Injuries of nerves and their consequences - Reflex Sympathetic ...

280 INJURIES OF NERVES.
Large numbers of our array cases were intensely poisoned
by scurvy or malaria, or both, and in these persons
the traumatic neuralgias seemed to me to be increased in
severity by the general lowering of tone, and to react on
the system with exaggerated power. In many cases it
was only necessary to treat successfully the scurvj^ or ague
in order to see very speedily diminish the pain which
seemed to be due to the wound alone.
The malarious element, even more than the scorbutic,
appeared to foster neuralgia but the presence of any
;
cause tending to lower the standard of health was sure to
make this alfection doubly unmanageable.
As regards the presence of ague in neuralgic cases of
traumatic origin, it is to be remembered that the latter
disease is sometimes most distinctly periodical, but is not
made so by the most severe ague poisoning in a case with
no original tendency to recur at a fixed hour. I saw at
the Filbert Street Hospital a very instructive case of traumatic
neuralgia, in which the pain returned daily between
4 and 5 p.m., the cause having been a gunshot injury of
the crural nerve.
After being some time in the wards,
the patient was seized with a morning quotidian ague,
which yielded easil}^ to quinine, although the most liberal
use of this drug and of arsenic failed to disturb the regular
recurrence of the evening neuralgia.
The malarial element, when present, is
only an additional
cause of enfeeblement, and just to this extent
serves to make more severe and lasting the recurrent
neuralgia. In a word, there is apt to be, in any traumatic
neural pain, a tendency to periodicity which seems to be
a part of the natural history of such cases.
Quinine in the largest doses exercised, as a rule, no certain
control over traumatic neuralgia and the same ;
may
be said of arsenic, which, in functional neuralgias, has so
good a reputation.