1888 Journal of the American Medical Association  
My second interview took place December 14. She had kept the side of her face protected with a soft warm pad, lined with silk, but the periods of suffering had increased in frequency and dura¬ tion, and the pains had increased in intensity. I then advised the application of a 4 per cent, solu¬ tion of cocaine along the course of the right lingual nerve. The next day she expressed the opinion that the applications of cocaine had diminished her suffering, in that the periods of painful seizures
more » ... painful seizures had been shortened. I advised its continuance and ordered a mixture containing the salicylate of soda with the oil of gaultheria. This treatment was continued for one week with¬ out satisfactory results. I then advised the con¬ tinuous use of morphia sulphate in y& grain doses, to be repeated at such longer or shorter intervals as might prove necessary to control the pain. The lady very reluctantly consented be¬ cause she had lost faith in drugs, and was averse to the use of morphia. She did not follow the method of treatment very assiduously, but suffici¬ ently so to obtain very marked relief. The months of January and February were passed in comparative comfort. With the returning mild weather of spring, the pain, as during the six previous seasons, entirely ceased. The best that can be said is that she suffered very much less than during the same season of either of the previous six years, but a cure cannot be claimed. Perhaps, a more decided result would have been obtained if the plan of treatment had been more diligently employed. The history of the case points very clearly to season as the predisposing and determining cause. In this particular there is nothing peculiar. But the curious array of accidental and incidental conditions which would produce longer or shorter periods of paroxysmal pain is certainly surprising, if not unique. Then, too, the paroxysms would recur during sleep, when the incidents detailed could not occur, either singly or concurrently. This fact also points to season as the prédominent etiological factor. Peripheral irritation produced by the move¬ ments of the tongue in speech, mastication and deglutition, and certain articles of food was a fre¬ quent and direct exciting agency in bringing on pain. Emotional conditions, such as surprise and the unexpected presence of a person, were equally effective. During sleep these influences were in abeyance and the paroxysms recurred much less frequently, but with equal severity. Sudden falls of temperature and inclement weather, during the autumn and winter seasons, even though the patient remained in-doors during such atmospheric changes, would also induce attacks. The initial attack began under like conditions and circumstances for seven successive years, and followed the same course, the paroxysms gradu-ally and continuously increasing in frequency, duration and intensity during the autumn and winter seasons, and ceasing abruptly with the beginning of spring-weather. The pain was always limited to branches of the right tri-facial, but the point of beginning varied. Far most frequently it began at the base of the tongue and was limited to the right lingual branch. When beginning at other points it was expended along the course of that nerve. mulatto woman, married, ast. about 38 years, was first seen by me on November n, 1887. She gave the following history : She has always suffered more or less at her menstrual pe¬ riods. About six years ago she had a miscarriage, since which time she has not been pregnant. Has suffered for a number of years from haemorrhoids. Of late has had much pain in defecation. During last March she noticed an enlargement of her ab¬ domen, and in May following her physician made a vaginal examination and introduced a sound into the uterus. Since that time she has not men¬ struated. She has been under the care of several physicians, but has continued to grow worse. She has been taking morphia and belladonna in sup¬ positories to relieve her pain. She is now much emaciated and has had a diarrhoea for several days, her temperature is 1020. There is a fluctuating tumor just above the pubis and extending entirely across the abdomen. It is very painful to touch. Vaginal examination shows the uterus enlarged and fixed, but the examination is unsatisfactory, owing to the pain produced in the manipulation. No positive diagnosis was made, but medication was directed to the control of the diarrhoea ; this was partially successful after a few days' treat¬ ment. A large hasmorrhoidal tumor, about an inch in diameter, was now protruding and caused much suffering. To relieve this the tumor was injected with carbolic acid and glycerine with most satisfactory results. The hasmorrhoid disappeared entirely and the patient expressed herself as much more comfortable than she had been for a long time. After this the diarrhoea was pretty well con¬ trolled, and less morphia was necessary to soothe her pain, but there was no change in the abdom¬ inal tumor.
doi:10.1001/jama.1888.02400710015001f fatcat:5qiayimtfneabgjzmfeyjkubdq