under the two heads of Intermittent and Neuralgia; while I might even have extended it, by adding what occurred in other seasons, in the same place; among which I might have enumerated an irregular intermittent with neuralgic palpitation of the heart; an acute hepatitis (probably dependent on the same cause); two instances of diseased spleen; one of Neuralgia, with obscure intermittent, in the foot; one of periodical toothach with double quotidian; one of periodical quotidian rheumatism in the arm: one of quotidian with irritability of the bladder, a second, of very severe neuralgia of the heart, replaced and cured by a common quotidian; and one of a periodical general chronic rheumatism, of a most defined type and quotidian character." 324.

Our author has not a doubt, nor have we, that the same cause acting on different persons, produced all these disorders-more especially as the same individuals suffered, in different and subsequent seasons, several of the above-mentioned forms of disorder. A remarkable instance is stated, in the person of a gentleman, with whom the author was intimately acquainted for nearly thirty years, during the greater part of which he was harrassed with the various forms of chronic intermittent.

In mere fever, this patient experienced various remittents, together with tertian, double tertian, quotidian, and double quotidian, in different years; and, in the anomalous varieties, what may perhaps be referred to the Asthmatica, and to the Stranguriosa, and also what may possibly be the Nephralgica of Sauvages; together with the Emetica, the Hysterica, and the Soporosa, of the same arrangement. These intermittents also, at different times, were united with, or succeeded to, or were replaced by, periodical and marked general chronic rheumatism, periodical local rheumatism in a limb, and rheumatism of the face, with repeated slight attacks of the ophthalmia of one eye, attended by hemicrania. In simple Neuralgia, this patient also experienced that of the face, repeatedly, long relapses of pure hemicrania, clavus, that of the eye, or optic nerve, sciatica, and a similar affection in one radial nerve and in the anterior crural; as on different occasions, he suffered quotidian intermittent toothach, and the most severe neuralgia of the heart which I have ever witnessed, recurring annually for many years, replacing once a local periodical rheumatism, and more than once replaced and cured by a quotidian simple intermittent

"This is probably a rare case of severity and multiplicity, as the case itself was remarkable for its inveterate duration; but I doubt not that it can be parallelled, if not equalled, by the experience of others. But it is plain that it can be so parallelled, only by taking the same views of these diseases as myself, since, under the present opinions, most of those would have been considered as independent disorders, accidentally meeting in a single subject." 329.

To these two branches of evidence, community of cause-co-existence and interchangeableness-our author adds another, the effects (whether good or bad) of remedies. Throughout the whole catalogue, it is to the same class or system of remedies that we must look for the cure-and these are all remedies acting on the constitution-a fact that strongly confirms the view which our author has taken. Even when the remedies are not medicines, as change of air, mental impressions, &c. the same argument holds good. They act on the whole system, and thereby relieve the local neuralgic disease. Again, the same system of treatment which is injurious in one of these diseases is injurious in all the rest of the class-and the same kind of evil consequences arises in all as in one.

"Whether it be an intermittent of the most ordinary character, whether it be an anomalous one, or should it be any of all the neuralgic diseases, however apparently local and simple, it is the constitution, or the system at large, which suffers from that improper

treatment, and in the same manner; while as far as the local, or even the general disease may suffer, it is, in all, also, in the same manner; namely, that they become confirmed or aggravated, or acquire a tendency to recur when they would otherwise have terminated." 333.

The following is an abstract of all that precedes, and in the words of the author.

"The abstract in question is therefore the following, passing over the community of remittent and intermittent fevers, as an admitted fact. Intermittent fevers arise from Malaria, certainly, as principally, and from mere cold possibly; but are renewable by mere cold, when once they have existed.

"They are often attended by peculiar local symptoms producing the anomalous varieties, while, when the febrile state is slight or obscure, these local disorders appear to be the chief disease.

"Such local disorders are either affections of the nervous system, or of an inflammatory character, and they have been fully described.

"The same intermittent fevers, more or less distinct, are accompanied by all the Neuralgia that have been described, whether these consist of simple pain, or are attended by inflammation; and when the febrile state is slight or obscure, those local affections appear to form the chief disease.

"If intermittent fevers alternate with all the anomalous local symptoms or diseases, so do they with all the neuralgic diseases: and in such cases, the supervention of one is the removal of the other.

"Thus also, all those local diseases, including all the Neuralgia, alternate with each other; or the appearance of one form is the cure of a preceding one.

"Many of the Neuralgia will exist almost simultaneously, or else in alternating parox. ysms; these having any of the types of intermittent.

"They also exist in alternating paroxysms with simple intermittent: or a particular doubled type will consist alternately of a paroxysm of pure fever and a paroxysm of Neuralgia.

"The same individual, under a persevering intermittent, will experience many of the anomalous forms of that disease, and also many of the neuralgic diseases, in alternation or succession, or else in union; and, in such cases, the type, and the hour of recurrence, will be the same for all the forms, even through a long course of years.

