The face as an index to disease / by Judson S. Bury.

  • Bury, Judson Sykes.
Date:
[1889]
Catalogue details

Licence: Public Domain Mark

Credit: The face as an index to disease / by Judson S. Bury. 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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    6 Of differences in size between the two sides of the face, the affection known as unilateral atrophy is the most remarkable ; in this disease the skin, connective tissue, and fat are thinned and wasted, while the muscles are spared; the bones too, if the atrophy begins in early life, may be arrested in their development, and then the two halves of the face look as if they belonged to different individuals, one side having the fulness of youth, the other the wrinkles of old age. Slighter degrees of another variety of hemiatrophy are also of importance to observe in connection with defects in the opposite hemisphere, and it is interesting to note that the atrophy has often a crossed distribution, thus—if some of the convolutions on the left side of the brain are wasted or wanting, the left parietal bone may feel flatter than the right, and the left side of the forehead shore off more than the right side, but below the eyes the arrested growth will affect the right cheek and the right limbs. Of this Fig. 2. condition I have seen several examples, and in one case (see Fig. 2) the right half of the tongue has suffered more than the right limbs. Slightor degrees of this asymmetry are by no means uncommon; indeed, it is> perhaps, rare to see perfect equality between the two sides of the face, and it may be that there is a corresponding asymmetry between the cerebral motor areas. Alterations in the size of the pupils and palpebral fissures are often of great aid in diagnosis. For example, narrowing of the palpebral fissure on one side with contraction of the corresponding pupil points to a lesion of sympathetic nerve fibres in some part of their course from the medullary centres through the cervical portion of the spinal cord, along the rami communicantes of the eighth cervical and first dorsal nerves, and upwards in the cervical sympathetic till they reach the muscles of the eye. Now this symptom, namely, sinking in of the eye-
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