vanced cases ever become cured. The only question unanswered being-which are advanced cases? Dr. J. D. Gibson, Denver: I think we should pay as much attention to the diagnosis of locomotor ataxia as to the treatment and I believe the disease can be diagnosed before there is want of locomotion. It seems to me that there should be symptoms of the disease in this stage which could be recognized as characteristic of the disease; my experience, however, has not been sufficient along this line to speak positively. Several years ago a patient was brought to me apparently with neurasthenia. There was great hypersensitiveness about the lower extremities and almost all over the body. There was a specific history. He had shooting pains about his body and limbs and had been unable to get relief. He had been to many physicians and the diagnosis in all instances was that of neurasthenia. My diagnosis was that of neurasthenia, but with the proviso that I feared locomotor ataxia. There was still some patellar reflex, no Argyll-Robertson pupil, but there were pains in the legs and a general neurasthenic condition which I attributed to irritation going on in the spinal canal. While I was not willing to make a diagnosis of incipient locomotor ataxia, that is what I feared. He so far improved under treatment that he abandoned it, when in a few weeks he had a decided exacerbation of his condition and was brought to Philadelphia to some specialist. A diagnosis was made of neurasthenia and he finally went to Hot Springs, where he stayed for some months without amelioration. From there he went to Johns Hopkins, and there after some time he was told that he had incipient locomotor ataxia. I have not seen the patient since, but I understand that he is up and about but not well. An interesting feature of the case is that this man was the only patient I have seen who could not stand static electricity, but galvanism had a soothing effect. In the technic I placed a large pad in the nape of the neck and the lower lumbar region and passed the current downward. I find usually that the static spark is rather agreeable to cases of locomotor ataxia and probably benefits them to some degree. I do not think that the benefit is wholly from the mental influence. Dr. Herbert F. Pitcher, Haverhill: In one case of locomotor ataxia treated by the continuous current rapid improvement occurred after giving the patient heavy sparks. When he first came to see me there was complete relaxation of the sphincters, and he was unable to get into the office without help. I intend to send him to the Massachusetts General Hospital and have him taught to walk. A Swede there under Drs. Walton and Taylor has a class of taxic patients and uses the Frenkel method with great benefit. Patients who have been treated by different methods improve up to a certain point and are then unable to co-ordinate their muscles. He then takes them, and Locomotor Ataxia. 227 it is very interesting to see the enthusiasm of the class and to see them compete with each other. As Dr. Geyser says, I think many of these cases can be taught to walk. Dr. Bishop (closes): I am sorry that Dr. Rockwell has gone before I could have a chance to answer him. It seems that whenever one gets good results in cases that are usually considered hopeless, that his diagnosis is immediately questioned. I think anyone who has given nervous diseases any considerable study and has had a large experience in treating those diseases ought to be able to diagnose locomotor ataxia; for there are only a few diseases with which it could be confounded. In neuritis, for instance, there is almost always preceding fever, accompanied by pain, while locomotor ataxia comes on more rapidly, often without fever and with its own characteristic shooting, darting pains. In other conditions with which it might possibly be confounded we have a number of symptoms that we do find in locomotor ataxia. I will not go into the points of diagnosis before an intelligent audience. To go over the points of differential diagnosis before this audience would be an insult. Suffice it to say that this case reported was a case of locomotor ataxia. Dr. Geyser was very fair in his discussion. He seems to catch my idea exactly. I regret that he is sorry that I spoke of the cases that die; my paper, however, was on locomotor ataxia, and I did not think it would be complete did I not say something about the cases that die. I did not say that I could cure locomotor ataxia in any stage. I simply said that I believe if the case is seen early enough it can be cured. I do believe it, but I do not know it. When my paper is printed, I hope that it may be carefully read, so that I may not be accused of making wild assertions. If this paper will cause my friends to devote the time and care necessary to the treatment of these cases, much suffering may be avoided. ELECTRICITY IN OCULAR THERAPEUTICS.* BY S. LEWIS ZIEGLER, M. D., PHILADELPHIA, PA., Attending Surgeon, Wills Eye Hospital; Ophthalmic Surgeon, St. Joseph's Hospital, Philadelphia, Pa. The medical profession for more than a century has looked with great skepticism on electricity as a terra incognita unworthy of investigation. The marvelous scientific development of this revolutionizing agent in the field of commercial utilities, during the past two decades, has stimulated the modern medical mind to a realization of its living potentialities and therapeutic possibilities. The internist and the neurologist have blazed the way. The ophthalmologist has either followed as an enthusiast, or a rank agnostic, according to his success or his failure in grasping and applying its therapeutic principles. The galvanic current is probably the most efficient modality that we can employ in ocular therapeutics. The high-frequency current has been much exploited, but it is still employed tentatively, and its therapeutic indications and applications are not sufficiently defined. Dr. Abadie, of Paris, who advocated its employment for a time, has reverted to the use of plain galvanism. Its therapeutic possibilities, however, are probably inherent and simply await scientific development. The galvanic current has a twofold action (1) physiological, and (2) physico-chemical, as seen in electrolysis and cataphoresis. These facts must be kept in mind in explaining the diverse electric phenomena and the resulting therapeutic effects. The first named action is manifested chiefly in its direct effect on the nervous system, while the more obscure bio-chemic action not only originates a decomposition of the watery elements of the solids and fluids of the body, but also transmits certain wellknown chemical agents from one pole to the other. The whole process is, therefore, a most complex one. The effect of polarity on the subjacent tissues covers the very essence of therapeutic action. The anode or positive pole is sedative in its action, and should, therefore, be applied to all inflammatory lesions, while, per contra, the cathode or * Read at the Sixteenth Annual Meeting of the American Electro-Therapeutic Association, at Philadelphia, September 21, 1906. negative pole has a stimulating effect, which benefits atrophic conditions. This dictum is not inflexible, but may be modified according to the experience of the observer. For example, the rule is reversed in glaucoma where the negative pole will reduce the hypertonus, and control the disease, while the positive pole will exaggerate all the symptoms. The polarity should, therefore, be easily discernible and kept clearly in mind, as Fig. 1.-Keystone electric cabinet, arranged for treatment of the eye. reversal of the current may not only be painful or injurious, but might cause ultimate blindness. For use in an organ as delicate as the eye, all the apparatus should be carefully adjusted to measure most accurately the therapeutic currents employed, and the current should be applied with the greatest precision. As a rule, the constant current yields the best results when there is a high electromotive force and a low amperage. Sixty to seventy volts may be used, controlled down to one-half or one milliampere. A higher amperage would require a lower voltage, as stronger currents would be unbearably painful to the eye. If a battery is employed, about fifty or sixty cells will be needed to secure the required strength. If the street current is used a volt controller on the shunt principle is necessary, as well as a carbon rheostat to control the amperage. I always use the ninety-volt shunt controller as arranged in the Keystone electric cabinet (Fig. 1), with a secondary carbon rheostat and a milliamperemeter in circuit with the patient. The milliamperemeter should be arranged for lower readings, on a secondary scale, graduated from zero up to five ma. The two electrodes must be well constructed, and should always be carefully watched for the development of defects which may occur while in use. I have had the active electrode made with a curved metal eye-piece (either single or double), a long thin arm, and a thick hard-rubber handle that can be easily grasped by the patient (Fig. 2). I have abandoned the use |