The above case is an example of the occasional necessity of very painful electrization.

There is a sort of reflex contraction which sometimes follows upon contusion of an articulation, as in the wrist from falls upon the back or palm of the hand, and which usually appears after the local inflammation has subsided, affects a number of the muscles about the joint, and at length may extend to other joints of the limb. The pain, limited at first to the muscles first affected, soon extends to others, to the nerve trunks, and finally to their origin in the brachial plexus. Here again painful faradization of the antagonists of the painful muscles has, in Duchenne's hands, been most successful.

Hysterical paralysis, whether accompanied by anæsthesia or hyperæsthesia, will frequently be removed by cutaneous faradization with the wire brush, or by localized muscular faradization. In most cases while contractility is intact, sensibility is abolished or diminished (a valuable diagnostic sign of hysterical from cerebral hemiplegia). If electrization proves of benefit, it will usually do so in two or three sittings, and it is as a rule useless, to continue beyond half-a-dozen if there is then no improvement. The treatment must be localized in each of the affected organs, and continued some time after return of movement, so as to fix, so to say, the cure. In hysterical contractions, as of the fingers, on account of the extreme excitability

of the cord, faradism may do harm. Dr. Radcliffe's positive charge should be used. In those cases in which there is excessive localized sensitiveness, which is not lessened either by cutaneous faradization or voltaization by sparks, I have occasionally found benefit from the constant current, one electrode on the painful spot, and the other as near as possible to the nerve origin, with as powerful a current as the patient will submit to. I refer only to hysterical hyperæsthesia, not to neuralgia.

In all cases of local paralysis which are dependent upon blood poisoning, such as mercurial and lead palsy, electrization is never to be neglected. In most cases, even those which have resisted the most energetic prior treatment, a combination of the interrupted voltaic current and faradization, alternately localized in the affected muscles, will triumph over the disease. The current must be sufficiently powerful to cause pain. Such cases are tedious, requiring from twenty to fifty sittings.

In the local or partial paralysis of muscles, which not uncommonly results from exposure to cold, the farado-muscular contractility is usually intact. Rheumatic paralysis of the radial nerve may be cited as an example. This is liable to be confounded with lead palsy. In both diseases the same muscles are affected, the extensors of the hand and fingers, the supinator longus, and all the muscles supplied by the radial nerve, but in lead palsy farado-con

tractility and sensibility are diminished or abolished, while in paralysis from cold they are normal, and the sensibility may be increased. The only exception to this rule is in facial paralysis from cold, where the farado-contractility is diminished, or absent, and this diminution may perhaps be explained by the fact of the facial nerve traversing a bony canal (the acqueductus Fallopii), where, if the nerve swells, it is practically compressed. This paralysis may almost always, even after it has been stationary for many months, be cured by voltaization and faradization, but much more quickly where the farado-contractility remains. The muscles must be treated by that current to which they respond, but with faridization it is especially necessary on the face that the direct should be preferred to the indirect application. In almost all cases the muscles recover unequally; reaction returns in one before in another, although supplied by the same nerve. The excitation must then be localized more in the backward muscles, or a deformity may result. In the most favorable cases an unnatural expression of countenance will generally persist for a long time, from the non-recovery by the muscles of their perfect tone, that quality which imprints upon each face its characteristic features, and which has been called the "gymnastic of the soul." Few patients will submit long enough to electrical treatment to obtain perfect regularity upon both sides of the

face. Any spasm or fibrillation following faradization, or any artificial excitation, is a warning of threatening tonic contractions of the muscles, and faradization must be at once discontinued, or deformity will result. Such cases make good progress under Dr. Radcliffe's positive charge, applied daily. I have now under treatment a case of right facial paralysis of twenty-three years' standing. Before the patient was placed under my care there had been, from energetic faradization, considerable improvement, but incessant muscular fibrillation remained. Under daily treatment with this positive charge the fibrillation has disappeared, and there is also much increase of power in the paralyzed muscles.

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There are several other strictly local palsies that may be successfully treated by electrization, as for instance, paralysis of the muscles of the eye, when the disease is not the result of central lesion. pole must be placed over the facial nerve below the ear, and the other applied to the closed eyelid for about twenty seconds, the entire application lasting about five minutes.

In such cases Mr. R. Brudenell Carter has recommended tenotomy of the contracted, and faradization of the paralyzed, muscle by direct application to the conjunctiva. This is an exquisitely painful application, and I have found few patients who will submit to it, while in the majority of

cases the above far less severe procedure is equally efficacious. Similar treatment is required in mydriasis or dilated pupil from paralysis of the iris, a very troublesome affection on account of its interference with the sight by admitting too much light to the retina. If, however, direct applications be made to the conjunctiva, see that the margins of the eyelids do not touch the stem of the rheophore, or severe spasm will result: to avoid this pinch up the skin of the eyebrow between the thumb and finger, and so retain it during the operation.

Certain amauroses depending upon torpidity of the optic nerve may be removed or greatly lessened by a daily application of the interrupted voltaic current, the special action of which upon the retina has been already set forth. The directions above given for faradism apply equally to voltaization : but as these amauroses are symptomatic of essentially different conditions, the ophthalmoscope must always be first employed for their diagnosis.

Faradization is often of signal service in nervous deafness, that variety of deafness in which no organic lesion can be discovered by the aurist, and which is frequently extremely intractable to medical treatment. Duchenne quotes cases that had existed from two to twenty years, and in which a perfect and permanent cure resulted after from fifteen to thirty applications made as described at page 93. Commence with the lowest power of the