[62] _A Civilian War Hospital_, p. 228. [63] _Surgical Experiences in South Africa_, p. 293. [64] _Lancet_, March 3, 1906. [65] _Army Med. Corps Journal_, April 1905. [66] _Surgical Experiences in South Africa._ [67] _Traumatic Injuries of the Brain_, p. 387. [68] _Surgical Experiences in South Africa._ CHAPTER X TRIGEMINAL NEURALGIA Neuralgia of the fifth or trigeminal nerve is, in its varying degrees, of frequent occurrence. In its cause, manifestations, and progress, it offers so wide a field for discussion that the question must be focussed down by means of some simple form of classification such as enables one to include the majority of cases that come before one’s observation. For all practical purposes, the following types will be sufficiently inclusive:-- Neuralgia minor. Neuralgia major. Hysterical neuralgia. NEURALGIA MINOR This variety is almost invariably dependent in its development on some exciting cause. In some cases this cause is readily demonstrated, in others great difficulty may be experienced before the source is discovered. These secondary neuralgias may be regarded as resulting from the following injuries and diseases. Diseases of the tongue, fauces, and pharynx. For example, the pain referred to the lingual nerve in epithelioma of the tongue. Diseases and injuries of the maxillæ. For example, the neuralgia associated with dental caries. Injuries and diseases of the nose and its accessory cavities. For example, the infra-orbital pain experienced in empyema of the antrum. Injuries and diseases of the bones of the skull. For example, the pain referred along the course of those nerves emerging through the basal foramina involved in a fracture of the base of the skull. Errors of refraction. For example, neuralgia of the supra-orbital nerve. Anæmia, influenza, alcoholism, Bright’s disease, cold, worry, malaria (brow-ague), rheumatism, &c. But slight allusion need be made to the _symptomatology_ of neuralgia minor--the conditions are more or less familiar to every one. The pain, though usually most intense in that particular branch of the nerve which is most intimately related to the source of the neuralgia, is often referred to other branches of the same nerve-trunk, and sometimes to an entirely different nerve. Thus, in the case of an epithelioma of the tongue, the pain, though perhaps most acute in the region supplied by the lingual nerve, is nevertheless frequently referred to the ear along the course and distribution of the chorda tympani.