But  the  existence  of  considerable  paralysis  can  often  be  ascertained.  Some-
times a  pinch  will  cause  a  movement  of  the  sound  limb,  but  not  of  that
which  is  paralyzed.  There  is  greater  flaccidity  of  the  paralyzed  limbs.
The  face  is  smoother  on  the  paralyzed  side.  The  lips  are  less  closely  approx-
imated on  that  side,  and  the  paralyzed  cheek  may  flap  with  respiration.
The  passive  mobility  of  the  limbs  is  greater  than  on  the  other  side,  and,  if
raised  and  allowed  to  fall,  the  paralyzed  arm  falls  like  a  dead  weight,  influ-
enced only  by  gravitation,  while  the  other  arm,  although  it  also  falls,  does
so  less  suddenly.  We  are  also  helped  in  this  condition  by  the  state  of  reflex
action,  which  is  often,  though  not  always,  diminished  or  abolished.  This  is
best  seen  in  the  abdominal,  cremasteric,  and  plantar  reflexes,  when  these  are
compared  with  the  corresponding  actions  on  the  opposite  side.  Moreover,
during,  the  period  of  unconsciousness,  the  conjugate  deviation  of  the  head
and  eyes  is  often  distinct ;  if  the  head  be  placed  in  the  mid  position,  the
deviation  slowly  returns.  A  slight  degree  of  ptosis  may  also  sometimes  be
noticed  on  the  paralyzed  side.
If  the  patient  is  conscious,  the  power  of  voluntary  movement  can  be
directly  tested,  and  if  the  paralysis  is  not  absolute,  the  several  movements
of  each  joint  should  be  separately  examined,  and  the  force  with  which  pas-
sive movement  can  be  resisted  should  be  ascertained.  The  patient  is  almost
always  able  to  close  the  eye,  but  often  a  strong  contraction  of  the  orbicularis
is  less  on  the  paralyzed  side.than  on  the  other.  When  there  is  no  difference
in  the  strength  of  contraction  of  the  orbiculares  palpebrarum,  the  patient,  if


SYMPTOMS.
