From a series of observations published by E. Stoopen (184), we chose the following:

"Right trigeminal neuralgia for the past 10 years, with short, sharp pains. Neither food intake, nor time of day have ever influenced the pain. The patient was submitted to various treatments such as ultraviolet rays, quinine, neosalvarsan, cobra poison and vitamin B. First alcohol nerve block calmed the pain for 15 months. Second alcohol injection brought no relief. Third block calmed the pain for one year. Fourth alcohol injection calmed pain for three months. The last injection caused, however, trophic ulcerations of the throat and corneal ulcerations with ultimate loss of the sight.

In June 1942, a treatment with glycerin and the insaponifiable lipid fraction was begun. The pain which proved to be of an alkaline type, ceased in 3 days.

In July 1943, the patient had a lumbago attack, a condition from which she had often suffered and which had been both long lasting and resistant to classical medication. Treatment with the insaponifiable lipid fraction made the pain subside within a few days.

In an attempt to modify the ulcerations in the throat, though the pain had not reappeared, the patient was continuously treated with the insaponifiable fraction and cholesterol, and with large doses of vitamin A. However, there was no effect on the ulcerations.

In February 1944, the pain reappeared. Study of the pain curve revealed it to be of the acid type since the paroxysmal pain corresponds to a very low pH. The patient was given ammonium acetate and lipoesters. Four days later the pain had considerably decreased, and fifteen days later, completely subsided."

"Mrs. W. For eleven years this patient has suffered of a left trigeminal neuralgia. Each year the crisis lasted four to five weeks, during which time the pain always appeared between four and seven in the morning, lasted for one to two hours and then disappeared. The pain was so severe, being almost unbearable. For the rest of the day, the patient only felt a slight sensitivity. Barbiturates taken even in large amounts had no influence on the pain. Removal of the Gasser ganglia was suggested as the sole possible cure by numerous doctors consulted in Mexico and the United States.

The patient came under our care on November 12, 1943. Her most recent crisis had started on October 31. Study of her pain showed it to be of an alkaline character, since pain is quite intense when the urinary pH is high. We recommended glycerine. The patient protested, feeling that a few drops of glycerine would not be able to help her, pointing out that intensive treatment, had given no results. However, on November 15th, when pain started at 5:00 a.m., the patient took the glycerine drops and to her amazement, the pain disappeared within two minutes. She asserted that no medicine had ever been able to stop the pain once it had started. At 7:30 a.m. the pain returned but again decreased after the patient had taken several glycerine drops.

On November 16th, the patient experienced pain at 1:30, 5:30 and 7:30 a.m. During the first two periods of pain, the pain was instantaneously calmed with glycerine and phosphoric acid; the third period of pain was decreased in intensity but lasted for 40 minutes.

On November 17th: pain appeared at 9:00 a.m. but disappeared three minutes after medication of glycerine and phosphoric acid.

On November 18th: pain which started at 8:00 a.m. could not be calmed with medication. Coramine, Cholesterol and insaponifiable fractions were then prescribed.

On November 19th: pain was experienced at 4:00 and 8:00 p.m. but subsided within three minutes after medication of glycerine, phosphoric acid and coramine was taken.

On November 20th: from this day through November 25th, the medication was unable to influence the pain, and consequently the patient became disheartened. A study of her pain pattern at this point indicated that it had changed to the opposite type—from alkaline to a definite acid pattern.

On November 26th: bicarbonate was given at the onset of pain resulting in a considerable decrease in its severity. No further pain was felt on the following days and the crisis was considered ended. In this instance, the crisis had lasted for 27 days (the length usually varied from 27 to 35 days). However, the treatment achieved what had been impossible for all previously tried treatments—the cessation of pain once it had started.

These observations led to the following pertinent conclusions: 1) they showed the existence of typical acid or alkaline pain; 2) the possibility of changing pain from one type to the opposite one, either during the course of the disease or due to medication; and 3) the possibility of eliminating pain with appropriate treatment."

Chapter 14, Note 2. Dr. Welt's Publication On Butanol Conclusions

"n Butanol was administered to a large number of patients with pain due to the trauma of various common otorhinolaryngological and ophthalmologic surgical procedures. Pain was relieved in approximately 90 per cent of the patients so treated.

These clinical results were considered in the light of studies by Revici and his co workers regarding the physiopathology of wounds. The results indicate that the proposed concept of pain has significant practical clinical applications."

Chapter 14, Note 3. Dr. A. Ravich's Conclusions (189)

In his article concerning the post operative care in prostatectomies, A. Ravich arrives at the following conclusions exemplified in Figure 298.

Summary

"A new concept of the local physicochemical changes occurring within pathological foci as introduced by Revici, has been briefly described. According to this view, pain is the result of local pH changes brought about by the accumulation of acid or alkaline substances within disturbed tissues. Changes in the lipid balance are associated with and may account for these alterations.

"The possibility of correcting or neutralizing such lipid changes has been explored clinically in several series of urological cases. The favorable effects upon pain as well as upon bleeding, wound healing and other important postoperative problems and complications indicate the need for further study along these lines."