 years duration, no alteration of the integu- 
 ments is perceptible. In rheumatism, a patient 
 is sensible of a tenderness of the surface, whe- 
 ther he be suffering from a paroxysm of pain, 
 or be at perfect rest ; while in Neuralgia no 
 such tenderness is complained of. Should, 
 however, the patient consent to a trial of the 
 operation for Neuralgia, he will be satisfied as 
 to the nature of the disease, by the effect which 
 a division of the nerve will have upon the pa- 
 roxysms. 
 
 The periodical nature of hemicrania ; its being 
 confined to either side of the scalp and face ; the 
 absence of those acute spasms noticed in Neu- 
 
31 
 
 ralgia ; its recurrence at a regular hour of the 
 day, generally at noon ; and its yielding to cin- 
 chona and alterative medicines, are deemed suf- 
 ficient diagnostick distinctions between hemi- 
 crania and Neuralgia. Dr. Curry, of Guy's 
 Hospital, is of opinion, that hemicrania is only 
 a neuralgick affection of the nerves supplying 
 the scalp and temporal muscle. 
 
 TRMA TJWEJVT. 
 
 Is Neuralgia a disease of the whole system, 
 or is it to be considered a local affection, con- 
 fined to the nerves ? According as this ques- 
 tion shall be determined, will be our indication. 
 If we are summoned to a case in which the pa- 
 tient complains of neuralgick pain, suddenly 
 showing itself in the part ; and if he be inclined 
 to gout or rheumatism, we may safely treat 
 the disease, as one connected with the arthritick 
 or rheumatick diathesis. At all events, in the 
 employment of remedies, as palliative or cura- 
 tive, the distinction will be serviceable in regu- 
 lating the class of medicines which should be 
 most extensively tried, and most assiduously 
 persevered in. Unfortunately the most marked 
 
m 
 
 cases are those where no other habit of body is 
 present, and where the progress has been so 
 slow and regular, as to preclude even reasonable 
 hopes from any application except the knife. 
 
 The tedious and innocent advance of Neu- 
 ralgia, has afforded ample scope for medical 
 experiment ; and of the great variety of reme- 
 dies put in requisition, the effect has been va- 
 rious in the hands of different practitioners. 
 The malady is so capricious, that at one period, 
 nothing but the most powerful impressions ap- 
 pear to produce any alleviation ; while at others, 
 applications the most simple and soothing lull 
 the sufferer to rest. 
 
 As an assistant in the exhibition of pallia- 
 tives, Dr. Rush's observation to Dr. Jones, is 
 highly important, and may suggest many useful 
 applications in this and analogous diseases : 
 '• A weak sensation of a pleasurable nature 
 may predominate over a painful one." The 
 catalogue furnished by that venerable martyr 
 to Neuralgia, shows the assiduity with which 
 he embraced every possible means of solace, 
 and answ T ers as a useful guide and beacon to 
 other practitioners. He has established one 
 fact, that, " every thing in this wayward, in- 
 coercible disease, has a limited season of utility, 
 and is forthwith either inert or detrimental, or 
 of trifling avail." 
 
The arrangement of articles from the Materia 
 Medica, employed to cure or relieve Neuralgia, 
 is that adopted by M. Alibert*, in his able and 
 learned work on Therapeuticks. 
 
 1. Of the substances derived from the vege- 
 table and mineral kingdom ivhtch act on the 
 tonick poiver, or fibrillar contractability of the 
 stomach and intestines, Cinchona has been fruit- 
 lessly employed. It has been exhibited either 
 in the form of powder, or the compound tinc- 
 ture, or conjoined with the volatile alkali, as re- 
 commended by Dr. S. Fothergill. I do not dis- 
 cover that Iron has been relied on, or faithfully 
 tried. The extensive agency which that mi- 
 neral has exercised in the prescriptions of mo- 
 dern practitioners, and its wonderful, even un- 
 expected, beneficial effects on some occasions, 
 would seem to direct the attention of physicians 
 to its employment. The contrary, however, 
 has happened. Its prospect of affording benefit 
 is quite as rational as that of many other reme- 
 dies, which have been administered with some 
 success. 
 
 2. Catharticks, constituting the class of me- 
 dicines ichich act on the myotility or muscular 
 contractile power of the intestinal canal, have 
 been found of much service. 
 
 When we reflect on the universal connexion 
 maintained by the alimentary system, we can 
 
 a Nouveaux elemens de la Therapentique, et de matiere medicale, &c> 
 Paris, 1814. 
 
34 
 
 readily conclude that powerful impressions made 
 in that quarter, would affect the nerves supplying 
 every part of the body. Dr. Jones, in his trials, 
 entertained a high opinion of a moderate purga- 
 tive ; and was sensible of the beneficial conse- 
 quence of its operation on the intestines, even 
 when its cathartick effect was hardly apparent, 
 
 3. Vegetable and mineral substances which 
 act on the stomach and intestines, by their poi- 
 sonous qualities. 
 
 Of the efficacy of this important class of 
 remedies, ample experience is on record, in the 
 endeavours to cure or relieve Neuralgia by 
 cicuta or conium maculatum, datura stramo- 
 nium, atropa belladonna, hyoscyamus, and 
 arsenick. 
 
 Baron Storck, of Vienna, having made known 
 his experiments on the anti-cancerous virtues of 
 hemlock, Dr. Fothergiil and others, relying on 
 the reputation of the Baron, placed their confi- 
 dence in its properties. They were aware that 
 so active a poison, if judiciously exhibited, must 
 produce decided effects on the animal oecono- 
 my ; and accordingly, Dr. J. Fothergiil fully 
 believed that Cicuta would cure his " painful 
 affection of the face." Dr. Jackson's remarks, 
 and experience with this remedy, are very use- 
 ful ; and his boldness in its exhibition is an evi- 
 dence of the advantage and harmlessness, with 
 which a watchful physician may administer the 
 
85 
 
 most dangerous medicines. He is of opinion, 
 that Dr. Fothergill could not be mistaken in re- 
 gard to the operation of hemlock ; and is strength- 
 ened in that idea, by the opposite results report- 
 ed by two able colleagues in the healing arte 
 The various quality of the extract is assigned as 
 one reason for this difference. The imported 
 Extractum conii maculati is generally very inert ; 
 therefore whenever it is prescribed, the physi- 
 cian should be well satisfied as to the good qua- 
 lity of the article. The cautions given by Dr* 
 Fothergill for the preparation of this extract, 
 are, that the plant should have acquired its full 
 vigour, and should be rather on the decline: 
 "just when the flowers fade, the rudiments of 
 the seeds become observable, and the habit of 
 the plant becomes yellow. It has then had the 
 full benefit of the summer heat ; and the plants 
 that grow in exposed places, will generally be 
 found more virose than those that grow in the 
 shade. The less heat it undergoes during the 
 preparation, the better." 
 
 The timidity of some practitioners, the want 
 of confidence of others, besides the indifference 
 and carelessness of a third set, are additional 
 causes of the failure of the medicine. 
 
