Neuralgia and the Diseases that Resemble it

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Anstie Francis Edmund. Neuralgia and the Diseases that Resemble it

PREFACE

INTRODUCTION. ON PAIN IN GENERAL

PART I. ON NEURALGIA

CHAPTER I. CLINICAL HISTORY

CHAPTER II. COMPLICATIONS OF NEURALGIA

CHAPTER III. PATHOLOGY AND ETIOLOGY OF NEURALGIA

CHAPTER IV. DIAGNOSIS AND PROGNOSIS OF NEURALGIA

CHAPTER V. TREATMENT OF NEURALGIA

PART II. DISEASES THAT RESEMBLE NEURALGIA

CHAPTER I. MYALGIA

CHAPTER II. SPINAL IRRITATION

CHAPTER III. THE PAINS OF HYPOCHONDRIASIS

CHAPTER IV. THE PAINS OF LOCOMOTOR ATAXY

CHAPTER V. THE PAINS OF CEREBRAL ABSCESS

CHAPTER VI. PAINS OF ALCOHOLISM

CHAPTER VII. THE PAINS OF SYPHILIS

CHAPTER VIII. PAINS OF SUBACUTE AND CHRONIC RHEUMATISM

CHAPTER IX. PAINS OF LATENT GOUT

CHAPTER X. COLIC, AND OTHER PAINS OF PERIPHERAL IRRITATION

CHAPTER XI. DYSPEPTIC HEADACHE

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Although it is, in a general way, unadvisable to introduce abstract discussions into a treatise which should be strictly practical, it is almost impossible to avoid some few general reflections on the physiological import of Pain, as a preliminary to the discussion of the maladies which form the subject of this volume. This whole group of disorders is linked together by the fact that pain is their most prominent feature; and, with regard to most of them, the relief of the pain is the one thing required of the physician. It seems, therefore, very important that we should ascertain, at least approximately, in what the immediate state consists, which consciousness interprets as pain. It is not necessary to enter at this stage into any inquiry as to the pathological causes of the phenomenon; what we know of these, and it is unfortunately too little, will be discussed in detail under the headings of the several affections which I shall have to describe.

The question before us now is this: What is that functional state of the nerves which consciousness interprets as pain? Is it, or is it not, an exaltation of the ordinary function of sensation?

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The liability of particular nerves in the upper extremity to neuralgia from external injuries requires a few words. The nerve which is probably most exposed to this is the ulnar. Blows on what is vulgarly called the funny-bone are not uncommon exciting causes of neuralgia in predisposed persons, and cutting wounds of the ulnar a little above the wrist are rather frequent causes. The deltoid branches of the circumflex and the humeral cutaneous branches of the musculo-spiral are much exposed to bruises and to cutting wounds. So far as I know, it is only when a nerve trunk of some size has been wounded that neuralgia is a probable result. Wounds of the small nervous branches in the fingers, for instance, are very seldom followed by neuralgia. I have no statistics to guide me as to the effect of long-continued irritation applied to one of these small peripheral branches, but it is probable that that might be more capable of inducing neuralgia. As far as my own experience goes, however, it would appear that a more common result is convulsion of some kind, from reflex irritation of the cord.

(d) Dorso-intercostal Neuralgia.– This is one of the commonest varieties of neuralgia, and yet it is very likely to be confounded with other affections not neuralgic in their nature. The disorder with which it is especially liable to be confounded is myalgia, which will be fully described in another chapter, and which, when developed in the region of the body to which we are now referring, is commonly spoken of as pleurodynia, or lumbago (according as it affects the muscles of the back or of the side), or muscular rheumatism. It must be owned that the severer forms of this affection can scarcely be distinguished from true intercostal neuralgia by anything in the character or situation of the pains. It will be seen, hereafter, however, that myalgia has its own specific history, which is very characteristic; at present, it is sufficient to remember that it is often extremely like neuralgia when situated in the dorso-intercostal region.

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