What is wanted is to Dr. Radcliffe's

Positive

city by an earth wire.
charge the outsides of the sheaths positively as Charge.
they are charged naturally. What is aimed at is
to put the fibres by this means in the condition
most favourable to the preservation or recovery of
their irritability—not to provoke this irritability into
existence by shocking it; and certainly there is much
in theory and much in practice to recommend this
view as one which opens out quite a new field in
electro-therapeutics. Before long I trust there will
be something definite as regards practice to be said
respecting it.

Use of Volta

dism.

The question of the differential use of the voltaic Differential current, as well interrupted as constant, and that of ism and Fara faradism, has been largely discussed of late years, and for some time divided electro-therapeutists into two great schools, the Faradists, led by Duchenne, in France, and the Voltaists by the late Professor Remak, in Germany. The advocates of the voltaic current claim for it an action sui generis upon the nervous centres, an action which faradism can in no way replace. Benedikt, in his "Electrotherapie,"* of Brain. contends that the voltaic current will directly affect the brain and cord. He advises, in cerebral disease, that it should be applied to the long or short axis of the cranium, sittings not to exceed thirty

Electrization

* Electro-Therapie, von Dr. M. Benedikt. Vienna: 1868.

of Sympa-
thetic"
(so-called).

seconds, and to be stopped instantly on the occurrence of the slightest giddiness. The electrodes must be maintained immovable, and may be applied to each mastoid process, to each temple, or to the frontal and occipital protuberances. He advocates "Electrization still more strongly, for symptoms of intracranial origin, the so-called "galvanization of the sympathetic"-its cervical ganglia. One electrode may be deeply pressed into the auriculo-maxillary fossa, and the other, with a good-sized sponge, applied over the sixth or seventh cervical vertebra, or to the manubrium sterni, close to the border of the sternomastoid. The duration of the application should be from one to three or four minutes and with from ten to twenty cells. Whether voltaization can be localized in the sympathetic or not, very powerful effects are produced by the electrodes placed in the above positions, and when so applied the greatest caution must be exercised by the operator, as also in cerebral galvanization. Giddiness, syncope, and convulsions are recorded as the sequel of a too powerful or too prolonged application. Benedikt also advocates galvanization of the cord, by keeping one sponge, usually the positive, stationary, and moving the other up and down by the sides of the vertebræ, about forty times at each sitting; or by one pole on the spine and the other on a nerve or muscle. After galvanization of the nervous centre has restored voluntary power he advises that the nutrition of

Electrization of Cord.

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.

it

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. electrodes should be so applied as to include in their circuit the part or nerve affected. The number of

The

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

H