 " It may be most prudent to begin with a sin= 
 gle grain of the inspissated juice, but we may 
 give five grains for the second or third dose ; 
 and afterwards we may add at least five grains 
 
36 
 
 to every dose, until we produce an effect on the 
 system." u When given in a full dose, it oc- 
 casions slight nausea, a giddiness more or less 
 severe, and often a loss of muscular power, so 
 that the patient cannot stand. It seldom does 
 good unless used in such a dose as to produce 
 these effects in some degree, and indeed in as 
 great a degree as can easily be borne." " I 
 have ventured in urgent cases to repeat the dose 
 every half hour. I believe it must always be 
 abundantly safe to repeat them once in two 
 hours, if the patient and attendants are careful 
 and watchful, and well informed in regard to 
 the effects*." 
 
 Dr. Fothergill seldom went beyond seventy 
 grains in the course of twenty- four hours. Dr„ 
 Jones ventured to one hundred — but Dr. Jack- 
 son administered three, hundred grains in six 
 hours. " I conceived that if the system could 
 be made to feel the effects of this medicine sud- 
 denly and powerfully, there would be a chance 
 of effecting a real cure ; a better chance than 
 from giving a much larger quantity during a long 
 space of time. Accordingly, after having ex- 
 hibited the medicine for about a fortnight, and 
 increased the dose to six and eight pills of five 
 grains each, and having ascertained that when- 
 ever any sensible effect was produced, it took 
 place within fifteen or twenty minutes after the 
 
 6 Dr. Jackson on Tic douloureux. New-England Journal. 
 
37 
 
 dose was swallowed, I resolved on a bold trial 
 of this medicine. I directed eight pills to be 
 taken as soon as the pain should come on, and 
 that the same should be repeated, at the end of 
 twenty-five or thirty minutes, if the pain should 
 continue, and the medicine should not affect the 
 head or stomach. At this time the paroxysms 
 of pain had become inexpressibly severe and 
 very frequent My directions were carefully 
 followed. The intervals of pain were such as 
 sometimes to prolong the intervals between the 
 doses ; but in the course of six hours, sixty 
 pills were taken, making three hundred grains, 
 After the last dose, the patient was quite over- 
 come by the medicine. She became dizzy and 
 faint, and was unable even to sit up. She laid 
 upon a sofa for some time, in a state of intoxi- 
 cation, but without suffering any very unplea- 
 sant effects afterwards. The respite from pain 
 and from susceptibility of pain, was more per- 
 fect and longer than at any time for several 
 weeks before. But the disease was not con- 
 quered ; it returned the next day with consider- 
 able severity. 1 had directed the medicine to 
 be repeated as soon as the pain should return } 
 which was done, and in the course of the day 
 forty-eight pills, two hundred and forty grains^ 
 were swallowed. These gave entire relief 5 and 
 affected the head, but not so powerfully as on 
 the day before. The disease seemed now to be 
 
vanquished. This was in November 1808. 
 and for two months the pain was not felt, ex- 
 cept in very transient twinges, which were never- 
 repeated for any length of time. About the 
 middle of January following, this lady walked 
 out on an extremely cold day, and the disease 
 returned before night, with very considerable 
 force. The hemlock was employed again, but 
 in smaller doses at first. In three days the dis- 
 ease gave way, without having required very 
 large doses of the medicine. Since that time it 
 has never recurred ; that is, during more than 
 three years." 
 
 The tincture of hemlock, prepared in the 
 same proportions as the tinctura Digitalis pur- 
 pureae, has been found equally efficacious in 
 Dr. Jackson's practice. In another case of 
 Neuralgia, he began with thirty drops at a 
 dose, " to be frequently repeated, and pre- 
 sently increased, if relief be not obtained. 
 The dose was gradually increased to three 
 hundred drops. It never gave relief except 
 when it affected her head, and always when 
 it did. The disease yielded in two or three 
 weeks after she commenced the use of the 
 hemlock, and since that time it has not re- 
 turned." 
 
 By these two interesting cases, the timidity 
 and unbelief of practitioners should be dimi- 
 nished ; as since whatever benefit may ulti- 
 
39 
 
 mately result, the precedents afforded by a 
 highly respectable physician, will justify any 
 trial to the same extent. Perhaps, from the 
 reasons before stated, other practitioners have 
 given opposite opinions on this subject, and 
 have been inclined to believe, that the gene- 
 rality of the cases reported to be absolutely 
 cured by hemlock, were actually rheumaticke 
 A similar belief has been entertained with re- 
 gard to the cures said to have been effected by 
 Stramonium. 
 
 Datura stramonium has been extensively 
 employed with this view in the State of Con- 
 necticut, especially in New-Haven, and its 
 vicinity. A disease sometimes appears in young 
 females of a plethorick and rather irritable ha- 
 bit, strongly resembling Neuralgia, which yields 
 to Stramonium, and may have given rise to a 
 belief in the anti-neuralgick virtue of that vege- 
 table'. A case of this I have never seen, and 
 cannot point out any distinctive marks ; I know 
 no reason why it may not be genuine Neuralgia, 
 symptomatick of some uterine derangement. 
 We are authorized, however, to express some 
 doubts as to its efficacy, in general, as well as 
 of Belladonna and Hyoscyamus. According 
 to Dr. Darwin, "■ five grains of the powdered 
 leaves of Atropa belladonna, are recommended 
 in some foreign publications, to be repeated 
 
 c MS, Notes on Dr. Mott'e lectures. 
 
40 
 
 once in two days ; and are said to be success- 
 ful*." 
 
 " After a few days/' says Dr. Jones, " arsenick 
 produced so much excitement in the vascular 
 system, as to render the complaint intolerable." 
 
 Mr. M'Kechnie's case", is more satisfactory 
 and consolatory. " On the 1st October, 1807, 
 I prescribed the following mixture : 
 1^ Soi. min. arsen. 
 Aq. pur. a. sj- M. 
 Of this the patient was directed to take fifteen 
 drops in a basin of gruel, three times a day, 
 till sensible signs of the operation of the medi- 
 cine should be observed. For a few days, there 
 was no alleviation ; but as the dose was increas- 
 ed, the paroxysms became less frequent, and 
 more tolerable. On the 15th, the pains were 
 completely gone ; but to prevent a relapse, I 
 thought proper to persist in using the mixture. 
 On the 17th, violent pain seized the stomach; 
 the pulse was strong, and the thirst intense. — 
 Blood was abstracted, castor oil was prescribed, 
 and copious draughts of demulcent drinks Avere 
 recommended. The medicine was also inter- 
 mitted ; but in a short time the patient was so 
 much recovered, that it was resumed in small 
 doses. 
 
 " 14th May, 1811. The painful affection of 
 the face, has never returned since the arsenical 
 
 d Zoonomia, CI. I. 2 4. 11. 
 
 e Med. & Phys. Journal, vol. vii. No. xxvii. p. 302. 
 
41 
 
 solution was desisted from ; and the general 
 health has been in every respect good." 
 
 In those instances where the same happy 
 effects are not experienced from the use of 
 arsenick alone, its combination with digitalis. 
 as recommended by Dr. Currie, u by bridling 
 the circulation/' might be productive of mark- 
 ed, and perhaps beneficial, consequences. The 
 stimulating property of arsenick being blunted 
 by its adjunct, it might direct its energy towards 
 the nervous S3^stem. 
 
