Practical diagnosis : the use of symptoms in the diagnosis of disease / by Hobart Amory Hare.

  • Hare, H. A. (Hobart Amory), 1862-1931.
Date:
1897
Catalogue details

Licence: Public Domain Mark

Credit: Practical diagnosis : the use of symptoms in the diagnosis of disease / by Hobart Amory Hare. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    cases of neuralgia, particularly of the supraorbital nerve, which are due to chronic poisoning by one of the metallic poisons, such as lead and arsenic, aud also as a result of malarial infection (brow ague). If the neuralgic pain be due to neuritis, it will not only be typical of neuralgia, but along the track of the nerve marked tenderness will be developed on pressure, and often an eruption will appear on the skin, as a herpes zoster. Pure neuralgia, on the other hand, is often relieved by pressure upon the nerve involved. When the fifth cranial nerve is affected by neuralgia we find that if the upper branch is involved the pain is felt in the forehead, the eyebrow, and the eyeball, the conjunctiva often becoming injected. If the pain be in the upper lip, the posterior nares, and the cheek, the infraorbital or second branch is affected ; while if the pain is in the lower jaw and chin, the third division of the fifth nerve is in- volved. A peculiar form of neuralgic pain coming on in attacks or par- oxysms of great severity is migraine or megrim, in which the pain is usually confined to one side of the head, is associated with great tenderness of the scalp, and preceded in many cases by disorders of vision, such as hemianopsia or dimness of visual perception. Asso- ciated with this pain at its zenith we frequently see vomiting and retching, faintness, with sweating localized to the pain-area or dif- fused, and great facial pallor. Pressure by the fingers upon the painful area often gives no more pain or even partial relief, but a light touch will often cause marked increase in the pain. Rarely a somewhat similar condition to migraine, which is not unilateral but bilateral, is found in connection with rheumatism of the scalp. As migraine may be due to, and this last-named condition arises from the rheumatic diathesis, care in making; a differential diagnosis is neces- sary. The pain of migraine is, however, unilateral, more severe, more transitory, and associated with the symptoms named, whereas in the rheumatic head-pain the history of rheumatic tendencies of a marked character, the diffuse pain, the increased soreness on ex- posure to cold or changes in the weather, aid in separating it from migraine. When syphilis or injury causes a periostitis of the skull, violent pain of a neuralgic character may be present, particularly at night; but the local symptoms are manifest, and when compared with the history make the diagnosis possible. It is also necessary to separate the headache of cerebral tumor or cerebral abscess from neuralgia of the head. The pain of such a