The cause of the paralysis is either an internal one (an apoplectic stroke), in which case other parts of the body may be involved ; or it is an external one, such as exposure to constant draught, or injury to the nerve itself. The patient may, for instance, have exposed one side of his face to a draught of cold air by sitting for hours in a railway train by an open window. Facial paralysis following an apoplectic stroke is usually very persistent. Serious damage to the brain-tissue has occurred, and is not readily overcome. Only in the most favourable cases is it possible to achieve a certain degree of improvement in the course of time and with proper treatment. Paralyses due to involvement of the nerve itself, as those following exposure to cold, run a more favourable course. The mildest forms of paralysis of this nature may be cured in a few weeks or months under proper medical treatment ; in the severer cases it takes several months to effect a cure. In those rare instances where the cause is other than a simple exposure to cold, it may be impossible to effect recovery. The paralyses due to diseases of the ear are frequently of this nature.
The treatment for paralyses due to internal causes includes the appli cation of electricity to the affected part, massage, sweating-baths, and packs. Where an apoplectic stroke is the cause, the treatment consists in regula tion of the mode of living, rest, and internal medicines ; recent cases may be benefitted by the application of ice or cold compresses to the head, and by blood-letting. Rubbing the affected half of the face with alcohol stimu
lates the skin and promotes the circulation of the blood. The much-vaunted, so-called " apoplectic waters " are humbugs. The sufferer should learn to acquire patience.
Spasms of the Face.—l? the faces of many persons, especially under the eyes, there is often 'observed a rapid, periodical twitching of the muscles.
The affection is designated as a convulsive tic. It may involve, also, other muscles, sometimes causing peculiar facial grimaces. It is not a painful affliction, but is disturbing and inconvenient. These spasms may occur on one or both sides of the face, and are caused by affections of either the jaws, the eyes, or the cars. Painful diseases of the teeth, paroxysmal pains of the face, as well as a number of nervous diseases, such as hysteria and St. Vitus's dance, may give rise to the " making of faces." A frequent form of facial spasi•is " winking " of the eyes.
Electricity, almost the only remedy employed in the treatment of this disorder, does not give as certain and rapid relief as repeated stretching and massage of the affected muscles. Pure nervousness or fatigue • may he the cause of many of these tics, and in such cases rest and food are frequently sufficient to bring about relief. The movements are often self-induced, and these are among the most difficult to cure. The patients get into a bad " habit," and the convulsive movements, at first voluntary and readily controllable, gradually become almost beyond the control of the patient.