TREATMENT.– Psycho-analysis has been and is of great service to neurasthenia. It is, however, a matter for the expert, and the amateur may do great harm. The one essential for the patient is to feel at home with the psycho-analyst– the least jarring or even unconscious antipathy will be fatal to success. Usually it is best for the patient to be treated by one of his (or her) own sex.
Apart form psycho-therapy, systematic rest and massage, isolation from worrying surroundings, change of mental occupations, are all helpful and palliative. Games and exercise are apt to be overdone in these cases.
Homoeopathic drug treatment may be invaluable, but requires, great patience and perseverance. Each case must be fully worked out by a therapeutic expert. Those most likely to help are; Lycopodium, Silica, Aurum, Platinum, Sepia, Natrum Mur., kali- Carb., Sulphur and Calcarea.
If an intestinal germ is found, vaccine treatment should be given an opportunity.
For sleeplessness in these cases Actea Racemosa is one of the most helpful drugs.
93.– Neuritis.
DEFINITION.– Inflammation of one nerve or many (multiple or poly neuritis.)
CAUSATION.– Cold, principally seen in the facial nerve; injury; extension of inflammation elsewhere to a nerve. These concern single nerves.
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Poly-neuritis is the result of toxaemia, either from disease, (leprosy, diphtheria, etc.) or from poisons such as alcohol, lead, arsenic, bisulphate of carbon. It occurs in the late stages of Anaemia or cancer. Beri-beri is a general neuritis, but this is a deficiency disease, due to the absence from the diet of one of the factors known as vitamins.
SYMPTOMS.– These naturally vary with the nerve attacked. Pain in usual and severe, and tenderness of the affected parts. With this go twitchings and spasms of the muscles supplied, pins and needles of the kin areas. later, pain gives place to numbness, and spasm to paralysis, nd deep reflexes are lost as the the nerve ceases to be irritated, and becomes more or less destroyed. The duration of an attack varies, but may be prolonged. There is an acute febrile poly-neuritis (rare) which may prove fatal.
In Alcoholic neuritis as in Lead neuritis, the extensors are more affected that the flexors, so that wrist drop and ankle drop occur. It is the steady tipper and not he heavy drinker who tends to get neuritis.
TREATMENT.– Rest in all but mildest cases; very gentle massage and weak interrupted electric current applications help after the acute pains are passed. Homoeopathic drugs are indicated largely by the varieties of pain and these will be found in the Section on Neuralgia. For obstinate cases Arsenic, Carbon Bi-sulphide and Plumbum are most likely to help. and Gelsemium in post- diphtheritic paralysis ( which is due to a neuritis). Great patience is required in chronic cases.
94.– Neuralgia.
DEFINITION.– Severe darting, stabbing, or burning pain along a nerve trunk or its branches, chiefly affecting those of the head and face, recurring in paroxysms, at regular or irregular intervals; in recent cases the periods of intermission are comparatively free form suffering; but in chronic cases, more or less persistent local pain and mischief occur from some morbid condition of the nerves of sensation,. produced by a local or more frequently a general affection. Neuralgia is therefore a symptom, not in itself a disease (See neuritis.)
VARIETIES.– The chief superficial Neuralgias are the following; (1) Facial Neuralgia.– the branches of the fifth pair of nerves are the seat of the pain; any one, or in rare cases, all three of its divisions may be involved; one very severe form of it is known as Tic-douloureux, and more frequently affects women then men. (2) Hemicrania, Megrim, or brow-Ague– the seat of pain is on one side of the head, just above the eyebrow. (3) Intercostal Neuralgia or Pleurodynia– often associated with an eruption of clustered vesicles (Herpes zoster). Herpes may occur in relation to neuralgia of other nerves, but is most common with Neuralgias of nerves supplying the chest wall. It is a distinct disease of which the severe Neuralgia is a prominent and distressing symptoms.
(4). Sciatica.– Neuralgia affecting the sciatic nerves form the nates to the knee, and sometimes to the ankle; often associated with Rheumatism, indeed most frequently caused by it.
Of the visceral neuralgias we may mention Gastrodynia — the disease being located in the nerves of the stomach.
Angina pectoris.– the cardiac nerves being involved;
Hepatic; Ovarian; Testicular. These last three names are to be regarded rather is indicating a site than a pathology. So-called ovarian neuralgia is not always dependent on ovarian disease. it is, however, an anatomical fact that the same nerve generally supplies an organ and the skin area above it,. So that superficial sensory disturbances may indicate disease lying deeper. Further Dr. Henry Head and others have shown a definite relating to exist between disease of internal organs and certain skin areas apparently far removed. So that, for instance, disease of the stomach may be accompanied with pain in a definite region of the head.
