488 PROP. B. C. A. WINDLE ON TEBATOLOGICAL EVIDEIfCE 



are — a brittle character of the hair, which frequently becomes 

 grey or falls out ; circumscribed areas o£ inflammation of the 

 skin, and the appearance of a vesicular eruption upon the face 

 (often following the distribution of certain nerves), which may 

 also occur on the cornea, constituting the neuralgic herpes 

 corncEe of Schmidt-Eimpler. Lastly, there is the progressive 

 atrophy of the face, which is usually confined to one side, but may 

 occur on both sides. It is caused very probably by atrophic 

 affection of the trigeminus, although the vaso-motor nerves may 

 also be affected reflexly." The following cases will illustrate 

 the effects : — 



(1) Otto Schmidt* was first affected at the age of ten, 

 atrophy of the left side of the face commencing at that age. At 

 the age of forty-one, the muscles, boues &c. of the left side of the 

 face were much smaller than those of the right, and all the sub- 

 cutaneous fat had quite disappeared, no hair save a very small 

 moustache growing upon that side. The left orbit was much larger 

 and the eye deeply sunken from disappearance of the post-orbital 

 fat. Atrophy did not extend beyond the vertex. The median line 

 of the face was crescentic, with the concavity directed to the left, 

 from the shrinking of that side. The left side of the tongue was 

 atrophied, and the sight of the left eye impaired, though not from 

 atrophy of the optic nerve. The sense of smell and discharge of 

 mucus were both less on the left side thau on the right. All these 

 changes were probably due to some lesion of the trophic fibres of 

 the trigeminus. 



(2) Dr. Stewart f has recorded a case where the patient, a 

 boy, aged 14, was severely frost-bitten at the age of ten, on 

 the left cheek and ear. Eighteen months after, atrophy was 

 first noticed. Two years later, when he came under notice, 

 atrophy affected those parts of the face innervated by the two 

 lower divisions of the fifth nerve. The skin, subcutaneous tissue, 

 muscles, and bones were all atrophied, the muscles least. The 

 lower jaw was thinner and shorter, and the upper distinctly 

 atrophied on the left side. The teeth were well developed. 

 Owing to atrophy of the turbinated bones, the left nostril was 

 w ider than the right. There was distinct atrophy of the left half 



* The account is taken from a note made when Prof. Purser sliowed the 

 patient to his class in the University of Dublin, 

 t Montreal Med. Journ. 



