Facial diplegia, in which the expression of the face somewhat resembles that of a patient affected with labio-glosso-laryngeal paralysis, is distinguished from the latter disease by the paralysis affecting both divisions of the facial nerve, while the tongue remains free and deglutition is undisturbed.
There are still other affections of the cerebro-spinal axis, such as paralysis of the insane, disseminated sclerosis, etc., which in their course present some or perhaps all of the symptoms characterizing labio-glosso-laryngeal paralysis; these may be distinguished from the latter disease by taking their own special symptoms into consideration.
TREATMENT.—Although almost all cases of progressive labio-glosso-laryngeal paralysis terminate fatally, some cases have been reported by several observers in which a temporary improvement in the symptoms of the disease, or even a total cure, had been obtained by treatment. Of course such favorable results can only be obtained in the initial or earlier stages of the disease. Thus, Kussmaul recommends in the initial stage, when pains in the head and neck are present, wet cupping of the nape of the neck in strong persons, also the use of the shower-bath, while nitrate of silver may be given internally. The application of galvanism in an alternate direction he also recommends—first, through the neck, and later on through the whole spinal column—and at the same time currents in an alternating direction from the neck and hypoglossus nerve to the tongue. Dowse reported a case of bulbar paralysis which he cured by the application of the constant current upon the paralyzed parts, subcutaneous injections of atropine and strychnine, with the internal administration of cod-liver oil, quinine, and phosphorus. He attaches great importance to the careful feeding of the patient through a tube passed through the nose, and to the strict application of the galvanic current; for excessive salivation he recommends atropine. Erb recommends to regulate the diet and the habits of life of the patient in such a manner as to avoid every irritation of the nervous system; furthermore, to generally stimulate the nutrition in order to produce a tonic effect upon the nervous system. For this purpose he principally relies upon a cautious hydropathic treatment, to be continued for a long time and with great regularity. The greatest importance, however, he attaches to electricity, considering the best method of galvanism as follows: “Galvanize with stabile application transversely through the mastoid processes and longitudinally through the skull, the so-called galvanism of the cervical sympathetic (anode on the nuchus, and cathode at the angle of the lower jaw), and then induce movements of deglutition (twelve to twenty at each sitting); besides this, apply, according to circumstances, direct galvanic or faradic currents to the tongue, lips, and palate.” The electric treatment must be continued for some time, with from four to seven sittings a week. Of the medicines taken internally, Erb recommends nitrate of silver, iodide of potassium, iodide of iron, chloride of gold and sodium, ergotin, belladonna, and preparation of iron and quinine.
DISEASES OF THE PERIPHERAL NERVES.
BY FRANCIS T. MILES, M.D.
The nervous system of the higher animals is the apparatus by which stimuli coming from the external world or originating in the interior of their own bodies are perceived (its sensitive functions), or cause muscular contraction (its motor functions), or, lastly, cause molecular changes in tissues (its trophic functions).