- Category
- Brain, nerves and mind · Glands, hormones, thyroid and diabetes
- What is given
- Ajay Normal; (15) Medulla × 6 trts; (½) Ku – 40 secs; Oxygen-Hormonal on its three-month schedule — month 1 daily, month 2 + (15) Medulla × 6, month 3 + (15) Medulla × 12; (8) Rt Parkhoo; Dorsal — research still going on; (30) Medulla — perhaps
- What must come first
- Ajay Normal: that you have not restored Spl out of habit
- What is barred
- Ku bars. A patient who coughs on liquids or whose voice sounds wet after drinking is sent for a swallowing assessment as part of the treatment, not as a disclaimer
- Explained in
- Seated I — Brain, Medulla, Neck
Watch
From Cranial Nerve and Brain Formulas
The face and the mouth
Eight doors into one list: what the face feels, and what the face does
The longest table in the formulary runs across four pages. It is set out here in eight groups, so that a therapist can find a row in the time a patient takes to describe a complaint. Nothing has been left out and nothing has been combined; the groups are only doors into one list.
Table 9 — Swallowing Seated × 3
| Point or condition | Treatment |
|---|---|
| For swallowing — to take the bolus, the mouthful, backwards | (5) Medulla |
| For swallowing — to open and close the epiglottis, by way of the cricothyroid and arytenoid muscles | (10) Medulla |
| For swallowing — for the muscles of the tongue | (12) Medulla |
| To close the epiglottis | (9) Medulla |
| To remove a problem in swallowing — in swallowing food | (9) Medulla |
| To remove difficulty in swallowing — because of narrowing of the food pipe | (10) Medulla * Left |
| To open the oesophagus — the food pipe — if it has contracted | (10) Medulla * Left |
Two instructions decide between the two commonest rows of that group, and they are worth learning as a pair, because they are a diagnosis made from one extra question:
Which nerve, when swallowing is hard
If, with difficulty in swallowing, taste does not come — that will be put right by (9) Medulla.
But if, with difficulty in swallowing, the voice is heavy — that will be put right by (10) Medulla.
One complaint, two answers, and the question that separates them takes four seconds: and how is your taste? and how is your voice?
Behind it: cranial nerves 5, 9, 10, 11 and 12 together look after the work of swallowing, and the motor impulses that cause swallowing are transmitted by the 5th, 9th, 10th and 12th. The larynx and the pharynx are both controlled by cranial nerves 10 and 11, while the pharynx is also controlled by cranial 9. Both of those organs are necessary for swallowing food and for the voice to come out correctly.
Table 10 — The voice and the larynx
| Point or condition | Treatment |
|---|---|
| To bring back a voice that has gone | (12) Medulla |
| To correct a heavy voice — thick speech | (12) Medulla |
| To bring sweetness into the voice | (10) Medulla |
| To remove hoarseness — roughness — in the voice | (10) Medulla |
| To remove difficulty in speaking — to widen the larynx, the voice-box, by way of the left vagus | (10) Medulla * Left |
| The muscles of the larynx | (10) Medulla |
| The mucous membrane of the larynx | (10) Medulla |
| Contraction of the muscles of the pharynx and larynx | (10), (11) Medulla |
| It contracts the smooth muscles of the trachea and bronchi — for bronchitis | (10) Medulla |
Table 11 — The face
| Point or condition | Treatment |
|---|---|
| Paralysis of one side of the face | (7) Medulla |
| The expressions of the face, by which a person's face contracts or lights up according to the emotions | (7) Medulla — and this should be used in Parkinson's disease |
| The mouth turning towards the good side — as happens in Bell's palsy | (7) Medulla |
| The mouth becoming crooked, in which all the muscles of one side are paralysed | (7) Medulla |
| Not being able to whistle | (7) Medulla |
| Silhouette or wrinkles not appearing on the forehead or the eyebrow | (7) Medulla |
| Pain on the face, or the sensation or absence of sensation | (5) Medulla |
| Pain on the temple, or the sensation or absence of sensation | (5) Medulla |
| Pain in the eyebrow, or no sensation there | (5) Medulla |
| Trigeminal neuralgia | (5) Medulla |
| Problem in the cheekbone | (5) Medulla |
| The skin and mucous membrane of the cheeks | (5) Medulla |
Notice what that table does with one face. Everything that the face feels is the fifth. Everything the face does is the seventh. Sensation and movement, two nerves, side by side over the same cheek. When a patient's face droops but she can still feel your finger on it, you are looking at the seventh; when she feels nothing but the face moves normally, you are looking at the fifth.
