On facial paralysis from cold : with special reference to its prognosis / by A. de Watteville.

  • Armand de Watteville
Date:
[1880]
Catalogue details

Licence: Public Domain Mark

Credit: On facial paralysis from cold : with special reference to its prognosis / by A. de Watteville. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    possibilities ; and even where they are positive, they do not enable us to reach a conclusion directly, but only through a pro- cess of inference in which of course any link may be erroneous and vitiate the conclusion. Thus, in an ordinary case of wrist-drop, where we find signs of degenerative atrophy, we cannot assume either a lesion of the musculo-spiral nerve arresting the trophic influence of the cord or a lesion of the trophic centres in the cord itself without taking into consideration all the features of the case, its history and concomitant symptoms. Again, to argue from the presence of a perfect electro-contractility in a paralysed nerve to the non- implication of its trunk, and to the cerebral localisation of the lesion, is to expose oneself to grave mistakes. For instance, a patient came to me with complete right facial paralysis. He complained of having a few days before felt strange sensations on that side of the face, with pains in his head. The next morning lie found, to his dismay, his face distorted to the left and immovable on the right. There was also some impairment of the sense of taste on the right side of the tongue. On apply- ing both currents successively, I found that both nerve and muscles reacted on both sides alike. Was I then justified in attributing a cerebral origin to the paralysis without any further investigation ? Far from it; apart of the fact that the upper branches of the facial were as completely paralysed as the lower ones—an unusual occurrence in paralysis of this nerve from cerebral cause—I obtained a clear history of exposure to a cold draught, and diagnosed the case as one of peripheral Bell's palsy. The electrical investigation having proved that the nutrition of the muscles was not impaired, and that the nerve had not suffered beyond losing its conductivity to voluntary impulses, my prognosis—which a short time sufficed to justify—was most favourable. Very different was another case in which a similar cause—exposure to cold air during a railway journey—resulted in paralysis of the left facial nerve. Here I found a complete abolition of response, nervous and muscular, to the strongest faradic currents. Strong galvanic shocks failed to stimulate the nerve; whilst the muscles freely responded to the galvanic stimulus ; indeed, on the diseased side a much weaker current was necessary to make them contract than on the sound side. But beyond this “ quantitative ” alteration
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