BELL'S PALSY OF THE FACIAL NERVE. 369 



According to Bomber g, the following are the signs whereby we 

 may recognize whether the source of the paralysis is to be sought 

 within the cranium, in the petrous bone, or upon the face itself: 1. 

 We may infer that the affection originates in disease at the base of 

 the skull, when there is participation of other cerebral nerves in the 

 palsy, as shown by squinting, deafness, anaesthesia, etc., as well as by 

 the simultaneous occurrence of palsy of the extremities of the other 

 side of the body. 2. Evidence that the palsy originates in a disease 

 or destruction of the facial nerve within the canal of Fallopius con- 

 sists in long-standing otorrhcea, hardness of hearing or complete deaf- 

 ness, obliquity of the uvula, dryness of the mouth, perversion of the 

 sense of taste, which depends upon implication of the nervus petrosus 

 superficialis minor and chorda tympani, which are never affected except 

 hi this form of the disease. 3. We know that the palsy proceeds from 

 the peripheral ramifications, when the disease is plainly dependent 

 upon exposure to cold, or upon some violence done to the face, or upon 

 the pressure of a tumor upon the facial nerve, especially in the region 

 of the stylo-mastoid foramen, the ear itself meantime being sound, the 

 taste normal, and the uvula straight. 



The course of facial palsy varies greatly, according to the seat and 

 nature of its cause. Where the nerve has been destroyed by a tumor 

 at the base of the skull, or by caries of the petrous bone, the palsy is, 

 of course, incurable, as is also the case when a tumor has broken the 

 continuity of the nerve by continued pressure upon its peripheral 

 branches. When the affection proceeds from exposure to cold, or from 

 slight injuries, the prognosis is better. This is especially true of the 

 congenital palsy induced by pressure of the obstetric forceps. But, 

 even in adults, it by no means invariably happens that traumatic or 

 rheumatic paralysis disappears in the course of a few weeks or months. 



TREATMENT. From what has been stated regarding the prognosis 

 of facial palsy, the rheumatic and traumatic forms of the complaint 

 are the only ones susceptible of treatment. Although they usually 

 recover without interference, it is better, in recent cases of traumatic 

 origin, to employ local antiphlogistics. Whenever an adult has a 

 palsy of one side of the face, caused by a blow or shock, we should 

 prescribe leeches and cold compresses, and should rub the part with 

 mercurial ointment. Congenital paralysis, also, when of traumatic 

 origin, may be left alone. When the disease arises from cold, and is 

 recent, the affected side of the face is to be covered with well-wrung 

 cold compresses, covered with oil-silk or india-rubber cloth, which are 

 not to be changed until after the lapse of several hours. The face may 

 also be enveloped in cotton wool, and a vapor-bath may be taken. At 

 a later period stronger irritants may be used : lotions of essence of 



