In the remittent or intermittent form, recourse must be had to arseniate or hydroferrocyanate of quinine, conjoined with arseniate of iron, if the neuralgia is of a paludal or miasmatic character:

A granule of each every hour, in the interval or at the approach of the paroxysm.

In the chronic form, arseniate of soda and arseniate of antimony must be administered, with arsenious acid as an adjuvant :

A granule of each, six to eight times a-day.

Between the paroxysms, and at the moment of accession, strychnine (sulphate), cyanide of zinc, hyosciamine, and cicutine must be given as anodynes :

A granule of each, together, every half-hour.

Tic-douloureux of the face, due to a rheumatic affection of the fifth and seventh pairs, is distinguished at first by symptoms of pain and spasm, with total absence of paralysis, the opposite part preserving its physiological sensibility and mobility. The flow of tears and saliva takes place from the retracted side, which in paralysis is exactly contrary.

Caustic, in this case, should be applied to the point of emergence of the stylo nerves, that is to say, behind the under part of the concha of the ear.

Neuralgia of the Neck. That ensemble of tetanic symptoms is found here, to which Marshall 'Hall gave the name of trachelism. The muscles of the neck are painfully contracted and stretched like cords, the veins are swollen and dysphagia is complete, with whistling respiration and threat of suffocation. In order to understand these symptoms, it is necessary to describe the whole of the nerves of this region, which belong to the cranial and cervical nerves, such as the hypoglossal, the pneumogastric and its accessory and the ganglia of the great sympathetic, with which these nerves are con

Therefore, this neuralgia presents a character of

nected. extreme gravity.

It must be combated in the same manner as the neuralgias in general, especially by strychnine (sulphate) and hyosciamine, a treatment I found successful in a case under my

own care:

A granule of each, every quarter-of-an-hour, until sedation. Thoracic Neuralgias.-These include sternalgia and costalgia, characterised by lancinating pains, some radiating towards the neck, and others towards the shoulders and inferior members, and accompanied by tumultuous movements of the respiration, with great cardiac anxiety. Hence the term angina pectoris, which has been given to these neuralgias by some authors, although the word angina should apply more properly to the exudative affections. (Vide Diphtherias.)

These neuralgias, being characterised by periods of accession, must be combated by quinine, hyosciamine and strych

nine :

A granule of each, together, every quarter-of-an-hour, until sedation. Digitaline and arseniate of iron must then be administered, in order to completely re-establish the functional equilibrium :— A granule of each, together, three or four times a-day.

It must not be forgotten, that in reality, most of these neuralgias are due to an anæmic or a chloro-anæmic condition. Therefore, cyanide of zinc is also indicated in obstinate

cases:

A granule: 6 to 10 a-day.

Abdominal Neuralgias.-These include: 1. Diaphragmatic or phrenic neuralgias, with jerking respiration, hiccough, pains radiating towards the neck and ascending along the phrenic or diaphragmatic nerve, towards the shoulder and arm, involving the pharynx and causing spasmodic movements of it, on account of the communication with a branch of the hypoglossal. They must be attacked by hyosciamine,

hydroferrocyanate of quinine and strychnine, independently of the causal medication :

A granule of each, every half-hour, during the paroxysm.

2. Epigastralgia extends through to the back and is accompanied by cramp-like pains, with small pulse, leipothymia and cold sweats. It may be distinguished from gastrodynia by the absence of gastric symptoms, such as rejection of a serosity or clear water, and acid risings. The treatment differs, also, since epigastralgia is calmed by hyosciamine, morphine and strychnine; and gastrodynia by the subnitrate of bismuth.

3. Cælialgia, takes its origin in the coeliac plexus, and irradiates along the secondary plexuses-gastric, splenic, hepatic, mesenteric, renal, spermatic, and ovarian, so that it is possible to have as many distinct neuralgias as there are plexuses.

Caliac Neuralgia is deep-seated, approaching more to the back than to the epigastrium, which distinguishes it from the the neuralgias of the latter region. It induces spasmodic vomitings of the stomach, which, however, cause no sedation of the neuralgia.

