Facial Neuralgia.*

By Edwin J. Clark, M. D., Denver.

Under this term we include two different varieties of neuralgia of the fifth nerve. The first being the simple, sympathetic or reflex variety, and the second, the essential or tic doloureux. This simple variety is the most common form of neuralgia. Local or reflex dental troubles, errors in refraction, or nasal disease, are the most frequent causes, especially when grafted upon a rundown condition of the constitution.

The pain is located in the area of distribution of the fifth nerve, usually limited to one branch. The local cause of the disturbance may be located upon one branch, while the pain is felt upon another though when a diseased tooth is the cause, pain and tooth usually occupy the same area. The pain is of a sharp lancinating character, as a rule, though it may at times be a dull ache. It may last from a few hours to a number of days. Associated with the pain are various symptoms of sensation, as pressure, tension, numbness, formication, hyperesthesia or anesthesia. Muscular twitchings or spasms may occur. Noises in the ear, flashes of light before the eyes, disturbance of vision, photophobia, profuse lachrymation, may any or all be present, with many other disturbances of sensation or function.

The diagnosis consists in determining the cause and the pathological changes present. Examine the teeth and gums very carefully, notice the condition of refraction, and the presence of constitutional conditions. Remember that while you can modify the condition with your homeopathic remedy, you cannot cure as long as the cause remains, so search for the local focus of irritation and remove it. Then prescribe your homeopathic remedy for the constitutional condition.

The essential, or tic doloureux, also called Fothergill's neuralgia, or epileptiform neuralgia, is quite a different affection from the simple variety. We understand very little as to its etiology beyond the fact that it occurs principally in the latter years of

*Colorado State Medical Society, October, 1900.

life, when degeneration of tissues is apt to be present. Its pathol ogy is largely speculative, though it has been found associated with cranial and intercranial disease, with a low grade of neuritis and nerve degeneration dependent upon an obliterative inflamma tion of the arteries supplying the nerve.

Short darting pains that come without warning, in paroxysms of a few seconds to a few minutes, and then disappear as suddenly as they came, furnishes a peculiar symptom to distinguish it from the simple form. These paroxysms may recur many times through the twenty-four hours, may at times be almost continuous, and again may disappear for days or weeks at a time. Early in the disease the pain is limited to one branch of the nerve, though later other branches appear to be sympathetically or organically affected. When the paroxysm occurs the patient presses with the hand upon the affected spot; this pressure may cause local changes in the parts. During the paroxysm, local twitchings of the muscles, lachrymation, coryza or salivation may occur, any or all of them, or they may all be absent. Slight irritation of any kind may bring on a paroxysm. In these cases, and sometimes in the simple variety, sensitive spots are found in various parts of the face where the affected nerve branch closely approaches the surface. If you will remember the peculiar paroxysmal form of this variety, and its freedom from local cause, the diagnosis will be easy. Where organic changes are the cause of the disease only a very careful clinical investigation will show its presence. The prognosis is not generally favorable.

Organic changes would furnish a decidedly unfavorable prognosis. The tendency of the disease to appear and disappear makes it hard to say when a cure is secured. Cures with medicine are recorded. Galvanism, by restoring the tone of the arterial circulation and its action upon the nerve itself, furnishes a more favorable outlook in severe cases than surgical measures. Surgery gives relief for seldom longer than two or three years..

Bartlett says the treatment includes the thorough treatment of the patient, and that the physician should forget the pain except as an evidence of disease. He considers routinism in prac

tice as most pernicious, and says it is a certain barrier to the treatment of neuralgia.

We have under treatment now a patient aged 45 of a tubercular diathesis. The left side of his face is full of old roots, snags and decayed teeth, which he hangs onto with the determination of grim death, though we keep insisting upon the pulling of the teeth as a requisite to a cure of his neuralgia. With remedies we have modified and limited the severity and lessened the number of the attacks, but exposure to the weather, to damp or cold, often brings on an attack of neuralgia, affecting, when severe, the entire facial distribution of the nerve when light, limited frequently to the brow ague form.

