Chloroform, Ether and Alcohol in full doses will relieve all forms of neuralgic pain, hut their use is obviously contra-indicated owing to the dangers which are liable to follow their repeated administration.
Nitrite of Amyl inhalation occasionally cuts short a severe paroxysm of neuralgia of the fifth nerve, and in all neuralgic conditions involving the heart it may be resorted to repeatedly. The routine of some physicians is to .uhninister Trinitrin till the tension of the vessels has been markedly reduced.
Two drugs have been so often found to he efficacious in the relief and cure of neuralgia affecting various nerves that they require special mention, though their use must be regarded, like that of many other substances, from the empiric point of view. These are Quinine and Chloride of Ammonium.
Quinine in malarial neuralgia can hardly be regarded as an empiric agent, since the pharmacological action of the drug has been so clearly demon strated on the parasites in the blood, but it exerts specific influence over the neuralgia which supervenes in malarious patients long after the amcelim have perished.
Quinine seems to act best in those types of neuralgia in which inter mittency of the paroxysms is best marked, the intervals between the attacks being prolonged. One large dose of so grs. of the sulphate or 6 grs. of the acid hydrochloride should be administered before the expected paroxysm or as soon as this comes on. It may be combined with a small dose of Morphia or with so grs. Antipyrine, 5 grs. Caffeine, or a correspond ing amount of any of the new analgesics. This form of treatment is often highly efficacious for the relief of ordinary supra-orbital neuralgia. Brachial, cervico-occipital, sciatic, crural and intercostal neuralgias (which are often, strictly speaking, forms of neuritis), usually yield to quinine combined with Aspirin; the following formula may be employed : 11. Quinince suLph. gr. viij.
Aspirin gr. xv.
Morphice Hydrochlor. gr. s. Misce.
Ft. cachet. in die, p.c.
Chloride of Ammonium may he employed in the same empiric fashion, and as in the case of quinine, if relief be nut experienced after a few doses, the drug should be discarded. zo grs. may be given in solution every 2 or 3 hours, or the same amount may be prescribed with 5 to so grs. Quinine in cachet form, and this latter method of treatment is a good routine in facial and sciatic neuralgia, and sometimes proves effectual in the visceral types.
should constitute the main element in the treatment of neuralgia occurring in syphilitic patients, but the iodine salts undoubtedly possess marked pain-relieving properties in some forms of neuralgia in subjects who have never suffered from syphilis. Iodide of Sodium in 5 to so gr.
doses may be tried in chronic, intractable types of neuralgia affecting any nerve. When relief and cure follow, the physician will probably conclude that the case was one of chronic neuritis of rheumatic origin or of a neuralgia of syphilitic nature. The drug may be combined advantageously with full doses of Bromides, which, though possessing little if any analgesic action, will nevertheless assist in procuring sleep and diminishing restless ness. In hysterical patients Valerianates may be combined with whatever antineuralgic remedy is selected for administration, but to be of use the Zinc or Iron Valerianate must be administered in doses of not less than 5 grs. If quinine be tried in such cases, it appears better to give 5 to io grs. of the sulphate with the same quantity of the zinc valerianate in cachet than to administer a large dose of the valerianate of quinine.
Tonga, Cimicifuga, Piscidia Erythrina, Aconite, Veratrine, Sumbul and many other vegetable drugs have been administered and extolled from time to time.
Local treatment has been as varied as the constitutional; it may be employed for the relief of pain during a paroxysm, or after this has passed off, with the view of preventing a return.
Dry heat has been always a popular local agent, and in the great majority of cases a considerable amount of relief may be obtained from it. This is best seen in those examples of supra- or infra-orbital neuralgia where severe paroxysms are induced by every cold current of air which strikes the face. By applying a thick layer of warm cotton-wool and a bandage much comfort may be procured. In occipital, brachial, intercostal and sciatic neuralgia excellent effects may be obtained by the continuous application of a rubber bottle partially filled with very hot water so as to permit of its being moulded to the shape of the affected part. The luminous radiant heat of the Dowsing, or the ordinary thermoelectric bath, may be utilised to great advantage when the neuralgia involves a limb nerve, and a temperature of 400° F. can be safely employed. The Leucodeseent Therapeutic Lamp may be readily used for concentrating radiant heat upon any part of the surface of the body by means of a polished nickel-plated reflector and a high-power electric lamp. By the Greville Electro-thermic Generator the invisible rays beyond the red in the spectrum can be utilised without the light rays.