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PDF of Kisah Dari Sumba Maria Monica Wihardja Full Chapter Ebook
PDF of Kisah Dari Sumba Maria Monica Wihardja Full Chapter Ebook
PDF of Kisah Dari Sumba Maria Monica Wihardja Full Chapter Ebook
Wihardja
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The susceptibility of different persons to this drug is so different that
the dose should first be as small as 1/400 gr., but this may be repeated
every three hours, and gradually increased to 1/100 gr., or until its
physiological effects are felt. Patients must sometimes be kept under
its influence for weeks together.25 It is, however, a remarkable fact
that occasionally a few full doses will secure an immunity from pain
for a long period. Although most useful in facial neuralgias, the writer
has known it to be effective in brachial and mammillary neuralgia.
Aconitia can now be had in granules of 1/400 gr., or can be given in
alcoholic solution.
25 See Seguin, Arch. of Med., vol. vi., 1881.
It is, however, very important in acute cases to take care that the
current-strength should not be rapidly changed; and for this reason
the electrode should be drawn slowly to a distance from the nerve
before it is removed, or left in situ while the current is gradually
diminished by a suitable rheostat. As a rule, the former method is the
more practicable.
The use of the cautery and of blisters is in place in almost every form
of neuralgia where the temporary disfigurement is of no
consequence.
Of other cutaneous applications, aconite and chloroform liniments,
menthol in substance or in alcoholic solution (drachm j or drachm ij
to fluidounce j), aconite and veratrine ointments, are the most useful.
A strong aconitine ointment, made with Duquesnet's aconitia and
lard (drachm j to ounce j), has been recommended by Webber28 to
be used in portions of the size of half a split pea, but, though
effective, it needs to be employed with great caution.
28 Nervous Diseases, Boston, 1885.
During the past few years the operation of nerve-section has been to
some degree superseded by that of nerve-stretching, as being less
serious in its immediate (though not necessarily in its remote)
consequences, and sometimes more efficacious. Hildebrandt,
indeed, raises the question whether the traction which is apt to be
exerted when a nerve is cut is not an important element in bringing
about the result. On the other hand, cases are reported where
neuralgia which had not been relieved by stretching was cured by
resection.31
31 Nocht, Ueber die Gefolge der Nerven-dehnung.
The best showing for the operation is in the treatment of sciatica, but
most of the other superficial nerves, including the intercostals, have
been successfully treated in the same manner.
On the other hand, this treatment is not without its dangers. Apart
from the risks of the operation itself, cases have been reported in
which the spinal cord has been injured, so that chronic myelitis has
been set up, and a greater or less degree of paralysis—rarely
permanent, it is true—may be induced by the direct injury to the
nerve.
This means of treatment is therefore certainly to be thought of in
serious and obstinate cases, but not lightly decided on.
In one case of sciatica the writer has seen a neuritis of some severity
lighted up by this operation, perhaps because the disease was in too
active a state, although it had lasted some months. The operation is
probably most indicated in chronic cases.
Osmic acid has been used recently in the same way, and the reports
show about an equal number of successes and failures. The dose is
about 8 minims of a 1 per cent. solution, and the injection may be
repeated at intervals of a few days. It has been used successfully in
various parts of the body, including the face and the fingers. The
injection causes no great pain, but occasionally, though rarely,
excites abscess.
The auras are manifold and important. On the day before an attack
the patient may feel remarkably well, or may complain only of such
sensations as thirst or giddiness. The attack itself is apt to be
ushered in by visual hallucinations of dazzling and vibrating points or
serrated images, sometimes with prismatic outlines, accompanied by
a loss or obscuration of vision over one-half or some other portion of
the field, which lasts half an hour or more, and sometimes clearing
up in one part while it advances in another. Simultaneously or
immediately after this there may be tingling and a sense of
numbness of the tongue, lips, hand, or one-half of the body,
sometimes followed by partial hemiparesis, and, if the right side be
affected, by more or less aphasia or mental confusion. Occasionally
the other special senses are affected. Sometimes the aura may
constitute the whole of the seizure.
The pain may begin on the same side with these prodromal
symptoms or on the opposite side. Sometimes drowsiness is a
marked symptom throughout the attack, and this differs in
significance from the sound, refreshing sleep with which the
paroxysm often comes to an end. Sometimes the arteries of the
affected side seem strongly contracted, as shown by pallor and
coldness of the face and dilatation of the pupil (angio-tonic form);
sometimes, on the other hand, they are dilated and pulsate strongly,
or the latter condition may follow the former (angio-paralytic form).
The radial pulse may show corresponding modifications. These
vascular phenomena are often, however, entirely wanting.
Finally, there is great probability that the disease will cease of itself
with advancing years, not always, however, without having left its
mark on the patient's mental and bodily vitality.
Of the drugs used to control the liability to the attacks, the most
important is cannabis Indica, given in doses of about half a grain of a
good preparation of the extract several times daily for weeks or
months together. Valerianate of zinc and the iodide and bromide of
potassium in full doses are also recommended, but are less
efficacious.
In the treatment of the attack itself, besides absolute rest and quiet,
large and repeated doses of guarana or caffeine, either alone or
combined with drachm doses of bromide of potassium, are
sometimes of use if given at the very outset.
The writer has known a strong faradic current applied with the
moistened hand to the back of the neck to relieve an attack, and
prolonged but gentle manipulation of the painful area with the finger-
tips may have a like effect if the pain is not too severe; as, for
example, toward the end of a paroxysm.
These varieties are of course closely allied, and have many features
and causes in common.
The relation of caries of the teeth to neuralgia of the fifth pair forms a
very important chapter, which is admirably treated by J. Ferrier.36
Opinions on this subject are conflicting and unsatisfactory, and the
fact that many patients have had nearly all their teeth drawn in the
vain attempt to get cured of one of the severe forms of facial
neuralgia often creates an impatience of further investigation in the
matter. Ferrier points out that as a rule it is not the severest cases of
epileptiform tic douloureux that arise in this way, but, on the other
hand, that it is a mistake to conclude, because a neuralgia is
benefited by medical treatment and made worse by fatigue,
exposure, etc., and because it occurs in a person of neurotic
temperament, that it is not likely to be due to this form of irritation.
The teeth need not themselves be the seat of pain, and the disease
in them may be detected only after diligent search.
36 Les Névralgies reflexes d'Origine dentaires, Paris, 1884.
Pain in this region, often due to neuritis, may accompany acute and
chronic thoracic disorders, and may be the precursor of herpes
zoster. Caries of the vertebræ and meningitis should be thought of,
and cancer if the neuralgia is very persistent, even if it is paroxysmal
in character.
The most important facts with regard to them are that they are
intimately associated, in relation both of cause and of effect, with
affections of the abdominal and the pelvic organs and of the testis.
Neuralgias of the terminal branches of the lumbar plexus, the
obturator and anterior crural nerves, though well recognized, are
comparatively rare.
The TREATMENT of sciatica must vary with the probable cause of the
disease and its stage of progress. Diathetic taints are to be met if
present, and the greatest measure of physical health secured that
the circumstances possibly admit. It is a good precaution in all cases
to secure free evacuation of the bowels and to guard against
hemorrhoidal congestions.
As against the neuralgia itself, the proper means vary with the
acuteness of the attack and the presence or absence of neuritis. For
the acute stage absolute rest is almost always desirable as a prime