be dangerous, but perhaps fatal. At this time an inverse current would increase the irritability, and perhaps produce a fresh apoplectic attaek. When we have convinced ourselves that the irritability at the point of effusion has subsided, we may begin treatment. In doing this, we are to gauge the electric irritability of the muscles (their contractility), and are to take into consideration the state of the patient, his age, and other influences. If the lesion has been produced by embolism, softening, or disease of the brain-substance, we must also be guarded in the exhibition of our treatment. We must wait for absorption to be well under way. A proper use of the direct current must be made to hasten this, and a mild faradic current locally to prevent the atrophy of muscular tissue till the cerebral mischief is over. It is well to observe a proper medium in the time of application, for, if we begin too early, the bad results I have just alluded to will follow; if too long after the hæmorrhage, we shall find that the response to stimulation will be weak. In muscles long paralyzed, the electric contractility will not respond to the faradic current, but a rigid and sometimes violent contraction will follow the galvanic. Daily séances should be made. The faradic current may be used in the following ways: 1. One pole to some central locality, i. e., the lower part of the vertebral column, and the other to some peripheral point. 2. One pole at one end of a muscle, and the other at its point of insertion. FIG. 40. 3. Mediate electrization (vide p. 57). 4. Immediate electrization. A galvanic current of moderate tension may be directed through the head. This treatment, with an auxiliary use of strychnia, iron, and phosphorus, will improve most cases of hemiplegia. During our treatment, we should test, from week to week, the cutaneous sensibility. This may be done by an ingenious little instrument known as the æsthesiometer. Fig. 40 represents that form known as Hammond's æsthesiometer. The approximation of the two points will indicate the extent of morbid sensibility. When these points are brought together, the patient will distinguish both of them simultaneously at a certain distance of separation between the points. The minimum normal distances at which the two points. can be distinguished in different regions of the body are as follows:1 In disease, the distances will be greater or less, according to the hyperesthesia or anæsthesia. The thermometer should also be used. Dr. Seguin's improved thermometers, with broad bases, are excellent instruments, and with two of them placed simultaneously on the skin, we can compare the difference in temperature in two parts of the body-the paralyzed and the non-paralyzed. Dr. Seguin's Surface The muscular power should be tested also, and this may be done by the dynamometer. This instrument must be grasped in the hand, and one slow and forcible attempt at squeezing the two flat borders of the ellipse should be made; the ends a and b will be expanded, and the transverse diameter diminished. With this movement a toothed arm revolves an indicator, which registers the extent of the compression. The relative scale indicates the muscular power of the hand. This 1 "Diseases of the Nervous System," Hammond, p. xvii. instrument is ingeniously constructed to register the force exerted after the effort is made. It was invented by M. Mathieu of Paris, and first introduced into this country by Dr. Wm. A. Hammond. The prognosis of cases treated in the manner I have described, is exceedingly favorable; in fact, it is impossible to thoroughly and quickly restore a paralyzed limb without electricity. The existence of softening makes the prognosis invariably bad, the relief afforded being only temporary. If the patient's condition be such that there is a gradual breaking down, I doubt if electricity or any other mode of treatment will do any good. When the paralysis is so complete as to involve the sphincter ani and the muscular fibres of the bladder, improvement is unappreciable.' I. Right Hemiplegia, the Result of Thrombosis, with Ataxic Aphasia.-W. W., aged thirty-one. In March, 1868, first noticed the symptoms of formication; numbness and feelings of 1 Dr. Emil Fliess, of Berlin, relates the results of the treatment of eighty-five cases of hemiplegia with the constant current. The patients were of all ages, and the disease was of most various origin in different cases. Two methods were employed: 1. Galvanization of the sympathetic, by placing one pole on the cervical sympathetic of each side, or else one pole on one sympathetic and the other on the spine or on the course of a cerebro-spinal nerve or on some indifferent spot. 2. Central galvanization; a current being passed either from front to back of the brain, or along the spinal cord or centripetal, two points of a nerve-trunk being included in the circuit. Of sixty-four cases treated by the first plan, five were cured, and nine were much improved; of fifty patients treated by the second method, two were cured, and seven much improved. Seven patients were also cured by the combined use of both methods. Only a slight improvement, or none at all, was noted in the rest of the cases; in one, the treatment did harm.