"Malaria will produce the neuralgic diseases directly, as, probably, will mere cold; but they are renewable by mere cold when once they have existed; and in these cases, though the intermittent fever is probably always present, it may be so slight as to be overlooked, In this, the first cause, Neuralgia, in all its forms, resembles intermittent: but it differs, inasmuch as it can be excited by direct injury of a nerve; a difference however which is of no moment as to the general identity, because we know of no means of thus injuring the entire nervous system so as to produce general intermittent.

"The same Malaria, in the same spot, acting on different individuals at the same time, will produce either intermittent or Neuralgia, and every form of each.

"Intermittent and Neuralgia, in all their forms, are cured by the same remedies, and injured by the same wrong treatment; and those remedies are constitutional ones, whether the diseases be local or general; while, very particularly, the local and the general diseases both, are cured by operations on the imagination.

"The conspicuously wrong treatment for all of these diseases, whether Neuralgia or intermittents, consists in the debilitating practice, as the right treatment is found in what is esteemed the reverse; and whatever be the disease, be it local or general, when that practice is pushed so far as to become injurious, the injury is always of the same character, affecting the entire nervous system." 337.

We must pass over a short chapter, (XII.,) on certain consequences of intermittent and neuralgia, in order to devote more of our remaining space to

CHAP. XIII.-ON THE CURE OF NEURALGIA IN GENERAL.

If our author be right in considering neuralgia as a disease dependent on a constitutional cause, however prominent may be the local symptoms-in short, if it be a mode of intermittent fever, or fundamentally of the same nature, it is natural that the same system of treatment should be enjoined. To this he was led, more than twenty years ago, from theory, and is now confirmed in the propriety of the system by practice and observation. This plan of treatment has never failed him in recent cases, and has often succeeded in those which were of long standing. In this chapter, our author has been unavoidably led into considerable repetition, as the principles of cure, and even many of the individual remedies, have been broached or detailed in preceding chapters, more especially when treating of intermittent. It will not be necessary for us, however, to go much into the minutia of the treatment; since it was of infinitely more importance to connect the etiology and pathology of these varieties of disease, than to dwell on their management when once recognized.

The first remark, and it is a very important one, is this-that the neuralgiæ often disappear without medicines, by a spontaneous effort of the constitution-while they are also truly cured by circumstances that are not noticed, and to which credit is not given. This explains the reputation which has been gained by particular modes of cure, which were, in reality, either nugatory or injurious in themselves. Hence improper practices are continued from mistaken observation. Particular periods of life, as the climacteric in males, and cessation of the catamenia in females, often root out old and inveterate neuralgic affections, that had defied all remedies. The most frequent of the real, though little observed causes of cure, however, will be found in change of air, and of general habits of life-which, by the bye, is a direct remedy of great power, though often recommended to the patient when the practitioner is tired out with fruitless attendance. The effects of moral impressions are under-rated and ridiculed. A change of physicians, or the acquisition of a new and strong confidence in a new and reputed person, often effects a cure, where the remedies prescribed had little or nothing to do in the business.

"Hence an actual benefit often derived from empirical remedies and empirics, or from physicians of popular if false reputation, or of peculiar, perhaps insolent or coarse manners; an influence extending widely over all the nervous disorders, of which so many occur from the general cause of disease which includes the subjects of this essay" 370.

This, in reality, is the cure by charms This is the reason why quack medicines, the composition of which, being unknown, is more respected, effect cures, when the same medicines fail in ordinary prescription.

"Hence that universal confidence in substance and formulæ and numbers and quantity, and hence especially that enormous consumption of Empirical remedies; compounds found in every pharmacopoeia, but divested of all their virtues under this form, because separated from the mystery and the incantation. The physician who attempts to reason with his patient on the effects and utility of his remedies, pays a most unmerited compliment to human reason and while he will fail to influence, he will not be very long in discovering that he will shortly have no patients to enlighten or to cure. With the loss of the mystery, the merit is at an end: and he who proves himself to be the true philosopher and physician, is precisely the man who will never be trusted." 371.

This is a melancholy picture, but we fear it is too true. It may account for the immense reputation of a living practitioner, who never reasons or says a civil word to his patients, but drives them from his presence, all having, and all knowing before hand, that they will have the same prescription or box of pills, whatever be the nature of the malady! Dr. M. relates a case of tic douloureux, which he had long treated in vain with arsenic and other remedies, but which instantaneously vanished before the solemn gibberish of an old woman, celebrated for the possession of a charm against toothach.

We know that intermittents are sometimes cured by giving a powerful anodyne just before the expected paroxysm, which breaks the chain, and interrupts the morbid process. The same is sometimes done in neuralgia, and ought not to be neglected, though they are not the real remedies in this class of maladies.

"But the chief and the most energetic remedies in Neuralgia, be the form what it may, are the tonics; and of these, as in intermittent, the most efficacious are bark and arsenic. Each, in its class, may stand at the head of a list which it is fruitless to enumerate, since it is so well known to even every druggist; nor need I repeat what relates to the mode of using these, since it is precisely the same as in intermittent fever. That there is any one vegetable tonic more efficacious than bark, or differing in the mode of action, as far as we now know these remedies and their powers, I am inclined to doubt: but not to deny that such do exist, since I consider that we are very far from having exhausted the medicines of the vegetable kingdom; so far, indeed, as rather to be in an absolute infancy of knowledge on this subject."

