the muscles should be aided by localized faradization. This question of the therapeutic value of direct voltaization of the great nervous centres is still sub judice. The reader will, in any such operation, do well to remember the cardinal rule never to apply electricity to a patient until he has first tested upon himself.

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Electricity has been fully proved to be sometimes Relief of Pain. unapproached in its power of relieving pain. None of its therapeutic results is more firmly established, and were it in no other respect of use, its services here would entitle it to the foremost rank as a remedy. I refer especially to its application in neuralgia. The constant voltaic current is the form in which it must almost invariably be applied, both electrodes being held firmly pressed and immovable upon the skin. Faradization is seldom of any use except with the wire brush as a counter-irritant. Franklinization, if voltaization fails, should always be tried, the patient being insulated and simply charged with static electricity by being connected with the prime conductor, while the machine is kept in rotation for about fifteen minutes. If this fails, sparks may be drawn in the track of the affected nerve or nerves; but the voltaic current in nineteen cases out of twenty, where electricity is advisable, must be our resource. The electrodes should be so applied as to include in their circuit the part or nerve affected. The number of

Relief of Pain, cells should be the highest number that the patient can bear without pain or discomfort The length of application should be from five minutes to ten minutes, and the frequency once or twice a day. Dr. Althaus considers that the positive pole should always be applied to the seat of the disease. In my experience I have not found the direction of the current of importance, but only that it should be constant. The seat of the disease in true neuralgia is always in the posterior nerve-root, and one of the electrodes should be placed as nearly over this as possible. I generally place the negative pole with a large sponge, on the spine over the point of origin of the nerves affected, and apply the positive pole to the painful spot, and if there be more spots than one, to the different spots in succession. The result of this is almost uniformly good, and it is seldom that considerable relief is not afforded, even if a cure do not result, and this in most varieties of neuralgia, whether centric, reflex, or constitutional. The number of cells must be regulated according to the region affected. In the face it is best to commence with about five, as the sensitiveness of the retina varies so greatly. On the occurrence of the least giddiness the application should be discontinued and fewer cells used. The battery being in good order, about fifteen or twenty cells will be the maximum applicable to the face, which may be increased in other parts of the body; but

the practical guide must be, as stated above, the Relief of Pain. highest number that can be borne without discomfort. Professor Eulenberg, who has had wide experience, considers sciatica as by far the most curable of neuralgia-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

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Relief of Pain, 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.

Paralysis.

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 Paralysis. described at page 78. 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 endeavour, 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."

Voltaism

But there are other instances in which, although Irritability to the muscles give no response to faradism, their irri- increased. tability 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