Page images

caused marked contraction, and pursuing the same course that he had done before, Mr. Radcliffe used daily, for about a dozen times, this form of current only. At the end of the twelve applications, on using the full force of the current from the primary coil of a large Stöhrer's induction instrument, distinct but slight contraction of the deltoid and infraspinatus occurred. From this period faradization of the paralyzed muscles was persisted in four times in the week.

The history of this case was not completed in the account given by the Lancet reporter. I am now able to give the result. The affected muscles steadily increased in bulk, their electro-contractility improved, sensibility to the electric current, touch, tickling, heat and cold, returned, and at the end of four months the patient was enabled to use his right arm freely and return to his ordinary occupation. At this time no difference in appearance could be distinguished between the right and left deltoid, and voluntary control was as complete over the one muscle as the other, but the electro-motility of the right muscle was not equal to that of the left. In the autumn of 1869, this case came under my observation. During the interval the man had followed his occupation, using with freedom even the large hammer. But about four weeks before placing himself under medical care again, he had begun to suffer from severe erratic pains in the right arm and fore



arm, and an inability to wield the hammer freely. In bulk of muscles and voluntary action no difference could be detected between the right and left arms. The right deltoid was apparently as fully developed as the left. There was no alteration of sensibility of any form over the right arm, and all the muscles responded to an induced current of ordinary strength, an interrupted voltaic current producing no contraction until its force was raised to a point that it would act upon healthy muscles. But the motor effect produced on the right deltoid by induced currents of equal strength was much less than on the left.

I had under my care recently a gentleman who had resided for some years upon the west coast of Africa. The muscular symptoms were those of lead palsy; the extensors of the fingers and the muscles of the thenar eminence had almost entirely disappeared in both arms, there being complete flattening of the ball of the thumbs. There was no lead line and no history of lead, but there was enlargement of the liver, and there had been more than one attack of jaundice. The voluntary movements of the affected muscles were almost entirely abolished. The wasting and loss of power began, after an attack of remittent fever, about two years since, and in nine months had reached their present condition, when the patient returned to this country for treatment. Iodide of potassium, sulphur and alkaline baths, and

other remedies administered for some months, had caused no improvement. On testing the affected muscles there was not a trace of reaction to the full strength of Stöhrer's induction instrument, but distinct contraction to the interrupted voltaic current from ten cells of the Becker-Muirhead battery. The reaction in the other arm muscles was normal to both currents. The interrupted voltaic current from twenty of Muirhead's cells was localized in the wasted muscles for ten minutes, and they were faradized for ten minutes. This was repeated thrice a week for four months, the strength of the voltaic current being gradually increased. At the end of this time the muscles were fairly well developed, and their voluntary power for all movements was restored, though a little awkwardness remained. There was no reaction to less than thirty-five cells of Muirhead's battery, and there was no return of reaction to faradization. No medicine was taken during the treatment. My patient has returned to Africa, armed with an induction and a voltaic instrument, and I have since heard from him that he continues well.

In cases of atrophic paralysis from traumatic injury of the nerves, faradization is indispensable. In the cases of men wounded in the civil war in America, it was largely tested in the hospitals of Philadelphia, and the surgeons specially selected for its investigation report as follows :“ The only important means in the treatment of paralysis from default of innervation is faradization by the method of Dr. Duchenne. Most of our cases were from wounds that were of old standing when they came under our care, and localized faridization proved of the utmost value. In some cases, at a single application it restored the power of movement to parts long deprived of it, and we have seen very few instances in which there has not been improved nutrition and greater sensibility and strength when we were able to continue it sufficiently long."* Duchenne reports cases which were of many years standing, and in which the paralyzed limbs were so wasted that the muscles, whose farado-contractility was also abolished, appeared to have quite disappeared. Their sensation and temperature were diminished, the cutaneous veins contracted, and the skin shrivelled, and often purple. Under direct faradization sensation and temperature were quickly restored, the natural colour of the skin returned, the muscles gradually increased in bulk, and regained their voluntary movements, and afterwards their farado-contractility. The following is a typical example.


A printer, 19 years of age, was injured on the inner side of the forearm by a cutting instrument,

* S. Weir Mitchell, George R. Morehouse, and W. W. Keen. "Gunshot Wounds and other injuries of Nerves." Philadelphia : 1868.

which penetrated about an inch above the metacarpus, grazed the anterior surface of the ulna, and passing within the tendon of the palmaris longus, lacerated all the tendons in front. The flexor carpi ulnaris,

Fig. 44.

Hand before Treatment. Palmar Surface.

inner fibres of the superficial and deep flexors, the the palmaris brevis, and the ulnar nerve and artery,

[merged small][ocr errors][ocr errors][merged small]

must consequently have been severed. In three months the wound had healed, but the hand was

« PreviousContinue »