The Surgical Aspects of Major Neuralgia of the Trigeminal NERVE.A Report of Twenty Cases of Operation on the Gasserian Ganglion, With Anatomic and Physiologic Notes on the Consequences of Its Removal.

Case 16. —Mrs. R., aged 55, was referred to me by Dr. Baker of Elmira, N. Y., through Dr. Osler. History. —She had suffered for fifteen years with a neuralgia which originated in the supraorbital territory. It had become acutely aggravated a few years before her ganglion operation after an exposure to a cold wind. She had taken opiates in large doses during this entire period and, indeed, had been addicted to the habit before the onset of her neuralgia. For the last year the pain had been extreme and almost continuous. A constant attendant was necessary, day and night. All inhibition was lost and she invariably screamed aloud during her paroxysms. She was more or less narcotized most of the time and seemingly was maniacal. The teeth had all been extracted at one sitting two years before. No peripheral neurectomies had been undertaken. The entire territory of the fifth nerve