372 DISEASES OF THE PERIPHERAL NERVES. 



CHAPTEK XXII. 



PROGRESSIVE PALSY OF THE CEREBRAL NERVES PROGRESSIVE PALSY 



OF THE TONGUE, VELUM PALATI, AND LIPS GLOSSOLARYNGEAL 

 PALSY. 



A SERIES of observations have recently been made, particularly by 

 French writers, of a paralysis, which, commencing at the lips, extends 

 successively to the tongue, palate, pharynx, and sometimes to the 

 muscles of the glottis, more rarely to those of the eyes. In all cases 

 hitherto observed no coexistent derangement has been perceptible in 

 the sensory nerves, nor in those of special sense. 



The pathogeny of this peculiar disease is obscure. The only lesion 

 constantly found post mortem is an intense fatty atrophy of the pal- 

 sied nerves, especially the hypoglossal nerve. In some cases a diffuse 

 sclerosis of the medulla oblongata has also been found. According to 

 an hypothesis which is as yet unproved, advanced by Wachsmuth, who 

 proposes to call the malady in question " bulbar palsy," the disease 

 consists in a " central affection of the medulla oblongata, having its 

 seat in the olivary bodies, and in the gray matter lying far back be- 

 tween the diverging lateral and posterior columns, and which forms 

 the floor of the fourth ventricle. According to Wachsmuth, the atro- 

 phy of the nerves is secondary, and a consequence of the degeneration 

 suffered by the nuclei at the points above named. In some cases the 

 palsy of the region supplied by the cerebral nerves was preceded by 

 the symptoms of an incipient, progressive muscular atrophy, and the 

 majority of French authorities regard the two diseases as closely 

 related, although, in the progressive palsy of the cerebral nerves, no 

 diminution in size is observable in the affected muscles. At the out- 

 set the patient makes but little complaint. He cannot pucker up his 

 mouth, and hence cannot blow, whistle, nor spit. The saliva which 

 collects in the mouth runs from it involuntarily. The expression of 

 the countenance becomes blank and strange, as the muscles of the lips 

 cannot take part in the play of expression. Pronunciation of the 

 labial letters is difficult, and gradually becomes impossible. If the 

 malady extend to the tongue, not only does articulation become still 

 more embarrassed, but the acts of chewing and swallowing become 

 impeded; and afterward, when the tongue has become still more help- 

 less lying quite motionless in the mouth these acts are no longer 

 practicable. Palsy of the palate shows itself from the nasal tone of 

 the voice, and, as long as the pharyngeal muscles remain sound, by the 

 regurgitation, through the nose and mouth, of food and liquids which 

 enter the pharynx. If the pharynx also become palsied, the patient, 



