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Selecting, now, in the order in which they occur, ten consecutive cases of neuralgia in which the family history has been written, we find striking evidence in support of these propositions. It should be said in passing that in the pressure of work the family histories of many cases of these neurotics have not been written, hence these cases are not literally consecutive cases of neuralgia, but consecutive cases of that disease, in which the family history has been recorded: Table showing the neuralgic and ocular conditions in ten successive cases of important neuralgic affections, with the physical condition or immediate cause of death among immediate relations, with the result of treatment directed to refractive and muscular conditions of the eyes.

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Table showing neuralgic and ocular conditions (continued).

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1. In all, the hereditary tendency is clearly shown. 2. All have marked refractive and muscular anomalies, which are physical features, distinctly hereditary.

3. The uniform relief from the irritation caused by these physical peculiarities proves that the hereditary tendency to nervous troubles and the hereditary physical peculiarities were in these cases one and the

same.

It is distinctly stated that the ten consecutive cases above quoted do not materially differ in their signifi

cance from a like number of cases taken incidentally from other parts of the records, although in a like number the same proportion of marked refractive lesions might not always prevail. Should a greater number of consecutive instances be selected in any part of the whole list, the teaching would be practically the same.

The unmistakable inference to be drawn, therefore, from the study of a great many cases, is that the hereditary tendency to neuralgia is quite commonly found in the physical construction of the eye or of its appendages, and that when it is found elsewhere it may be regarded as in a degree exceptional.

In assuming this inference to be correct, it is not necessary to ignore known facts concerning the disease, although some ancient prejudices may possibly obtrude themselves in opposition to it.

This inference is entirely consistent with the facts that certain influences act as immediate agents in inducing the disease, and that in a certain proportion of cases other permanent conditions may be quite as active as causative instrumentalities.

It is also consistent with the fact that neuralgia is a complaint which most frequently makes its appearance, not in childhood, when the tissues are most pliant, and when the effects of refractive anomalies and muscular insufficiencies can be most easily overcome, but at an age when efforts to overcome these difficulties increase, and when the faculty of close and critical vision is brought most prominently into use.

This inference is also notably in harmony with the

fact that neuralgia is so frequently interchangeable with migraine, epilepsy, and insanity; for we have already seen that visual defects are most important factors in the production of migraine, and we shall find that it is scarcely less so in the causation of other

neuroses.

It is manifestly fallacious to presume that epilepsy and neuralgia are convertible diseases, and that one can be directly the originator of the other by inheritance or by any necessary sequence in the same individual. On the other hand, it is quite reasonable to suppose that a common cause acting upon different individuals, or upon the same individual at different times, may give rise to such irritation as shall be manifested as neuralgia, epilepsy, or insanity, depending upon the resisting strength of the individual, upon his environment, and other circumstances.

By accepting such a view, a great element in the doctrine of heredity may be removed from the realm of mystery, and placed in the domain of legitimate knowledge.

In order that the inference here asserted may not be misunderstood, it may be repeated that it is not claimed that ocular defects are the only hereditary features which may give rise to neuralgia, but that they are pre-eminently important.

Incidental causes may become more or less permanent according to their nature, and induce neuralgia or other neuroses during their continuance.

A gentlemen who had suffered most violent facial neuralgia for many months, forcing him to relinquish

his business and to seek in vain relief at a celebrated spa, was found to have a mass of hardened cerumen in The removal of this mass was followed by

the ear.
instant and permanent relief.

Many instances of which this is a fair illustration might be mentioned, but they constitute no such general class that the nature of the cause may be inferred from the presence of the disease. They are accidental, and should always be sought for.

Such instances might be classified with those arising from pressure from tumors or growths and from traumatic causes.

SPINAL IRRITATION AND NEURASTHENIA.

Closely related to neuralgia are the conditions commonly known as spinal irritation and neurasthenia. They are characterized by general loss of nervous energy and by local symptoms more or less complex ; certain symptoms, however, prevailing more in one than in the other form of nervous disturbance.

In females the neuralgoid pains at various points at the neck, back, and loins are wont to assume much prominence; great weariness, reduced power of endurance, disinclination or even disability to walk or to perform any physical exertion, increased mental irritability and disturbance of sensations, all go to constitute a group of symptoms quite commonly known as "spinal irritation"; while in men there is less of the neuralgic element, with more dull pain in the extremities, or general sense of exhaustion, inability to continue at office-work where writing or attention to ac

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