A text-book of practical therapeutics . ing statements by Cushing are worth reading, and Iwish to call particular attention to the fifth paragraph: 1. Deep extracranial injections of alcohol into the maxillary andmandibular nerve trunks near their foramina of exit from the skullhave completely superseded peripheral neurectomies. 2. In neuralgias limited to one of the two lower divisions andwhich may possibly not extend into the other trigeminal areas,alcohol injections represent unquestionably the treatment of choice. 3. When the neuralgia has spread beyond its original area andcome to involve
A text-book of practical therapeutics . ing statements by Cushing are worth reading, and Iwish to call particular attention to the fifth paragraph: 1. Deep extracranial injections of alcohol into the maxillary andmandibular nerve trunks near their foramina of exit from the skullhave completely superseded peripheral neurectomies. 2. In neuralgias limited to one of the two lower divisions andwhich may possibly not extend into the other trigeminal areas,alcohol injections represent unquestionably the treatment of choice. 3. When the neuralgia has spread beyond its original area andcome to involve that supplied by the adjacent division, a trigeminalneurectomy must be contemplated; but if no preceding deep injec-tion has been given, it may be useful not only in insuring the typeof the neuralgia but in giving the patient some warning as to whatthe numbness resulting from the neurectomy may amount to. 4. They are sometimes useful, furthermore, in determining indoubtful cases whether the syndrome is a true neuralgia of the tic <. OBESITY 881 douloureux type or one of the peculiar and rare pseudoneuralgiasnot amenable to relief either by injections or neurectomies. 5. Even these extracranial injections are not entirely free fromrisk, and in no cases should they be purposefully pushed to the pointof attempting an injection of the Gasserian sheath itself. 6. With such perfect and permanent results as may be securedtoday by a trigeminal sensory root avulsion, the prolonged andrepeated use of injections in refractory cases which involve more thanone division should be deplored. NIPPLES (SORE). Whenever the nipples become sore, so that it is impossible forthe mother to allow the child to nurse, a solution of cocaine of thestrength of 4 grains to the ounce () should be applied tothe part and washed off carefully just before the child sucks. Fol-lowing the nursing, a solution of boric acid, of the strength of 20grains to the ounce () or water or mucilage of acac
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