times accompanies facial paralysis, and is commonly a sign of existing ear disease.

Treatment. The facial paralysis following exposure to cold usually disappears with complete recovery in from two to six weeks. Persons have been

known to have several attacks.

Hot applications should be made about the ear for the first few days. If there is running from the ear, or earache, an aurist should be consulted. The most valuable measures aiding recovery are electricity and massage, which must be managed by a physician. Some cases may run on for six or eight months, and yet eventually recover.

NEURALGIA.-Neuralgia means pain in a nerve or nerves. Theoretically there is no change of structure in the nerve in neuralgia, but practically it is occasionally impossible for even a physician to distinguish inflammation of a nerve (or neuritis) from neuralgia.

Causes. Neuralgia occurs more frequently in those inheriting a weak nervous system, in the overworked and underslept, the anxious, nervous, excitable person. It is rare in childhood, and many varieties, as facial neuralgia, are more common in women, while sciatica attacks men more frequently. A "run-down run-down" condition favors the disease, especially when combined with poor blood (see p. 446). Exposure to cold, bad teeth, overindulgence in alcohol and in tobacco, rheumatism, gout, kidney disease, diabetes, and lead poisoning are among the exciting causes. It is more apt

to attack women during pregnancy and the "change of life."

Symptoms.-Neuralgia may begin suddenly. More often there are some peculiar feelings, as a sensation of cold or prickling, before the pain commences. The pain is of a sharp, darting, shooting, stabbing, or burning nature, with intervals of a second or few minutes when the patient is free from suffering. It occurs more often on one side of the face or body. The skin over the painful region is sometimes red, swollen, and hot or cold, and very tender. When pain attacks the eye tears may flow; when the pain is referred to the teeth the saliva may flow freely. Neuralgia about the head leads rarely to falling or whitening of the hair. Twitching or spasms of the muscles in the painful area may be present. Painful spots along the course of the nerve which gives rise to the pain are a peculiar feature of neuralgia.

Attacks of neuralgia may subside without treatment in time, but are likely to last from one to several hours, and to return at regular or irregular intervals of long or short duration.

FACIAL NEURALGIA (Tic Douloureux). This is the most common form in women. The pain may be felt in the forehead, eye, and nose on one side of the face, with a spot of tenderness just above the eye. The eye is often bloodshot and the tears flow, or the pain is felt between the eye and mouth, with spots of tenderness on the side of the nose, below the eye,

and along the line of the gum of the upper jaw on one side of the face. Frequently the pain attacks the temple, ear, lower jaw, teeth, and tongue, with a tender spot in front of the ear; and there is increased pain in chewing and speaking, and saliva runs from the mouth. Neuralgia of the face occasionally causes severe pain, and continues obstinately for a long period, especially in those with inherited tendencies and in the elderly.

Neuralgia sometimes attacks the back of the head and neck, or the shoulder and upper arm, when the pain resembles that of rheumatism or of an injury to the shoulder.

Neuralgic pains of one side of the chest are not rare. They are much aggravated by motion, deep breathing, or coughing. They may resemble the pains of pleurisy, but there is usually no fever or cough; still, examination of the chest by a physician is essential to rule out the latter disease. With neuralgia of the chest may be associated an eruption on the skin known as shingles. After a few hours or days, or even a longer period, a red, tender spot appears, and upon this occurs a group of small blisters. When the eruption disappears the pain usually subsides, but may continue indefinitely, and there is great tenderness to touch. Shingles may be seen on the head, forehead, face, upper arm, shoulder, buttock, and thigh, accompanied with severe pain. It usually attacks only one side of the body, and is relieved by the remedies rec

Plate VIII

THE PALM OF THE HAND

The illustration opposite shows the nerves, muscles, etc., in the palm of the right hand, and gives some idea of the possibility of dangerous results from wounds or bruises of this member of the body. The nerves shown carry impulses of motion or sensation. Neglect of any deep injury involving the nerves may permanently cripple the hand.

The Arteries Shown in Red form the palmar arch, which supplies blood to the palm and fingers.

The Radial Nerve supplies the thumb, forefinger, middle finger, and half of the ring finger. The Ulnar Nerve is distributed to the little finger and remaining half of the ring finger. The Median Nerve supplies the muscles in the palm.

The Tendons that close the hand are shown as Broad Flat Bands entering the center of each finger near its surface.