 4. From that class of remedies tohich act 
 particularly on the vital properties of the large 
 intestines, much assistance has been derived. 
 Enemata were strongly recommended to Dr. 
 Jones by Dr. Rush. He employed them of 
 different degrees of pungency, and sometimes 
 they were made so irritating as to be followed by 
 bloody, mucous discharges. The stimulus of 
 distention, besides the irritating quality of the 
 injections, at first was beneficial, but, like many 
 other useful prescriptions, they were soon ranked 
 among the " inert or detrimental." 
 
 5. Of venesection and leeches, the only cura- 
 tive measures particularly founded on the vital 
 properties of the venous circulation, little is 
 recorded in relation to their efficacy. Their 
 indication depends so much on the accessory- 
 circumstances of each individual case, that no 
 
 6 
 
42 
 
 remarks need be hazarded as to their employ* 
 merit 
 
 6. Of the substances derived front the vege- 
 table, animal, and mineral kingdoms which act 
 on the vital properties of the nervous system, 
 opium, castor, musk, camphor, assafcetida, and 
 zinc, have been used in the treatment of Neu- 
 ralgia. 
 
 The usual anodyne property of opium 
 has been much relied upon, in overcoming the 
 paroxysms of this disease. Astonishing quan- 
 tities have been administered ; showing the 
 wonderful ability of the system to resist power- 
 ful medicines, while under the operation of an 
 internal excitement. In the case related by 
 Dr. Hosack 7 , which was cured by the vol. tine, 
 of Guaiac, many ounces of laudanum were 
 given ; the intensity of pain prevented much 
 soporifick effect, and it failed to produce a cure, 
 Opium joined to nitre, whose sedative quality 
 through the medium of the urinary organs is 
 very decided, Dr. Jones found more efficacious 
 than when administered alone. Dr. Duncan g 
 conducted a case to a happy termination by the 
 6C black drop*/' after it had resisted the power 
 of opium simply. 
 
 / Amer. Med. and Phil. Reg. loc. cit. 
 
 g Dublin Med. and Phys. Essays, vol. 2. 
 
 h J^ Opii purificati uncias quatuor; pimenti et cinnamomi utriusque 
 drachmas duas, croci et cort. aurant. utriusque drachmam unam ; spiritus vim 
 libram unam. 
 
 Digere per dies septem ; tunc cola, et adde sacchari chrystalizati uncias 
 duas vcl tres . 
 
 
43 
 
 Annexed to Dr. Kelly's dissertation is a de-? 
 tailed case which was treated by opium, united 
 to camphor, cinchona, and aloetick purges after 
 the operation. 
 
 The remaining articles have been used with- 
 out success, but their influence in other dis- 
 eases of a nervous character would designate 
 them as not deficient in energy for this. Their 
 administration is certainly justifiable on analo- 
 gical grounds, but they must be pushed to the 
 extreme which the constitution will admit. 
 
 In the Medical and Physical Journal, No, 
 183, a cure is said to have been effected by a 
 mixture of equal parts of zinc, valerian, hyos- 
 cyamus. 
 
 7. The next class is composed of such me- 
 dicines , derived from the vegetable , mineral \ 
 and animal kingdoms, as act on the vital 
 properties of the cutaneous system, considered 
 as an exhaling organ. 
 
 The analogy traced by Dr. Hosack between 
 Neuralgia and rheumatism, has induced him to 
 repose confidence in the volatile tincture of 
 guaiacum officinale. He has successfully treat- 
 ed one severe case by this remedy, and its 
 active sudorifick and alterative qualities entitle 
 it to high consideration. " A tea-spoonful of this 
 
 1^.. Opii uncias quatuor ; succi cydonii mali, librae quatuor ; digere per 
 tres septimanas ; tunc adde croci, nucis moschatce, carjophiilorum utriusque 
 unciam; iterum digere per septimaaam, cola per canulam, et evapora liquo- 
 rem colatam ad syrupi spissitudinem,— Kelly. Dissertat. Imug. de Neuralgia, 
 Appendix . 
 
44 
 
 medicine was given every two hours in half a 
 a glass of wine." Its use, however, is evident- 
 ly indicated in those instances, where a gouty or 
 rheumatick diathesis is connected with Neu- 
 ralgia. 
 
 A bag of common salt held between the 
 cheek and the gums, by the copious flow of sa- 
 liva it occasions, has produced alleviation. 
 
 Dr. S. Fothergill strongly recommends the 
 aqua ammonise causticae as a powerful remedy ; 
 and Dr. Jackson in one case confirms the strong 
 bias in its favour expressed by Dr. F. 
 
 8. Remedies particularly applied to the vi- 
 tal properties of the nervous system, consider- 
 ed as an organ of sensation. 
 
 Blisters, sinapisms, and issues, all acting with 
 a two-fold intention, as irritants and as drains, 
 have been found of little service in Neuralgia. 
 Issues promise more benefit than the other ap- 
 plications. Dr. Jones made trial of several at 
 the same time, which, though not fulfilling the 
 expectations he had formed, were for a season 
 of some benefit. 
 
 Electricity, both in form of sparks and of 
 the aura, has been much resorted to. Dr. 
 Haighton's experience is rather against its utili- 
 ty, and Drs. Rush and Jones consider it a very 
 feeble resource. 
 
 The salutary influence of the magnet on the 
 nervous system, is more acknowledged. Messrs. 
 
45 
 
 Thouret and Andry, and the Abbe Lenoble^ 
 have made extensive experiments on this sub- 
 ject. They have described cures of odontalgia, 
 head ach, and tic douloureux., by means of the 
 artificial magnet. In a case of severe pains in 
 the upper jaw, that baffled every attempt at 
 relief by other means, M. Lenoble contrived a 
 magnetick coronet, collar, cross for the breast, 
 and two plates for the legs, which removed 
 ever j symptom of the complaint. Professor 
 Sparmann employed the magnet in two cases of 
 dolor faciei, and the relief it afforded was 
 very striking, though a complete cure was not 
 effected^. On this head, Dr. Jones is explicit 
 and instructive. " For a considerable time it 
 lulled the pain like a charm, and its operation 
 was so prompt and effectual in repelling, at 
 least, minor attacks, that I found in it a valua- 
 ble auxiliary. As often as I was roused from 
 sleep by darting pains or twinges, I applied it 
 with such success, that at length I slept with it 
 in my mouth, and in this way, passed the night 
 comfortably ; but after a certain time, it seemed 
 gradually to lose its efficacy as a remedy, though 
 its magnetic virtue remained nearly the same ; 
 or it may be, the pain becoming more severe, 
 greater power in the remedy was required to 
 produce the same effect ; and yet on procuring 
 a larger magnet, which probably concentrated 
 
 k Alibert ? Nouveaux Siemens de la Therapeutique, &c Tome II. p. 450, 
 
46 
 
 more magnetism within a given compass, this 
 proved too powerful for my purpose. The part 
 affected could not bear the stronger at all, and 
 the weaker served as the pain was going off, to 
 check it the more suddenly." Some attention, 
 therefore, is required in regulating the size of the 
 magnet, and had the Doctor with more assidui- 
 ty graduated this instrument to the degree and 
 severity of his sufferings, more assistance might 
 have been received. 
 
