Imagens das páginas

served as a striking exemplification of this fact, that as the sun proceeds northward in the ecliptic, carrying heat and moisture in his train, the period generally termed the unhealthy season, is later in the northern colonies than in those to the south."


The reporters very properly disclaim the idea of miasmata being wafted by the winds from the vast forests and savanhas of South America by the S. W. winds. The reporters attempt to upset the hypothesis, as they term it, of the extrication of malaria from the soil, by very unsatisfactory arguments. Thus, because the physical characters of two localities are apparently the same, and yet they are not equally healthy, miasmata can have nothing to do with the production of fevers!!! With such reasoning it is useless

to reason.

So again, that marshes, swamps, and lagoons cannot harbour or emit febrile miasmata, is, they think, proved by the fact that, in very marshy places, as Guiana, Honduras, &c. fevers are not so frequent as in some places in Jamaica, where marshes are little observed. The medical world are well aware that malaria may issue from localities where no marshes exist, as in Rome, for example; but the almost universal fact that swamps and marshes are unhealthy in hot countries, is a sufficient proof (however numerous the exceptions of the other kind) of the connexion of febrific miasmata with fevers and morasses. We know little or nothing of the nature of miasmata that issue from the Pontine marshes, or the vicinity of Rome, no more than of those which emanate from certain localities in the West Indies and other countries; but there are hardly any facts in medical history so well established as the emanations of malaria from the soil of those countries. It is vain to say that the marshes always exist, whereas the fevers are much more violent one year than another; and that in some years they hardly occur at all. We may deny the existence of variolous contagion in the air, because in some years it is ten times more destructive than in others. The reporters would seem to have a great inclination to doubt the security which elevation is supposed to confer on people in hot climates, but the facts which they have already stated, render scepticism on that point impossible.

"The instances of Fort St. George at Tobago, Morne Fortuné at St. Lucia, and Morne Bruce at Dominica, demonstrate that mere elevation to the height of 600 or 700 feet, instead of securing a healthy position, seems rather to have the reverse tendency." 103.

The topographical researches of medical men, in all quarters of the globe, have long proved that miasmata will rise to a certain elevation, and be carried by currents of air to a certain distance; but the exemption from malaria at a height of some thousands of feet, shews that there is a limit to the range. At a considerable elevation (3000 feet or so) grounds capable of emitting malaria may exist, but the low temperature of the mountainous heights checks the extrication effectually.

The reporters, after having, as they supposed, demolished the theories of preceding writers, seem a little inclined to start an hypothesis of their own; but they are too diffident on this point, and merely throw out a hint for others to improve upon.

We are too sensible of the difficulty of the subject to venture on any theory of our own, which might on subsequent examination prove as futile as those

which preceded it; but we merely wish to call the attention of such persons as may be disposed for further inquiry, to the circumstance that as yet no experiments have been made on the electrical condition of the atmosphere in the West Indies, during periods of epidemic; and as it is possible either an excess or deficiency of that powerful though unseen agent, may exercise an important influence on the vital functions, the subject seems worthy of attention. Heat and moisture are well known to be intimately connected with the development of electrical phenomena, and its influence on vegetation has also recently been established by experiment; consequently, if the prevalence of disease could be satisfactorily traced to that source, the reason why heat, moisture, and vegetation should have been mistaken as the causes, when acting only as auxiliaries, would be readily accounted for; and even should the results leave the cause of disease as undetermined as before, science will at least be benefitted by the inquiry." 103.

Passing over the electrical hypothesis (which is not new) we beg to say that, while we differ widely from the reporters in respect to their conclusions -" in which nothing is concluded "-we tender them our unfeigned thanks for the valuable mass of facts which they have accumulated in this volume. These facts will stand when the deductions drawn from them are forgottenand will furnish data for future speculators, when the present race is no more. We hope the editors will be spared their health for the arduous labours in which they are engaged, and we shall hail with pleasure the advent of another report from the same bands.

P. S. Could they not give us some pathological and therapeutical details, as well as statistical?

A TREATISE ON NEURALGIA. By Richard Rowland, M.D. Physician to the City Dispensary. 8vo. pp. 174. Highley, Sept. 1838.

