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twenty minutes. Faradize only those muscles that respond to the excitation. To faradize others is useless, for in this disease as long as any muscular tissue is left, response to faradism remains and its abolition proves complete degeneration. No electrization can then recall the muscles to life.
In all cases in which tremor or spasm is a pro
minent symptom Dr. Radcliffe's positive charge holds out promise of the happiest result. If during the time of the charge the tremor ceases the prognosis is the more favorable. From this treatment I have had good results in several cases of spasmodic wry-neck (torticollis) from contraction of the sternomastoid, splenius or clavicular portion of the trapezius, or of some deeper seated muscles. In these cases it is always advisable to combine with the charge energetic faradization of the antagonists of the contracting muscles; and the same treatment may be followed with advantage in writer's cramp and
analogous affections, especially when conjoined with appropriate gymnastic exercises of the affected muscles alternating with periods of perfect rest to them.
Fig. 61 is an instance of torticollis, of thirteen months' duration. The patient was a girl. The head was inclined towards the right shoulder, and slightly towards the scapula. She could bend the head but very little forwards, and not at all to the right, and trying to do so caused acute pain in the back of the neck near the upper attachment of the right trapezius, whose rigid tendon could be seen and its resistance felt. The prominence of the sternomastoid could be artificially caused on the right side by faradization. Localized faradization of the clavicular portion of the trapezius of the opposite side resulted in a perfect cure.
Fig. 62 represents a case of contraction of the splenius. The symptoms were inclination of the head backwards and towards the contracted side, with swelling of the splenius sensible to the touch. Faradization of the antagonist splenius entirely removed the deformity.
In long-standing cases also of tonic contractions of muscles, such as sometimes accompany muscular rheumatism, excitation of the antagonists of the affected muscles proves highly successful. Duchenne reports numerous cases. In one of these, in which contraction of the rhomboid had existed for some years, faradization of the radiating fibres of the serratus magnus, its antagonist, was quite successful. Fig. 63 represents the case before, and fig. 64 after treatment. The patient was a girl thirteen years of age.
The affection commenced with pain in the centre and right-hand side of the neck, increased on pressure or movement of the head. This was followed by deformity of the muscles, which increased for four years.
When Duchenne first saw her, her condition was as follows. The arms hanging at rest, the inferior angle (D, fig. 63) of the right scapula was drawn up until it was
almost on a level with the external angle and caused a marked projection. To bring it down into its normal position required the exertion of considerable strength, and the moment it was released it sprang back with an audible crack. Beneath the spinal border of the scapula, which occupied an oblique position from within outwards, was a considerable swelling, B, the retracted rhomboid. A second swelling over the right shoulder was caused by the internal angle of the scapula, which could be distinctly felt under the skin, and to the prominence, A, of the levator scapulæ. Finally the head was slightly bowed to the right, and an attempt to incline it to the left caused pain. Duchenne produced during the passage of the current a precisely analogous deformity in a healthy person by faradization of the rhomboid and levator anguli scapulæ. To bring down the inferior angle, D, to the level of that of the sound side, the radiating fasciculi of the serratus magnus were faradized; the scapula resumed its normal position, and the swelling, B, disappeared. The sitting lasted ten minutes, but at the end of it the deformity returned. This treatment carried out three times a week for a month produced not the slightest improvement, but to avoid pain to the child, the current had been interrupted only once or twice in a second. A very quickly interrupted current, causing great pain, was now used. In four or five minutes there was a sensible improvement; the inferior angle resumed its abnormal position less readily, and remained slightly lower than before. The improvement was maintained the next day, and in a few more applications all deformity disappeared, and the bone retook its natural position.
* A. The levator scapulæ. B. The retracted rhomboid. c. Fibres of the serratus magnus. D. Abnormal position of the inferior angle of the scapula. E. The inferior angle on the healthy side.