"While with bark as the type, the physician may command the whole range of astringents, aromatics, and bitters, he is also bound to try one where another fails; since thus may it possibly be discovered, even that what is most efficacious in common intermittent may not be most so in the Neuralgia, differing as they do in respect to the local action in the latter. But as I can, on this, say nothing of any great value from my own experience, I must be satisfied with having pointed out the leading principle and the road to be followed; as I need also do no more than suggest those combinations, whether of these vegetable substances themselves, or of the same with narcotics, the occasionally superior value of which in intermittent is well known.

"If arsenic be admitted as the type of the metallic remedies, it is equally easy for the physician to command the whole range of these: so well known, that I could add nothing respecting their powers; while I much suspect that very fanciful values have often been attached to some of them, from that common mechanical system which looks more to variety of medicines than to a knowledge of diseases. Much has indeed been lately said respecting the especial value of the carbonate of iron (as it is generally called) in the common Neuralgia (Tic); while in reality it has been administered as a merely empirical rem edy, and without system. In my own experience, I had resorted to it long before these recommendations, both in intermittent and Neuralgia; but without discovering that it pos sessed any collateral merit above arsenic, while far less generally efficacious as a remedy. But, on all these remedies, I shall be very glad to hear of the experience of others, since I have wanted both temptation and opportunity to do them justice. As to the value of arsenic compared to bark, can only repeat what I said formerly, that I have found it more generally efficacious in Neuralgia, while it has appeared less so in intermittent: often acting almost like a charm on the pain, and even in cases of many year's duration. this also I am ready to be corrected; as I am satisfied that the experience of no one individual, even were it far greater than mine has been, is sufficient to decide on subjects of

this nature." 377.

But on

Dr. M. makes no distinction, as to treatment, in the different forms of the disease with the exception of sciatica, in which he has not had much experience. A medical friend, residing in a district noted for this disease,

informs our author that he has derived the most marked advantage from this remedy in numerous cases.

When the attacks of intermittent or neuralgia are either very irregular or of long standing, the power of medicine is very limited in breaking the chain of morbid action. A single blood-letting has often rendered a recent intermittent regular, though previously irregular; and Dr. M. suggests, but without having experience on the point, a similar experiment in irregular neuralgia, while he condemns the practice of repeated depletion. Mercury, pushed so as to affect the mouth, will sometimes render agues amenable to tonics, though previously rebellious. The same may be tried in the neuralgiæ, since, in both classes, the glandular viscera are often deranged, and the mercury acts beneficially in correcting such disorders. But as the greater number of cases which present themselves are now chronic, and, consequently inveterate, probably from the wrong treatment employed when they were recent, so the cures will be comparatively few, however judicious the remedies. It is not until the old cases shall have died off, and a generation of the same diseases has arisen under the improved practice, that a fair trial can be given to the latter.

One great cause of neuralgia becoming chronic, is the caprice or impatience of the afflicted. Anxious for a speedy cure, they are led away in succession by name after name, and recommendation after recommendation, the consequence of which is, that no steady system is pursued, and no cure effected. The work, half done by one, is reversed by another, till, at length, the patient is rendered sceptical as to the skill of the practitioner or the potency of medicine.

But the paramount object is to withdraw the patient, if possible, from the operation of the primary causes of the disease. On this account, the locality of his residence should be carefully examined, according to the rules which have been already laid down by the author in his Treatise on Malaria, and of which the reader will find ample analyses in this Journal. Without such removal from the sphere of the causes, no permanent cure need be expected. The dread of moisture should ever be in the patient's mind—he should remove to a dry, but not to a cold situation, since cold itself is an exciting cause. The change of scene and air resulting from travelling alone, would often effect the cure, both in agues and the neuralgiæ.

"What remains as to the general treatment, relates to diet. As in intermittent, whether recent or chronic, I have no hesitation in saying that the usual full diet of persons in health, with a rational use of wine, forms an essential aid to the cure; and that it has often proved a cure in itself, when used as replacing the opposite and pernicious system. But I shall not enlarge on this; as the evils arising from low diet are involved in those belonging to the debilitating practice on which, even after all that I have said, I must offer some additional remarks hereafter." 386.

Dr. M. like

Of the local remedies for Neuralgia we need say but little. Dr. Heberden, found blisters to aggravate the pain, when placed near the nerve affected. What has been called a perpetual blister is still worse, as proving "almost always a positive aggravation, not only of the local disease itself, but of the general irritation and disorder of the system."

"The only local remedy from which I have really seen such advantageous effects as to induce me to recommend it, is the application of steam directed by the usual means of a pipe, to the affected part; while of course, the same reasoning applies, if in a minor degree, to fomentations and hot water. The value of these latter applications, indeed, in rheumatism of the face, in the rheumatic or neuralgic ophthalmia, and in sciatica, has