frequent reversions of polarity. The pain yielded very soon, while the mobility improved slowly and gradually. At the end of several months he could walk and use the arms and hands naturally; the general health was restored; the treatment, however, was continued occasionally for some time until complete recovery.

Faradic Current in Heart Diseases.-I found the faradic current of great value not only in functional but in organic diseases of the heart. Chronic myocarditis and the degeneration of the myocardium constitute the principal danger in organic cardiac affections, the treatment is therefore directed toward restoring the nutrition of the heart. I employ the following method: A large negative electrode is applied (stabile) to the nape of the neck, a smaller positive electrode to the jugulum sterni and the current gradually increased and diminished several times; then the small electrode is placed over the vagus and sympathicus and the current again increased and decreased several times, the same being repeated on the other side; finally, the positive electrode of a moderate current is moved along the lateral and anterior surface of the neck, the negative electrode remaining steadily in the same place. This treatment is continued daily for a considerable time. It affects in a direct manner and by reflex the vagus and the sympathetic, strengthens the heart's action, the circulation and nutrition, prevents heart failure and renders the valvular diseases almost harmless by producing hypertrophy of the cardiac muscle.

The secondary effects of organic cardiac diseases, hydropic effusions, engorgements of the viscera and cyanosis, gradually disappear under this treatment.

Mrs. M. of Albany, N. Y., about thirty-six years old and mother of several healthy children, came under my care in 1885 with a diagnosis made by eminent physicians in Albany and New York of an organic heart disease of long standing, aortic stenosis. and dilatation of the left ventricle. The patient comes from a healthy family, her father was a well preserved octogenarian and her brothers and sisters were all healthy married people. Although well

built she was always the weakest of the family and anæmic since an attack of rheumatism. During a year or more she became subject to fainting, and would suddenly fall even in the street and remain unconscious for some time. All exercise was then forbidden and she was not allowed to walk up the stairs. Her pulse was very weak and easily compressible and the heart's action feeble; she suffered besides from a severe trigeminus neuralgia. I regulated her functions, ordered a methodically increased daily outdoor exercise and began at once the faradization of the neck by the above described

method. Besides this, I occasionally used galvanizaThe patient's health improved steadily under a continuous treatment of several months, which was repeated at intervals until the disappearance of all morbid symptoms. The patient, after the lapse of so many years, appears in perfect health, the heart's action is regular and strong, the pulse normal, she can walk long distances, climb mountains, play golf-in fact, she has become the strongest of the family. Complete compensation of the valvular affection must have taken place under the combined action of electrical stimulation of the cardiac muscle, exercise and the removing of obstacles to the free circulation of the blood.

tion of the brain with mild currents.

In treating organic heart disease special attention must be given to digestion. I observed that the overfilling of the stomach with indigestible food produces irritation of the cardiac vagus by reflex

from the gastric branch of the pneumogastric; this arrests the heart's action and is followed by fainting and heart failure. Mild aperient mineral waters remove the obstacles to free circulation. In chronic cardiac diseases, judicious and methodically increased muscular exercise in the open air is of utmost importance.

The Galvanic Current.-Rational electrotherapeutics bears the same relation to electrophysiology as rational medicine bears to physiology. Indeed, the whole doctrine of electrodiagnostics and electrotherapeutics becomes intelligible and clear only in the light of experimental electrophysiology. It teaches, for instance, that the brain, the spinal cord, the organs of higher senses possess inherent electrical currents which obey certain laws and undergo changes during their functional activity. (negative variation, etc.). Thus, when a galvanic current passes through a motor nerve, this latter responds with a certain visible reaction-a contraction of the corresponding muscles-and at the same time undergoes a certain modification of its excitability in the sphere of the cathode the excitability may be increased to such an extent that the slightest excitation, mechanical, chemical, or faradic, which would scarcely produce any contraction before the passage of the current, will now call forth strong tetanic contractions. In the sphere of the anode a lowered excitability obtains, and even strong faradic stimulation will produce but a slight contraction or none at all, whereas before the anelectrotonic condition it would have called forth tetanus. The galvanic current acts in the same way upon the sensitive, vasomotor and other nerves and the nerve-centers, producing analogous modification of their excitability; for instance, in the sensitive nerves-hyperæsthesia, anææsthesia, analgesia, etc.

