Writer's
Cramp.

mastoid, 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

FIG. 62.

།་་་་

Torticollis.

Contraction of Splenius.

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 Torticollis. 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.

Splenius.

Fig. 62 represents a case of contraction of the Contraction of 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.

tractions

Rhomboid.

In long-standing cases also of tonic contractions Tonic Conof 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 Contraction of 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

K

Contraction of head.
Rhomboid.

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

A.

The levator scapula. 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.

Rhomboid.

spinal border of the scapula, which occupied an ob- Contraction of lique 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 scapula. 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, в, 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.

Reflex Con

traction.

Hysterical
Paralysis.

The above case is an example of the occasional necessity of very painful electrization.

There is a sort of reflex contraction which sometimes follows upon contusion of an articulation, as in the wrist from falls upon the back or palm of the hand, and which usually appears after the local inflammation has subsided, affects a number of the muscles about the joint, and at length may extend to other joints of the limb. The pain, limited at first to the muscles first affected, soon extends to others, to the nerve trunks, and finally to their origin in the brachial plexus. Here again painful faradization of the antagonists of the painful muscles has, in Duchenne's hands, been most successful.

Hysterical paralysis, whether accompanied by anæsthesia or hyperæsthesia, will frequently be removed by cutaneous faradization with the wire brush, or by localized muscular faradization. In most cases while contractility is intact, sensibility is abolished or diminished (a valuable diagnostic sign of hysterical from cerebral hemiplegia). If electrization proves of benefit, it will usually do so in two or three sittings, and it is as a rule useless, to continue beyond half-a-dozen if there is then no improvement. The treatment must be localized in each of the affected organs, and continued some time after return of movement, so as to fix, so to say, the cure. In hysterical contractions, as of the fingers, on account of the extreme excitability