The secretion of saliva on the affected side may be diminished, causing the mucous membrane to be dryer than on the other side.

In rare instances spasms and contractions of the affected muscles oc

cur.

Double facial paralysis is extremely rare as a peripheral affection, but not very uncommon when central disease is the cause.

ETIOLOGY.

I can say very little under this head without repeating a great deal that has already been said. The majority of cases are due to so-called rheumatic causes. Exposure to draft, or sometimes while merely working or playing in the open air will cause an attack. The paralysis may appear immediately after the exposure, or from one to two days after; the former is the rule. In all cases its greatest severity is soon after its inception. In most cases, taste is lost in anterior third of the side of tongue affected. The velum palati and uvula very rarely implicated.

The light forms of the disease may disappear in from twelve to twentyfour hours, and as inflammatory exudation could hardly be absorbed in that time, it is probable a simple congestion of the nerve could cause a temporary facial paralysis. The more severe forms of the disease may last months, though the majority of cases get well in time with appropriate treatment. Inflammatory diseases of the middle ear may cause the disease; such cases usually develop slowly. Among the traumatic causes may be mentioned: direct injury to the nerve by knife or bullet wound; blow on the face with the fist, stone, etc; compression of the nerve by the

forceps during delivery; division of the nerve by the knife of the surgeon in opening of abscess, or removal of tumors, etc. Where the nerve is divided the paralysis is apt to be permanent. Intracranial diseases-exclusive of those due to central lesion, may produce this form of peripheral paralysis, but it is always attended with paralysis of some other nerve, and as a rule is more slowly developed, moreover it is almost sure to be preceded by headache. Syphilis may be a cause of this affection. It is apt to be developed slowly, and a history of the case would point to this as a

cause.

This affection may exist as a sequel of certain infectious diseasesdiphtheria, variola, scarlatina, etc. but such cases are rare.

Diplegia Facialis results most frequently from some affection at base of brain, which causes pressure on both seventh nerves, also from injury which has caused an extravasation of blood into each middle ear, or from double otitis media. In some rare instances the double form of this affection might occur from an otitis on one side and some other form of lesion on the other, or from a combination of any two of the causes mentioned

above.

DIAGNOSIS AND PROGNOSIS.

Diagnosis is easy especially in the unilateral form. Direct the

patient to laugh and the characteristic deformity will appear. In addition the absence of wrinkles on

the forehead, the drooping of the angle of the mouth and the wide open eye, are symptoms so characteristic that a mistake could hardly be made. To determine whether it is of peripheral or central origin, a his

tory of the case is important. If the patient has been exposed to severe cold, has had a blow or other injury, and in the absence of cerebral symptoms and paralysis in any other part of the body, it is safe to conclude it is of peripheral origin.

The prognosis is generally favorable, especially so in recent cases due to cold, rheumatic effusion, or to any removable cause. The paralysis will disappear in a few days or weeks under proper treatment.

So say the books, but in one case I have had under treatment since the last of January, although apparently a most favorable case in the beginning, the paralysis still continues, though some improvement is noticeable.

TREATMENT.

The first thing to do is to remove the cause when possible. This may often be done if paralysis is due to pressure from tumors, etc., by surgical means. Any rheumatic or syphilitic complications should receive the proper treatment for such affections. Electricity is undoubtedly of great benefit in these cases.

The remedies most often indicated. are: aconite, arsenicum, belladonna, causticum gelseminum, kali chloricum and when there is any reason to suspect syphilitic complication, mercurius vivus, and potassa iodide.

CASE.

On January 26, '95 I was called to see a gentleman about 50 years of age, who for two days had what he supposed a swollen face from a cold. Two days before while at a restaurant when taking a drink of water, a stream of water spurted from the left corner of his mouth across the table.

Afterwards he had some difficulty in masticating on account of food getting between his cheek and gums. He very soon noticed his inability to pronounce correctly certain words or to whistle, but attributed it to swelling of the cheek and lips. He was unable to close the eye, and as he expressed it, "instead of being swollen shut it was swollen open."

I found the characteristic symptoms, wide open staring eye, absence of wrinkles on the whole left side of the face, mouth drawn to right side, thick speech, etc. He did not remember of being exposed to cold any more severe than usual, had had no headaches.

