Arsenic holds a chief place among remedies for neuralgia. Dr. Fowler's original reports contain several conclusive cases, although their relief seems somewhat counterbalanced by the gastric symptoms, which he did not scruple to produce. Maculloch, in a well-known "Treatise on Malaria," speaks highly of arsenic in confirmed neuralgia; and Romberg, a still higher authority, notes its value especially in facial neuralgia, and in forms connected with uterine or ovarian disease. Anaemia is also an indication for its use, and full doses are necessary. Among modern French observers, Isnard reports many cures of various typical neuralgiae, and of ordinary neuralgic pain ("De 1'Arsenic dans la Pathologie du Systeme Nerveux"). M. Boudin found it invariably succeed in periodic - probably malarial - forms, and M. Cahen has published sixty-five successive cases of almost uniformerly good result (Archives de Med., 1863). Borella devotes a long chapter of his work in praise of arsenic, to its value in nerve-disorders (Brussels, 1866). Of modern German writings on the subject we may quote Erb, who adopts mainly the views of Isnard, considering the remedy as "a neurosthenic tonic," with the power of restoring order to disturbed action. He places it in the first rank among specific remedies, not only in recent and periodic cases, but also in chronic forms of purely idiopathic neuralgia. In the facial variety and in sciatica, he endorses its high reputation, but in the latter affection places its value below that of turpentine ("Ziemssen's Cyclopaedia"). In the treatment of sciatica, arsenic is most suitable when the pain is deep-seated, worst at night, but with occasional marked intermissions, and temporarily relieved by hot applications.

Sir Thomas Watson notes the great use of the drug in hemicrania or migraine (Op. cit., i., p. 733), and successful results in various cases from full doses of Fowler's solution were published by Mr. Thomas Turner, of Manchester (Medical Times, ii., 1861). Dr. Anstie, in his "Treatise on Neuralgia," speaks of arsenic as "one of the most powerful weapons in the physician's hands," "likely to act best in affections of the fifth and of the vagus nerves, but probably the most generally effective remedy in almost any given case." He looked upon it as calculated to improve the quality of the blood, to stimulate the nerve-system, and oppose periodic (disordered) action. The same physician also pointed out the connection and frequent interdependence of gastralgia, angina pectoris, and asthma, as neuroses of different branches of the vagus, and he illustrated this connection by the history of families in which these affections occurred in alternate generations. From my own extensive trial of arsenical medication in neuralgiae, and especially of the fifth pair of nerves, I also conclude it to be almost our best remedy, particularly, as in my own person, when the pain felt is of burning stinging character, and when the attack is connected with miasmatic influence.

Gastralgia is a term properly restricted to painful affections of the stomach unconnected with organic disease or inflammation, or even with ordinary dyspepsia. Such cases are not very frequent nor very easy of diagnosis, but occur especially in females during youth, and at the climacteric period, and are accompanied with other evidences of impaired nerve-power: sometimes they are reflex (being connected with uterine derangement), and sometime malarial (Niemeyer). Trousseau describes attacks dependent on exhaustion, and Budd on alcoholism. The nerve-character is evident when, as in Dr. Anstie's cases, the malady alternates with attacks of asthma, and Tessier (Journal de Med. de Lyon, 1848) and Anstie agree in estimating highly the value of arsenic in such cases. Dr. Clifford Allbutt speaks of gastralgia as readily distinguishable from dyspepsia, and described sudden violent pain in the gastric region and back, and another form less severe and more gradual in onset, and irregular as to time, and unconnected with eating (Liverpool and Manchester Reports, 1873). Dr. Leared also restricts the term to a nerve-disorder with cramplike, fixed or diffused pain, coming at irregular intervals, often at night, accompanied by prostration, followed by bilious vomiting, and occurring generally in middle-aged persons from mental anxiety (British Medical Journal, 1867). Such cases furnish a special indication for arsenic, and Allbutt says it is, for such, the "king of remedies," only I would interpret "gastralgia" in a wider sense, and without attempting to diagnose it rigorously from dyspepsia, would include under the term many forms of painful stomach-disorder, not inflammatory nor organic. In this sense it is used by Barras ("Traite sur les Gastralgies") and other French writers, and a reference to the observers I have named will show that, in their cases, such symptoms as flatulence, vomiting, and pain increased by food, were often present, and although the tongue might be clean, and certain dyspeptic symptoms absent for a time, yet they would readily occur, and to restrict the use of the remedy to purely nervous attacks is needlessly to limit its value: we shall see, in fact, that in gastric catarrh it is an excellent medicine.

The following is one of many cases of climacteric gastralgia, complicated with dyspepsia at times, and relieved by arsenic. Mrs. S., aged forty-three, auburn hair, thin, describes very acute pain in upper front chest, and sometimes in the back about the second dorsal vertebra and interscapular region, almost constant; sometimes easier after food, sometimes worse: no vomiting, pyrosis, or haematemesis: no physical signs in the chest, no evident hepatic disease, and bowels regular. Pulse 64. No heart or lung complication. Youngest child is five years old. Menstruation lately irregular and profuse; has some prolapsus and back-pain, distinct from her gastric pain. Nursed her husband anxiously for two years, during which time the pain first came on, and is now often brought on and always aggravated by mental worry, of which she has much. The pain is generally worst on waking, about 2 a.m.; gets better after breakfast, and worse again in the evening: it is sometimes referred to the epigastrium and left shoulder, and described as "like a hot bar pressing," or "like a hand gripping." Arsenic relieved the pain more effectively than any other remedy tried, and although during attacks of painful digestion nux vomica given before food did much good, according to the patient's own statement, the steady use of arsenical solution was always the most effective.