Medicine: Grimaces, Grunts, Glaucoma

Thomas Gooch Tickle, 44, is a slender, timid-looking Manhattan nerve surgeon. Joseph Albert Sullivan, 34, is a husky, combative Toronto surgeon. Several years ago they studied together in Manhattan under the late Surgeons Sir Charles Ballance and Arthur Baldwin Duel, both of whom died a few months ago. Surgeons Ballance and Duel taught the younger surgeons how to repair facial palsy. In that disease the facial nerve controlling all the muscles which give character and expression to the features, degenerates. A chill, a mastoid operation or a fracture may cause facial palsy. No matter what the cause, one side of the face falls slack as a wet towel on a hook. Half the features sag in a drooping grimace.

Electricity may cure the diseased facial nerve and restore action to the features. When that fails, Surgeons Tickle and Sullivan splice a piece of healthy nerve taken from the patient’s thigh into the dying nerve of his face. The frequent success of this reparative operation was spoiled by an occasional misadventure. In some patients the operation caused a mad, uncontrollable jigging and grimacing of the treated half of the face.

The cause and prevention of such facial fluttering caused the longtime friends to disagree before the whole convention of the American Academy of Ophthalmology & Otolaryngology in Manhattan last week. Dr. Sullivan declared that “these movements were due to the fact that the transplants were made too soon, that is, when the nerve cells of the injured facial nerve were in a state of physiological unbalance with degeneration and healing going on at the same time. When the paralysis immediately follows a mastoid operation, the nerve may be under pressure and should be exposed at once. When the nerve is destroyed sufficiently to require insertion of a nerve graft, the operation must be delayed several months; if cut across or torn across in skull fracture, three weeks after the injury seems to be the best time to insure perfect regrowth of nerve fibres and restoration of motion to the face.”

Dr. Tickle objected to any delay of the operation. Grimacing, said he, “was due to a splitting of the neurofibrils in the graft. A lapse of time for degeneration of the facial nerve does not help. I have found a large proportion of cases of spasm where the grafting took place six months or more after injury.”

Leaving victims of facial palsy to struggle within the coils of this expert dissension, the Eye, Ear & Throat specialists turned their attention to those perennially interesting individuals who talk with deep-throated belches. They have lost their vocal cords usually as result of cancer or accident. Dr. William Wallace Morrison of Manhattan, who has taught many to talk, presented some prize scholars who belong to the Lost Cord League, and explained his methods. The voiceless patient first learns to swallow air. This he does by relaxing his throat and gullet, and gulping. Quickly a big bubble of air accumulates in the stomach, which the patient soon learns to treat like a bag-pipe’s bellows. At his will he burps up puff after puff, makes sounds. First controlled sounds are “gut,” “hut,” “hoot,” “who.” To the uninitiated they sound like strangled grunts. Although these people eventually learn to enunciate clearly, their voices always have a flat, lifeless tone.

Another performance which fascinated the convention was Dr. Otto Barkan’s operation for chronic glaucoma. In this disease the tiny drain called “canal of Schlemm” becomes clogged. It cannot carry away excess fluid which accumulates within the ball of the eye. Internal pressure eventually atrophies the optic nerve, causes blindness. The usual operation for glaucoma punctures the eyeball daintily, lets accumulated fluid escape. However, in many cases the hole soon seals itself, necessitating further operation. Dr. Barkan found that blockade of the canal of Schlemm is often due to grains of pigment which slip in from the iris. To visualize those interfering grains Dr. Barkan applies a cup-shaped magnifying lens to the glaucomatous eye. With his own eyesight thus fortified Dr. Barkan pierces the canal of Schlemm with a needle-like knife at the precise point where it is clogged. Out pop the iridic grains and a flood of intraocular fluid.