The above is a well-marked example of neuralgia of the trigeminus causing secondary inflammation and ulceration of the eye of a precisely similar kind to that which had been experimentally produced by Magendie by section of the fifth, at or posterior to its Gasserian ganglion. We shall see, hereafter, how extremely important are this and similar facts, not only in regard to the clinical history, but also to the pathology of neuralgia in general.
The first regular attempt, I believe, to classify the complications of neuralgia, was made by M. Notta, in a series of elaborate papers in the "Archives Generales de Medecine" for 1854. We may specially mention his analysis of a hundred and twenty-eight cases of trigeminal neuralgia, which is well fitted to impress on the mind the frequency, though, as we shall presently see, it does not adequately represent the seriousness, of these secondary disorders. As regards special senses, Notta says that the retina was completely or almost completely paralyzed in ten cases, and in nine others vision was interfered with, partly, probably, from impaired function of the retina, but partly, also, from dilatation of the pupil or other functional derangement independent of the optic nerve. The sense of hearing was impaired in four cases. The sense of taste was perverted in one case, and abolished in another. As regards secretion, lachrymation was observed in sixty-one cases, or nearly half the total number. Nasal secretion was repressed in one case, in ten others it was increased on the affected side. Unilateral sweating is spoken of more doubtfully, but is said to have been probably present in a considerable number of cases. In eight instances there was decided unilateral redness of the face, and five times this was attended with noticeable tumefaction. In one case the unilateral tumefaction and redness persisted, and were, in fact, accompanied by a general hypertrophy of the tissues. Dilatation of the conjunctival vessels was observed in thirty-four cases. Nutrition was affected as follows: In four cases there was unilateral hypertrophy of the tissues; in two, the hair was hypertrophied at the ends, and in several others it was observed to fall out or to turn gray. The tongue was greatly tumefied in one case. Muscular contractions, on the affected side, were noted in fifty-two cases. Permanent tonic spasm, not due to photophobia, was observed in the eyelid in four cases, in the muscles of mastication four times, in the muscles of the external ear once. Paralysis affected the motor oculi, causing prolapse of the upper eyelid, in six cases; in half of these there was also outward squint. In two instances the facial muscles were paralyzed in a purely reflex manner. The pupil was dilated in three cases, and contracted in two others, without any impairment of sight; in three others it was dilated, with considerable diminution of the visual power. Finally, with regard to common sensibility, M. Notta reports three cases in which anæsthesia was observed. Hyperæsthesia of the surface only occurred in the latter stages of the disease.