18. Facial Paralysis. By CHAS. G. BACON, M. D., of Oswego. Mr. D. F. S., an intelligent, active, and temperate man, aged twenty-one years, came to consult me, on the 5th November, 1857, for a paralysis of the left side of the face.

He stated that while at work digging potatoes, with his brother, on the 30th of October last, being a cold, windy day, he experienced, as he says, a disagreeable stiffness in the left side of the face, upon which the cold wind had been for some time blowing, he commenced rubbing the side of the face, and making efforts to move the muscles, or bring his face to its natural feel and use, but could not. He then called the attention of his brother, by telling him that he could not whistle; after which, and through the remainder of the day his distorted appearance was the subject of remark and jest by his brother.

He now presents the following state: The features at the left side of the face blank, unmeaning and motionless, while those of the right side retain their natural motions, and their lines are more strongly marked, and the angle of the mouth is drawn upwards and towards the right side to a considerable extent. The lids of the right eye are half closed, while those of the left are open, and he has not the power of closing them. When desired to close his eyelids, the eyeball rolls upward, and the cornea is covered behind the curtain of the upper lid, the lower lid hangs down, exposing the conjunctiva and allowing the tears to trickle down the cheek. On an attempt at blowing, the left cheek is puffed out, and when attempting to drink, a quantity of the water escaped at the left angle of the mouth. In masticating his food, the morsel gets between the cheek and gum on the left side, and he is obliged to put in his finger to dislodge it. Sensation on the paralysed side is more acute, and there is a sense of soreness extending back to the mastoid process on the left side. There is no deafness, alteration of taste or loss of vision. With respect to the tongue, he says it feels awkward and sore on the left side; the muscles, however, seem to have suffered no injury; he can direct it with facility to either side. There is a slight degree of

thickness of speech, and awkwardness, which can be remedied by supporting the paralyzed cheek with the hand. He complains of soreness in his jaws, and inability to open the mouth wide, so as to enable one to see his fauces, which are red and triflingly swol len. He can masticate his food with some difficulty, frequently having the mucous membrane of the cheek drawn between the teeth, and could move the lower jaw so as to incline the symphesis to either side, but more to the right than the left side.

His health has been good up to this attack, since which he has experienced pain on the left and back part of the head, inclined to paroxysmal-not continual, neither periodical. Bowels nearly regular, inclined to sluggishness in their motions.

Tongue coated with short white coat; mucous membrane of tongue redder than in health; pulse 75 in the minute, leaving the finger quick and easily compressed; tonsils, velum, palati, together with the mucous membrane of the fauces, were somewhat inflamed and swollen. He has no dens sapientia, but the gum over the upper maxilla where the third molar usually appears, on the left side, was swollen to some little extent, and tender to pressure. No swelling on the right side.

Diagnosis. Paralysis of the left side of the face from irritation of the facial or seventh nerve by the dens sapientia of the upper maxilla of the left side, and exposure to cold air.

Treatment. The swollen gum was freely incised, and he was directed to use at bed time a foot bath, as follows: R. Mustard ground, 1 ounce, boiling water, 4 galions, cool so as to be able to keep the feet in for 30 minutes; to take 10 grs. of the compound cathartic pill of the U. S. Dispensatory; bathe the parts over the mastoid region and around the angle of the jaw with the camphorated liniment, with tinct. opii. Diet to be light, and easy of digestion.

Nov. 5th. Paralysis nearly the same; less head ache; pulse 72, full and soft; cathartic caused five motions of the bowels. Directed to continue the use of the liniment, and apply fomentations of anthemis.

7th. Face appears less distorted; says he feels well excepting the face; Applied the electro magnetic machine, placing one pole of the battery over the mastoid process, and the other on the symphisis mentis, moving it over the left side of the face, following the different branches of the portio dura, causing some little twitching of the paralyzed muscles, and afterwards a slight burning sensation in the cheek.

This was repeated every day, or every other day, with apparent improvement, until the 15th Dec. 1857. In addition to the elec tro-magnetism, he took every three or four days an aperent, first an infusion of senna and mint, afterwards rhei. et magnesia, viz., R. rhei. 8 grs., magnesia cal. 15 grs., zingber 5 grs., M. ft. pulv., to be taken at a dose in syrup.