 Analogous to this plan of treatment, is that 
 recommended by Heurteloup', whose curious and 
 successful device was the wearing of an iron 
 mask on the face. 
 
 Galvanism, which seems to be a medium be- 
 tween electricity and magnetism, in theenergetick 
 effects it displays analagous to those of the first, 
 while its silent and unseen agency resembles the 
 latter, might be supposed of more utility than 
 either'; but experience does not warrant the 
 conclusion. 
 
 Cold, hot, and tepid bathing, fomentations, 
 and a heated atmosphere have been tried, and 
 with various success. The general rule concerning 
 the employment of cold water in persons of ner- 
 vous habits, is applicable to Neuralgia ; where it 
 produces an increase of suffering, its use must be 
 suspended. Pediluvium in warm water, from 
 its soothing and grateful influence on the sys- 
 
 l Journ. de Med. 1811. 
 
47 
 
 tern, is strongly recommended as an auxiliary ; 
 and it may be assisted by wrapping the head in 
 cloths wrung out of warm water, or warm 
 brandy and water. Bathing has been too little 
 watched for any decided report concerning its 
 utility. The preservation of an uniformly high 
 temperature in his chamber, Dr. Jones found 
 rather to increase his sensibility, than to lull the 
 pain. After a few days, the slightest breath of 
 cooler air would renew his agony with increased 
 violence. 
 
 Frictions and embrocations, camphorated and 
 combined with opium, maintain their standing 
 for a limited period, and then must be abandon- 
 ed as useless. 
 
 Incisions in the gums, and neighbourhood 
 of the part immediately affected, have been pro- 
 ductive of some benefit; but so short lived was 
 the relief, as hardly to give them any character 
 as a resource. 
 
 Ice held in the mouth or on the diseased 
 nerve, by benumbing the part, has prevented 
 the immediate return of the paroxysms. 
 
 Tar has been successfully employed in one 
 case communicated by Mr. Colville*, after 
 many other expedients had failed. It was 
 adopted in consequence of the resemblance of 
 the disease to rheumatism. If I may venture 
 an opinion, although the symptoms detailed 
 
 l Edinb. Med. and Surg. Journal, vol. x. No. 39, 
 
48 
 
 correspond with those of Neuralgia, the disease 
 must have been on the decline, or must have 
 been intimately connected with rheumatism : 
 otherwise, an application so simple and inert 
 would hardly have manifested any decided ope- 
 ration on an affection so obstinate, and deeply 
 rooted, as confirmed Neuralgia. 
 
 9. Of the substances which act on the cuta- 
 neous system, considered as an absorbing or- 
 gan , mercury has been resorted to for the cure 
 of this disease. Mr. Pearson, in his paper be- 
 fore mentioned, describes the condition of seve- 
 ral patients whose affliction was removed by 
 salivation. Mr. Watson 7 " also treated the disease 
 in the same manner. Hufeland", in Ger- 
 many, has published the cure obtained by 
 the extract of hyoscyamus niger combined 
 with calomel. Dr. Jones placed some con- 
 fidence in the apparently universal agency 
 of this mineral. After salivation had been gra- 
 dually produced by the corrosive muriate, and 
 moderately maintained for a few days, his sys- 
 tem became so irritable, that the attacks of his 
 dire enemy were more frequent and excruciating 
 than before. 
 
 m Journal de Medicine, 1793. March. 
 n Journ. de Med. vol. xvi. 
 
49 
 
 SUMGICAL TME*ATJWEJVT. 
 
 The system of treatment described in the 
 foregoing pages, in conformity with the twofold 
 plan of managing hydrocele, may be denomi- 
 nated the palliative. The remaining section 
 of this dissertation will be devoted to the radical 
 or surgical treatment. 
 
 The history of the operation is coeval with 
 the first lucid description of Neuralgia. In an 
 instance related by Sauvages, the celebrated 
 surgeon Mareschal divided the nerve ; the pa- 
 tient, who had suffered excessively from the 
 disease, slept well that night ; but within a few 
 days the disease returned. " Tandem post 
 biennium Audraeas ope lapidis caustici ad nasi 
 latus inusti, aquoe mercurialis supra escharam 
 affusse, incisionis ad os productee post duodecim 
 dies, quibus hee operationes institutes sunt, sta- 
 timam sublevit, quae denique omnino sanata 
 fuit ; cum chirurgus initio denudatum stylo at- 
 tingebat, paroxysmum trismi pro lubitu excita- 
 bat, cicatrice obducta, &gra sana vixit " 
 Andre employed caustick as his great curative 
 
 o Nosol. Method, vol. iii. p. 19= 
 
50 
 
 indication, and his practice prevails in France 
 at the present period. In an aggravated case 
 of Dr. Haighton's, reasoning on the apparent 
 pathology of the disease, he was convinced that 
 a division of the nerve would be effectual in its 
 consequences ; nor was he deceived. The tes- 
 timony of many surgeons is united on this 
 point. Dr. Haighton p , besides his own expe- 
 rience, quotes, from Sabatier's anatomical trea- 
 tise, one instance from De Haen's Ratio Me- 
 dendi ; another by Mr. Ritch, a Polish surgeon 
 of high respectability ; and a third in Paris, in 
 which the success was only temporary. M. 
 Louis 9 practised this operation with success 
 on a prior of Premontres. In addition to 
 Dr. Haighton's authority, many excellent sur- 
 geons admit, that where the nerve can be 
 effectually divided, a perfect suspension of 
 misery will be attained, at least, until the 
 nervous re-union be effected. 
 
 The most strenuous advocate for the opera- 
 tion, in this country, is Professor Mott. His 
 success has been so unequivocal, and his op- 
 portunities of witnessing the disease so compa- 
 ratively numerous, that his unqualified opinion 
 in all cases of Neuralgia, is ' divide the nerve ; 
 then, if necessary, employ the other remedies 
 to destroy or diminish the susceptibility to re- 
 
 p Med. Records and Researches. 
 q Gazette Salutaire, No. 36. 1766. 
 
51 
 
 turn, which will be accomplished most certainly 
 by hemlock and other narcoticks. Dr. Mott has 
 operated on five patients. He has divided dif- 
 ferent nerves on Dr. Jones' face eleven times, but 
 the disease seems so rooted in the old gentleman's 
 constitution, as to require frequent repetition of 
 the operation. He has become so accustomed 
 to it, that whenever the inveterate tormentor 
 developes itself, he sends for his surgeon with- 
 out delay, knowing, that from his hands he 
 shall receive relief. Mr. George G. Graham, 
 practitioner in Orange County, while a student 
 of medicine, divided the infra-orbitar nerve 
 with perfect success ; and Dr. Post, associated 
 with Dr. Mott, operated lately on a gentleman, 
 whose left cheek was diseased, and he instantly 
 arrested the spasms. 
 
