THE JOURNAL OF

ELECTRO-THERAPEUTICs.

NEW YORK, JANUARY, 1897.

ORIGINAL ARTICLES.

THE TREATMENT OF OLD PARALYSIS.

BY F. M. FRAZER, M. D., NEW YORK.

I wish to present to you the outline of a case which came to my clinic last winter, together with my treatment of it, and my reasons for selecting that course of treatment.

It is the case of a woman of about fifty, who, twentyfour years ago, while pregnant, burst a vessel in the brain, and had a well-marked crossed paralysis. When she came to me, the facial paralysis had disappeared, but the left limb was paretic and the left arm was practically useless, as her hand was not entirely under her control, and would open and close involuntarily. The contour of the arm was changed, probably on account of the unusual character of the exercise her muscles had in making these athetosic movements. Sensibility was intact.

As it was practically an incurable case, I gave an extremely guarded prognosis and started treatment. There was neither wasting nor reaction of degeneration, showing that the lesion was above the anterior horns of the cord, and thus according with our intercranial diagnosis. Treatment consisted of running over the motor points

with the interrupted galvanic-negative, of course-and static sparks.

My idea in following the motor points was that this would exercise the muscles normally, and not in that eccentric manner they had exercised by her athetosis. If she could not control her muscles I could, and perhaps thus improve the contour of the arm. This, however, would do little toward benefiting the lesion in the brain. For that I trusted the static spark. To explain why I selected the static and its effect, I must digress into physiological psychology for a moment.

When an external stimulus acts on the end organ of a sensory nerve, a centripetal nervous impulse is determined (1) to the cord, (2) to the basal ganglia, and (3) to the cerebrum. If it goes to the cord it wanders about (in the path of least resistance, presumably) from cell to cell, and center to center, until it reaches a motor center which it stimulates. The motor center at once discharges, a centrifugal nervous impulse traverses the motor nerve connected with the center, and stimulates a muscle, which contracts. This is reflex action.

If the centripetal impulses reach the basal ganglia, we obtain co-ordinate movements, or automatism. The principle is the same, but the development is higher.

If, however, the centripetal impulse reach the cerebrum, we obtain a new factor: concatenated with the physical act is the psychical element of consciousness. This, of course, is in a normal person: if I stick a pin in your hand I expect impulses to travel to motor centers in your cord, medulla, and cerebrum, and so to stimulate these centers that they will discharge and send motor impulses to your muscles, causing them to contract in such a way that your hand is removed from the pin; you are conscious of what is going on.

Paralysis occurs physically when, owing to some defect n the conducting apparatus, the nervous impulses cannot