Page images
PDF
EPUB

not known an intermission of a month in several years. During the past few months attacks have occurred pretty regularly on alternate days. Her physician resorts to hypodermic injections of morphine, often repeating the injection several times. during the same night.

The eyes were examined August 25, 1882, and she was found to have myopia, right 1:50 D, left 1.25 D, with insufficient power of adduction. Glasses for the correction of the myopia were adopted, and the eyes exercised daily until the adducting power was fully established.

Her last attack of neuralgia occurred three weeks after the first effort was made to correct the ocular defects, and during the intervening time of more than a year, she has enjoyed complete immunity from pain and perfect health in all respects.

Insufficiency of the external recti muscles, causing a constant demand for exertion to maintain parallel visual lines when looking at a distance, or perplexity in preventing too strong convergence when the eyes are accommodated for near points, is a third and very frequent cause of neuralgia.

Miss G. M., aged twenty-three, has been during two years a sufferer from facial neuralgia. The focus of pain at the beginning of the attack is at the side of the nose. From this point the pain extends to the face and temple of the same side. She has also severe dorsal neuralgia, and much pain at the lower angles of the scapulæ. During the past six months has suffered from inability to

use the left arm. From the shoulder downward there is marked loss of power, demanding a very pronounced effort to move it. The leg of the same side suffers similarly, and she walks with a very noticeably halting gait. She is also quite dyspeptic.

She has compound myopic astigmatism, and says that she has double vision when fatigued. There is insufficiency of the external recti muscles of 4° at twenty feet.

The myopic astigmatism was corrected by glasses March 30, 1882. The neuralgic attacks were modified but not cured, and on the 4th of June, 1882, tenotomy of the internal rectus of the left eye was made. The neuralgic symptoms disappeared at once, the limbs regained their usual elasticity, and the dyspepsia gave her no further trouble.

October 4, 1883, after more than a year had elapsed, she called, saying that she had been entirely well since the tenotomy, but that within a few days there had been slight returns of pain, but of only sufficient consequence to cause her to inquire into the condition of the eyes.

All modern writers on neuralgia agree in regarding it as an hereditary neurosis. The part played by the hereditary tendency has been very carefully observed in respect to its various manifestations, as exhibited in different individuals of families in which the complaint has been found.

These observations have resulted in showing that in families in which neuralgia exists there is fre

quently not only a tendency in the blood relations of the patient to neuralgic affections, but to a large class of affections, including chorea, insanity, epilepsy, and phthisis.

The nature of the tendency has remained a mystery, the question of direct transmission of a special form of disease being encountered by the fact that it frequently appears as a sequence of some other form of neurosis.

There are many other reasons for believing that neither neuralgia, epilepsy, nor the other neuroses are directly transmitted as diseases, and it is believed. that the evidence about to be brought will remove all doubt upon this subject.

After comparisons of the family history and physical conditions in many hundreds of instances of neuroses, the author ventures the following propositions:

1. Hereditary neuroses, such as epilepsy, migraine, neuralgia, chorea, and insanity, and the same principle may be stated to hold in respect to phthisis, are not transmitted from parent to child directly.

2. Such neuroses are the manifestations of transmitted physical peculiarities which render difficult the performance of certain important functions.

3. That of the hereditary physical defects which thus tend to develop neuroses, anomalous conditions of the eyes are among the most frequent and important.

Taking in my hand at a venture a book of records of cases, I find that it commences January 1, 1878.

Selecting, now, in the order in which they occur, ten consecutive cases of neuralgia in which the family history has been written, we find striking evidence in support of these propositions. It should be said in passing that in the pressure of work the family histories of many cases of these neurotics have not been written, hence these cases are not literally consecutive cases of neuralgia, but consecutive cases of that disease, in which the family history has been recorded: Table showing the neuralgic and ocular conditions in ten successive cases of important neuralgic affections, with the physical condition or immediate cause of death among immediate relations, with the result of treatment directed to refractive and muscular conditions of the eyes.

[blocks in formation]

Table showing neuralgic and ocular conditions (continued).

[merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][ocr errors][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small][merged small]

1. In all, the hereditary tendency is clearly shown. 2. All have marked refractive and muscular anomalies, which are physical features, distinctly hereditary.

3. The uniform relief from the irritation caused by these physical peculiarities proves that the hereditary tendency to nervous troubles and the hereditary physical peculiarities were in these cases one and the

same.

It is distinctly stated that the ten consecutive cases above quoted do not materially differ in their signifi

« PreviousContinue »