370 DISEASES OF THE PERIPHERAL NERVES. 



mustard, mustard-plasters, embrocations of croton-oil, blisters, etc. A 

 great number of cases are on record in which rheumatic facial palsy 

 has been cured by the application of the constant galvanic current. 

 In two cases, I myself have succeeded in effecting a cure, although but 

 a gradual one, by employment of galvanism. In each of these cases, 

 treatment by the induced current remained without effect. Where 

 the electric contractility can be reestablished by localized faradization, 

 the cure will be promoted and hastened by the methodical use of the 

 induced current. 



CHAPTER XXI. 



PALSY OF THE SERRATUS MUSCLE. 



ETIOLOGY. In rare instances, two of which have come under my 

 personal observation, palsy of the serratus has formed part of a myo- 

 pathic paralysis, involving many of the muscles, the result of the so- 

 called progressive muscular atrophy (see appropriate chapter). The 

 affection is much more commonly confined to the serratus alone. This 

 fact, and the circumstance that the long thoracic nerve is not distrib- 

 uted to any other muscle except to the serratus anticus magnus, would 

 imply that most cases of palsy of the serratus are neither of cerebral 

 nor of myopathic origin. We have laid it down as an important sign 

 of the peripheral nature of a palsy, that the affection involves the re- 

 gion supplied by some particular nerve, and while neighboring muscles 

 supplied by other nerves remain sound. Besides this is the well-known 

 fact that peripheral palsy and peripheral neuroses by preference affect 

 the region supplied by nerves which pass through long, narrow chan- 

 nels and holes, like the long thoracic, which runs through the scalenu? 

 medius. This very important point in the pathogeny of palsy of the 

 serratus, and the proof of the fact that, in most of such cases, we have 

 to deal with a peripheral neuropathic affection, have not hitherto ob- 

 tained the notice which they deserve. 



The exciting causes of palsy of the serratus are usually obscure. 

 It is plain that the long thoracic nerve, in its passage through the 

 scalenus medius, may suffer injuries which escape our attention. In 

 some instances, over-exertion of the upper extremities, or cold, has 

 been the assigned cause. In one observation, reported by Neuschler, 

 the palsy of the serratus was preceded by a fall, and a tumor afterward 

 formed in the neck, which the physician in charge proposed to open by 

 mcision. In one very interesting case, which came under my own ob- 

 servation, a carpenter, who used to carry the heavy beams for build- 

 uigs upon his right shoulder, had to employ the left shoulder instead, 