 The degree of certainty promised by the 
 operation, as resulting from the physiology of 
 nervous re-union, becomes an interesting ques- 
 tion. Dr. Haighton's masterly and conclusive 
 experiments on the re-union of divided nerves, 
 have completely established that point : and it 
 is a settled dogma in physiology, that by the 
 growth of fresh matter, or by the approxima- 
 tion of the divided ends, the functions of a nerve 
 are restored. Mr. Abernethy, however, arguing 
 from the renewed sensibility and mobility of the 
 ring finger on which he operated, thought that 
 the anastomosing branches had become en- 
 
52 
 
 larged, and, officiating in lieu of the original 
 trunk, rendered a complete cure impracticable. 
 Had that learned surgeon removed a portion of 
 the trunk of the ulnar nerve, and then been 
 baffled in his anticipated cure, his apprehension 
 would be well founded. There is some differ- 
 ence between the effects of a divided trunk and 
 of its branches. Nervous influence can readily 
 be re-communicated by the preservation of the 
 former, should the latter be effectually operated 
 upon. Moreover, as the nerve of the opposite 
 side of the finger was derived from the radial 
 nerve, the difficulty of solving the mystery is 
 diminished. 
 
 In opposition to the utility of operating, the 
 uncertainty of immediate relief from a division 
 of the nerve has been particularly urged. For 5 
 say they, the re-union is so speedy and so cer- 
 tain, that nature will commence her counter- 
 vailing process before the desired object is com- 
 pletely attained ; thus tantalizing the patient 
 still more, and adding unnecessarily to his suf- 
 ferings. The author of a thesis" supported be- 
 fore the Faculty of Medicine of Paris, expresses 
 his doubts of the success of the operation ; he 
 pretends that it was repeated five times on one 
 patient, and asserts that he finally owed his 
 cure to the warm baths of Plombieres. 
 
 r Utrum in pertinacibus capitis & faciei doloribus aliquid prodesse possif, 
 sectio ranjorum nervi quinti pari? , ? proponebat Veillart, 1768, conclusio 
 negativa. 
 
53 
 
 In the same dissertation are the histories ot 
 two other patients, on whom a Parisian surgeon 
 practised without success the division, and af- 
 terwards the cautery on the supra and infra- 
 orbital* nerves, the malar branches of the 
 portio dura, and the mental nerve'. The 
 preceding remarks on the success of the ope- 
 ration are a full reply to such objections. 
 
 Wherever a considerable portion of the nerve 
 can be abstracted, a greater duration will as- 
 suredly be given to the cure. This cannot be 
 attempted on many of the nerves of the face; 
 because the ramification is so immediate and 
 extensive, as to preclude a successful endeavour 
 to remove much of the frontal, infra- orbital, or 
 mental nerves. The branches of the pes anse- 
 rinus are intimately connected with the parotid 
 gland and duct ; also by some very beautiful and 
 extraordinary anastomoses with the other facial 
 nerves, so that a similar hinderance occurs here. 
 The only nerve about the head which affords 
 the slightest chance for effectual and final divi- 
 sion is the portio dura, in its passage between 
 the stylo-mastoid hole^ and the angle of the 
 lower jaw. When the disease is in any other 
 part of the system, if half an inch of the princi- 
 pal trunk supplying the affected spot could be 
 removed, there would be little dread of its re- 
 turn. A repetition of incisions through a nerve, 
 
 s Richerand Nosographie Chirurgicale, T. II. p. 204. 
 
54 
 
 by insulating several portions, would be another 
 means of protracting a renewal of the disease ; 
 and in the sub-orbitar nerve, this has been done 
 by Doctor Mott, when operating on Doctor 
 Jones". This improvement, I believe, is attri- 
 butable to Doctor Mott, and its application must 
 be productive of decided and happy conse- 
 quences. 
 
 It is a curious circumstance connected with 
 the operation, that although the nerve shall be 
 completely divided, from some cause, the chain 
 of morbid actions will not be interrupted for 
 several, perhaps twelve or fourteen, days. This 
 has induced some to pronounce hastily, that the 
 operation has failed. Any attempt satisfactori- 
 ly to explain this occurrence, I think would be 
 fruitless. 
 
 Operation on the infra-orbitar nerve. 
 
 The participation of this nerve in Neuralgia^ 
 may be detected by the course of the pain up 
 the side of the nose., sometimes following an 
 arched direction between the eyebrow and up- 
 per lid, or in either the brow or lid, and extend- 
 ing along the zygomatick arch : or it may be 
 confined to the muscles passing between the os 
 
 r Medical R-epository, {new series,) Vol. II. No. 2. 
 
55 
 
 malae and the angle of the mouth, involving the 
 buccinator and masseter. Pressure may be ap- 
 plied to the infra- orbitar foramen, during which 
 the pain will be arrested, provided the disease 
 depends on that nerve. A tremulous motion of 
 the upper lip on one side, most commonly at- 
 tends this variety of Neuralgia. 
 
 To Doctor Haighton we are indebted for an 
 excellent view of this nerve, and a delineation 
 of the point for division. " He measured the 
 space between the inferior edge of the orbit and 
 the superior edge of the foramen in thirty skulls, 
 and found the distance in sixteen skulls | of 
 an inch, which he considers the medium distance 
 from the upper part of the foramen ; and if we 
 allow i of an inch for the breadth of the fo- 
 ramen, and i below its inferior part, half an 
 inch from the lower edge of the orbit will be a 
 proper place for performing the operation, 
 Having endeavoured to establish a rule for de- 
 termining its distance from the orbit, it may be 
 proper to ascertain its situation with respect to 
 a line drawn from the inferior part of the in- 
 ternal angular process of the osfrontis, ob- 
 liquely across the orbit, to the centre of the os 
 Tnalce. The measurement of this line in thirty 
 skulls, did not vary more than i of an inch, 
 and it was found that a line drawn downward 
 perpendicular to this oblique line, at the distance 
 of I of an inch from the internal angle of the 
 
56 
 
 eye, passed across the orifice of the sub-orbitar 
 foramen." 
 
 This point being settled. Dr. Haighton's di- 
 rection for operating, is " to make an incision of 
 | of an inch in length, carried obliquely down- 
 wards, (on account of the oblique course which 
 many of these nerves take, in their passage from 
 the foramen to the ala nasi,) the centre of which 
 must correspond with the foramen, only \ of 
 an inch below it. The incision must be made 
 down to the bone, otherwise we cannot be cer- 
 tain of dividing the nerves, as they are situated 
 very deep." 
 
 The deformity produced by a large cicatrix, 
 in this method of operating, exposes it to objec- 
 tion. Professors Post and Mott have employed 
 the following mode with the happiest success, 
 and perfect facility. 
 
 The only instrument required is a sharp- 
 pointed bistoury or phymosis knife, either in 
 a stiff handle, or well secured. 
 
 Having ascertained the situation of the infra- 
 orbitary foramen, by Dr. Haighton's rule, and 
 also by the depression which can be distinguish- 
 ed in most subjects, let the nose be held aside 
 by the assistant who secures the patient's head. 
 Introduce the bistoury about midway between 
 the nose and the nasal margin of the foramen ; 
 carry it down to the bone, and pass the point 
 dose to the bone, in order to get it under the 
 
ot 
 
 nerve. The point must then be elevated a lit- 
 tle, though it must not pass through the skin 
 from beneath ; by a little rubbing motion with 
 one finger upon the point of the knife, at the 
 same time cutting gently with the knife, the 
 nerve will be divided. 
 