NEURALGIA is a rapidly increasing malady; and consequently we may expect successive publications on the subject. The torture occasioned by the disease-its uncertain and treacherous attacks-the almost impenetrable obscurity in which it is shrouded-and lastly the difficulty of cure, must always render neuralgia an interesting subject of inquiry, both amongst physicians and the sufferers themselves. There is no doubt, too, but that young practitioners every day confound neuralgia with phlogosis, by which much mischief is occasioned. There is no internal organ or structure of the body exempt from attacks of neuralgia, and it may be very easily believed that when such parts as the heart, the pleura, the peritoneum, &c. are invaded, the inexperienced, and still more the incautious and routine practitioner, may be readily thrown off his guard, and unsbeath his lancet against the formidable enemy in the shape of carditis, pleuritis, peritonitis, &c. Even when neuralgia exhibits the chief characteristics of inflammation, rubor, tumor, dolor, calor, as is sometimes seen, the inflammation is of a peculiar kind that ill bears depletion of the vascular system. Who bas not seen, in "brow ague," as it is called, the conjunctiva, the palpebræ, and, in short, all the visible structures of the eye and its connexions, become

scarlet, hot, swelled, and painful, thus fulfilling the four essential requisites of phlogosis-yet all these phenomena will disperse in a few hours, without leeches, lotions, or purgatives.

Phlogosis is not nearly so often mistaken for neuralgia, as the latter for the former. It is so far fortunate; for to treat inflammation as a neurosis would be fatal.

Dr. Rowland's work is a regular systematic treatise, compiled from all accessible authorities, and containing scarcely anything original, except a few cases at the end. It would therefore make a capital article (somewhat condensed) for an enlarged cyclopædia of medicine. We shall not attempt an analysis. We might as well try to analyze a pocket dictionary. Dr. R.'s book is a very useful one, as collecting into a focus the rays of light—or at least of supposed light-scattered through multitudinous journals, memoirs, and monographs. It might not be either useless or uninteresting to present our readers with a kind of synopsis of the various causes that have been assigned for neuralgia-the conjectures as to its seat and nature-and the remedies that have been proposed for its cure or mitigation.


1. Exposure to wet and cold is one of the most common exciting causes. 2. Cutaneous irritation, as contusions, eruptions, cicatrices, &c. Herpes zoster is accompanied by so much pain as to resemble neuralgia. 3. Tension of nerves. The stretching of limbs, the suspension of heavy weights, violent twistings and contortions of the trunk or members have excited neuralgia. 4. Pressure on nerves, as from a foreign body, enlarged organ, dilated vessel, tumour, &c. The subcutaneous tubercle is attended by an almost neuralgic pain. 5. Carious teeth. This is a very common cause of facial neuralgia. 6. Disorder of the alimentary canal. Great diversity of opinion prevails on this point-very many attributing neuralgia to chylopoietic derangement where no other cause is evident, while some distinguished practitioners deny the reality of this cause altogether. Among the latter, for example, are Montfalcon and Dr. Elliotson. Most of the observant and unprejudiced practitioners will be inclined to believe that irritation of the gastro-intestinal nerves is very frequently the cause of painful states of other nerves. The late Dr. Wollaston was stricken with neuralgia by eating an ice-cream. He became sick, threw up the ice-cream, and the pain disappeared. Sir B. Brodie relates that and some other similar cases. 7. Diseases of the urinary organs. Sir B. Brodie and others have related cases where severe neuralgia was produced by this class of causes. 8. Disorders of the heart and large vessels. We have some doubts of this source of neuralgia, except where enlargements act mechanically on the adjacent nerves. 9. Uterine disorders. This source has been well attested by numerous and competent witnesses. This may account for the greater frequency of neuralgia in women than in men-and also for the circumstance that it occurs not unfrequently about the approach of the catamenia. "That peculiar form of neuralgia which simulates visceral inflammation, very commonly originates in uterine disorder." 10. Spinal irritation. This source of the complaint in question, was pointed out so long ago as 1785, by

Pouteau, and more recently by Bradley, Brown (Glasgow), Darwall (Birming ham), Teale (Leeds), and others. In these cases, pain is seldom complained of in the back itself, except when examined by pressure or hot sponge. Then the patient shrinks when a particular spot is touched. There is a very general relation between the seat of the neuralgic pain and the portion of spinal column where the tenderness is felt, readily enough traced by the anatomist. It is to be remembered, however, that spinal irritation may itself be caused by disorder in other parts, as in the line of the digestive organs, and then the two affections act and re-act on each other. 11. Organic disease of the brain and spinal marrow. This is not confined solely to the cerebral nerves, but extends to nerves of spinal origin-or even of the ganglionic class, as those of the stomach, liver, or other internal organs, whilst the cerebral symptoms are absent or very slight. Thus Andral relates a case where ramollissement was going on in the brain, but the only symptom was pain in the lower extremities. A patient in Bartholomew's Hospital had such violent pain in the knee that the limb was amputated, but nothing found to account for the pain. Some years afterwards the patient died, and then plates of cartilaginous and bony deposits were found in the posterior surface of the spinal cord. 12. Malignant Diseases. The dreadful lancinating pains attending malignant diseases seem to be neuralgic. 13. Chronic inflammation. The pains in these cases, are generally periodical, and very different from those of ordinary chronic phlogosis. 14. Malaria. Van Swieten observed the striking analogy between ague and periodical neuralgia; but it was Macculloch, as our readers know, who traced, with a masterly hand, neuralgia to malaria. Scarcely a day passes that we do not observe neuralgia clearly traceable to this cause, especially among those who are mad enough to spend the Summer in Italy and other malarious countries.

