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To the Medicat Society in London. Gentiemen, HEN I related to 3 ou, at one of OUrlate assemblies, the purpori of the sol lowing narrative, severat instances os a similarassection were theni recollected ; cases, whicli, though nearly akin in appea rance to the toothach, and that hi nil of di sorder of the jaw Whichis sonaetimes called the rheumati sim, sonaetiinesthe ague in the head, and which had not givenWay IO those remedies and applications that insuch complaints are most common ly successis ut incuring them ; you thera thought that a more particular account of this clis ea se, and the method of removing it, mugiit not be uia acceptableto the public : sor though it does not cvery day Occur, yet to be abIe to distinguisti and to cure,
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with me degree of certainty, a diseasse, that, dum Og the time it talis, is extremely excruciat- in g, is an addition, however sinali, to the utili tyos our prosesilon. In the third volume of the Medicat Observation S, among the remariis ora the essicacy of hemiock in relieving s me anomaloias Pallas, there is one Case mentioned os a person cured
is a disease that has occurret to me severat times; it seems to be of a singular natUre, and,so sar as Ι know, altogether Undescribed. This affection seems to be peculiar to persons advancing in years, and lo Women more than tomen. I never met With it in any one much Under forty, but after this period, no age is exempti rom it. The case does not occur very frequently. Ican recollect but about fourteen instances in theco arse of my bustines S. This last year I Was consulted sor tWO Women, o ne near eighty, the Other about fisty years of
age, both os them in other respects healthy. Frona impercepti ble' beginnings, a Palla attacks sonae pari or other of the face, or the si de of the head: metimes about the orbit of theeye, sonaetimes the ossa malaram, somelimes the temporal bones, are the paris complained of The patia comes suddenly, and is excruciating; it lasis but a mort time, perhaps a quarter Or
' See p. 56, & seqq. of this volume ..
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half a minute, and then goes off; it retUrns at irregular intervais, semetimes in half an hour,
The hind of pain is described differently by
disserent persons, as may be reas nably expected ;but one sees enough to excite one's compassion, is present during the paroXysm. It returns fuli as osten in the day as in thenight. Eating will bring it on some persons. Talking, or the least motion os the muscies of the face, assedis others ; the gentiest toti ch of ah and or a liandi erchies will somelimes bring onthe pain, Whilst a strong pressure on the part hasno effect.
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this rheumatic disposition is conjoined, thoughthe patias are never inti rely oss, yet the night is the time of their greatest severi ty. Besides, thesea n of the tooth ach and this species of rheu mali sim is generalty frona the end of adolescencuto the meridian os lisse, or later.
and through the later stages of lise. Contraryto what happens in the preceding Complainis, the affection I am treating of is mosi commonlyseverer in the day than in the night; sometimes, indeed, it is excited to an extreme degree of Violence by the lightes: touch of the bed Clothes, whicli can scarcely be avoided in turning, orany Other motion in bed. Some patias ut affections of the head, and whicli sonaetimes extend to the face, lihewise occur in praetice, that arisse frona ancient venerealcomplainis imperfectly Cured. These likewise, as the rheumatiis above mentioned, are alWays most severe in the night; they come on insensi bly about bed-time, theyincrease illi moria ing, then abate, se as to allow
The patia is described by the patient to be in
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the bone iistis, as is bored with a ginalet, or
ment in the evening tili it abates in the morn-Ing, it never is entirely off, nor does it misti rom one part to another of the head and face,
health, in easy circumstanc es, and without any apparent cause of anxiety, or other latent causes
of distase. In a moment me would be seiged mitti themost acute excruciating patia, assecting the innet eauthus of thia eye: it lasted but a sew secones, forced out the lears, and gradually went ossi In a sew minutes the same thing happened, and in like manner at unequat distances during theday, so as to occasion a lise of great misery. Iis appe ance Was lita that os a severe spata: it had been considered as such, and trealed with the most efficacious antispasmodicribui to litile purpose; the pain stili continuedreturning in the fame manner. Opium in considerable doses Was the only medicine that procured relles; but the costivenesi it occasioned, with the thirst and head - ach, almost madeher of opinion, that the remedy Was not lesi
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As I was osten present when these exacerba
tions happened, it was not dissiculi to recollest the disease when I met with it in other subjects; severat of whom Ι have seen, and always with Concern, as the methods I had pursued for themost pari obtained but a temporary relies, tili Ιmade use of the extrast of hemlocli in the caseabove mentioned. Since that time I have had recoui se to it whenever the disease occurred, and sor the mos part with successi. One of the las: cases I met with, was themost obstinate I had Pen. A gentlewoman nearsisty, os a fuit habit, rather strong malae, ac customed to plenty, and Using much and Variotis exercisse, had been seiZed with a violent pain affecting.one side of her head and face, Domthe tipper edge of the temporal muscie down iis whole extent, and reaching to the ieeth on that side. Besore I had been in the room two mi nutes, Ι suspected, stom the Violent contortions of the face and the whole. body, that her complaint was of the kind I have been describing.
Not that these contortions are spasmodic or inta voluntary, but such as severe patia osten occasions, when We en deaVour to abate the sense of patia in one part by a generat exertion os forceupora sonae other, or OVer the Whole hody.
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ilie skin or the fide affected mitti the sos test hand-herchies, would immediately excite the patia, Whicli, after continuing perhaps a quarter or halia minute, gradu atly went o T, tili it was againawahened by sonae fressa motion. She had been
inder the care of severat persons of emineiace in
the profession, who had scarcely lese any rationalmethods of relieving her uia attempted. She hadno sever, no other indisposition that potiated out
means of reli es. The extract of hemiock was ordered, ille
quantity gradu alty increased to a fuli dose; and
Still we perstite d. It was almost a year that saepersevered in this method, and to her entire sa-.tisfaction; as near another year has elapsed with out perceiving any intimation of it. She to Eno other medicine during the use of the extrade, excepi sonaetimes a gentie laXatiUe when occasion required; nor Was her diet altered, onlysome cautions given to usu the lightest, least sa-voury kinds, and with sonae restrictions in retagard to quantity. In cases of singular dissicut ty and obstinacy, it 1s natural for has to be inquisitive in to their causes and their nature; unsnccesssul experitamenis sonaetimes lead the Way to instruction ; and we ought never to cease investigating the naost abstruse
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abstruse recesses of nature, nor at the same time sorget the narroW limits of our capaci ty, and thedanger of presumption. What theres ore I haveto osser Upon the nature of this disease, is rather submitted to your Consideration as matter of farther enquiry, than as opinions sufficiently esta-blisaed.
On reviewing the cases I have seen of this di sorder, I recollected the subjects were mostly women. That they were sor the most pari, is notali, past the time of menstruation. That they were generalty of a firm and sonaewhat robust habit, generalty with blach hair, and not subject to any particular distases. Most of them had bornechildren ; and nothing rem arkable had occur- red about the cessation os the menses ; in generat, rather of a costive habit, and in the naiddlingiituations of lisse. In two of these cases, a simali hard tu mour in the breast had occasioned sonae suspicion os a schirrhus; but had never proceeded to give
These appearances, hoWeVer, excited my at tention, and induced me to suspeet that the cause of these extreme patias in the face might possibi he of a cnncero is nature; the method of cureand other circumstances seem to corroborate thesuspicion. The sex, the time of lise, two cases where aetenden cy to this Was obvious, as Weli as the