By. Dr. P. Jousset, Paris.
In facial neuralgias there are two different forms, namely, the ordinary form, and the extremely painful form, which is connected with twitches and is also called “tic douloureux” or “Forhergill’s face ache.”
The ordinary form of facial neuralgia calls for Nux vomica as the chief remedy. The action of this remedy is pretty sure, where the following symptoms are observed: Pains which follow the course of the upper branch of the trigeminus, and thus have their chief seat in the socket of the eyes and in the frontal region and which return in attacks beginning in the morning, increasing during the day in violence, disappearing in the evening; the pain is almost unendurable. Nux vomica in the 12. Or even the 30. Potency alleviates these attacks more surely than the sulphate of Quinine, that is commonly used. I prescribe six pellets dissolved in 125 grams of water, of which solution one spoonful is taken a full half hour before dinner and another before going to bed. In the journal “L’Art Medical” I published a cure of an old man who had a gouty diathesis and was seventy years of age, with whom these attacks had been returning for more than a year, and who had been treated ineffectually with Quinine and had also spent some time in the mountains.
Aconite is indicated where the pain appears in the frontal branch of the trigeminus and shows one or more points which are painful on pressure, and also radiates into the temples and the vertex. A peculiar indication for Aconitum is the formication which always accompanies the pain and which is alleviated by violent rubbing. if the 6. or the 12. Dilution should not suffice we would recommend a trial of the mother tincture (this is of course only permitted to the physician).
Spigelia is used more rarely than the first mentioned remedies. It should be considered when there is a pain in the eye-ball, as if it were being torn out or pressed into the eye-socket. Belladonna, Chamomilla and Gelsemium may also be used in the ordinary form of facial pain.
Fothergill’s pain of the face, or the tic douloureux, is a dreadful ailment which offers an obstinate resistance to almost every kind of treatment, and in many cases it is incurable, and the excessive pains drive the patient almsot to despair, and at times even to suicide. The pains come on suddenly and last for several seconds or even a minute, and then disappear again at once and totally. Trousseau and Gilles de la Tourette treated these nerve-pains with immense doses of Opium; but the one as well as the other confesses that he never made a cure by such a dose. Cutting out the nerve which causes the pain, as a rule, only causes a translent relief of the pains and of the ailment. I myself am able to recommend a less hopeless treatment, which I will illustrate by the following case:
Mrs. X., sixty-eight years of age, spare of build and feeble, was sent to the Hospital of St. Jacques on the 1st of March to complete the cure of her pneumonia. The patient had for some time been suffering from attacks of tic douloureux, which ailment had so far resisted every kind of treatment. The attacks of pain came on when moving the jaws for the purpose of eating or of speaking. It was a penetrating pain, which darted like lightning through the left middle branch of the trigeminus (thus through the region of the cheek and the upper jaw); the patient would at once lay the hand on the painful spot in order to press upon it and would remain immovable in this position. During the attack the muscles of the side affected were in a cramp like motion.
The pains would last but a very brief time, but would return every day from ten to fifteen times.
On the 27th of March i prescribed for the patient Thuja6, which remedy was given for four days. The consequence was a very considerable alleviation in the attacks. Coccus cacti 6., given for two days, remained without effect. On April 2, Thuja 3. Was given, after which the attacks disappeared within four days. Two days later a relapse set in. After some doses of Coccus cacti 3. In the trituration, the attacks returned only two or three times a day, and in a much slighter degree. On the 12th of April the patient received again Thuja 3. On taking which, after four days, the attacks disappeared and did not return again. Nevertheless, the remedy was continued till April 26. The patient seemed to be cured, but on May 30 a slight relapse appeared, which, however, disappeared quickly after renewing the Thuja.
We need not expect that we may cure all these cases with Thuja or with any one remedy. Only too often the ailment will resist every remedy, even the excission of the nerve. Still the example adduced is an encouragement and a proof that in treating this ailment we should never despair and not lightly pass on it the judgment of incurability.
Dr. Tessier, sen. Has cured several cases of tic douloureux with Thuja and Coccus cacti in alternation, and I myself can recount a number of such cures with the sames remedies Dr. Escalier has published in the “L’ Art Medical” cases of tic douloureux which had resisted the excission of the nerve, but were cured with Thuja.
Pains in Thuja are very lanciuating, following the course of the nerve, and often accompanied with reflectory contractions of the muscular fibers. These phenomena appear especially in the face, cramp-like pains, violent contractions and sharp stitches in the upper jaw, in the cheekbone, in the teeth, a sensation of interior cold, a sudden redness in the face, with attacks of pain and convulsive motions of the upper lip. The pains let up in the open air, from walking, and more rarely from touching.
Coccus cacti has less application in the treatment of Tic douloureux than Thuja. It is indicated when the pain starts from the incisors or the eye-teeth. The pains are pressive with lancinations, are worse in the evening, in the warmth of the bed, and are accompanied with a rush of blood to the head and with salivation.
Thuja and Coccus cacti are not, however, the only remedies which have been successfully used in Tic douloureux. Mezercum (3.-6.) has also done good services, when the pains appear with great severity in the cheek-bone on one side, and when they spread like lighting to the temples, the ear, the teeth and the gums and are aggravated by chewing, talking and by the slightest touch. The following case shows a brilliant result from Mezercum:
Mrs. X., fifty-six years of age, else. In good health, has been suffering for several years from Tic douloureux. The pains were situated in the right middle branch of the trigeminus, and radiated to the temple. The quick darting pain, which only appeared in attacks, was called forth by the motion of the jaw for eating and especially for speaking. On entering the hospital, the patient was seized with such an attack even without any motion of the jaw; she would alleviate the pains by constant pressure, which she exerted almost unconsciously with her hand on the part affected. She came to the hospital on November 5. She first received some doses of Methylin, after which the attacks appeared at somewhat longer intervals; but beginning with November 12 she received Mezercum 6. In the dilution every day ten drops. This remedy had been selected on account of aggravation from eating, was continued till November 23, and caused a noticeable improvement in the condition of the patient. On November 24th I prescribed ten drops a day of the 3. Attenuation this was given up to December 9, and caused a further improvement. From the 17th of December on, the patient improved so much that she could leave the hospital as cured on the 31st of December.
Phosphorus (6. and 12.) influences chiefly those pains which are aggravated by eating and by speaking. I have had such patients, who would rather starve than eat and who were improved by taking Phosphorus. Also Atropinum sulphuricum in low triturations and Strychninum sulphuricum which so frequently act favorably on the pains from atrophy of the spinal marrow, may also be used, as well as cupreum and Zincum.
Electrotherpeutists claim to have had some success with the constant currents.