Table 12 — The jaw, the teeth and the gums
| Point or condition | Treatment |
|---|---|
| Problems of the muscles of chewing | (5) Medulla |
| For every problem of the teeth | (5) Medulla |
| Problems of the gums | (5) Medulla |
| Problems of the lips | (5) Medulla |
| The soft part inside the jaw | (5) Medulla |
| Problems of the muscles of the jaw — from the motor root not working | (5) Medulla |
| The jaw turning towards the paralysed side, and the patient not being able to chew properly | (5) Medulla |
| Problem of the upper or lower part of the jaw | (7) Medulla |
Table 13 — The tongue, the mouth and taste
| Point or condition | Treatment |
|---|---|
| The mucous membrane of the front two-thirds of the tongue | (5) Medulla |
| Not experiencing sensation in the tongue | (5) Medulla |
| Not experiencing pain or touch sensation on the mouth | (5) Medulla |
| Movement of the muscles of the tongue | (12) Medulla |
| Paralysis of one side of the tongue — the tongue repeatedly going to one side | (12) Medulla # |
| Problems of the palate inside the mouth | (5), (9) Medulla |
| Contraction of the muscles of the palate | (10) Medulla |
| Taste — the posterior third of the tongue | (9) Medulla |
| The experience of taste — the chorda tympani | (7) Medulla |
| The experience of taste — from the front two-thirds of the tongue | (7) Medulla |
Table 14 — Saliva
| Point or condition | Treatment |
|---|---|
| If the mouth has gone dry — to bring saliva | (7), (9) Medulla |
| To increase saliva — from the parotid glands | (9) Medulla |
| To increase saliva — from the sublingual and submaxillary glands | (7) Medulla |
| The salivary glands — the visceral motor nerve | (7) Medulla |
Ptyalin is found in greater quantity in the saliva of the parotid glands. And it is the 9th cranial nerve that stimulates the parotid glands, not the seventh. That sentence is printed as a footnote, and it is a correction — the kind of small, exact self-correction that tells you somebody checked.
Table 15 — The pharynx and the tonsils
| Point or condition | Treatment |
|---|---|
| Control of the muscles of the pharynx | (9) Medulla |
| The mucous membrane of the pharynx | (9) Medulla |
| Sensation from the pharynx | (7), (9) Medulla |
| To stimulate the nerves of the tonsils | (9) Medulla |
Table 16 — The blood pressure and the carotid sensors
| Point or condition | Treatment |
|---|---|
| Control of BP by the nerves of Hering | (9) Medulla |
| Control of BP — by way of the carotid sinus | (9) Medulla |
| Problems of the carotid arteries and the carotid bodies | (9) Medulla |
Two marks travel with the face-and-mouth list and must be carried wherever a row from it is copied onto a card:
Also explained in
- Washing the hands, and the water poured around the plate Food as Medicine
It bites hardest for four kinds of patient you will meet constantly: Anyone whose swallow is not what it was — after a stroke, in Parkinson's disease, in motor neuron disease, in advanced age with a dry mouth.
- The ladder of tools, from most to least The Child, the Elder and the Frail
It is the rung for the patient whose pain is the obstacle to being treated for the pain — the bed-ridden woman with motor neuron disease, the man whose every joint hurts, the patient four days after a fracture.