On facial paralysis from cold : with special reference to its prognosis / by A. de Watteville.

  • Watteville, A. de (Armand), 1846-1925.
Date:
[1880]
Catalogue details

Licence: Public Domain Mark

Credit: On facial paralysis from cold : with special reference to its prognosis / by A. de Watteville. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    in the muscular irritability, there was a corresponding “ qualita- tive ” change, which manifested itself by an abnormal response to the negative and positive pole respectively. Healthy muscles react more readily to the negative pole when the current is made, aud to the positive when broken. How, on testing the diseased muscles in this case, I obtained precisely the opposite; the positive pole excited greater contractions than the negative on closing the circuit; the negative greater than the positive on opening it. At the same time the muscular contractions had lost their vigorous, momentary, and well-defined character, and had become slower, almost vermiform, like those of un- striated fibres. From these phenomena and the other circum- stances of the case I diagnosed a severe lesion of the facial nerve, leading to its degeneration, with corresponding changes in the muscles; and framed a prognosis in consequence. Six months afterwards hardly any voluntary power had returned, and further progress took place very slowly. Between the two types of cases just described are often found transitional forms, which are characterised by a simple diminu- tion in the irritability of the nerve tested by both currents, and an abnormal mode of muscular contraction to the galvanic stimulus. The latter does not necessarily show the complete inversion of the normal formula above mentioned. There may be simply increased irritability with a tendency of the diseased muscles to react more readily to the positive than to the negative pole on closing the circuit. The name “ reaction of degenerative atrophy,” or simply “ degenerative reaction,” has been applied to the abnormal mode of response of the affected tissues to the electric stimulus. And the form of it where the muscles only present the phenomenon has been characterised as the “ partial,” whilst that where there is also loss of nervous excitability is called the “complete,” type of degenerative reaction. For further details, with diagrams, illustrating the development of these phenomena, and their connection with histological changes in the affected nerves and muscles, I must refer the reader whom it may interest to my Practical Introduction to Medical Elec- tricity. My main task here is to show the value of electro- diagnosis in facial paralysis a frigore in furnishing data applicable to the prognosis of each individual case. II. In the three categories of cases just described the loss A A