Theoretically it would seem easy to construe electrotherapeutics on the basis of electrophysiolo gical principles, but it is not so in practice. We cannot always determine in the living body the direction in which the current flows, because of the multiplicity of heterogeneous tissues and their different conductibility. Brenner therefore introduced the polar method, where the anode practically represents the ascending current and the cathode corresponds to the descending current. Since the physiological and therapeutic effect of the anode and cathode differ as widely as their electrolytic, chemical effect, the active electrode alone is applied to the affected part while the other, the indifferent electrode, is placed at a considerable distance, in order not to interfere with the action of the former. In morbid conditions the altered structures react

differently from the normal, and in the motor nerve, for instance, the anodic reaction often prevails over the cathodic. According to electrophysiologic law, the increased sensitiveness in neuralgia should be subdued by the anode, but sometimes it will on the contrary increase the pain, which, however, will yield to the cathode; in some cases, as in neuritis, only a strong irritation with the faradic brush will bring relief. Again, where the anode subdues the pain, it will sometimes carry it to the corresponding nerve of the opposite side; in such cases, in order to prevent this complication I apply to the symmetrical nerves a bifurcated anode (my polar symmetrical method).

In the normal auditory apparatus the cathode produces a distinct sound, like the ringing of a bell, which instantly ceases under the influence of the anode. Thus the latter can be used to abolish tinnitus aurium. But in pathological conditions

the reaction of the auditory apparatus is often perverted, and the noises can be stopped only by the cathode. When the reaction is paradoxical, i.e. when the noises cease in one ear to appear in the other, a bifurcated electrode applied to each ear brings both under the influence of the same active electrode and abolishes the noises.

These examples show that electrophysiology has to guide electrotherapeutics, but the physician must find his own methods based on clinical observation. The limited space of this article allows to describe but a few electrotherapeutic methods and to briefly allude to the principles on which they are based.

Galvanization of the Brain.-A mild galvanic current applied to the head may call forth cerebral symptoms-flash of light, taste, sound, vertigo, etc., which prove that the current, percutaneously applied, affects the brain directly, and not by reflex, and acts upon the vasomotor nerves and the circulation. The galvanic current, being the normal stimulus for the brain, is indicated in all functional and some organic cerebral affections; in neurasthenia, hysteria, hypochondria, in mental diseases. insomnia, etc. Even organic diseases of the brain, which are generally preceded and accompanied by cerebral congestion, anemia, and other vasomotor disturbances, are favorably influenced in the first stage. As galvanization of the brain improves the circulation and nutrition of the nerve centers and these latter control all the functions of the body. it is obvious that their improvement affects the whole system. My method is described in the Archiv für Psychiatrie und Nervenkrankheiten.

Mrs. L., about forty years old, suffered from deep melancholia without delusions since her husband deserted her six years before. She was very anæmic and emaciated, pulse slow and easily compressible, all the functions retarded. She constantly remained quiet, exceedingly depressed, scarcely uttered a word, ate very little and had only a broken sleep. A friend accompanied her to my office and gave the anamnestic data while the patient sat silent, motionless, even the facial muscles remaining immovable and presenting a masklike appearance. The eyes alone expressed intelligence and showed that she was aware of her surroundings. Soon after I began the galvanization of the brain the face gradually assumed a more natural appearance, she smiled and said she felt better, and at the end of the application she looked differently, gave me some details of her condition and walked cheerfully away. Under the continued treatment she recovered and resumed her former occupation.

Mr. E., about forty-three years old, formerly healthy, very active and one of the best students at college, where his professors and colleagues predicted for him a brilliant literary career. After the death of his young wife, several years ago, he lost his former ambition and energy, became inactive, irritable and capricious, quite in contrast to his former good-natured and amiable disposition. He complained at first of a dull headache, various paræsthesias and other neurasthenic symptoms. Later he suffered from præcordial distress, congestions to the head and different vasomotor disturbances. These latter symptoms would assume at times an acute exacerbation in the form of attacks of insomnia, intense psychical depression, accompanied with dyspnoea, præcordial distress and suicidal tendency which would last for weeks without yielding to any treatment, and would only gradually subside, leaving the patient weak and depressed for many months and sometimes until the

appearance of a new attack. The morbid condition presented a strange combination of neurasthenia, hysteria and recurrent melancholia (described by me in the MEDICAL RECORD, 1898, June 11. He had been treated with but little success by a variety of methods; during the acute attack no remedy would alleviate the suffering; no hypnotic would produce sleep if administered in the ordinary doses, and the patient seriously contemplated suicide. Galvanization of the brain, however, gave immediate relief and removed the præcordial distress, the dyspnoea and insomnia. By continuing the treatment for some time supplemented by galvanization of the cervical sympathetic the patient would rapidly recover and would remain comparatively well until, under the influence of some depressing emotion, a new attack would be called forth and would again yield to galvanization of the brain.

