Injuries of nerves and their consequences - Reflex Sympathetic ...

128 INJURIES OF NERVES.
to determine that the paralyzing cause has been external
to the track of the nerve in the temporal bone.
In the three cases which I have seen, the paralysis was
very marked, the ala ceasing to move and the eye remaining
open. In two there was difficulty of nursing, but
little or none in the third, owing to the large nipples of
the mother. All of them recovered readily within a
month and without treatment. I have also seen a patient,
sent to me from Delaware, the child of a physician, in
whom there was left facial palsy following
a failure to
terminate a long labor by the forceps. The birth occurred
naturally several hours. afterwards. The palsy existed
from birth, and at the sixth week, when seen by me, was
complete. I decided against the instrument as a cause,
since there was no mark of violence, and because there was
not only a hanging down of the palate on the aflected right
side, but also of the posterior palatine arch, with oedema
of these parts, and because of a slight dryness and loss
of epithelia ou the tongue limited to the diseased side.
The child died soon after of convulsions, with discharge
of offensive and bloodv matter from the left ear.
As regards the marks made by the forceps, in all of my
cases there was some indentation, but not ahvavs over the
line of the nerves. It is well to remember, as Landouzy
has pointed out, that in some instances there is no external
trace of violent compression by the forceps blade, so
that we need not expect in every case to meet with this
diagnostic aid. Fortunately we rarely need such assistance,
the diagnosis being easy except in rare examples,
like that of the last case cited.
Paralysis from local pressure on nerves owing to malposition
out of
during sleep. — Every one has awakened occasionally
cause
;
but it seems to me quite' certain that in these brief palsys by the
forceps no loss of palate power is visible.