be pale and
moist with inspissated sweat, the patient not daring to touch or wash
it.

There is excessive tenderness at the points of emergence of the
different branches on the face, and pressure over one or other of these
points may excite a paroxysm. In typical cases the patient is unable to
take any active part in life. The attempt to eat is attended with such
severe pain that he avoids taking food. In some cases the suffering is
so great that the patient only obtains sleep by the use of hypnotics,
and he is often on the verge of suicide.

_Diagnosis._--There is seldom any difficulty in recognising the disease.
It is important, however, to exclude the hysterical form of neuralgia,
which is characterised by its occurrence earlier in life, by the pain
varying in situation, being frequently bilateral, and being more often
constant than paroxysmal.

_Treatment._--Before having recourse to the measures described below, it
is advisable to give a thorough trial to the medical measures used in
the treatment of neuralgia.

_The Injection of Alcohol into the Nerve._--The alcohol acts by
destroying the nerve fibres, and must be brought into direct contact
with them; if the nerve has been properly struck the injection is
followed by complete anaesthesia in the distribution of the nerve. The
relief may last for from six months to three years; if the pain returns,
the injection may be repeated. The strength of the alcohol should be 85
per cent., and the amount injected about 2 c.c.; a general, or
preferably a local, anaesthetic (novocain) should be employed
(Schlosser); the needle is 8 cm. long, and 0.7 mm. in diameter. The
severe pain which the alcohol causes may be lessened, after the needle
has penetrated to the necessary depth, by passing a few cubic
centimetres of a 2 per cent. solution of _novocain-suprarenin_ through
it before the alcohol is injected. The treatment by injection of alcohol
is superior to the resection of branches of the nerve, for though
relapses occur after the treatment with alcohol, renewed freedom from
pain may be obtained by its repetition. The ophthalmic division should
not, however, be treated in this manner, for the alcohol may escape into
the orbit and endanger other nerves in this region. Harris recommends
the injection of alcohol into the semilunar ganglion.

_Operative Treatment._--This consists in the removal of the affected
nerve or nerves, either by resection--_neurectomy_; or by a combi