Of recent years my attention has been called to a number of cases of neuralgia, the exciting causes of which were obscure, as is frequently the case. Among others was a case of supposed tic douloureaux accompanied by the apparent death of the periosteum over a larger portion of the lingual surface of the inferior maxilla of the left side. While the exciting cause in this case may have been central, it apparently was peripheral; it yielded to local treatment, which fact strengthened belief in the peripheral origin. The finding of this lesion was the result of desperate effort, every logical treatment, both systemic and local, having been resorted to, aside from nerve section, and all without relief.
—Mrs. X., aged 55 years, suffered with paroxysmal pains resembling tic douloureaux; these continued with increasing tendency for three or four years, always including the first molar, which was the