responded either to the emotions or to the volitions which control them in their normal state.
The character of the anastomosis, surgically considered, will easily be seen from the charts (Fig. 1 and Fig. 2); and the unfortunate condition of the patient on making the effort to close his eyes is represented by the accompanying photograph (Fig. 3).
Dr. Cushing's surgery, so far as the completeness of the union effected between the two nerves was concerned, seems to have been unusually successful. This fact gives additional interest to the discussion of the results from the physiological and psychological points of view. At the time of the operation, owing to the healing of the injury done to the chorda tympani, the sense of taste had largely returned; but 'the patient's face had become, even during repose, much drawn to the left, and an effort to close the eyes would result in the peculiar grimace characteristic of facial paralysis, with tilting up of the eyeball,' as shown in the photograph (Fig. 3).
Almost immediately after the operation the patient insisted that his condition was improved; that he was no longer troubled with lachrymation, less troubled with saliva, and better able to dislodge food from his flaccid cheek. He also thought that some power of motion had returned to the eyelid. The doctor urges that this last symptom of improvement could only be due to the inhibitory action of the muscle concerned in raising the upper eyelid; the other 'subjective assurances of improvement' he confesses that he is at a loss to explain. About them it would seem we must say, either that the patient was altogether mistaken, or that at least some slight nervous impulse was already passing over the recently united nerve-tract?
On the tenth day after the operation the patient was sent home, provided with a small galvanic battery which he used for daily electrical treatment, and was later required to exercise the facial muscles persistently before a mirror. From this time on a fairly steady improvement was noticeable, beginning with the decrease in the asymmetrical appearance of the face while at rest, the lessening of the cleft between the eyelids; and ending with the more and more highly differentiated voluntary control of the facial muscles and even with the partial recovery of their response to the varied forms of emotional excitement. On the ninety-fifth day the patient reported that, while galvanizing the muscles and at the same time watching his face in a mirror, he noticed to his surprise, on moving his shoulder, that he could produce considerable contraction in the paralyzed muscles. As he expressed it: 'When I wish to laugh straight, I can help it out with my shoulder.'
A more particular description of this patient's condition at only two points of time subsequently will be quite sufficient for my purpose.
