Facial Palsy, paralysis of one side of the face, is due to some affection of the part of the seventh cranial nerve (p. 152) which confers movement on the muscles of the face. This affection of the nerve may o-cur in any part of its course from the brain to the muscles of the face. The common form, and the form which it is desirable to note in this place, is fre quently due to cold caught by a person sitting in a railway train at the side of an open win dow and facing the engine, so that the draught blows on one side of the face. It has been mentioned that one half of the face is paralysed in hemiplegia, but this paralysis of the face differs from what is called facial palsy in the completeness of the paralysis in the latter case as shown by the symptoms.
side of the face is motion less, quite smooth, unwrinkled, and soft. The patient cannot shut the eye of one side, the eyeball is consequently exposed continually, dust may lodge on it, and thus a state of con stant irritation is set up, and the tears flow over the cheek. The person cannot whistle or blow out a light. When he tries, the paralysed cheek is simply blown up with the air. When he eats, food is apt to lodge between the gums of the affected side and the cheek, and is pro ductive of great annoyance. Sometimes the hearing and taste are affected. The brow is smooth on the palsied side, and when the patient wrinkles his brows only the healthy side is thrown into furrows. The face is drawn to the healthy side by the action of the muscles of that side. When the person tries to laugh or make a grimace the result is very ridiculous, one side responding and the other being abso lutely smooth. Now in paralysis of the face, due to hemiplegia, the eye and forehead usually escape.
Besides cold, rheumatism, inflammation of th3 ear, and decayed teeth may cause this affection.
Treatment. — Let the patient be sure that rheumatism, ear or tooth affection, is not present to account for the paralysis. If it is believed to be due to cold, the probability of recovery is great, but not for a few weeks or perhaps some months. If it is due to cold, the speedy ap plication of leeches on the bone immediately behind the ear, and, after it, blisters, hot fomen tations, &c., are recommended. Later the most beneficial treatment is with electricity, which, even after the lapse of considerable time, will restore the nourishment and tone of the muscles, and has great chance, with patient use, of ulti mately restoring voluntary movement. Let it
be observed that electricity does not mean mag netism, and that the use of magnetic belts, collars, &c., are absolutely valueless. The electricity to be used is either that obtained directly from a galvanic battery, or the kind called induced electricity, obtained by sending a galvanic cur rent round a specially constructed coil of wire (induction-coil), and the electricity should be directly applied to the paralysed muscles.
There are several varieties of paralysis due to degenerations going on in various portions of the spinal cord. Some of these will be briefly described, others will only be mentioned.
Locomotor Ataxy (Greek a, not, and ono, to order) is a peculiar disease, so called because sufferers from it cannot order their movements for definite purposes, so that walking is difficult, and there is a peculiarly awkward gait.
The symptoms are specially connected with movement. The person needs to guide the movements of his feet and legs by means of his sight, so that if his eyes are shut, or if he is in the dark, he loses balance, and cannot go at all. When he walks, his feet are lifted up ex travagantly high and jerked out and brought down in a violent way. This difficulty of move ment is called " want of co-ordination of move ment." In advanced stages it becomes so ex treme that the person cannot take even a couple of steps, and is confined to his bed or chair, and this although there is plenty of muscular power in his limbs, and although he can move them easily enough when lying in his bed. Associated with the difficulty of movement is a peculiar tingling and numbness and loss of sen sibility in his toes and feet, so that he feels as if he were walking on some thick soft material. These are the most striking symptoms when the disease is developed. For some time previous to this, however, perhaps even for years pre viously, there may be what are called premoni tory symptoms. The chief of these are shoot ing and boring pains affecting the trunk and lower limbs. There are also feelings of con striction and pains connected with the abdomi nal organs, especially intense pains in the stom ach. There are also affections of various other parts of the body, joints, ear, and eye. There may be squinting, double vision, defective sight. In particular the pupils of the eye are very small. The disease extends to the hand and arm, and their movements are affected, the clumsiness of movement being remarkable.