II. SEAT OF Neuralgia.

Hardly any one will doubt that the seat of this disease is in the nerves. It was long doubted, and even denied, that the ganglionic nerves could be the seat of pain, as vivisections had shewn that they might be pricked or cut without sensation. Most physiologists-especially those who are in active practice-now admit that the sensibility of the ganglionic nerves may be raised by disease to that degree possessed by the cerebro-spinal nerves. Brachet has set this matter in a clear point of view.

"He found that the sympathetic ganglia and the filaments which proceed from them, might be repeatedly pricked, without any sign of suffering being shewn by the animal, but when the irritation was continued until the ganglia became red and inflamed, that acute pain was then produced by every puncture; that when a ganglion had been thus irritated, and rendered sensible, its sensibility was again destroyed by the section of the nerve which connected it with the spinal marrow; but if the irritation were renewed after the lapse of a few minutes, the ganglion was found to have regained its sensibility, of which, however, it was finally and completely deprived by making a section of the nerves of communication passing between it and the ganglia situated immediately above and below it; that when a ganglion had been excited to sensibility, subsequently to the section of its spinal branch, it was permanently deprived of this property, by dividing the nervous twigs passing from the spine to the two ganglia, situated immediately above and below that, where the irritation was applied." 49. F

No. LIX.


We know very little of this part of the subject. Neuralgia has been defined a "" preternatural elevation of function in one or more of the sentient nerves, without corresponding excitement of the vascular, or of the great mass of the nervous system." This is, perhaps, as good a definition as can be formed. Its connexion with rheumatism is very close; but we cannot maintain that the two are identical. Many of the continental pathologists consider neuralgia as, in fact, neuritis of a chronic kind; but this doctrine is untenable. Inflammation, however chronic, soon induces alteration of structure; but it is well known that neuralgia may exist for years without effecting any perceptible change of structure in the nerve. It is useless to pursue this part of the subject farther.


There are few active remedies in the Pharmacopoeia that have not been either proposed or tried for this terrible malady—a pretty clear proof of the intractable nature of the disease! Many remedies have acquired unmerited renown for a time, chiefly owing to the intermissions which naturally, and often capriciously occur in neuralgia-the post hoc ergo propter hoc argument being a very favourite one with most of our specific-mongers. Dr. R. justly observes that, "it is by a careful and patient investigation of the causes and habitudes of this dreadful malady, rather than by the introduction of a new remedy, that any improvement in the manner of treating it is to be hoped for." This observation applies indeed to every disease with which we have to contend. With the view of facilitating this investigation, Dr. R. divides neuralgia into four classes, according to the exciting causes.

"I.-Cases where the symptoms continue after the original cause has ceased to exist.

II.-Cases arising from functional disorders.

III.-Cases occasioned by causes of an irremediable nature.

IV. Cases where the cause cannot be ascertained.

I. Under the first class, are included those cases of Neuralgia, which can be traced to causes that have already disappeared; as when the pains continue after the subsidence of a cutaneous eruption, the removal of a tumour, the extraction of a tooth, &c. These cases generally yield rapidly to remedies which act powerfully on the nervous system; to be presently enumerated.

II. In the cases comprehended under this section, the first indication is to remove the cause upon which the disease obviously depends; until this preliminary treatment has been accomplished, the remedies, which in the first class of cases, often afford relief, will generally be of no avail, and may increase the severity of the symptoms. But when the original disorder has been removed, the pains frequently disappear without further treatment; or at least, may now be removed by those remedies which had previously failed to make any impression on them.

III. In this class are placed those unfortunate cases, depending upon causes of an irremediable character; but even in these, the nervous pains may be aggravated or calmed, according to the state of the disease with which they are connected.

The same remark is applicable to Neuralgia accompanying malignant diseases;

« AnteriorContinuar »