-(Quoted by Beard and Rockwell, p. 395.) heat and cold in the right side. In two weeks these symptoms advanced till they reached the shoulder; there was no loss of consciousness. On the 11th of May, the patient lost the power of speech, and did not regain it at all till four months afterward, when he was able to enunciate, in a very indistinct manner, a few words. The patient was admitted to the out-door department of the New York State Hospital for Diseases of the Nervous System, August 22, 1870, and came under the observation of Dr. T. M. B. Cross, who afterward treated him. His condition was this: "There was hemiplegia of the right side of the body, including the arm and the leg, but the face was unaffected. There was no strabismus nor facial paralysis. The pupils were very much contracted. The tongue did not deviate to either side. Every sense was unimpaired, except tactile sensibility. His intellect was as clear as ever; no loss of the memory of words, no impairment of the motor power of the tongue, but simply a defect in the faculty of coördination of the muscles used in the act of speaking. The patient found more difficulty in pronouncing labials and linguals than gutturals. There was much atrophy of the muscles of the right side of the body, but the process of degeneration was more advanced in the arm. Muscular power in the arm appeared to be nearly abolished. He could not bend the arm on the forearm, nor raise the arm by means of the deltoid. The dynamometer indicated but very feeble power of the right hand. Tactile sensibility, electro-muscular sensibility, and contractility, together with temperature, were markedly diminished in the right arm, while sensibility to pain was normal. “Patient had but little power in the thigh, could hardly walk, and when he did so it was with a shuffling gait. Heart-sounds natural; urine normal. The thermometer detected difference in temperature. The patient could not whistle, and in talking he had a peculiar hesitating, stammering manner. "The treatment consisted in the administration of hypodermic injections of strychnia, and the faradic and galvanic currents. The former was applied three times a week to the leg and arm, and to the tongue and lips; the latter to the head, as has been directed by Dr. Hainmond. small doses of phosphorus were given. With this treatment, "November 15th.-The case has shown the most marked improvement. The patient can articulate words containing many labials and dentals. The muscles of the right upper extremity have increased in strength; he can flex his forearm on the arm, raise the arm at a right angle to the body above his head, and keep it there voluntarily. He walks with greater ease, and lifts the toe off the ground. All the muscles respond to the weak faradic current. Sensibility is gradually returning, while the temperature and nutrition of the limbs are constantly increasing. The patient has so far recovered that he intends to make an attempt to earn his livelihood by engaging in some light business which only requires moderate activity." II. Right Hemiplegia Cure.-O. S., aged fifty-two, butler, came under my charge October 2, 1872. He had been deprived of consciousness and power of motion a year before, by a cerebral hæmorrhage, and, after resuming the duties of his avocation some months afterward, continued well till three months ago, when a second attack prostrated him; but, through the good treatment he received at Bellevue Hospital, he partially recovered the power of locomotion. When he came to me for treatment, there was complete hemiplegia of the left side. There was no peculiarity in his gait, beyond a very slight dragging. The arm was slightly atrophied, and the amount of power exerted by a forcible grasp of the dynamometer was indicated by 15° of the lesser circle. He could not button his clothes, nor lift his arm above his head. There was no difficulty in speech, except it might be embarrassment in speaking the words containing the letters b and p, when the labial muscles were required. Electric irritability in the arm was slightly exaggerated. After giving him a simple prescription for his constipation, I dismissed him. In three weeks afterward he returned in very much the same condition. I then systematically applied the galvanic current to the head, and the faradic to the limbs. The improvement was marked and immediate. The muscles lost their atrophic state, and became firmer and larger. The patient was able to perform many actions with his |