"A woman suffered from neuralgia; the pain which was in the cheek, was like that of a violent and repeated pressure from a blunt instruThe attacks were accompanied by sickness and nausea, and ment. violent vomiting came on in two hours before the cessation of the paroxysm. During the attack, large flow of light-colored urine; flatulence, distention of the abdomen and borborygmi; face pale and sallow; she is very weak, tongue tremulous; catamenia much too profuse almost amounting to flooding, and continuing ten or twelve days. Cannabissativa 30° was prescribed. Improvement followed in a few days; catamenia occurred rightly, as to quantity, &c., for the first time in twelve years. A few doses of Aconite and Chamomilla subsequently required for diarrhoea, but Cannabis alone sufficed for the cure of the affection." The case was considered one of "neuralgia dependent on sympathy with uterine irritation, partaking of the nature of Clavus hystericus."

Sticta-pulmonaria has been used with much success by several of our medical friends in the cure of facial and frontal neuralgia. It is especially useful when the pains affect one side, and shoot from the jaws to the face and side of the head.

Apis has cured several cases of severe neuralgia of the head and face, accompanied or succeeded by impaired memory.

Cannabis-indica is a valuable remedy in cases of neuralgia occurring in weakened and exhausted subjects, especially when accompanied by optical illusions and alternations of exalted spirits and extreme mental depression. Codeine and Opium are indicated in similar attacks.

Coffea will prove highly serviceable in neuralgic affections accompanied by great nervous excitability, sleeplessness, and mental activity. COMPLICATIONS OF NEURALGIA. The irregular forms and complications of neuralgia are very numerous, and may be briefly noticed. They often arise from some irritation, near or remote, which may be easily overlooked. Thus constipation, with or without gastric derangement, causes or increases cerebral plethora. Dr. Parry supposes that neuralgias of every form arise from increased vascularity of the nervous neurilemma, the extremities of which are the seat of the disease; others refer the pain to a similar condition of the nerve at its origin. Hemiplegia, though transient and partial, is often connected with epileptic paroxysms. Loss of some of the external senses in these can only be explained by reference to the state of irritation or congestion at the origin of the nerves.

The face is more largely supplied with nerves than any other par of the body; it also exhibits more of the moral and physical phenomena of nervous irritation. 1. We see here acute pain in one point, caused by irritation at the root of a painless, though not insensible tooth. the real disease being felt at the sentient extremity of a nerve, con

nected only through the brain with the sentient extremity of the nerve which supplies the tooth. 2. In cephalea spasmodica, or sick headache, there is a temporary cerebral plethora and pain, generally seated in the upper branches of the facial nerves of the same side. 3. Cephalea hemicrania or periodical headache is often met with in persons who have never lived in malarious districts, and who for years are repeatedly attacked by it. 4. Neuralgia ophthalmia is one of the most painful forms in which neuralgia ever appears. We have seen some cases which originated in the irritation of a tooth, which resisted all treatment until a slightly sensitive tooth was extracted. The sensation of extracting the tooth, which in one case was quite loose, was felt in the inflamed eye. Recovery was immediate, without any further treatment. 5. Dyspeptics are liable to spasmodic twitchings of the eyelids of one side, which may pass nearly into a temporary paralysis affecting the motor nerve only, as the affection is without pain. 6. Palsy of one side of the face and tongue may appear in the same muscles that are supplied by the nerves which are the seat of the pain in tic-doloureux. The affected side loses its expression; the cheek grows smooth and sinks downward; the eyelid droops and does not cover the ball in sleep; the tongue, when projected, turns towards one side; and the opposite angle of the jaw is drawn back.

