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

DIAGNOSIS AND PROGNOSIS OF INJURIES OF NERVES. 219
whole tongue, when at rest, lies straight in the mouth,
but it cannot now be projected. When, early in the case,
this was possible, it turned distinctly to the left side.
Deglutition is imperfect; he has to take moistened food
only, and coughs and chokes verj' frequently while eating.
He is liable to fits of gaping when tired or overheated.
Voice nearly perfect. The eyes are healthy.
There is no pain anywhere. The heart and lungs are
sound.
Appetite and digestion good.
It is clear, from the facts before us, that the ball
9ut the left hypoglossal nerve and also the right lingual
branches of the glosso-pharyngeal nerve. The
former accident sufficed to palsy the left side of the
tongue. The latter mav be assumed to have had some
share in the destruction of gustator}' sensation on the
right side of that organ ; but these accidents account
neither for tiie
accompanying total loss of tact and pain
in the right side of the tongue, nor for that of the right
side of the face. To paralj'ze sensation in the latter
regions, there must have been either a secondary afiection
through induced disease of the centres, or else a
wound of the fifth nerve ;
and if the latter took place far
it would involve some of the branches which
enough back,
go to, the tongue, and some which supply the face.
question is answered, I think, by the following facts :
Tlie
Early in the case, Seymour felt a pricking in the right
side of the throat, far back. At the fourteenth day a piece
of bone, half an inch wide, and verj^ thin, escaped into the
throat from the part mentioned, and was coughed up. Unfortunately
it was not preserved. I suppose this splinter
was broken off the left jaw, and driven across the throat
80 as to wound the third branch of the fifth nerve.
Seymour's recovery was rapid, although
treatment at all.
I used no
October 10th. — The face has recovered sensation.