About a year before he had had a severe fall, stepping off from a rail road platform one dark night, falling about four feet landing on his side (he don't remember which.) The ground was sandy. He does not think he struck his head; his shoulder and side were lame for several days.

This was all the history I could obtain of the case.

For the satisfaction of all concerned I called Dr. Kershaw in consultation and he confirmed my diagnosis. I had given belladonna and nux and upon the recommendation of Dr. Kershaw I gave belladonna and merc.

I have also given gelseminum and iodide of potassa.

About a week after the commencement of the disease I commenced electric and massage treatment.

There has been considerable improvement though not as rapid or marked as I could desire. The mouth is still drawn to one side. When attending to business accounts, etc., or meeting people where he has to do

DISCUSSION.

Dr. Cummings.-I think the safest way to use electricity in these cases of paralysis is through water as administered by the Drs. Sargent of this city.

Massage is also good.

Dr. Mary Sargent-spoke of three cases treated by them with galvanism and hot applications. Rhus tox and causticum were also found to be of great service, hepar or calcaria if chills be present.

Dr. Edmonds-I would call attention to a class of cases which come, remain and go without apparent cause or reason with but little treatment. I think electricity should be used with care, as a most powerful remedy with which we are not yet fully familiar.

Dr. Clara Russell-In my treatment I go over the part first with the positive pole, then with the negative, and always a light current on the head. I use the faradic current most frequently.

Dr. Comstock-I fear the faradic current. I use the galvanic current. In cases of prosopalgia I put a ten per cent solution of cocaine on cotton and then apply the pole.

tia mollis of the seventh pair,—and an accessory branch of the facial lie close together, and are connected by several small filaments. At the bottom of the meatus it enters the aqueductus Fallopii, follows the canal through the petrous portion of the temporal bone, and terminates at the stylo-mastoid foramen. Facial paralysis, or Bell's palsy, is a comparatively frequent disease. It affects the portia dura of the seventh pair. The face is drawn to the well side, the eye waters, and remains wide open day and night-lagophthalmus -owing to paralysis of the orbicularis palpebrarum. If the fifth pair is not involved, sensation is not impaired. It is caused by wounds, rheumatism, ear disease, caries of the mastoid, pressure of forceps, falls, scarlet fever, measles, colds, exposure to draughts. It has followed mumps and enlarged cervical glands, causing pressure. In paralysis of the face due to brain disease, the eye can be closed. Most cases recover, but some incompletely. Sometimes the paralysis is double and is then due to compression of the nerves while passing through the medulla and pons varolii. Electro-muscular contractility is quickly lost. Galvanic irritability is usually heightened. Galvanism and massage are important methods of treatment. The open eye should be protected, the paralysed muscles drawn back into position by adhesive plaster or a rubber hook. Belladonna, gelsemium, rhus toxicodendron and mercury have rendered me good service in the treatment of these cases. The earlier treatment is begun, the greater are the chances of complete recovery.

HE Missouri Institute of Hom

THE

œopathy convened in its nineteenth annual convention in parlor S of the Midland hotel Kansas City Missouri, at 10 o'clock Tuesday morning April 23d.

Local Committee of Arrangements: Dr. A. E. Neumeister, Dr. J. F. Elliott, Dr. L. G. VanScoyoc; Reception Committee Dr. S. H. Anderson, Dr. E. F. Brady, Dr. Henry Crosky, Dr. W. P. Cutler, Dr. S. C. Delap, Dr. Mark Edgerton, Dr. C. S. Elliott, Dr. S. C. Elliott, Dr. Wm. D. Foster, Dr. W. A. Forster, Dr. T. H. Hudson, Dr. W. H. Jenny, Dr. C. C. Olmstead, Dr. M. T. Runnels, Dr. J. H. Sutfin.

President Morgan of St. Louis, called the convention to order and Rev. Dr. J. M. Cromer, of the First Lutheran church, offered prayer, after which Dr. Frank Elliott, of Kansas City, chairman of the entertainment committee, introduced Mayor Webster Davis, who delivered a short address of welcome to the visitors. He assured them that for all gatherings in the interest of science, for the betterment of mankind and the alleviation of suffering as well as all others of a right nature and laudable purpose, the latch-string of the city hung out always. The members of the convention were welcome and the city was glad to have them here, and hoped their stay would be both pleasant and profitable. He referred to the many attractive features of the city, its commercial advantages, its good physicians and faithful ministers, not forgetting its packing houses and stock yards and other like enterprises, and then bade all

welcome to all the hospitalities of the municipality.