Pathology-The fifth pair of nerves, and occasionally the portio-dura of the seventh pair are the seat of all these anomalous forms of neuralgia. They are much exposed to moral as well as physical agencies. External impressions are transmitted to the cerebral centres of the nerves. These central extremities are declared by Dr. Gall to be surrounded by a mass of cineritious matter, which seems to be little less than a congeries of blood-vessels. It is, says Dr. Drake, "extremely probable that when a nerve is excited to perform its ordinary functions, there is an increased determination of blood to this cineritious substance." And when this increased determination is frequently repeated, the point on which it is pressed receives a larger proportion of the sanguineous fluxion than the cineritious roots of the nerves. The state thus induced is one of predisposition.

It is through this portion of the fifth nerve, which gives external sensations from the face to the brain, that that keen perception of heat and cold is communicated, by which a few drops of water in syncope revive the energies of the whole system; and, also, through the same channel the body and mind are invigorated by washing in the morning, or after fatigue. The minute fibres of the nerve impart acute insensibility to the teeth, associate the salivary glands with the tongue, endow it with the specific sensibility to form the organ of taste; they give to the retina its sensibility to light, cause it to contract when light is too strong; and, in the nerves establish that well-known

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relation between the taste and smell, and preserve the Schneiderian membrane in a proper state for the exercise of the olfactory branches. (Drake, Wes. Med. and Phys. Jour., Vol. I. p. 1.)

Nervous headache is a sympathetic affection, and the concomitant result of some deep-seated disturbance of the organism. The vege tative system is generally in fault-stomach, liver, bowels, and especially the uterus in females. It is often dependent on an overtasked brain. Aconite usually palliates, and generally does not prevent the due action of specifics.

1. NEURALGIA FROM LOCAL IRRITATION.

Sir H. Halford has made some publications to illustrate the history of neuralgia, which he thinks is generally connected with the deposition of bone in places where it does not commonly exist, or a preternatural growth of bone in a diseased state. In a case of a lady, aged forty, after the resources of the faculty were exhausted, a tooth was extracted which had no external marks of disease. A large exostosis was found at its root. The neuralgia gradually subsided into a less severe form, returning less frequently and with less pain. An English nobleman suffered from this disease in its most marked and painful form. All treatment was unavailing for two months and a half; at that period a portion of the bone enclosing the maxillary antrum exfoliated the Duke speedily recovered, and had no return. The bone had beer injured by a fall from a horse many months before. The Earl of C endured inexpressible agony from this disease for many years; and sub mitted to the excision of parts of various branches of the fifth pair of nerves by the hands of Sir Everard Home and Sir Charles Bell, with only temporary relief. At length, seized with apoplexy, he lay for some days insensible; and after recovering from this he suffered less; but he was never cured, and only died of old age. Repeatedly did the separation of portions of exfoliated bone show the source of his sufferings; and yet the only relief he obtained was from the apoplectic attack, which partially paralyzed the nerves of sensation. A distinguished physician endured all the agonies of martyrdom during many years, and at last died of apoplexy. No treatment had ever afforded him any relief, though several branches of the nerve were divided. On dissection the frontal bone was found of unusual thickness above the frontal sinuses. On the falciform process of the dura mater was found a small osseous substance of three-fourths of an inch in width, and a line in thickness. (N. Y. Med. Phys. Jour., 1827.)

Extreme pain in various parts of the face may be excited by decayed teeth, which in themselves are not painful, and will usually cease entirely on the extraction of the teeth.

2. DENTAL NEURALGIA.

Cases caused by Local Irritation or Pressure on a Nerve.-1. In a case of fourteen years' standing, the anterior maxillary foramen, at which pain had been felt, was found to be almost entirely closed by an osseous deposit, consequent upon the formation of an alveolar abscess contiguous to it. Dr. Fundenburg, of Pittsburg, exposed the foramen by incision, and drilled out the bony deposit: the nerve was freed from pressure, and the patient entirely recovered.

2. A well-marked case of facial neuralgia: The teeth not suspected as the cause of it. But, on tapping a superior bicuspis, the patient screamed with pain. The tooth was extracted, and a large exostosis was found at the end of the fang, the patient was cured.

