Bell's Paralysis: A Complicated Case Ascending Paralysis.

V. A. Baker, M. D., Adrian, Mich.

Mr. A., a man 74 years of age, mental motive temperament, rather stout in make up, weight 190 pounds, was taken ill some two months since. He first noticed a slight puffiness of the left side of the face, which rapidly became swollen to tenseness; no pain but a feeling of discomfort.

The eye on that side of the face was firmly closed. There was no perceptible rise of temperature. He was able to protrude the tongue, speech and hearing were unaffected. This condition in a passive form continued several days. He had on the affected side of the face a decayed tooth, though it had troubled him none of late, but I attributed to it the exciting cause.

After remaining in the condition described for several days the swelling disappeared rapidly, but all the indications of Bell's paralysis were noticeable. The mouth was drawn to the reverse side, the speech was muffled, the tongue protruded with difficulty and imperfectly. After remaining in this condition several days, he was at tacked by severe neuralgia involving the left hip and the groin and descending colon, which was most stubborn to treatment, although remedies specific to the condition were resorted to.

This state of things kept up for three weeks. Occasionally the intense neuralgia like pain affected the stomach. The secretion from the kidneys was only slightly modified, they acted freely, considering his condition, and the bowels as a rule moved with regularity. During the worst of the neuralgia, he had some fever, followed by a very drenching perspiration. This was readily amenable to treatment.

I need state also that he was a subject of rheumatism for several years, some of the time severe, though as a rule he kept about his business, that of a carpenter. Never in my experience have I had just such a case. My opinion is that absorption of a putrefactive alkaloid affecting the nerve ganglia supplying the parts in an ascending manner, is, perhaps, explanatory, as the mind did not seem affected in the least, as I would expect if there was a lesion within the cranium. At this time, February 4, 1909, he is comparatively free from pain, though the facial muscles are distorted, mouth drawn and the speech thick.

A few years since I had a case of so called ascending paralysis which resulted from infection, starting after cutting a corn. The man was in middle life, healthy, of phlegmatic temperament, by occupation a farmer, married, having a family of three children. The foot began to swell soon after the accident, an abscess with but little pain forming, which on lancing (between the little toe and its neighbor) discharged but a little pus and that of a sanious character, the discharge stopping suddenly within two days after lancing and nothing would tempt its renewal. The parts seemed to heal kindly, with the exception of a feeling of numbness and a prickly sensation in both limbs extending to the knees.

He was about the house ten days after lancing the foot, before the morbid manifestations, just mentioned, became noticeable. It then gradually extended to both knees, creeping up as it were, steadily, the anesthesia becoming more and more in evidence as time passed. In ten weeks it had reached the gluteus muscles and gradually extended to the abdominal region, finally reaching the thoracic organs, inducing the symptoms of severe asthma, lividity of countenance, etc., death ensuing from apnea. His mind remained clear to the last, and, remarkably strange to say, the kidneys and bowels moved fairly well; digestion was painless, although he had an indifferent appetite; deglutition right until the very last. The emotional and secretory systems seeming comparatively unaffected. A case of superinduced ascending paralysis was my diagnosis.

Ellingwood's Therapeutist, Vol. 3, 1909, was edited by Finley Ellingwood M.D.