INORDINATE EXCITATION OF FACIAL NERVE. 691 
predisposition to symptoms of this nature. A week or two 
prior to the general implication, a simple involvement of 
the lip muscles presented itself, but this twitching, which I 
am told was tolerably continuous, had been taken little 
notice of, until suddenly there was presented a most aggra¬ 
vated implication of the whole muscular and other struc¬ 
tures under facia] control, producing excessive and con¬ 
tinuous spasmodic jerkings and twitchings of the lip, nasal 
and other facial muscles, involving both sides of the head 
simultaneously. There was no very appreciable exaltation 
of excitement noticed as affecting the one side of the head 
over that of the other; all en masse were under similar 
circumstantial conditions. Particularly, may 1 notice the 
involvement of the labii muscles and that of the dilatatores 
and compressores of the nasal orifices, and I was careful to 
note the negative implication of the masseters, giving us 
distinctive evidence—although these masses of structure are 
largely traversed by the facial—of the non-supply of facial 
nerve-fibres. The buccinators were implicated, and the orbi¬ 
cularis palpebrae muscles were very severely under influ¬ 
ence, as evidenced by the marked continuous twitching of 
both eyelids. The muscles also of the ears were similarly 
implicated ; sometimes the anterior were more largely affected 
than those of the posterior, and vice versa. The sense of 
hearing, I need hardly mention, was much interfered with, 
so that the perception of sounds generally could be dis¬ 
tinctly noticed to be very faultily acknowledged. The cervico¬ 
facial subcutaneous muscles (Chauveau) were similarly under 
influence, these excitations and twitchings extending as far 
posteriorly as the lower point of the shoulder. 
There was no very favorable opportunity given of minutely 
inspecting the interior of the mouth or fauces, yet, I think, 
it may be reasonably concluded that there must have 
been excitations of structure here also; there was an almost 
complete inability to masticate and deglutate food; even 
pultaceous or watery nutrients could only be partaken of with 
extreme difficulty. The masticatory muscles were not imme¬ 
diately implicated; they are not recipients of facial distribu¬ 
tion, but their contiguous tissues of the lips, cheeks, and soft 
palate, and submucous tissues of the tongue are such 
recipients, and we may thus reasonably conclude how the 
normal masticatory action could be seriously involved, and, 
doubtless, largely to be attributed to this internal implica¬ 
tion of these structures. Finally, I may mention the salivary 
glands as being largely under influence, and it is to this 
particularly that I would further direct attention. 
