Heretofore the only recognized seat of an her¬ petic inflammation on a cranial nerve was that of the Gasserian ganglion of the trifacial. Herpes zoster in the distribution of one or more of its branches was the result. I believe, however, that the geniculate ganglion situated in the depths of the internal auditory canal at the entrance to the Fallopian aqueduct may be the seat of this specific inflammation. . . . As was long ago pointed out by Bärensprung and is now definitely established by the elaborate clinical and pathological researches of Head and Campbell, the primary or infectious form of herpes zoster is dependent upon a specific inflam¬ mation of one or more of the posterior spinal ganglia. Head suggested the name, posterior poli¬ omyelitis for the affection, and certain points of resemblance were drawn between it and acute an¬ terior poliomyelitis. The ganglia involved are swollen by the products of inflammation and by extravasation of blood, and in some cases even the sheath and nerve roots may be involved in the inflammatory process. In very rare instances the anterior or motor root, resting upon the sheath of the ganglion may be implicated and paralysis re¬ sult. . . .Where the herpetic inflammation attacks the geniculate ganglion, palsies are of much more fre¬ quent occurrence than in any other localization of the disease. I have collected 56 cases from the lit¬ erature to which I can add 4 personal observa¬ tions, making a total of 60 cases in which palsies accompanied the inflammation in this situation. This I would attribute to the peculiar location and relations of the ganglion involved.Clinically the cases of geniculate herpes resolve themselves into three groups. The simplest ex¬ pression of the disease is a herpes of the auricle and external auditory canal. Within this skin area is to be found the zoster zone for the geniculate ganglion. In another group of cases there is added to the aural herpes a paralysis of the facial nerve. This I explain by pressure of the inflamed gan¬ glion or in some cases by a direct extension of the inflammation to the nerve. The most interesting, as well as the most severe, type of disease occurs when the acoustic nerve is also involved. In this form there are with herpes auricularis and facial palsy, various auditory symptoms, ranging in se¬ verity from tinnitus aurium and diminution of hearing to the more severe forms of acoustic in¬ volvement as seen in Ménière's syndrome. In these cases I assume that the inflammatory process has extended to the auditory nerve which is envel¬ oped in the same sheath, and courses in the same canal as the facial nerve.Each of these groups has separately been the subject of careful study by many observers; but their intimate clinical relationship to one another, their common pathology and their common seat of origin, the geniculate ganglion of the facial nerve, has not heretofore been recognized. I have already expressed my belief that the geniculate ganglion has its cutaneous representa¬ tion and zoster zone in the auricle and ...

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In previous communications1 I have already elaborated in some detail the symptomatology and complications of the posterior poliomyelitis of the geniculate ganglion of the facial nerve; a syndrome which is characterized by herpes zoster oticus, facial palsy and auditory symptoms. When the ganglion alone is involved, herpes oticus results, the eruption being distributed in the central portions of the external ear. If the inflammation extends from the ganglion to the nerve-trunk, facial palsy follows; and when deafness and symptoms of M\l=e'\ni\l=e`\re'sdisease occur they are produced either by an extension of the inflammatory process to the adjacent auditory nerve or by simultaneous involvement of the peripheral auditory ganglia (Fig. 1). I shall now consider the localization of the same process in the peripheral root ganglia of the glossopharyngeal, vagus, and auditory nerves, their respective neural complications and the various clinical combinations which may occur.2 I shall also endeavor to differentiate the zoster zones of the geniculate, glossopharyngeal, and vagal ganglia on the external ear, and within the buccal cavity. It may be said in general that all of these clinical types are related, and together form a definite group of cases, which is characterized by herpes zoster of the cephalic extremity, with facial palsy, auditory, and pneumogastric symptoms in various combinations. This group forms an interesting chapter of herpes zoster, an affection which is distinguished by an eruption of herpetic vesicles, usually uni¬ lateral, and strictly limited to a definite area of the skin or mucous mem¬ brane (the zoster zone). The underlying lesion is an inflammation in