In July, 1899, a patient presented herself at Dr. Kehr's clinic with the following symptoms: Condition had been present for four years steadily growing worse. Any touch or motion or slight irritation of a spot on right upper lip near the alae nasi brought on excruciating pain as if a dozen bees had stung her all at once. On attempting to talk, the attacks would continually come, and at each attack the spot was covered with the hand and firm pressure made, except just at the point of irritation. She was given Apis 3x every hour and referred to my clinic, at which she reported five days later not much improved. Sleep was poor, both owing to her neuralgia and environment. Appetite was very poor. She was in an extremely run down condition, very nervous and apparently considerably worried over family matters. She was baking for a livelihood, which kept her most of the day in a very hot kitchen. Apium Virum 60x was given, followed two weeks later by Sul. 2 m. One month later Sul. 70 m. two months later Apis cc., one month later Apium 90x, another month Apis cc, the next month Nux cc. In April she had an attack of La Grippe which she weathered very nicely, and reported only a slight aggravation of the pains at that time. There is now no difficulty in eating, in washing the face, no trouble in talking. Pain of a very slight degree was experienced for a short time in April up under the eye. Since the first of April she has been so well that I have only seen her twice, when from some cause or other a faint reminder of the disease lead her

to think of her doctor. The effect of the Apium when first given. was to change the pain from the stinging character to a sharp, knife-jab spreading over the portion of the face where the 2nd division of the 5th nerve was located and to modify the frequency of the attacks. She was then given Sul. on account specially of the constitutional symptom. This remedy produced marked amelioration of the local condition, as well as improvement in general health. In eight months and sixteen days she was given eight doses of medicine. In the last five months no medicine or placebo has been given.

Even the most skeptical student in attendance at the clinic had to admit the results obtained in this case due to high potencies. The evidence was too marked to deny.

Some Cases From Practice.*

By A. J. Clark, M. D., Loveland, Colorado.

In my own experience the Homeopathic law of cure has been most beautifully illustrated in the treatment of rheumatism. This is shown in the following cases:

Case First. A day laborer, exposed to inclement weather, was taken with articular rheumatism. Nearly every joint was red and swollen. Pulse 110, pains severe. Gave Acon. 3. The next morning his mother called at my office saying, "that her son had not slept any on account of pain, that the suffering was very severe, and he could not endure to remain in bed; that he had to get up constantly and move about, as much as he could, for in this alone he found the greatest relief. Yet he was soon obliged to lie down again, because the motion wearied him so much."

Here we had the Rhus Picture, Acon. and Bry. had been the indicated remedies in my previous cases. They were aggravated by motion, and relieved by perfect rest. Here was the antithesis:

* Colorado State Medical Society, October, 1900,

worse at rest, better by motion. I sent Rhus 3, with direction to call and report the next day.

The woman came the next day overjoyed, to report "that after taking the medicine through the day the pain all left him, and he had slept all night, and got up in the morning entirely free from pain and lameness, and thought he was all right;" and so it proved.

Case Second. Mrs. H., a middle aged woman, suffering with inflammatory rheumatism, involving the hips, knees, ankles, and feet, pulse 100, unable to move, could not lie down. Had spent three days and nights bolstered in a big chair; could not sleep on account of pain. Prescribed Acon. 3, and covered the parts with dry cotton. The next day found but little change; pulse not quite so high, and she thought the pain not quite so severe; but was weared out for want of sleep.

The disease having followed close upon damp rainy weather, I prescribed Rhus. Found my patient not so well the next day. What was the matter? I asked if there was any time during the day when the pains were aggravated. She said that she commenced to get worse every afternoon about four o'clock and was very much worse until about ten in the evening, then the pain would ease up a little and she would not suffer so severely, although she suffered enough all the time. I then asked to see the urine, and found the bottom of the vessel covered with brick dust sediment. Here was the child of promise, and I prepared a few drops of Lycopodium 30 in a glass part full of water, with directions to take once in two hours, and I would not call the next day, but would call the day following.

The forenoon of the day I was to call, this woman gave me a great surprise by walking into my office, entirely free from rheumatism, walking as easily and nimbly, she said, "as she ever did in her life." When asked how long before she began to improve after taking the medicine, she said, "almost as soon as taken, and by the time for the second dose I felt the pain and swelling all dropping off like a garment; it was the most remarkable sensation I ever experienced."

I think that even the most bitter Allopath could not remain