The response to the welcome was made by President Morgan, who made reply and with thanks acknowleged the courtesies extended, and stated that they would be thoroughly appreciated by the visitors. The formal appointment of committees was then taken up.

Upon assembling after the noon hour the annual address was read by President Morgan. It was a paper that contained some sound advice and suggestions to the practitioners and pointed out some matters of interest to the school of medicine and the profession in general. In the address he referred to the failure to establish a chair of homoeopathy in the medical department at the state university by the last legislature and gave as a cause for the failure the fact that the application of the osteopathists was made at the same time. There was also a stout opposition made by the dozen members of the legislature who were practitioners in a different school of medicine. He urged the members of the convention to be more careful in their practice, observe the laws of hygiene better, and in this way the public was bound to take cognizance of the reliability of the practice and the work of the profession.

The following bureaus reported: The report on the committee of legislature was presented by Dr. Brady, of Kansas City, and was to the effect that the committee had gone to see Governor Stone and had asked that he advise the founding of a chair of homeopathy at the state

university, and that he had promised to do so, but he had refused to go further, as he was asked to do, and set aside one of the state insane asylums for the use and practice of the physicians of that school. The report said it was the duty of the members of the convention to go on with the investigations and spread the work of education, so that from the next legislature better results might be obtained.

Clinical Medicine: Chairman, F. M.. Martin, M. D., Maryville, Mo."Necessity of Proper Alimentation in the Continued Fevers"--Danger from allowing patients to go a long time without nourishment. Nourishment and fluids as necessary as medicines. J. Martine Kershaw, M. D., St. Louis, Mo.-"Diet in the Treatment of Epilepsy." 1. Diet of solid food will increase the attacks in one already epileptic. 2. Fluid food will diminish the attacks in one already epileptic. 3. Fluid food will sometimes cure epilepsy without any medicine. Report of Clinical Cases-H. W. Roby, M. D., Topeka, Kansas. Cistus Canadensis, H. P. Holmes, M. D., Omaha, Neb.

Materia Medica: L. C. McElwee, M. D., St. Louis, Chairman. The Amalgam Filling as a Factor in Treatment, Howard Crutcher, M. D., Chicago, Ills.; Actea Racemosa in Preparation for Parturition, T. S. Hoyne, M. D., Chicago, Ills.; Sabul Serrulata (Saw Palmetto); T. C. Duncan, M. D., Chicago, Ill.; Why Does Surgery Dominate Medicine? Eldridge C. Price, M. D., Baltimore, Md., Pensive Pulsatilla, S. C. McElwee; M.D., St. Louis, Mo. T. C. Duncan, M. D., Chicago, Ill.-"Climate." Climate influences the prevalence of con

sumption, whatever may be its etiology. Therefore, we may expect its increase in the Mississippi valley. It will be retarded in the Western plateau, above the altitude of 2,000 feet. Residents of the Mississippi valley should recruit in the mountain regions or the pine forests of the North.

Gynaecology: T. G. Comstock, M. D. St. Louis, Chairman. J. Martine. Kershaw, M.D., St. Louis, Mo.-"Hot Water in Gynaecological Practice." 1. Hot water will cure some mild cases of endometritis. 2. Hot water with the douche curette will cure most cases of endometritis alone. 3. Hot water with the douch curette will help most cases of salpingitis and pyosalpinx. 4. Hepar is indicated in septic inflammation of the tubes and endometrium and should be used, regardless of the operation performed.

L. F. Schussler, M. D., Alton, Ill. "The Tissue Remedies in Gynaecology." Diseases of the uterus, except strictly surgical, best treated by materia medica. General practitioners should make few local examinations and fewer local treatments. Cases requiring more than glycerine and calendula should be. sent to a specialist. Simplicity of selection in tissue remedies secures accurate prescribing. Certainty of action of tissue remedies. Not memorizing, but careful analysis and study required. Author's best success obtained with tissue remedies. E. M. Hale, M. D., Chicago, Ill."The Primary and Secondary Action of Some Uterine Medicaments." The scope of this paper is to illustrate the method of selecting medicine by their primary and secondary symptoms and the importance of such symptoms in determining the proper