Splenalgia occupies either the concave or the convex surface of the spleen. In the former case, it irradiates towards the left shoulder, and in the latter, towards the stomach, with stitch in the side and vomitings.

Hepatodynia follows the direction of the anterior and posterior hepatic plexuses; that is to say, it irradiates either towards the right shoulder or towards the stomach. It is often the cause of spasmodic icterus, on account of the contraction of the biliary passages. It also be due to the presence of

biliary calculi.

may

4. Mesenteric Neuralgia (miserere), thus named on account of the distress which it causes the patient, and because it is likely to lead to internal strangulation or knotting of the intestine.

5. Spermato-renal Neuralgia causes a retraction of the testicle.

6. Ovario-uterine Neuralgia, which is observed on the approach of the menses and in dysmenorrhoea. The pains are very acute and affect the inner side of the thighs, as in the spermato-renal neuralgia in man, the corresponding organ— the ovary-being in the belly. It must be opposed by the sedatives, such as hyosciamine and strychnine :—

A granule of each, every half-hour, until cessation of the crisis. Until now, the only remedies used to alleviate ovario-uterine colics have been the ethers, the gum-resins (assafoetida), and the products of the genital secretions (castoreum). But why excite when it is necessary to calm? Is not such treatment like those mirages in the desert, which only serve to provoke thirst? To excite, therefore, the generative organs by the administration of matrimonium in pills, is but to add other. evils to those we desire to cure.

Bromated camphor may, indeed, be administered if the generative passion should show a tendency to overstep its natural bounds (nymphomania). The fire must, therefore, be mitigated without extinguishing it. This can be done by the dosimetric medicaments, such as hyosciamine, ergotine and strychnine (sulphate), which are, when administered together, inciting and regulating agents.

Cysto-prostatic Neuralgia.-Spasm of the bladder and of the prostatic portion of the urethral canal is accompanied by dysuria, sometimes with complete retention of urine, which causes many specialists to have recourse to mechanical means. (sounds, bougies), which only still further complicate the condition. Before resorting to such measures, always dangerous. in these circumstances, recourse must be had to baths, leeches and sedatives, especially to cicutine and hyosciamine, in order to relax the neck of the bladder, and also to strychnine (sulphate) to aid the contractions of the body of that organ :—

A granule of each, together, every half-hour, until sedation of the symptoms.

DOSIMETRIC TREATMENT of INFLAMMATION.

It is necessary thoroughly to understand the morbid process termed inflammation, in order that it may be combated.

As this word indicates, there is an exaggerated combustion, and consequently, the production of products, some organic, such as diphtheritic and other pseudo-membranes, pus, etc.; others chemical, as ammonia, urea, the chlorides, etc.

These are those products of exudation or secretion which give rise to those anatomo-pathologic lesions, consequent upon all inflammation which has not been jugulated at the commencement.

The necessity of jugulation exists, therefore, in inflammations as well as in the pyrexias. We have already had an example in the diphtherias, which form the transition between those two orders of diseases; the one local, the other general. Inflammation takes place under the influence of irritation. All the vitality seems to concentrate itself in the organ which is the seat of that morbid superexcitation, and to withdraw itself from the periphery; hence, the chilliness or the shivering which declares itself at the commencement of every inflammation. The skin is pale, the pulse small, and there is a general prostration, which renders the patient incapable of all movement, and compels him to keep his bed.

In the initial period of the disease, the nervines and sudorifics should be prescribed, in order to bring back the heat and the blood to the periphery, and relieve the point or internal organ where the congestion is set up :—

Phosphoric acid, sulphate of strychnine, digitaline; a granule of each, together, every half-hour, with a warm beverage (elder, borage, etc.), in which a teaspoonful of Seidlitz salt has been dissolved.

The above medication will produce an alvine evacuation, followed by some serous stools, and afterwards an abundant diaphoresis. In reference to this, I must make some remarks.