II ov. eN el-, as age advances these intervals t: lid to become shorter and the painful ictiods longer until the disease is per il Allt III. All hysterical form can be dis tinguished from the true by the irregn.
oteurrenee of the attacks.
rhe first form of neuralgia is always benetit.,1 by analgesics antipyrine, naeetin, hydrobromate or valerianate of quinine); the second. or true tie. is quite uninfluenced by them. lhe only drug which can be relied on in the latter is opium in large doses. It may be given En pills containing 2 centigrammes of the thebaie extract of the French pharmaeopteia, made freshly and not too hard. Three a day are given at first, and, the effect being carefully watched, one pill is added every other day until the desired effect is produced. This dose is continued for a few days, and then diminished by one pill every other day. Gilles de la Tourette (Sem. AIM., June 24, '06).
Etiology.—Neuralgia is a disease of middle life, rarely affecting children and rarely occurring in old age. It is some what more frequent in women than in men; more frequent in cold than in warm weather; more frequent in cold and damp climates than in dry and warni localities. Alembers of neuropathic families are more liable to the disease than are persons of good nervous hered ity. The immediate exciting causes are anything which lowers general nerve tone and any toxic agent or disease tended by toxmmia, such as anremia and g.eneral eacheetie states, malaria, tious diseases, autogenous poisonings, diabetes, lead poisoning. etc. Exposure to cold may precipitate attacks in those predisposed, as may reflex irritations from disease of eye, ovaries, abdominal organs, carious teeth, etc. Where hered itary predisposition is very strong the affection may develop -without discover able cause. The neurasthenic and hvs laical are particularly prone to sillier from neuralgia.
In many cases of neuralgia, the true "functional.' or idiopathic cases, no pathological alterations in the nerve fibres, cells, or ganglia ean be detected, the presumption being that the pain is due to malnutrition or toxrernias of a de gree too slight to cause alterations of structure. In other eases the nerve
trunks are swelled and tender, and in most such cases the pathologico-an atomical changes of a mild interstitial neuritis.
Account of 15 eases of a peripheral 4 nervous affection loealized in the area of distribution of the external cutaneous I nerve, name of "external partesthetie neuralgia" being applied to these cases. The chief symptoms are pain, pants thesia, and anmsthesia of the external aspect of the thigh. It is found chiefly 1 among males suffering from various dis turbances of the circulation lhoids and varicose veins) and who lead I a sedentary life. Symptoms believed to be due to pressure upon the nerve where it passes by the antero-superior spine. Roth (Le Bull. Me'd., June S, '95).
Treatment.—The first indication is re moval of the cause, when such is coverable and can be removed. General tonic and hygienic treatment is always advisable, as any improvement in vital tone and blood-quality gives measurable relief from idiopathic neuralgia. moval from an unhealthy climate often gives relief. Iron, arsenic, strychnine, eodliver-oil, and phosphorus singly or in combination are the tonics most used. Quinine, at one time much lauded as a specific for some forms of neuralgia, is apt to prove disappointing.
A gouty temperament often underlies an attack of neuralgia. Purgatives and other measures calculated to eliminate waste-products of metabolism are often effective. Tablespoon doses of sulphate 0 of soda every two or three hours in bot water until purging occurs, then followed up each morning with enough to thor oughly clear the intestinal tract, and Turkish baths, remaining just long enough to start the sweating process—to arouse the activities of the skin, may be employed with appropriate remedies for the gouty diathesis proper. I. N. Love (Med. Mirror, May, '99).
The systematic use of electricity, long continued, is one of the most valuable means at our disposal for the permanent relief of neuralgic pain, the galvanic current giving best results.