A smart neuralgia may for a time persist after the removal of the cause which, in the first instance, induced the neuralgic condition in the nerve trunk or its branches, and this consideration should prevent the very common mistake of flying from one remedy to another in quick succession without waiting a sufficient time for that steady and continuous action of the drug which may be crowned by permanent success. It is only after the evident failure of such rational treatment that the scientific physician will feel justified in resorting to the various empirical methods which experience leads him to hope as likely to prove useful.
As regards the routine use of drugs, it is the experience of every physician that anemia and neuralgia often occur together, and that sometimes no treatment will give any permanent benefit till the anaemia is removed, hence in every such case Iron is indicated. The scale preparations, the tincture, saccharated carbonate, l3laud's pills or other preparations may he given according to the special indications present. Occasionally, indeed, it may be necessary to give one preparation for a time, and follow it up by another until the system is saturated with iron.
The following pills may be given for a considerable period: Ferri Redacti gr. iij.
Ferri A rseniatis gr.
Quinince Sulphatis gr. ijss. Misce.
Fiat Muhl. Mille tales xxiv. Sumat Imam ter in die post cibos.
Arsenic is another routine drug of great value in neuralgia, especially in the very chronic or obstinate forms. Like iron, it must be given in full doses, and be continued for a considerable time after the painful paroxysms have passed off. It is, moreover, useful in cases not characterised by marked aninia, and the writer generally gives it in combination with iron, or during the intervals when the administration of iron is suspended. It must not, however, be forgotten that the prolonged administration of arsenic in full doses when prescribed for other diseased conditions is liable to be followed by neuritis or neuralgic symptoms; hence the arsenical course should not be a prolonged one.
Phosphorus in the free state or as the glycerophosphates has been employed as a routine drug, and often with much benefit.
Rheumatic, gouty and malarial conditions of the system should be met by Alkalies, Colchicum, Salicylates, Iodides, Salol, Quinine or other recognised agents. Syphilis is to be met by Mercury and Iodides. Lead
poisoning, which not infrequently is the cause of neuralgia, calls for appropriate management by Iodide of Potassium and purging with Sulphate of Magnesia.
Neuralgia occurring in glycosuric or diabetic subjects is a clear indication for a strictly regulated dietary.
The next indication is the urgent demand for the relief of pain; the selection of the most suitable remedy for a given case is little influenced by the site of the neuralgia. Hence in the following description of the value of the drugs ordinarily employed as pain relievers, except when specially stated, the dosage and method of administration may be taken as applying to facial neuralgia. The local treatment will be considered later on.
Opium or Morphia is the most reliable of all drugs for the relief of pain, but though it must stand at the head of the list it is practically banned in the treatment of the affection under consideration owing to the very obvious danger of the establishment of the opium habit. Whilst it never should be prescribed for the relief of neuralgia of any lengthened duration, it may under rigid restrictions be employed with advantage in a small percentage of cases when the first symptoms of a severe neuralgia abruptly manifest themselves. Even then it must be resorted to with the distinct understanding that its administration is not to be repeated after a few doses. The hypodermic method gives the speediest and most satisfactory results, but the rule must be laid down that never under any consideration should the patient himself he permitted to use the hypodermic syringe.
Experience shows that in a small percentage of cases pain does not return after being once subdued by a good opiate, and there are strong reasons for believing that this is the result of the opiate, and that the cessation of pain is not owing to the natural decline of the disease.
This desirable result is more likely to happen when the opiate has been injected into the immediate vicinity of the affected nerve than if admin istered by the mouth. In closely examining this statement it may be fairly supposed that the acupuncture is an important element in the treat ment, since excellent results have sometimes been obtained by simple puncture of the affected nerve trunk by a stout needle, and aquapuncture has also a beneficial effect, and the advantages of counter-irritation are in some cases also beyond doubt.