 As a considerable branch of the internal 
 maxillary artery accompanies the infra-or- 
 bital nerve, its division will be shown by a 
 copious arterial haemorrhage ; and a pecu- 
 liar acute pain accompanies the section of the 
 nerve, in addition to the difference, percepti- 
 ble to the operator, between cutting a nerve, 
 and any other soft solid. The upper lip must 
 now be examined by touch. If the patient ac- 
 knowledge a destruction of sensibility, the sur- 
 geon may withdraw his bistoury: otherwise, the 
 cutting must be repeated, until from numbness, 
 he is satisfied that the nerve is divided. By 
 asking the question previously to withdrawing 
 the knife, the patient has no reason to conceive 
 that any disappointment attended the first at- 
 tempt, and the repetition of incisions he may 
 suppose to belong regularly to the operation. 
 Being certain that the nerve is thoroughly di- 
 vided at the first point of section, make two or 
 three incisions through it lower down ; and thus 
 endeavour, as Dr. Jones expresses it, to '' insu- 
 late a portion of it, (included as it were in a pa- 
 renthesis,) with respect to the common senso- 
 
 8 
 
58 
 
 rium." Since the infra- orbitary nerve as it 
 leaves the foramen expands immediately like a 
 fan, and distributes its branches to the sur- 
 rounding parts, the incisions last mentioned 
 may be extensive, retaining the knife still 
 underneath the skin. The knife is then to be 
 withdrawn through the first opening, and the 
 lips of this diminutive external wound can be 
 drawn together, and secured by adhesive plas- 
 ter. 
 
 The only obstacle to a free section to- 
 wards the nose, is the facial vein, which, be- 
 ginning at the inner angle of the eye, holds a 
 diagonal course towards the angle of the jaw. 
 A wound of this, however, will not be attended 
 with any serious consequences ; it will only add 
 to the ecchymosis already arising from the ar- 
 tery, and can be compressed by a slight force 
 applied to the spot. The suffusion of blood 
 will be removed by absorption in a few days, 
 and its removal may be aided by any mode- 
 rately stimulating lotion. 
 
 The great advantage of this method over 
 Dr. Haighton's, will be apparent from the im- 
 possibility of any large cicatrix being the con- 
 sequence. 
 
59 
 
 Operation on the Frontal nerve. 
 
 This final distribution of a highly useful and 
 important branch of the trigemini, after it has 
 entered the orbit through the foramen lacerum, 
 appears to cling to the roof of the orbit, passing 
 between the bone and the periosteum r , of course 
 above the levator muscle of the upper eyelid. 
 It leaves the orbit through the supra-orbitar 
 foramen, which in many skulls is only a notch, 
 closed below by a ligament. The situation of 
 this hole or notch may be ascertained, with 
 tolerable precision, by finding the sub-orbitar 
 foramen ; as it is about | of an inch within a per- 
 pendicular line drawn from the latter, and con- 
 tinued up the forehead. 
 
 Pass a bistoury or knife about § of an inch 
 within the orbit, immediately beneath the su- 
 perciliary ridge of the os frontis, and divide the 
 nerve outwardly. A numbness must be felt on 
 the forehead and eyebrow, and down the nose/ 
 before the knife is withdrawn. The connexion 
 between the nerve and the bone, is sufficient to 
 impress the necessity of keeping the point of 
 the bistoury as close as possible to the bone, 
 
 r Meckel. Tractatus Anatomico-physiologicus de quinto pare nervorum 
 cerebri. Sec. xxxix. 
 
60 
 
 and the dense periosteum affords additional re- 
 sistance, while dividing the nerve. The ophthal- 
 mick artery will bleed profusely for a few mi- 
 nutes, and when its flow outwardly is repressed , 
 it will produce so much ecchymosis as to 
 blacken the eye to a considerable extent. 
 
 Operation on the Mental nerve. 
 
 The foramen through which emerges the in- 
 ferior-maxillary branch of the fifth pair, is situ- 
 ated generally about midway between the al- 
 veolar processes of the jaw and its base, in a 
 line between the cuspidatus and anterior bicus- 
 pid teeth. The nerve may be divided by turn- 
 ing down the lip, and introducing the bistoury 
 about the first bicuspid tooth, with the back 
 towards the angle of the jaw. Keep the knife 
 close to the bone, and by following the excava- 
 tion of the jaw, the nerve will be divided by a 
 cutting motion rather from the bone. 
 
 In the aged edentulous subject, from the ab- 
 sorption of the alveolar processes, no reference 
 can be made to the teeth, in finding the mental 
 foramen. It is situated generally in the same 
 line with the supra-orbitary hole, and conse- 
 quently can easily be discovered. 
 
60 
 
 Operation on the Portia Dura. 
 
 A mere description of the complicated and 
 extensive distribution of this nerve, will be suffi- 
 cient to justify a doubt of any operation being 
 so devoid of danger, or troublesome conse- 
 quences, as to authorize its performance. 
 
 When neuralgick sensations are traced from 
 just above the angle of the jaw, in transverse lines 
 across the face, upwards through the temples 5 
 downwards along the base to the symphysis of the 
 chin, backwards behind the ear ; exciting espe- 
 cially a profuse discharge of saliva', and fre- 
 quently, from their severity, absorbing all per- 
 ception of distinct linear direction, but commu- 
 nicating the idea of the whole cheek being in 
 a paroxysm of Neuralgia, a surgeon may pro- 
 nounce the portio dura to be the affected 
 nerve. 
 
 A brief display of the organs contained in the 
 side of the face, seems necessary for the purpose 
 of conveying a distinct view of the embarrass- 
 ment and difficulty, attending any projected 
 operation on the portio dura. 
 
 The parotid gland, whose agency in furnish- 
 
 s I have not noticed this in any description of Neuralgia ; but a moment's 
 reflection, I think, will show, that a diseased nerve passing through the paro- 
 tid gland, imbedded in its substance, must affect the flow of saliva from that 
 gland, 
 
62 
 
 mg saliva is superior to any other destined for 
 that use, occupies the whole space from the 
 mastoid process of the temporal bone, pene- 
 trating to the " very root of the external audi- 
 tory sinus, almost to the internal carotid artery 
 and jugular vein f ;" it is sunk behind the low- 
 er jaw, and adheres to the pterygoideus inter- 
 nus muscle, while it reaches forwardly , by means 
 of the socia parotidis, nearly to the anterior 
 edge of the masseter muscle, and upwards to 
 the zygoma. The ducts from its numerous lo- 
 buli unite, and are continued in one trunk to the 
 buccinator muscle, which it perforates nearly 
 opposite the second or third dens molaris. " Its 
 course will generally be defined, by a line ex- 
 tended from the junction of the lobe of the ear 
 and figured portion, to midway between the 
 root of the nose, and the angle of the mouth." 
 