Of all the varieties of neuralgia, those described as Tic- douloureux, or trifacial Neuralgia, and Sciatica, are most frequent.
DIAGNOSIS.– Neuralgia may be distinguished from Rheumatism by its paroxysmal character, and by the absence of swelling of the parts affected, but great care in diagnosis is needed, whenever pain is present, to determine its cause. Neuralgia is a name for a symptoms not a diagnosis, and the cause of the Neuralgia must always be sought., The word Pleurodynia may afford as much comfort to patients and doctor as the blessed word Mesopotamia, but as it is only after all Greek for pain in the side, it obviously does not carry very far. The cause of Neuralgia may be direct, like pressure on nerve of inflammation of its sheath, or may be more remote and due to toxaemia, but in any case, the cause of pain should always be closely sought. See below under Causes.
SYMPTOMS.– Darting or shooting pain in the course of a nerve, of different degrees of intensity, at times almost unendurable; the severe form generally comes on suddenly, and is of a sharp, darting, or tearing character, coursing along the trunk of ramifications of the affected nerve. Sometimes there is spasm in the muscles that are supplied by the nerve thus affected; in some cases, heat and redness of the surface, with augmented secretion from the neighbouring organs, as a flow of saliva or tears when the nerves of the jaw or eyes are implicated; in others, and this is very common, especially in chronic cases, there are tender spots at various points where the affected nerves pass from a deeper to a more superficial level and particularly where they emerge from bony canals, or pierce fibrous fasciae (Anstie). In many cases a paroxysm of neuralgia is preceded by anaesthesia or diminished sensibility of the nerves of feeling. A frequent, if not an invariable concomitant symptoms is general or local debility. It is true, Neuralgia is sometimes supposed to be associated with muscular vigour or robustness, but a close examination will almost uniformly reveal evidences of deterioration in the nervous system,.This is confirmed by the very common observation, that depressing agents– as bodily fatigue, or mental anxiety– act as exciting causes of Neuralgia, or aggravate an existing attack.
The duration of neuralgia is very uncertain; an attack may pass off after a few paroxysms, or it may persist for many days or month, with a well-marked, or irregular intermittent or remittent character.
NEURALGIA AND GREY HAIR.– The hair undergoes remarkable changes under the influences of Neuralgia, Dr. Anstie noted greyness of hair on the same side in eleven instances out of twenty; seven of these were cases of Neuralgia of the ophthalmic division of the fifth nerve in four of these case there was greyness of part of the eyebrow on the affected side. The same observer has also noted fluctuation of the colour, the greyness actually increasing during, and for some time after, an acute paroxysms, the hair subsequently returning more or less to its natural colour.
CAUSES.– These may be hereditary, constitutional or local. Neuralgia is distinctly hereditary, occurring in particular families, and appearing in successive generations. it is well known, also, that such neuralgic families are liable to the more profound derangements of the nervous system– Paralysis,. Epilepsy, Hypochondriasis, and even softening of the brain and Insanity– indicating some congenital imperfections in the formation of the nerve cells and fibres. This seems to be proved by the fact that, though a precisely similar accident occur to a hundred persons, not more than two or three will experience any neuralgia, and these will probably be found to belong to a neuralgic family.
Constitutional causes are– Impairment of the general health; depressing influences, whether mental or physical, as night- watching, sleeplessness, anxiety, insufficient nourishment, or violent exertion; haemorrhage and consequent debility; affections of the alimentary and urinary organs; exposure to wet and cold– to strong and cold winds, which are frequent causes of irritation to the animal nervous system; a gouty, rheumatic, or syphilitic taint; decay or loss of teeth, malaria; and lastly, organic degeneration at the decline of life, which is the most severe and intractable form presented to the physician. The great majority of patients are found among the hard-working, the poor and the badly-nourished classes; men suffering less frequently then woman. The cause of this is, that, men are a better protected, both naturally and artificially, from the effects of exposure, and that woman are tempted to indulge in brief exposure in the open air from warm rooms without any suitable covering to the head, or any protection to the face. The face of man, on the contrary, is covered by a beard which shields him from injury by exposure. He also spends less time in the relaxing atmosphere of heated rooms, and enjoys to a greater extent the bracing effects of out-of-door exercise.
LICENTIATE OF THE ROYAL COLLEGE OF PHYSICIANS; MEMBER OF THE ROYAL COLLEGE OF SURGEONS; LICENTIATE IN MIDWIFERY, LONDON AND EDINBURGH, ETC. PHYSICIAN TO THE READING AND BERKSHIRE HOMOEOPATHIC DISPENSARY.
Author of "The Stepping Stone to Homeopathy and Health,"
"Manual of Homoeopathic Treatment". Editor of "The Homoeopathic World."