lysis.

Infantile Para- even redevelop them. He does not speak favourably of treatment by the interrupted voltaic current. Hesitating, as I cannot but do, to express an

opinion adverse to the conclusions of so distinguished an authority, I am yet convinced that all those cases in which irritability to this current is increased, will make better progress under it than under faradization. As a rule, I should advise such cases to be treated at first with the interrupted voltaic current, and subsequently with the use of the two kinds of currents alternately. In Duchenne's hands the application of voltaism to infants has been attended with unbearable pain. I have not found it so, if only from ten to twenty-five cells are used, and more are hardly ever required. As soon as there is a return of reaction to faradization, faradization should be solely used. In addition to electrization the paralysed limbs should be immersed in water, as hot as can be borne, for a quarter of an hour twice a day, and should afterwards be well rubbed and shampooed. Infantile paralysis is almost always a

lysis.

tedious disease, and treatment must be continued Infantile Parafor weeks, months, or even years. Parents are apt to bring such children to you with the expectation that after every other remedy has failed, electricity is going to work miracles. The reader is advised always to explain to them the probable length of treatment required, and to decline to have anything to do with the case for a few applications only. Dr. Radcliffe truly says, in his article on this disease in Reynolds's "System of Medicine," that "if the paralysed muscles retain their electro-contractility and sensibility, and so show that they have not passed into that state of fatty degeneration into which they always tend to pass eventually, there appears to be scarcely any limit to the time in which improvement and even complete recovery is possible;” and, further on, he adds, "that in all cases the electrical and gymnastic parts of the treatment are of primary rather than of merely secondary importance, I am every day more and more convinced, because every day I meet with instances of muscles which I should once have looked upon as hopelessly paralysed, being resuscitated by these

When any amount of voluntary power has been restored by electricity, it is most important that the child should be encouraged to use the limb, and practise various movements. In every variety of paralysis, as well in adults as in children, it ought

Paralysis.

Hemiplegia.

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

dity."

partial return of voluntary movement, the patient Paralysis. Hemiplegia. 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. Theimprovement is generally sudden. The "late rigidity" "Late Rigiof 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 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,

open,

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 (x, fig. 11, page 21) 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 55, 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 fara

* 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.