always to be remembered that after protracted paralysis the muscles are likely to have forgotten their movements, and, like a child learning to walk, they want instruction. Every paralytic should devote a quarter of an hour twice a day, even when loss of power is well nigh complete, to trying to make the muscles obey the will. This is a matter that in general is far too much neglected.

The subject of electrization in hemiplegia from cerebral disease, and the proper moment for its application must be carefully considered. It is never advisable until some months, four to six, after the attack, and then the question arises whether the persistence of the hemiplegia arises from the muscles having lost their old aptitude of response to the influence of the will, or from the cicatrix or cyst exercising positive pressure upon the cerebral tissue, or from loss of cerebral substance. (I refer to hemiplegia from brain disease, hæmorrhage, or softening.) When there is no rigidity and the muscles are lax, faradization is advisable, for usually the brain lesion is then repaired, and the paralysis is peripheric, and localized in the muscles. Where there is much rigidity, especially with increased reflex action, irritative lesion still persists, and faradization will do no good, and may do harm. But there are many intermediate degrees of lesion that may be benefited; and in almost all cases in which after a spontaneous partial return

of voluntary movement, the patient suddenly stops short, and for many weeks or months makes no further progress, faradization comes in, and the immediate good that it will often do is surprising. Half a dozen applications give a fillip to the muscles, and more improvement is often effected in a week than in the preceding year. The improvement is generally sudden. The "late rigidity" of hemiplegia may be largely relieved by electrization. Such a case was recently sent to me for electrical treatment, by Mr. Willett, from St. Bartholomew's Hospital. As the result of an accident there had been compound fracture of the right parietal bone, loss of brain substance and immediate left hemiplegia. The patient was trephined, and after some months' treatment there was considerable return of voluntary power, but with cicatrization there supervened extreme rigidity of the flexor muscles of the left hand, the fingers of which were so tightly contracted that the hands could with difficulty be forced open, and immediately after being opened they reclosed involuntarily. There was also rigidity of the biceps, the forearm being carried semiflexed with inability to further extend it. The continuous voltaic current was localized in the rigid muscles for five minutes, and their antagonists energetically faradized for a second five minutes, three times a week for three months, with the result that at the end of that period the patient could quite straighten

his arm, and fully extend the fingers to a level with the back of the hand. In such cases, or whenever a powerful current with little pain is required, Duchenne's pedal rheotome (y, fig. 11, page 37) is of great value. By it the current may be interrupted three or four times in a minute, instead of three or four times in a second, which is about the slowest rate of any interrupting hammer of a faradic instrument; and a current sufficiently powerful to penetrate thick muscles may be applied in circumstances under which a very much weaker current rapidly interrupted would give equal pain, and be strong enough only to act upon the superficial muscular fibres.* I need hardly remind the reader that always in these electrizations every part of each muscle must be equally excited, as described at page 71, and that it is never necessary to use painful excitation in any paralysis except when the muscles have lost their sensibility, or when as in atrophy, their nutrition is impaired. During faradization I have never had the misfortune to witness the occurrence of a second apoplectic seizure, and I am confident that

* My friend Dr. Gowers has improved upon Duchenne's rheotome by having it so constructed that a slight twist of the foot will fix it immovable, and so maintain the current when required without interruption while the foot is removed, which cannot be done with Duchenne's. He has also arranged a pedal commutator of the poles by which the direction of the current may be instantly changed by pressure with the foot. Dr. Gowers' Pedal Commutator can be obtained from Weiss and Co., 62, Strand. It consists of three buttons arranged in a line upon a wooden slab six inches by four. The central button is the rheotome, and the outer buttons the commutators.

faradization skilfully administered has never produced one; but it is wise to remember that all such patients are predisposed to a second attack which, if it occurs, is very likely to be attributed to the electrization.

In paraplegia from myelitis electrization cannot be, any more than in hemiplegia, had recourse to during the period of active mischief; its use can but be to preserve the nutrition of the muscles cut off from central innervation, and this should not be attempted while active mischief exists. In the persisting localized paralysis following upon myelitis electrization is of the greatest service.* The difficulty is to determine the proper moment for the application of this agent. The paralyzed muscles should be examined at intervals with the faradic and interrupted voltaic currents, and when it shall have been determined that electrization may be used, one or the other form of current, and at a later period perhaps both currents, should be used according to the suggestions already given. I should be disposed also to charge the patient with

*Brown-Séquard's experiments prove that after traumatic lesion the cord may be perfectly restored. He divided the cord of a pigeon about the level of the fifth or sixth dorsal vertebra. There was a slight return of power in three months and almost complete recovery in fifteen. The animal was then killed, and on examination, it was found, in the author's words, that "les cicatrices des plaies anciennes de la moëlle épinière renfermaient des fibres nerveuses ayant tout à fait l'aspect normal et se continuent avec les fibres des parties intactes de la moëlle." Identical results were obtained in several cases. Brown-Séquard, Comptes Rendus de la Société de Biologie.-Juin, 1851.

postive voltaic electricity after the method of Dr. Radcliffe, or the constant current may be applied in continuity to the spine, or one electrode may be held stationary and the other moved up and down the spinal column as advocated by Benedikt. These methods are worthy of a trial also in those cases in which, although the cause of the paraplegia may have been removed, the cord itself would appear to have lost more or less of its excitability.

In that most distressing and intractable disease Cruveilhier's atrophy or wasting palsy a combination of localized muscular faradization with Dr. Radcliffe's "positive charge" should always be given a fair trial, the more so as medication is wellnigh useless. In some cases in which I have pursued this plan of treatment there has followed a filling out of the wasted muscles and an arrest of the disease. Localize faradization in the wasted muscles, and vary this treatment on alternate days by the "positive charge." If the disease is in the upper extremities, each hand may be immersed in a separate vessel of brine with one pole, and a "ground wire" carried to a chandelier from that containing the negative; or if the lower limbs are affected they may be placed in foot pails in the same manner, or one arm and one leg according to the localization of the disease. The patient and the battery must be both insulated, the charge as strong as can be borne without discomfort, and the length of time about