Also on the 1st Dec. applied a vesicatory to the mastoid region, and after removing the cuticle, sprinkled on the denuded surface one-eighth gr. strychnia twice a day for two days, when he refused to apply it, and was ordered to take 15 drops of the following: R. strychnia three grains, alcohol one ounce. Of this he took, however, but a few times. We saw no marked effects from the strychnia in this case.

Dec. 15th, '57. His appearance is much improved; his speech is natural, and when his mouth is closed the face nearly natural, but in laughing or in conversation, the right corner of the mouth is raised. At this time our treatment of the case ceased for the time, and he resumed his business, and I lost sight of him, until in March following, when his palsey had ceased entirely; the muscles of the face used at will, and the appearance the same as before the attack. The wisdom tooth on the upper jaw of the left side, had appeared through the gum, and the only third molar to be found in his mouth.

Since March last he has enjoyed uninterrupted good health to the 13th of January, '59, when he was seized with pain in the right and back part of the head, extending down to the shoulder and arm, continuing more or less severe until the 15th inst., when the pain in the head abating, he found a slight palsy of the face on the right side; paralysis increasing gradually until the 17th inst., when he came to my office to consult me. I found the right side of the face in a like state as the left was when first seen by me in the fall of 1857. At this visit I had him set for the purpose of getting a picture of his face, which was hastily taken. You will be able to judge of the degree of paralysis, somewhat, by comparing this ambrotype, which shows his face paralyzed, and the daguerreotype, here, which was taken before the attack of palsy, in 1857.

At this time, 17th January, '59, he seems more unwell, and is suffering more pain than he did during the previous palsey. He has still but the one wisdom tooth which made its appearance last March. His appetite and digestion is nearly normal. The gum on the right side is swollen, and the appearance of the fauces are

about the same now as they were when I first examined him for the palsey on the left side of the face, in 1857.

The gum on the right side was freely incesed, and 10 grs. of the co. cathartic pill of U. S. D. ordered to be taken at bed time; also to apply fomentations of camomile flowers to the angle of the jaw. Diet to be light and easy of digestion.

19th. Appearance of his face a trifling better; has had less pain; cathartic operated four times; pulse 75, full and soft. He is to take 10 drops of the tinct. hellobori nigri every six hours, in a little water or mint tea; also to bathe the mastoid region, right side of the face and shoulder with the camphorated liniment, three times each day; to confine himself to the house and avoid excitement and active exertion.

23d. He called at my office; face appears rather improved, if any change; yesterday in the afternoon, and all night, had severe pain in the right side of head, neck and shoulder; subsiding this morning, and now 2 P. M., is free from pain, excepting a soreness in the right side of face and head; has not had a motion of the bowels for the last 24 hours; pulse 72; regular and full; appetite good; secretions, as far as I could ascertain, nearly normal. To take R.-Rhei. pulv., 5 grs.

Magnesia cal., 15 grains.

Zingber pulv., 5 grs. ft. pulv.

To be taken in a little syrup; to continue taking the tinct. hellobori nigri, and call again on the 25th inst.

January 25th.-Paralysis about the same; has no pain about the shoulder or arm now, but some in the mastoid region of the head on the right side; has had two evacuations of the bowels yesterday morning from the Rhei. comp.; suggested to him to use the electro galvanism, which he says he does not desire to do, if he can possibly get well without it, as he says it gave him so much pain when used in 1857; he is to continue the drops and liniment.

27th. He called at my office; was out the most of the day yesterday; has been nearly free from pain since the 25th; distortion of the face a little less; gum on the right side but little swollen; but little appearance of the tooth; redness of the fauces less; consented to the application of the galvano electro fluid, which was applied as in 1857, in slight shocks; causes a little occasional twitching of the paralyzed muscles; he bears it well; does not complain of any pain, excepting a burning sensation under the poles of the battery on the face; he is to continue taking the drops and use the liniment, as recommended before."

He has called at my office every day since the 27th. His general health appears now, the 31st inst., to be good. There is still some little congestion of the fauces; the gum is less swollen, and but little indication of another tooth at present.

The paralysis of the face appear a little less; the tears from the eyes flow in their natural channels; he can drink liquid without any running from the angle of the mouth; his conversation is with but little impediment; he has had the electro magnetism applied each day since the 27th inst., about ten minutes at a time, we think, with sensible improvement.