PARALYSIS. 453 



time quite unable to account for this, but on consideration has no doubt he lost his 

 place in consequence of his staggering having been attributed to the effects of drink. 

 For two years he endeavoured to obtain employment, but unsuccessfully, and 

 being in trouble and distress, paid very little attention to the condition of his health 

 or the progress of his complaint. At the expiration of that time his powers of 

 walking were found to be greatly affected. On attempting to take a step, the leg 

 was thrown up in the air, and then brought down violently, the heels first coming 

 in contact with the ground. He could walk for a short distance, but was obliged 

 to take every opportunity of steadying himself by the table and other articles of 

 furniture about the room. His greatest difficulty in locomotion was in crossing 

 the road, and going round cornel's. Stepping on the curbstone was always a difficult 

 and delicate operation. He would often walk in the road until he came to a 

 lamppost by which he could assist himself on to the pavement. He was quite 

 unable to stand alone in the dark, and merely turning out the gas would cause him 

 to fall almost as if he were shot. There was no true paralysis, for when the patient 

 was in bed he could move his legs in any direction. He suffered greatly from pains 

 in his limbs, which he described as being " sharp, rheumatic, spasmodic, like 

 toothache." He derived considerable benefit from taking physostigma. He had 

 some pills given him, each containing a thirty-second of a grain of extract of 

 "physostigma, and of these he took one, six or eight times a day, for three or four 

 months. At the end of that time he could walk very much better, and could cross 

 the street, and step from the road on to the pavement with comparative ease. At 

 times he could walk almost as well as ever, and there was distinct improvement in 

 other respects. The physostigma did him a great deal of good, in spite of the fact 

 that from domestic and other reasons he was very unfavourably situated for carrying 

 .out systematically any plan of treatment. 



Facial paralysis is a variety of palsy in which only the muscles of the face are 

 affected. It most commonly arises from cold, as when a person is exposed to a 

 draught in driving or in a railway carnage, but it sometimes arises from rheumatism, 

 and other causes. The appearance presented by a patient affected with facial palsy 

 is peculiar and very striking. He cannot knit the forehead, neither can he raise 

 the eyebrows or draw them together. The eye remains open, as the power of 

 closing the lids is lost, and their blinking movement no longer exists. From one- 

 half of the countenance all power of expression is gone ; the features are blank, still, 

 and unmeaning ; the eyelids apart and motionless. The other half retains its 

 natural cast, except that in some cases the angle of the mouth on that side seems a 

 little awry. The patient cannot laugh, or weep, or frown, or express any feeling or 

 emotion with one side of his face, while the features of the other may be in full 

 play. Further, the patient cannot whistle, for he is unable to purse up his mouth 

 for that purpose, and for the same reason he can neither spit nor distend his 

 cheeks with air, or blow wind from the mouth. In mastication portions of food 

 are apt to collect between the cheeks and gums, as the support of the lips and 

 cheek necessary for its proper performance is lost. The saliva and fluids fre- 

 quently trickle from the mouth. At the same time it must be remembered that 

 this particular form of palsy is much less serious than the other forms we have 



