With respect to the event of the disease, we believe it to be always fatal ; not only has no cure yet been discovered for it, but it is doubtful whether we ale in possession of any plan of treatment, by which its symp toms, when once established, can even be alleviated. The general mode of treatment has been the adminis tration of large quantities of opium, upon the obvious principle of the nervous system being in a state of pre of this list, it will appear that these affections are often attendant upon, or a consequence of inflammation, and sometimes arise from structural derangement ; yet we have in some cases the most equivocal evidence, from the effect of remedies, that the disease is seated in the nerves of the part. We particularly refer to that most painful affection Prosophalgia, or, as it is popularly term ed, Tic doloureux, where the disease may be clearly traced along the course of a particular nerve, and is at least for a certain period entirely removed by dividing the trunk of the nerve. In order to form a correct judgment of these complaints, it is particularly neces sary to make ourselves acquainted with their history and symptoms from the commencement, otherwise there will be danger of our confounding the cause with the effect. In some of them, where the primary derangement is most evidently in the nervous system, we find obvious symptoms of increased action in the blood-vessels to su pervene ; and it even appears that a more permanent alteration in the structure of an organ may be produced by an affection, which, in the first instance, was simply attached to the nerves of the part. It is difficult to ex plain the nature of the operation by which a disease of the nerves is converted into one of the sanguiferous or secretory vessels ; but we apprehend there can be no doubt or the fact, and we believe that it may be even affected by the mere influence of mental impressions, if they be sufficiently powerful, and steadily directed to the same part.
The cure of the Autalgize necessarily depends upon a number of minute circumstances which are connected with the local situation and functions of the organ affect ed ; and in some of them there are certain remedies of a specific nature, which it is not easy to account for upon general principles, of which the use of the oxide of bismuth in simple pain of the stomach may be adduced as an example. In deciding that the disease is either idiopathic, or that it must be made the object of direct medical treatment, we first inquire whether there arc any symptoms of inflammation which may render deple tion necessary, or the other means by which we subdue the inflammatory action ; we then apply blisters, issues, or other stimulating remedies, upon the principle of ex citing what is called counter-irritation, proceeding upon a general law of the animal economy, according to which we remove a morbid action, by substituting for it a new, and probably a more considerable one, in some contiguous part, which latter is attended with no dangerous conse quence, and which we have it in our power to remove at pleasure. In the Autalgix, as well as in the Hype rxsthesim, purgatives arc generally useful, although perhaps not so universally ; and opium, if it does not accomplish a radical cure, is at least one most effectual means for affording temporary relief. It has been ob
served, that some of the most severe pains to which the human frame is liable, recur at periodical intervals ; and it has been found that in these, as in all other periodical diseases, bark, and even arsenic, may be employed with success ; this latter remedy, however, we should not be disposed to try, until all other methods had failed ; and it should likewise be accompanied by propel- evacuations. Of their mode of operation, as well as of the circum stances which tend to give the diseases in question their periodical character, we are totally ignorant, and our practice, in these instances, is entirely empirical.
The second order of the Neuroses is Asthenia, includ ing those diseases which consist in a diminution of th,: nervous energy ; and under this we include three genera, the first of which is simple Nervous fever. Wc are aware of the apparent incongruity in placing the dif ferent kinds of fevers in different classes, and in sup posing them to proceed from totally different causes, connected with a different set of functions, more par ticularly as it must, at the same time, be admitted, that the two diseases slide into each other by almost imper ceptible degrees, so that it is often extremely difficult to know into what class any particular case ought to be referred. But, notwithstanding these objections. we are clearly of opinion that certain sporadic cases of fever, as well as certain general epidemics, exhibit symptoms which may be supposed to arise from primary affection of the nervous system, while the sanguilerous system is but little affected, and that Mc two fevers are not merely different gradations of the same species of disease, in which the proportion be tween the symptoms remains the same, while the de gree of both is equally diminished. We think it is not difficult to perceive a difference in the exciting cause, as well as in the effect produced ; for while contagion is probably the sole cause of the proper Typhus, or putrid fever, the nervous fever never arises from this source, but from mental agitation, from overdatigue, from complete exhaustion, or from other circumstances which might be expected to act upon the brain and nerves, more than upon the heart and arteries. The symptoms, and general character of the two diseases, when we take the most strongly marked cases, are no less easy to discriminate from each other. In the Nerv ous fever we do not observe the successive stages which we have in Typhus ; there are no marks of oppression or congestion, nor of the subsequent attempt at reaction ; but, from the very commencement, there are indications of weakness and irritability, the pulse quick and feeble, the heart little affected, not much thirst or disorder of the alimentary canal, except a less relish for food than ordinary ; while, on the contrary, we have delirium, and all that derangement of the sensations, which indicates an irregular action of the brain and nerves, but, at the same time, without any appearance of turgescence in their vessels, or of that oppression which arises from a congestion of the fluids.