3. A case of two years' standing: There was "a singular pain in the side of the head, accompanied by a darting pain in the lower-jaw," extending down the neck and side. Pain excited by tapping an inferior cuspidatus-the tooth was extracted-"a large osseous deposit was found on the fang," and the patient was relieved. (Louisville Med. Jour., 1840, p. 336.)

4. A colored girl, aged twenty, general health good, except pain in the face, near the articulation of the jaw, and forwards towards the angle of the mouth; side of the head and down the neck backward towards the trapezius muscle, and to the point of the shoulder. Pain paroxysmal; worse at night; no fever; clearly neuralgia, not rheumatism. She had been treated with purgatives, blistered by concentrated Spirits of Ammonia over the seat of the facial nerve; took acetated Tincture of Opium. Veratria Ointment was tried, 15 grains to 2 ounces of lard for several days. The blister had given some relief, nothing else had done any good whatever. She took one-twelfth of a grain of Veratria every four hours, continuing the ointment. Up to the fourteenth day no improvement. The mouth was now examined-some decayed teeth on the affected side; pain produced by tapping several of the teeth. Most severe on the first molar above. It was extracted, and at the extremity of its fang was a sac as large as a pea, filled with pus; the root carious. Some other fangs in the same state were removed also. Some soreness remained several days, but no return of the neuralgia. (Dr. Bayles Louisville Naval Hospital Reports, 1840.)

3. TRAUMATIC NEURALGIA FROM WOUNDED NERVES.

Mr. G. Bell, of Edinburgh, gives the case of a young lady who was bled in the cephalic vein of the right arm. In ten days the elbow stood at an acute angle, and the fingers were firmly contracted. Extension when attempted caused great pain. The incision in the

vein had firmly united, but gentle pressure gave great uneasiness The pain extended downwards to the fingers; and upwards along the inside of the arm to the axilla and clavicle. When an exacerbation of pain recurred, she was seized with stertorous breathing, tremors, subsultus tendinum, with febrile symptoms. To arrest the progress of the disease every palliative measure was tried in vain, and tetanus was apprehended.

Operation.-An incision, three inches long, was made over the vein, which was displayed and tied in two places, one inch and a half apart. It was then divided between these two points, which caused instant relief, allowed the freest motions to the wrist and elbow. The patient. recovered perfectly. Several other cases were treated in the same way with success. (Edinburgh Journal.)

4. NEURALGIC OPHTHALMIA.-This is a form of intermittent fever in which the pain concentrates in the nerves of the eyes, increasing with terrible intensity at a certain hour every day. The exacerbation of neuralgic pain in the optic nerves comes periodically in the place of a regular chill; it increases regularly through part of the day and evening, then subsides during the middle of the night, and is scarcely felt on the following morning. Day after day it continues to recur until it is arrested by treatment, or is changed into permanent blind

ness.

TREATMENT. Of all remedies Quinine is the worst here. It requires large doses to cut short the periodical paroxysms; and such doses always increase the pain as well as render permanent the inflammation of the different structures of the eyes. In this manner permanent blindness is very often induced. The best treatment consists in Aconite and Bell, in alternation during the paroxysm; Camphor and Opium just before the next paroxysm; a warm bath at its commencement; and Arsen. during the interval.

5. SICK HEADACHE.

GENERAL REMARKS.-A distressing form of cephalalgia, occurring most frequently in literary or professional men, and in delicate but intellectual females. It occurs most frequently in persons between the age of puberty and forty or fifty years. Some are peculiarly subject to it for a long series of years; and many though temporarily relieved by various modes of treatment, are never permanently cured.

Description. It is common for sick-headache to commence in the morning on waking from a deep and unrefreshing sleep, after previous fatigue, mental excitement, or irregularity of diet. There is: disturbance of vision; dull and distressingly oppressive pain of the head, centering in one temple, most frequently the left; tenderness and fullness