 The arteria trangversalis faciei " is generally 
 placed midway between the parotid duct, and 
 the zygoma. At this part it lies between the 
 socia parotidis, and the masseter muscle." 
 
 " The portio dura, when passing from the 
 foramen stylo-mastoideum, lies behind the paro- 
 tid gland ; but it immediately dips into its sub- 
 stance. It continues a single and undivided 
 trunk, for about half an inch of its course. This 
 part of the nerve runs in a slanting direction, 
 downward and forward, imbedded in the gland. 
 
 t Surgical Anatomy of the Head and Neck, by Mr. Allan Burns of Glasgow. 
 
63 
 
 Where the portio dura is escaping from the 
 skull, it is deep seated, and nearly in contact 
 with the arteria posterior auris, and where that 
 artery and the occipital arise by a common 
 trunk, the latter vessel is quite in the vicinity of 
 the portio dura. By the styloid process/' 
 (which is the barrier between the external 
 and internal carotids,) u the nerve is sepa- 
 rated from the internal carotid artery, and 
 jugular vein. About midway between the 
 ascending plate of the jaw-bone, and the mas- 
 toid process, the portio dura is nearly opposite 
 to the posterior facial vein, and the external ca- 
 rotid artery. 
 
 " It is at this point, at a place where the 
 nerve is still deeply covered by the glandular 
 substance, that it divides into its branches, 
 which separately perforate the gland, to reach 
 the cheek, and other parts on which they are 
 to be distributed. The largest of these branches 
 inclines upward and forward, and while still 
 imbedded in the gland, it subdivides into a 
 numerous set of twigs, which cover as with a 
 net-work, the zygoma and the arteria transver- 
 salis faciei. The largest of these twigs, runs 
 nearly midway between the zygoma, and the 
 parotid duct. The other divisions of this nerve 
 ramify over the face, and about the throat 
 
 " The trunk of the nerve can be reached, with 
 safety, only by an incision beginning at the 
 
64 
 
 very root of the mastoid process, and continued 
 downward and forward, along the anterior 
 margin of the sterno-mastoid muscle. The 
 dissection, no doubt, will require to be deep, 
 but in performing it, the surgeon will not ex- 
 perience much difficulty. The lobe of the ear 
 will require to be pulled upward, and held for- 
 ward, while prosecuting this dissection. In per- 
 forming the dissection, the nervus superficial 
 colli will necessarily be divided, where entering 
 the lower angle of the parotid. The glandular 
 substance itself will be injured, and the arteria 
 posterior auris will be cut across *." 
 
 In this manner, Mr. Burns has been in the 
 habit of removing half an inch of the nerve on 
 the dead subject ; and Professor Mott, since the 
 inestimable Surgical Anatomy of the head and 
 neck made its appearance, has exhibited to his 
 class of surgery the mode of performing the 
 operation. It has never been attempted in this 
 complete and radical manner, on the living 
 subject ; although many incisions have been 
 made in the cheek, for the purpose of dividing 
 the branches of the pes anserinus. The outline 
 that has been given of the anatomy of the face, 
 exhibits the difficulty attending that procedure, 
 and the infallible consequence must be trou- 
 blesome, perhaps perpetual, salivary fistulas. 
 
 Should it be necessary, however, to divide any 
 
 u Surgical Anatomy of the head and neck. 
 
63 
 
 >i» the facial branches of the portio dura, it has 
 been suggested by Dr. Mott, that it might be 
 effected by introducing a bistoury, as in the 
 other operations, and making the incisions in 
 various directions beneath the skin. The pros- 
 pect of an unpleasant result will be thus con= 
 siderably diminished, and the fistula would pro- 
 bably admit of a more rapid cure. 
 
 A few observations on the propriety of em- 
 ploying caustick applications, will close the sub- 
 ject. If the object be to destroy every pros- 
 pect of a recurrence of Neuralgia, and if the 
 patient will consent to an experiment, which, if 
 successful, must effectually annihilate the nerve, 
 the precedents afforded by the French surgeons 
 will authorize the attempt. It has been object- 
 ed, that the proximity of some of the nerves to 
 the bone must necessarily involve exfoliation. 
 This consequence depends, very probably, on 
 the management of the caustick, which should 
 not be left so long in contact with the bone as 
 to endanger its continuity. 
 
 After the nerve has been divided by the ope- 
 ration, it may answer a good purpose to inter- 
 pose caustick between the extremities of the 
 nerve, and thus combine both expedients. The 
 tediousness of reaching the nerve from the sur- 
 face by caustick, besides the torture it would 
 inflict, possibly producing tetanus, seem to in- 
 
 9 
 
66 
 
 terdict any proceeding different from that propos- 
 ed. Dr. Jones declined the use of caustick, from 
 dread of tetanus, nor was his fear without foun- 
 dation. We should, however, impose some 
 confidence in the practice of the French, and 
 admit this method of destroying a nerve to an 
 equal rank with the knife, in those cases where 
 its employment is feasible, and unattended with 
 danger to the bone. 
 
 As the moment approaches in which I shall 
 be endowed with the valuable privileges within 
 your gift, permit me, respected professors, 
 to exercise the grateful office of expressing my 
 sense of the obligations under which your uni- 
 form attention and kindness have placed me ! 
 Lasting be the celebrity of the establishment 
 fostered by your exertions, and rendered illus- 
 trious by your learning— may its character 
 ever be equal to its transcendant usefulness, 
 and its patronage in proportion to its reputation ! 
 May the proud consciousness of honourable 
 endeavour shed its delightful influence over 
 your declining years — and when the period 
 shall arrive, commanding your retreat from the 
 toils and distinctions of publick life, may your 
 successors emulate your brilliant example, and 
 perpetuate the fame of our College in the grati- 
 tude of remote posterity ! 
 
APPENDIX. 
 
 In order to complete the view which has been given 
 of Neuralgia, the folio wing communication from Va- 
 lentine Mott, M. D. is subjoined. It gives a very sa= 
 tisfactory statement of the consequences attendant on 
 the radical treatment, and it is the only document of 
 that description on record, 
 
 ESTEEMED PUPIL, 
 
 Since a doubt has been expressed by some as 
 to the eventual result of the operation of dividing the 
 nerve in Neuralgia, allow me to avail myself of this 
 opportunity, to state the success which has attended 
 it in my practice. 
 
 In a confirmed case of Neuralgia, in a lady about 
 sixty years old, in 1810, 1 divided the infra-orbital nerve 
 on the right side ; the relief was instantaneous. Be- 
 fore the knife was withdrawn, she exclaimed, " I am 
 relieved, I can now speak, blow my nose, and swal- 
 low," which had been almost impossible for some 
 days, owing to the unspeakable agony of the disease. 
 There were slight neuralgic symptoms for about ten 
 days, then she became perfectly free from the slightest 
 trace of it, and has never since had a return se- 
 vere enough to induce her to resort to the operation, 
 the pain of which she by no means dreads : for all at- 
 test that a single paroxysm far surpasses the smart 
 from the incision. For about four months she was en- 
 tirely free from the disease. 
 
