BELL'S PALSY OF THE FACIAL NERVE. 367 



sometimes are subjected to by enlarged lymphatic glands, or other 

 tumors, as well as contusions and concussions, resulting from blows 

 upon the ear, may give rise to facial palsy. It is not unfrequently ob- 

 served in newly-born children, when branches of the nerve have been 

 bruised by the forceps during labor. Sudden chilling of a warm face, 

 however, is a much more common source of facial palsy than any other 

 agent. Many patients acquire it by looking out of the window imme- 

 diately after rising in the morning. Holla attributes the increasing 

 frequence of facial paralysis to the railroads. People hurry to the 

 station, arrive there warm, enter the carriage, and expose their face to 

 the draught of the window. The result is a palsy of the face. 



The affection is a somewhat common one, so that J. Frank has 

 seen twenty-two cases of it in the course of fifteen years. Statistics 

 as to its frequence at various ages, and in different sexes, and different 

 sides of the face, have not led to any important conclusions. If it be 

 true that the affection is more common upon the left side of the face, 

 it is not on account of any predisposition of the left facial nerve, but 

 because of the greater exposure of the left cheek to blows on the ear, 

 and to other injuries. 



SYMPTOMS AND COUKSE. The symptoms of facial palsy consist in 

 an immobility and relaxation of the facial muscles, which are supplied 

 by the affected nerve-fibres. Palsy of the frontal muscle, and of the 

 corrugator supercilii, makes it impossible to wrinkle the forehead. 

 Romberg says : " The old man's forehead becomes as smooth as that of a 

 child, and there is no better cosmetic for old women." Palsy of the 

 orbicularis palpebrarum prevents the patients from shutting the eye 

 completely. If told to do so, they lower the lid a little, by relaxing 

 the levator palpebrae superioris, over which they still have control, and 

 roll the bulb upward, so as to hide the cornea. The tears are no longer 

 conducted to the lachrymal puncta, but flow down over the cheek. 

 The eye, being imperfectly closed, and exposed to all manner of inju- 

 ries, readily inflames. The levator labii superioris, alseque nasi, the 

 levator anguli oris, and the zygomaticus, are unable to draw up the 

 upper lip, nose, or commissure of the mouth, and to dilate the nostril. 

 The buccinator being disabled, the cheek puffs out during expiration, 

 like a loose sail. Some of the purposes for which the facial muscles 

 are employed, the pronunciation of the labial letters, whistling, blow- 

 ing, and expectorating, now fail. Even in chewing, which process, 

 being independent of the facial, goes on undisturbed, the morsel, when 

 on the affected side of the mouth, often falls between the teeth and 

 the cheek, and has to be disengaged thence by the fingers. When 

 the paralysis involves the whole of one side, there is a remarkable dis- 

 tortion of the countenance with every play of expression. This arises 



