118 DISEASES CLASS I. 2. 4. 12. 



severe, passing from the ear under the zygoma toward the nose 

 and mouth, and upwards round the orbit. This route proved 

 pretty clearly, that the portio dura of the auditory nerve was also 

 affected; at least the uppermost branch of the pes anserinus. Be- 

 fore I preceded to divide this, I was willing to try the effect of 

 arsenic internally, and he took it in sufficient quantity to excite 

 nausea and vertigo, but without perceiving any good effect. 



I could now trust only to the knife to alleviate his misery, as 

 the pain round the orbit was become most violent; and therefore 

 intercepted the nerve by an incision across the side of the nose, 

 and also made some smaller incisions about the ala nasi. To di- 

 vide the great branch lying below the zygomatic process, I found 

 it necessary to pass the scalpel through the masseter muscle, till 

 it came in contact with the jaw-bone, and then to cut upwards; 

 this relieved him as usual. Then the lower branch was affected, 

 and also divided: then the middle branch running under the 

 parotid gland. In cutting this, the gland was consequently divid- 

 ed into two equal parts, and healed tolerably well after a copious 

 discharge of saliva for several days. 



I hoped and expected, that this last operation would have ter- 

 minated his sufferings and my difficulties; but the pain still af- 

 fected the lower lip and side^of the nose, and upon coughing, or 

 swallowing, his misery was dreadful. This pain could only arise 

 from branches from the second of the fifth pair passing into the 

 cheek, and lying between the pterygoideus internus muscle, and 

 the upper part of the lower jaw. The situation of this nerve 

 rendered the operation hazardous, but after some attempts it was 

 accomplished, and this day he set out for Leicestershire perfectly 

 restored. 



I am, sir, &c. 



LEIGH THOMAS. 



Since I wrote the above, I have seen an equally deplorable and 

 instructive case, of hemicrania idiopathica, of an elderly person, 

 described by Dr. Haighton, under the name of tic douloureux, 

 with an equally successful cure, by dividing the diseased nerves. 

 Medical Records and Researches. Cox, London. 



Two cases of tic douloureux are related by a Dr. Watson, in 

 the R,ecueil Periodique de Medecine, Paris, 1798, torn. IV. 

 which are said to have submitted to mercurial frictions and warm 

 bathing. These pains were probably venereal symptoms, as the 

 author suspects; but would persuade us again to try the use of 

 mercury, though it failed in the case above related, and especially 

 as it sometimes succeeds in the hemicrania sympathetica, as men- 

 tioned in Class IV. 2. 2, 8. Five grains of the powdered leaf of 