68 
 
 A gentleman aged about fifty, having had Neural- 
 gia for four years, applied to me, in the beginning of 
 the year 1811, for surgical relief. Palliative means 
 having failed, and the disease increasing in violence, 1 
 recommended the operation as the best, and only re- 
 maining- resource. I divided the infra-orbital nerve of 
 his right cheek. The paroxysms continued for a day 
 or two as frequent and violent as before the operation : 
 but in a week it entirely left him. In about four 
 months, the pain began to return, and increased in vio- 
 lence from time to time, but did not equal its former 
 severity, till about six months since, when it became 
 more severe than ever. About three months ago I 
 repeated the operation on the same nerve : the pain 
 went off gradually in about a week, and he says the 
 last operation is by far the most successful. 
 
 In 1811, I divided the right infra-orbitary nerve 
 for a lady, who had been labouring under severe Neu- 
 ralgia for two or three years. She experienced no 
 immediate relief; on the contrary, the paroxysms ap- 
 peared to be increased in frequency, and aggravated 
 in violence, for several days : they then began to 
 decline, and had entirely left her about the twelfth 
 day. 1 believe the disease has never returned. 
 
 On that highly respectable physician, and victim to 
 Neuralgia, Dr. Jones of this city, I have operated 
 about eleven times, and in every instance with the 
 most perfect success, 
 
 After having been afflicted with this horrible disease 
 for seven or eight years, and having exhausted all the 
 resources of the Materia Medica to no purpose, the Doc- 
 tor at last yielded to my frequent and earnest impor- 
 tunities, and allowed me to divide the right infra-orbital 
 
69 
 
 nerve, at the advanced age of sixty-seven years. His 
 pains were increased for several days, but about the 
 twelfth they abated gradually, and in a few days com- 
 pletely left him. He continued for four or five months 
 free from pain ; but after exposure to cold, he felt now 
 and then alarming touches of the disease, which at 
 length became very violent, Every subsequent ope- 
 ration on the infra-orbital and mental nerves, has been 
 followed with complete relief; but the intervals have 
 been mostly shorter than the first; they do not, how- 
 ever, gradually shorten ; several of the last operations 
 have varied very little in the interval of ease, it being 
 of from three to four months duration. 
 
 The violence of the paroxysms has several times 
 been augmented for a day or two after the operation, 
 and as the additional irritation of the division of the 
 nerves subsides, the pain gradually diminishes. The 
 disease always leaves him in from seven to twelve 
 days after the operation. From the last division, how- 
 ever, of the infra-orbitary, about three weeks since, 
 he received immediate ease, having scarcely a single 
 pain afterwards. 
 
 Last winter, I divided the right infra-orbital nerve 
 for Major B — , aged about fifty, who had been la- 
 bouring under a regularly increasing Neuralgia 
 for about four years. The operation increased his 
 disease in every respect for several days ; it then abat- 
 ed, and gradually went completely off in about the 
 usual period of twelve days. Four months and more 
 have now elapsed, and the disease has not returned. 
 
 About three weeks since, I attended, in conjunction 
 with Dr. Post, a Colonel K — , aged about sixty, who 
 for five years had been afflicted with severe Neuralgia 
 
70 
 
 of the left infra-orbital nerve. Dr. P. divided this 
 nerve, and it was followed with immediate relief. He 
 experienced little or no pain afterwards. 
 
 Hoping that all the miserable victims of Neuralgia 
 may be encouraged to resort to a surgical operation, 
 either in the form of a simple or double division, by a 
 single external incision, or where practicable, the re- 
 moval of a portion of the nerves, 
 
 I am, with sentiments of high regard and esteem, 
 
 VALENTINE MOTT. 
 
 5 mo. {May) 1st, 181ft ' 
 
 259 Pearl-st. New-York. 
 
 The following list of writers on this disease, in 
 addition to those contained in the body of this disser- 
 tation, is extracted from the Edinburgh Practice of 
 Physick. The impossibility of obtaining them seems 
 to render such a procedure necessary, that the occa- 
 sional opportunities of satisfying curiosity on the sub- 
 ject of Neuralgia may not be neglected, through want 
 of an easy reference. 
 
 Rahn ; $£ugeum tier ^eilftunde, i. e. Museum of Me- 
 dicine, Vol. II. Aepli ; ibid. p. 302. Sauter ; ibid, 
 also Tissot and Pohlen. Lentin ; first in Blumenbach's 
 Mtbitinigtfyt SBibliotJjecfe, i. e. Medical Library, Vol. 
 I. (A periodical work, that is now discontinued,) 
 in his Contributions to Practical Medicine, (in German,) 
 Vol. I. 1797, p. 382— -398. Vol. II. 1798, p. 92. 
 seq. Huf eland's Practical Journal, Vol. IX. No. 1. 
 conf. Medical and Physical Journal, Vol. III. p. 575. 
 Selle; in $eue &eitrage, frc. i. e. New Contributions 
 to Natural and Medical Science. Vol. I. p. 27. &c. 
 
71 
 
 Vogler Blumenbach's Medical Library, Vol. II. p. 556, 
 Thilenius ; Mtbitinigtbz una <Hf)trurgi^ctje Sfomerfcungen, 
 i. e. Medical and Surgical Observations, Franckfort, 
 1789. p. 283. Bohmer ; in BlumenbacKs Medic. Libr, 
 Vol. HI. p. 315—336. B aiding er ; in his Medical 
 Journal, Vol. II. p. 7. Lcidenfrost and Gunter ; in J. G. 
 Fortsmann Dissertatio de dolore faciei Fothergilli, 
 Duisburg, 1794, 4to. extracted in Tode's Medical 
 Journal, (in German,) No. 3. Vol. I. Richter ; in his 
 Surgical Library, Vol- XI. p. 135, (in German.) Van 
 Wy ; in ^Ucjjan&elingen mtgegetoen fcoor Jet ^eeugtogcfr 
 <6enoot^cJap tier iBeten?c^appen te Wtisgmgen, l&zu vii. 
 1782. i.e. Transactions of the Society at Vlissingen ? 
 Vol. VII. 
 
 Bonnard; Journal de Medicine, 1778, July. Lava- 
 gan, ibid. Thouret ; Memoires de la Societe Royale 
 de Medicine, a Paris, T. I. 1776. T. III. 1779. T. V. 
 1782 & 83. Journal Encyclopedique, m. April, 1777, 
 Gazette Salutaire, No. 73. conf. Richter 's Chirurgical 
 Library, Vol. II. in German. Andry ; Mem. de la Soc. 
 Roy. de Med. T. I. 1776. T. V. 1782 & 83. Guerin ; 
 Maladies des Yeux. Pujol; Treatise on that disease of 
 the face, which is called Tic douloureux, translated from 
 the French into German, by Dr. Schreger, 1788. 
 Spiehnann ; Gazette Salutaire, 1791. Petit and Lau- 
 gier ; Journal de Medicine, July, 1793. Watson; ibid, 
 1793, March, No. 1. 
 
 FINIS, 
 
ERRATA. 
 
 Page f , Note, /or Class IV. ii. 6. read IV. i. ii. 6, 
 
 33, Line 7, in some copies, for contractability read con- 
 tractility. 
 

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