HIS PAPER ON TIC DOLOREUX.
"Quis talia fando
Temperet a lachrymis."
?
Virgil.

Perhaps, of all known torments, there is none that can be compared, either in intensity or duration, with that curious disease which has been called Tic Doloreux. Like the term Neuralgia, it is merely a hard word to express a violent pain in a nerve. Conventionally, the term neuralgia, or nerve-pain, is generally used to express a case where the suffering is of a more or less diffused character. The term "tic" is more usually applied in cases where the seat of pain is found in some superficial nerve. Neither term has much claim to the character of scientific nomenclature; they are merely equivalent to saying that we know very little of the matter. This obscurity, however, may be soon lessened, if not entirely cleared, by any one who will go to work in the way suggested by Mr. Abernethy\'s principles, and in which, to a certain point, they will conduct him. He must, however, recollect that the pain, though a most distressing symptom, is still a symptom, and not the disease which gives rise to it.

This disease teaches us how beneficently framed we are in relation to all around us; and how small a deviation from a healthy condition of our sensations converts all usual sources of pleasure into so many elements of agony. The breeze, of late so grateful and refreshing, may produce more suffering than would be excited by the most intensely-heated furnace. In other cases, the cool spring, or the most delicious fruit, become causes of79 torture. We should exceed all reasonable limits if we were to enumerate all the usual sources of pleasure which, in different cases, are converted into so many instruments of suffering.

Tic doloreux is indeed a horrible malady; but one which, when properly considered, becomes very instructive. It admirably illustrates the views of Abernethy; and how ready he was to concede all that examination of the views of others which modesty and common sense require, as well as how superior his own were, both in philosophical acumen and practical value; first examining the views of others, and finding them defective, he, with the true philosophical spirit which first discovers what is wrong—

    "Primus gradus est sapienti? falso intelligere,"

then proceeds to develop his own.

The nerves are the organs from which we receive all our impressions from without; and when their ordinary sensibility is thus morbidly augmented, we may be persuaded that there is something very wrong within.

The tic doloreux is one of the examples showing how cautious and circumspect, and how modest withal, Abernethy was in advancing to his own comprehensive views of disease; and how entirely antithetical the method he pursued in arriving at them was to that which attempts to cut the knot of difficulty by gratuitous hypotheses.

When this disease first began to attract attention, it was suggested that it might be cured by the division of the nerve. The phenomena of the nervous system afforded abundant grounds for mistrusting the soundness of this view. The tendency, however, to confound the more salient symptom of a disease with its intrinsic nature, caused such phenomena to be overlooked or little considered; and the consequence was, that where the nerve was divided, the treatment was sometimes entirely confined to that proceeding.

In the end, the operation disappointed expectation; and that which careful reasoning might have predicted as probable, was left to be determined by experiment, In some cases, circumstances80 concurred to produce temporary relief; but on the whole the operation was a failure.

In the case he here published, Abernethy removed a little bit of nerve from a lady\'s finger. As she had suffered severely, and he was anxious to give her more permanent relief, he did not rest satisfied with merely dividing the nerve. For about nine months the lady was in comparative ease; but then the sensation returned. He remarks on the interest attached to this return of sensation, and observes on the analogy it suggests between the supply of blood, and that of nervous power. For if the vessels conveying the former be tied or obstructed, the supply is gradually restored through collateral channels. The return of the nervous functions, after the removal of a portion of the nerve, seemed to favour that view of the nervous system which regarded as the proximate cause of the phenomena some subtle principle or other, like electricity or magnetism, or some analogous power, of which the nerves might be the conductors.

Perhaps the most interesting fact of this case, however, was the significant bearing it had on those views which he was beginning to deduce from a multitude of other sources. The fact being, that when the lady died, which she did about four years afterwards, she died of disordered digestive organs. Showing, therefore, at least, the coincidence of the most severe form of nervous disturbance with disorder of these important functions.

We shall see, by and by, that Mr. Abernethy made this and other cases the instruments of much future good; but as we shall not be able to digress from that Summary of our obligations, which we shall then be employed in taking, we will add a few words here in aid of removing that difficulty which some people have in understanding how such dreadful pain can result from any organ in the interior of the body, where no pain is felt at all. In order to do this, it is only necessary to have a clear general notion of the nervous system. If you could take away everything but the nerves, you would have the brain, spinal marrow, and certain knot-like pieces of nervous substance (ganglions, as we term them) from which myriads of cords proceeded, varying in size from the smallest imaginable filaments up to moderate81 sized cords; the ends of the delicate filaments terminating in the various organs and on the surface of the body; millions of messengers of the most extreme sensibility, by which impressions are telegraphed with the swiftness of lightning between all parts of the body. There is, however, a habit or rule which is ordinarily observed, and that is one of the most curious things in the whole range of physiology—namely, that the immediate cause of our recognition of sensation is never in the part itself, but the action is constantly transferred to the extremity of the nerve. When you strike the ulnar nerve at the elbow (popularly termed, sometimes, the funny-bone), you feel it in the fingers to which its branches are distributed.

If you place your finger in cold or warm water, the action that makes you feel it is in the brain; and we infer this, because if we divide the communication between the brain and the finger, you no longer feel the sensation. Now, bearing this in mind, you easily understand how anything disturbing the nerves of any internal organ may produce pain in some distant branch; and that this is really so, many cases of tic doloreux have furnished conclusive and triumphant proofs. Now, as to why it should be seated in this or that particular site, is a question of extreme difficulty; as also in what organ the primary disturbance is seated, supposing it to have been in any of them. The former, I believe, is a question we have yet been unable to solve; the latter may usually be accomplished, if sufficient pains be taken.

Abernethy, in his lectures on this subject, when observing on the inefficiency of this division of the nerve—which was ministering to effects only—was accustomed to remark, with that peculiar archness of expression which his pupils must so well remember: "I wonder that it never entered into the head of some wise booby or other to divide the nerve going to a gouty man\'s toe." This was a very characteristic mode of terminating a discussion of any point which he wished to impress on the memory of the pupil.

82

SECTION.
OF HIS PAPER ON OCCASIONAL CONSEQUENCES OF BLEEDING.

In these days of improved statistical inquiry, it would be a curious document which should give us the comparative number of persons who are now bled, and that of onl............