The peripheral form of Bell's palsy, or facial paralysis, that arising from lesions of the nerve-trunk or nerve-roots in the pons, is one cf the most common of the peripheral paralyses. It is more often seen in early middle life, and in men than in women. The great ma jority of the cases have as their basis a neuritis of the facial nerve, due to ex posure to cold. Such cases are some times referred to as "rheumatic." Other causes are injury to the nerve-fibres, as from aceidental cutting during surgical operations upon the neck, or from blows, coinprcssion, temporal-bone disease, etc.
Treatment.—The pathological process underlying the paralysis, when such ex ists, should be first dealt with. In the common neuritic cases a mercurial purge should be given in the beginning, fol lowed by counter-irritation over the af fected nerve-trunk, in the form of a blister, the actual cautery, or a strong galvanic current. The internal adminis tration of salicylates or salol, continued for some days, is advisable. Iodide of potassium is almost always beneficial, even in cases destitute of syphilitic taint. It should be given in moderate doses, continued for a long time. After sub sidence of the acute syinptoms facial mas,sage and the local application of the faradic current in strength sufficient to produce muscular contraction will serve to hasten restoration of power to the paralyzed muscles.
Localized Neuritis.
Disorders of the GLOSSO-PHARYNGEAL, or ninth pair of cranial nerves, are at tended by perversions of the sense of taste, as well as by abnormalities of com mon sensation and motion in parts to which the nerve is distributed. The nerve rnay be affected alone, but is most often involved, along with the hypoglos sal, in the (nuclear) changes of bulbar paralysis.
The PNEUMOGASTRIC nerve, with its extensive distribution and varied func tions, gives, when affected by disease, a many-sided clinical picture, the more prominent features being, cardiac irregu larities and gastric disorders. The nerve is rarely alone involved, but not infre quently participates in the morbid changes of multiple neuritis, or beriberi.
It may also be affected from injury, as a result of pressure front a tumor, etc. The tachycardia and acute gastric symp toms pertaining to disease of the pneu mogastric nerve have already been re ferred to under multiple neuritis.
Some of the cases of "nervous" dys pepsia are attributable to disorder of the vagus. Some forms of paralysis of the larynx and pharynx, as well as some of the laryngeal neuroses, depend upon dis order of this nerve.
In 15 recorded instances in which the pneumogastric was accidentally involved in malignant disease or merely in acci dental injuries 11 died and 2 recovered, while in 2 instances the result was not reported. It is impossible to separate the causes of death so far as distinctly to state whether death was due to lesion of the nerve-trunk itself or to coincident lesions of other important structures.
Of 50 other eases the result is left in doubt in 2 instances, while, of the re niaining 48, 21 died and 27 recovered. Here, too, in the fatal cases, it is im possible to say that in any instance death was due to injury of the nerve.
The preponderance of testimony is in favor of the comparative safety of at tacking this nerve when involved in dis ease and when too much other operating is not necessitated by the condition for which intervention is undertaken. Ros well Park (Annals of Surg., Aug., '95).
The SPINAL ACCESSORY nerve may be affected by a neuritis, rheumatic or other, or by injuries, tumors, etc. The result is paralysis or weakness of sterno mastoid and trapezius muscles. Spas modic wryneck is sometimes traceable to spinal accessory disease.
The IIYPOGLOSSAL nerve is often in volved as a part of a bulbar palsy, or in course of general paresis or other degenerative nervous disease. The prominent symptoms are paralysis and atrophy', with fibrillary tremor in the side of the tongue, with deviation of the -tongue toward the sound side.
Neuritis of anterior crural nerve in childbed observed in 17 out of 1000 pa tients. Pain in the thigh began on about the third day, and there was distinct tenderness over point where the anterior crural nerve passes under the crural arch. It radiated to the hip, knee, and part of the foot supplied by the long saphenous nerve. ln all cases tbe pres entation was vertex, excepting 2 breech and 1 footling. Delivery was sponta neous in the remaining 13 eases. The cause of puerperal neuritis of the ante rior crural is obscure. Sepsis is out of the question, none of the eases showing evidence of such a condition. Meyer (Centralb. f. Gyniik., No. 25, 1901).