NEURALGIA OF THE TRIGEMINUS. 329 



the eye, and, from participation of the infratrochlearis, at the inner 

 canthus and caruncula lachrymalis. The twigs of the first branch, 

 which go to the lachrymal gland and conjunctiva, explain the increased 

 secretion of tears and redness of the conjunctiva, almost always ob- 

 served in neuralgia of that branch, particularly on remission of the 

 paroxysms. If the second branch of the trigeminus be the seat of the 

 neuralgia, the pain is usually most severe in the parts supplied by the 

 infraorbital, that is, in the lower eyelid, alas nasi, upper lip, and teeth 

 of the upper jaw. The attacks of pain in these cases are sometimes 

 accompanied by watery or mucous secretion from the nasal mucous 

 membrane. Neuralgia is rare in the course of the third branch of the 

 nerve : this is particularly true in the course of the auriculo-temporal 

 and lingual branches; it is somewhat more frequent in the inferior 

 alveolar, especially in the mental, after it escapes from the foramen ; 

 then the patient has pain in the chin and lower lip. Salivation often 

 accompanies neuralgia of the third branch ; this symptom agrees per- 

 fectly with the experiments of Ludwig (see vol. i.). Occasionally the 

 neuralgia chiefly affects those twigs of the second and third branches 

 that accompany the ramifications of the facial nerve. This explains 

 why the facial nerve itself was formerly often considered as the seat 

 of the neuralgia. 



In facial, as in other neuralgias, the patients suffer partly from a 

 permanent dull pain located at different points of the trigemmus; 

 partly from attacks of agonizing pain, wBich occur suddenly, then 

 cease as suddenly, in half a minute or so, and again return till the 

 attack, composed of these short twinges, " Tics," is over. The face 

 often twitches during these attacks, but does not usually do so invol- 

 untarily. Parson JBartk, who has given a very careful account of his 

 own facial neuralgia, was even able to continue preaching during the 

 attack. The attacks sometimes occur spontaneously, and, except in 

 the cases due to malaria, they are irregular ; sometimes they are in- 

 duced by the causes previously mentioned, such as speaking, sneezing, 

 gaping, blowing the nose, by using too cold or too warm food, occa- 

 sionally even by any attempt to chew. During the attack the face is 

 usually reddened, its temperature increased, and there is active pulsa- 

 tion of the arteries. To the cases observed by Brodin and Eomberg. 

 where, after long duration of severe facial neuralgia, the countenance 

 of the patient was greatly disfigured by swelling and development of 

 fat, I may add the case of one of my Magdeburg colleagues, in whom 

 there was decided disfigurement, particularly by swelling of the lower 

 lip, from facial neuralgia of one year's duration. In old cases of the 

 disease other disfigurements of the face have also been observed, sucfc 

 as increased thickness and prickliness of the beard, acne pustules, etc. 



