Vol. 60, 1909 - University of North Carolina at Chapel Hill

226 THE CHARLOTTE MEDICAL JOURNAL
The external treatment of this disease has
been almost as varied as the internal; all
manner of application of heat, cold, drugs,
liniments and lotions, have their testimonials
of cure. Electricity is employed in
the form of electrolysis and high frequency
current. The X-Ray has been used as well
as thorium and radium.
The number of surgical and semi-surgical
methods for the relief of this trouble are
probably greater than that ever advanced
for the cure of any other disease.
Owing to the mortality of operations on
the Gasserian Ganglion, which is at least
10 per cent, and the fact that at first we
may be unable to differentiate between a
major and a minor neuralgia, the peripheral
operation on individual nerves should first
be tried, provided all, or a large number of
the nerve, are not involved.
To obtain the best and most lasting results
from peripheral operations the nerve
should be removed as far centrally as possible.
The branches of the 5th nerve show a
very strong tendency to regeneration leading
to recurrence of the neuralgia after neurectomy,
especially those branches which
occupy a boney canal.
In mentioning some of the operations
which have been devised, the strecthing of
the nerve was done as early as 1748; it gave
some little relief, the method has been abandoned.
The division of the nerve was but
little better, in that the nerve reunited so
quickly.
Resections of portion of the nerve gave
relief from 6 months to 2 years, at which
time the nerve had succeeding in reproducing
itself.
J, Ewing Mears recommended the removal
of the Gasserian Ganglion in 1884, and this
was first done by Dr. Rose in 1890.
Dr. Abbe, 13 years ago, advocated the
intra-cranial inplantation of rubber tissue
to cover the foramen of exit of the various
branches of the trigeminal after their resection.
This effectually prevented the regeneration
or reunion of the nerves, and a further
report was made in 1903, showing permanency
of cure. Shortly after this original
work of Dr. Abbe's, Dr. C. H. Mayo,
accepting the idea of interposing mechanical
difficulties to the nerve union, devised
his operation, which is based on the different
function of the motor nerves from that
of the sensory nerves, namely: that the
motor nerves require a favorable opportunity
for reunion, while it is a most difficult
matter to prevent the regenation and return
of function of the sensory nerves.
The impulse of the motor nerves being
from the center outward, the peripheral end
degenerates. The function of the sensory
nerve fibers are just the opposite, which is !
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from the periphery to the center.
Ilis method is to remove as much of the !
nerve as possible, by resecting it out of the :
foramen by Thiersch's method, then plug
the foramen with a silver screw, the screw ,
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being sufficiently large as to be forced in ij
the foramen by means of a screw- driver,
thereby making it impossible for this screw
to become dislodged; such being true, the ;
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nerve can never grow back through this
foramen to reunite itself with its peripheral'j
end. 1
Report of Case.
Capt. E., aged 65. Suffered 9 years with
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facial neuralgia, having intervals of a few
months rest from pain.
As usual, he had every imaginable treatmeut
rendered him but with no permanent
results.
Finally his sufferings became so intense I
that he could not talk or eat without severe •!
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sufferings. Also he could not sleep except
under the influence of morphine.
Life under such circumstances he felt I
could not last long, therefore, he accepted
the operation which had been offered him j
several times before.
The operation consisted in dissecting the
infra- orbital nerve from the foramen and
with a hemorrstatic forcep caught the nerve
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close to the foramen and winding the nerve I
on the forcep by Thiersch's method, which
enabled me to remove at least 2 inches of
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the nerve. j
With a Mayo's silver screw, the same be- !
ing Yi, inch long and a /:; inch thick, by \
means of a screw-driver, placed this most '
firmly in the foramen, thereby making it i
impossible for it to ever become dislodged. \
This being true, the nerve will be prevented !
in its efforts to reunite itself with the peri-
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pheral end. j
It has been one year and a half since this
operation and the patient has been entirely I
free from any symptoms of the old neural- !
gic pains. Quoting his words "l am now '
a well man."
The Potency ol Medication in Serious
Cardiac Disease.
By Alexander G. Brown, Jr., M.D., Professor of
Theory and Practice of Medicine, University
College of Medicine; Physician to Virginia
Hospital, etc., Richmond, Va.
In no department of medicine has therapeutic
pessimism been more emphatically
checked than in the recent studies and treatment
of cardiac disease. This signal reaction
in the use of drugs for the amelioration
of the distressed, the prevention of the
premature termination in degenerative disease
processes, and the cure of disease itself
is nowhere more clearly evident than in this
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