Introductory lecture to a course of lectures on the theory and practice of physic : to be delivered at the Medical School in Aldersgate Street / by Marshall Hall.

Marshall Hall

Date:: [1835?]

Credit: Introductory lecture to a course of lectures on the theory and practice of physic : to be delivered at the Medical School in Aldersgate Street / by Marshall Hall. Source: Wellcome Collection.

Provider: This material has been provided by King’s College London. The original may be consulted at King’s College London.

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$accompanied with the most frightful grim- ace, of which the patient is unconscious. The countenance changes and becomes hide- ous, and it is hardly possible to recognise it. This alteration of the features is much greater on the left than the right side of the face. This phenomenon may, I think, be explained by the lesion of the sub-orbitar nerve. With regard to the sensibility ac- companying the mastication, which, a month after the accident, was still felt, it must be attributed to the passing of the ball through the sub-maxillary alveoli, and to the shock resulting from it.” 1147. For my own part, I do not pretend to have understood the case, which I have given § 1137, and which I observed and detailed merely as one of clinical observa- tion and diagnosis. M. Beauchene, the author of the second case, is absolutely iu error in considering it as an affection of the sub-orbitar nerve. I now lay before you a sketch of this spasmodic tic:— V I1] fw • n ' 1 ' Wx f 1148. In this case the countenance is also drawn to the right side; but it is the eye of the same side which cannot be closed. It is distinguished by this circumstance, from paralysis of the facial nerve of the left side. In this there is a spasmodic affection of that nerve on the right side. It is a peculiar affection not discriminated from the former, and will be illustrated by the fol- lowing case:— 1149. George Jefferson, aged forty, for- merly a lamplighter, now a seller of fruit in the streets, was affected three years ago w ith general rheumatism, in the midst of which this singular affection of the muscles of the face came on. 1150. The two sides of the face are not | alike; the left is nearly natural, but the right is affected with spasmodic contrac- tion; the chin is drawn to one side and dimpled ; the right angle of the mouth is drawn down\vards ; the right eyebrow Is higher than the left. Sometimes there is a a little rapid spasmodic action of the muscles. 1151. When he is told to shut the eyes promptly and forcibly, the distortion is ten- fold ; the right eye is drawn and only par- tially closed ; the right angle of the mouth is drawn spasmodically downwards; the nose and the chin are drawn to the right side. 1152. He laughs, and bites perfectly on the left side. On attempting to open the mouth wide, it is obviously tied by the muscles of the right side. He cannot whistle; in the attempt to do so the mouth is drawn to the right side. 1153. He takes snuff through both nostrils indifferently; on sneeziug, the left side of the face is chiefly distorted. 1154. The right side is a little benumbed in feeling; it is also colder, after exposure to cold, than the left. 1155. Besides these two cases I have seen several others; in one there was a defect of vision, with the spasmodic tic ; in another the tic was confined to the outer portion of the orbicularis. The former was of the most extreme character; the fact N$