The site at which the pain originates can often be fixed by the patient himself. Occasionally relief may be attained by pressure applied over some particular part, by heat or by cold, or by some other method discovered by the patient himself. The attacks are often accompanied by twitchings of the muscles supplied by the facial nerve, and, according to some investigators, by fibrillary twitchings of the muscles of the region affected. In the later stages, wasting of the muscles may be observed. _Vaso-motor and trophic changes._ The skin and mucous membrane supplied by the nerve involved become hyperæmic and hyperæsthetic, and, in the more chronic cases, these changes may be associated with œdema of the subcutaneous tissues--the clinical picture now closely resembling that observed in some cases of angio-neurotic œdema. Other symptoms of similar nature are herpes, increased salivation, furred tongue (on the side of the lesion), sweating of the skin, lacrimation, conjunctivitis, and keratitis. _General decline in health._ This depends, not only on the difficulty experienced in taking sufficient nourishment, but also on the moral effect produced by the more or less continuous pain. In the more severe cases emaciation is rapid. Treatment. 1. _Therapeutic remedies._ The following drugs have been recommended. Quinine, in large and increasing doses. Arsenic, given in a similar fashion. Gelsemium, in toxic doses, every few hours until tinglings in the fingers and nausea show that the drug has been pushed far enough (Sir Victor Horsley). Methylene blue, in three-grain doses (Sir Watson Cheyne). Iron, antipyrin, strychnine, cannabis indica, &c. Morphia. This drug is undoubtedly beneficial in its results, but the habitual use thereof is strongly contra-indicated, not only because of the temporary benefit received, but also because of the necessary increase in the quantity required to alleviate the pain. If persistently used the patient gradually develops the morphia habit. Some of these remedies suffice for the neuralgias minor, but with regard to their action in cases of neuralgia major, their effect may be summed up as follows: ‘True tic doloreux has been the therapeutic despair of most physicians and surgeons,’[70] and ‘too often the operation is put off till the patient is addicted to the morphia habit, depleted in strength and vitality by drugs, sleepless nights, and years of intense suffering’.[71]