mixture before meals, the carbonate of soda after; 6 grs. of blue pill, and 2 of ext. of hyoscyamus every other night, 10 grs. of Dover's powder every night, a scruple of the sulphur, a borax powder twice a-day, and warm baths as often as they could be taken. July 18th.-Decided improvement followed the sound sleep which came when the treatment had been followed for a few days; the paroxysms of neuralgia were no longer periodical, and she had only had two since the 10th. I continued the same treatment, but also ordered 2 belladonna plasters, one to the epigastrium, the other to the painful part of the spine, which were to be renewed every week. Aug. 15th.—The patient being very bilious, I ordered 3 grs. of cal. every other night, and a black draught in the morning; the mixture, the soda, and the Dover's powders were continued. She was salivated by 2 of the pills. Sept. 19th.The paroxysms of pain returned again every night; so I ordered the sixth of a grain of acetate of morphine to be taken in a mixture, every two hours, until sleep was induced. This procured 14 hours of sound sleep, and the attacks only occurred at long intervals. When I last saw the patient, I advised her to take the c. camph. mixt. and the Dover's powder occasionally, and every night to take a drachm of sulphur and magnesia, inducing narcotism with acetate of morphine, whenever an attack of intercostal neuralgia threatened. Her nervous system was too sensitive to admit of permanent health, particularly as the acuteness of its susceptibilities were constantly sharpened by her anxiety for a very nervous husband. The irregular performance of the m. function also fretted the nervous system. One point to be remarked in this case is, that the frequent flushes were dry and burning, being unrelieved by perspiration. Gentle perspirations coincided with the improvement in the symptoms, and their persistence afforded the greatest chance of immunity from worse symptoms. This patient had been fearfully nervous all 196 NEURALGIA OF THE EYES, DEAFNESS, her life, without ever having presented any of the forms of hysteria, so varied are the states of nervous suffering, for many of which there is no name. In four other cases, cessation was followed by intercostal neuralgia; in one, a lady sent to me by Mr. Trotter, of Stockton, remarkable for her portly and healthy appearance, looking as if she could not be nervous, was never hysterical until cessation took place; after which she became habitually irritable, nervous, fearful, with frequent globus hystericus, and intense mammary and intercostal neuralgia. NEURALGIC AFFECTIONS OF THE EYES.-In two women, at the c. of life, I have noticed the head symptoms to be accompanied by marked photophobia, and many patients complained of an unusual dimness of sight, which wore off on the abeyance of pseudo-narcotism, and other head symptoms. H. D., aged 50, and chlorotic-looking, has been irregular for the last 6 months, and suffers much from intense debility, even after a full meal. She can scarcely keep herself awake during the day, and at night is kept awake by a dull, heavy pain in the eyes, lasting more than two hours, the probable cause of which being that she has lately worked too hard at embroidery. B. de Boismont gives the case of a woman who, at 45, was blind for 3 days; Boyer rightly judged that it depended on the c. of life, and on recovering her sight, she remained subject to giddiness. Dusourd met with 3 women who were blind for 2 or 3 days at the c. of life, and he has several times observed them affected with hemeralopia; and Romberg erroneously considers women predisposed to amaurosis at the c. of life. DEAFNESS.-When deafness occurs at the c. of life it should not be considered senile, for it may depend upon inflammatory affections of the external canal, or upon the eczematous thickening of the tympanum, as in a lady recommended by me to Mr. Harvey, of Soho-square, who rapidly and effectually cured her of an infirmity which had lasted more than a year Deafness at this epoch is, in general, purely nervous, attending on pseudo-narcotism; the patients being, as it were, stunned, do not hear until they are fully roused from their state of torpor. I have seen this deafness appear and disappear suddenly; in one case it came on suddenly at cessation, when flooding abated about 6 years ago, but the deafness continued ever since; and I have known women driven to desperation by continued noises in the ear, which sometimes baffle all treatment. M. S., a dispensary patient, aged 52, never had a day's illness until 45, when she saw a man executed. Flooding then came on, the m. flow never reappeared, but loud and continued noises were constantly heard, which Mr. Harvey did not attribute to a diseased condition of the internal ear. They resisted cupping, blisters to the nape of the neck, and other treatment. In a very nervous lady, sent to me by Mr. Harvey, erysipelas of the face occurred at the c. of life, and left an excruciating pain, sometimes accompanied by a most annoying "forcing sensation" behind the ears. This had lasted for three years, but it yielded to my general treatment, and to the local measures necessary to cure uterine irritation. NERVOUS APHONIA.—This is a rare affection, but I have had a good opportunity for studying a case occurring in my own connexion. CASE 31.-Frequently-recurring aphonia.-A lady, at the c. of life, after losing her husband, came to town, and settled in Belgravia. Though she had not hitherto been subject to nervous affections, cold, over exertion, worry, or sometimes no apparent cause, would suddenly deprive her of her voice for a few days. The nervous nature of the ailment was shown by the sudden coming and leaving of the aphonia, and by the effect of change of air; for a drive in the Regent's-park or to Hampstead would often restore her voice to its natural tone. She therefore left town to reside in the country, and has since enjoyed a comparative immunity from 198 RHEUMATISM AT THE C. OF LIFE. this complaint. Sometimes a potion, containing ether, speedily dispelled the aphonia. Dr. Delieux has found chloroform useful, giving from 10 to 15 drops in a little water, so chloric-ether would probably give great relief. In two cases, I found sudorifics useful, the permanent return of the voice coinciding with a marked determination to the skin. Cerise speaks in favour of emetics for nervous aphonia, and I have witnessed their sudden good effects. RHEUMATIC PAINS.-This affection, improperly called muscular rheumatism, is a neuralgia of the nervous filaments of the skin. In many, cold may induce, and heat as speedily cure it; but at the c. of life, the damp state in which the underclothing is kept by continued perspirations explains the frequency of this occurrence. TREATMENT.-Heat under any form is good. Ironing with a hot iron, or the more scientific applications spoken of at p. 112, will cure the patient. Vapour baths are serviceable. Sponging, with alternately hot and cold water, or shower baths of the same, will harden the surface against rheumatic influences. The thermal waters of Aix en Savoie, used in a similar way, are very effectual. In advanced age, these rheumatic cutaneous pains are often exceedingly troublesome, but women are then generally free from the eccentric nervous pains and temporary paralysis which have afflicted them in youth, and have been described, by Sir B. Brodie, as hysterical. CHAPTER X. DISEASES OF THE GANGLIONIC NERVOUS SYSTEM. TABLE XXVII. Liability to Diseases of the Ganglionic Nervous System in 500 Women at the c. of Life. Epigastric faintness and sinking Fainting off for the first time in life Prolonged and intense debility. Chloro-spanæmia. Aortic pulsation Monthly hysterical asthma Thus 406 women out of 500 suffered more or less from diseases of the ganglionic system. The liability to these affections decreases in advanced life; epigastric pain is then seldom intense, but there frequently remains a liability to fainting, and to the sinking sensation at the pit of the stomach. On the whole there is a great increase of constitutional stamina until advanced age, when progressive debility and gradual decay occur from the exhaustion of innate power. The ganglionic nervous system, in a pathological point of view, is generally looked upon as a terra incog |