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the practical guide must be, as stated above, the highest number that can be borne without discomfort. Professor Eulenberg, who has had wide experience, considers sciatica as by far the most curable of neuralgiæ-many cases requiring only from three to five sittings. Intercostal neuralgia he has never known benefited. In ordinary trigeminal neuralgia he speaks strongly of the constant current as a palliative, but doubtfully of its power to cure. In cervico-brachial neuralgia it divides, he says, the field with hypodermic injection of morphia. Dr. Anstie, while endorsing this, places a considerably higher estimate on its curative power in ordinary trigeminal neuralgia, and he quotes two cases treated by Professor Niemeyer. “The patients," he writes, “were respectively aged sixty-four and seventy-four, and the duration of the neuralgia had been respectively five, and twenty-nine years; in both the pain was of the most severe type, and in both the success was most striking. In one, every possible variety of medication, and several distinct surgical operations for excision of portions of the affected nerve, had been quite vainly tried. The cases are altogether among the most interesting facts in therapeutics that have ever been recorded.” Galvanization of the cerebral hemispheres has been found very beneficial in true migraine (sick headache): the electrodes may be applied to each temple or to each mastoid process. Begin with not more than
two or three cells, and for not longer than a minute, and stop upon the occurrence of the least giddiness. In angina pectoris one pole may be applied to the spine and the other to the cardiac. region. Neuralgia of other parts must be dealt with according to the rules of application already enunciated. The reader will find the subject very exhaustively considered in Dr. Anstie's work.* He quotes some extremely severe cases in which the effect of the current was to arrest the pain in a few sittings, and to procure a remission for several days or even weeks; and I have had several cases which I believe to have been as fairly cured as an ague fit may be said to be cured by quinine. Dr. Russell Reynolds also quotes the case of a patient, a lady, who for twenty years had suffered from an extremely severe neuralgia of the ophthalmic branch of the fifth, which recurred daily and from which her health had greatly suffered. It was not only relieved but removed by a single application.
But it is in the many disorders that are classed under the heading of paralysis, that the chief field for the employment of electricity is found, and especially for its localized employment. In all cases the first step is to ascertain the condition of the muscles as regards their irritability to the interrupted
* Neuralgia and the Diseases that resemble it. By Francis E. Anstie, M.D., &c. London: Macmillan and Co. 1871.
voltaic and faradic currents. They must be tested as described at page 94. Having found the degree of reaction, it is as a general rule, to which, however, there are some exceptions, advisable to treat them with that current to which they most readily respond. Where, after three or four applications, there is no contraction under either current, electricity will do no good. Where reaction is normal it will usually not aid us in restoring voluntary power, though it may prevent the muscles from wasting; but where reaction is only lessened it will often prove of the greatest service, and in all cases it is likely to preserve the nutrition of the muscles, a point which in protracted paralysis is of the highest importance. In such cases, if we can do no more, we should endeavor, in the words of Sir Thomas Watson, “to preserve the muscular part of the locomotive apparatus in a state of health and readiness, until peradventure that portion of the brain from which volition proceeds, having recovered its functions, or the road by which its messages travel having been repaired, the influence of the will shall again reach and reanimate the palsied limbs.”
But there are other instances in which, although the muscles give no response to faradism, their irritability to the interrupted voltaic current is not only preserved but increased. Under the use of this current the increased irritability will usually diminish; ten cells will soon be wanted to produce the amount of contraction that at first was given to five, and then ensues generally a gradual return of response to faradism. Use then faradism only. There is a remarkable interesting record of a case of paralysis of the deltoid, which illustrates the above treatment, in the Lancet for 1866, vol. ii. p. 576. It occurred in the practice of my predecessor at the National Hospital for the Paralyzed and Epileptic, Mr. J. Netten Radcliffe. The patient was a blacksmith, aged 25 years. After several days' suffering from severe “rheumatic pains," so called, in both shoulders, but particularly in the left, he lost suddenly, while working with an ordinary sized hammer, one morning, the power of raising his right arm. When first seen, five weeks after this occurred, the deltoid and infra-spinatus muscles of the right side were found to be completely paralyzed, and there was some wasting of the former muscle. The contractility of both muscles to faradism was annihilated, the electric sensibility was diminished over the infra-spinatus, and this form of sensibility, as well as the sensibility to heat, cold, tickling and touch, was absolutely wanting in a triangular space (the apex pointing downwards) over the deltoid, measuring two inches and a half at the base, and five inches from the base to the apex. Under powerful faradization seven times repeated at intervals of three days, not a trace of contraction could be excited in the paralyzed muscles, and the wasting evidently increased. The interrupted voltaic current was then tried. With thirty-five cells of a Becker-Muirhead battery, which produced no effect on the healthy left deltoid and infra-spinatus, a marked contraction of both paralyzed muscles was excited, with forty-five cells (also ineffective upon the healthy muscles) an energetic contraction. Mr. Radcliffe from this time used the interrupted voltaic current only, thrice weekly, and each time about ten minutes, until it had been applied thirty times. At the end of this period seventy-five cells were required to produce the amount of contraction formerly caused by forty-five, and under the full force of the current from the primary coil of a large Stöhrer's induction apparatus, slight contraction was produced in the deltoid. The further wasting of the muscles appeared also to have ceased, although they did not gain in bulk.
At this time treatment was suspended for two months, the patient being compelled to leave town. In the interval, not only was the little ground which had been gained by electrical treatment lost, but the paralyzed muscles had become more and more wasted, and it was now clear that the supra-spinatus also suffered. The wasting, indeed, was so great that of the deltoid barely a filmy layer of fibres could be perceived to remain. Faradization over the affected muscle did not excite a trace of contraction. But again the interrupted voltaic current