Miss G. of this city, aet. twenty-eight, came came under my care twenty years ago, suffering since her fifteenth year from intense headaches, which would not yield, even temporarily, to anything but a complete anæsthesia by ether, which had to be kept up, with interruptions, for twenty-four hours or more, once a week and sometimes oftener. She was otherwise of a good constitution, but with a tendency to congestions to the head. The galvanization of the brain brought a speedy relief, the headaches became milder after each application, less frequent, and could be borne without ether. After a while the headaches left her entirely and have never returned. She still continues in perfect health.

Rev. Mr. A., aged fifty-five years, an eloquent preacher and scholar, of a very nervous temperament, suffered for many years from insomnia, and complained of different neurasthenic symptoms and was very much run down. He went to Europe in search of health, but on reaching Paris began to hallucinate with a complete confusion of ideas. It became necessary to place him in an asylum and Dr. Brown-Sequard telegraphed his family in Boston that he was probably hopelessly insane. When his condition improved somewhat he was brought back to New York and placed under my care in 1877. I found him weak, anæmic, emaciated, suffering from insufficient sleep (for about two to three hours). I treated him daily with galvanization of the brain, which soon brought nights' rest and after a while he could sleep for seven or eight consecutive hours. His general health improved with the regained sleep, and allowed him to resume, with renewed energy, his former work. He published later a new volume and has since continued

to be in good health.

་

Miss I., school teacher in Washington, D. C., referred to me in 1871 by her uncle, an eminent physician. She suffered for years of otorrhoea, noises in the ears and head, with severe headaches and insomnia. She was anæmic, emaciated, of a sallow complexion, and the countenance expressing intense suffering. I commenced the treatment of tinnitus aurium, at the same time using the galvanization of the brain. After the first treatment she slept almost twenty-four hours, awakening only for her meals, and slept well every following night. She left for Washington in a very satisfactory condition and resumed her usual occupation.

Mr. H., lawyer (1887), aet. forty-one, marfor ried, suffered many ried, years from severe nervous dyspepsia, and gastralgia with occasional vomiting and insomnia. He could not take sufficient food, as many nutritious articles invariably produced indigestion. He complained of general

I

debility, was anæmic, thin, weak, unable to have any outdoor exercise and often had boils and furuncles. A life insurance company had refused to accept him after examination of the urine, which contained a considerable amount of sugar. found the patient's heart weak, the pulse small and the muscular system undeveloped; the urine contained more than 2 per cent. sugar. Under the galvanization of the brain and general faradization the glycosuria disappeared and his health steadily improved in every respect. He gained flesh and strength, sleeps well and can now take outdoor exercise; his appetite and digestion are good and all other functions normal.

The incurable progressive paralysis of the insane s preceded by cerebral vasomotor disturbances long before the degeneration and destruction of the nervous elements set in. In the first vasomotor stage I consider the disease curable.

Mr. J., a wealthy bachelor over fifty years old, placed himself under my care in 1881. He was a high liver, and had syphilis, from which he was entirely cured many years ago. His friends and relatives had noticed for some time a gradual change in his temper and general appearance; from a quick, rather aggressive man, exceedingly active, and fond of society and of all sorts of pleasures, he became quiet, passive, even submissive, taciturn, and complained of neuralgias and insomnia. The examination showed that he was of a good constitution and the thoracic and abdominal viscera normal. speech was slow, hesitating, the pupils somewhat unequal. and reacting sluggishly, fibrillary contractions of the tongue and occasional twitchings of the facial muscles. The knee-jerk was diminished, he walked slowly and complained of sciatic pains, sometimes in the right or left limb and sometimes in both.

His

I pronounced the case progressive paralysis of the insane, with an absolutely unfavorable prognosis. However, the galvanization of the brain and of the cervical sympathetic gave beneficial results, and his general health improved progressively and so remained during twelve years. Together with the galvanic treatment I enjoined a healthy mode of living, forbidding all excesses and alcoholic drinks, and advised being under a constant medical observation. His relatives, who lived with him, thought he was entirely restored to health and concluded to spend a couple of years in Europe. Meanwhile he took up his residence in one of the fashionable clubs and resumed the gay life and excesses, of his youth. I did not see him for eighteen months, when he suddenly came to my office, after an apoplectiform attack, in a hopeless condition. His relatives returned and took him to Europe, where the disease progressed to a fatal termination. I believe the patient might have been saved had he remained under medical observation and led a quiet life, as in the following case.

Mr. R., a bachelor, thirty years old, a successful dentist, with a large and lucrative practice came under my care in 1887. He worked hard, but could not take sufficient sleep; he spent the evenings in society, or places of amusement, indulged in all sorts of excesses, and once acquired syphilis, from which, however, he had been cured. He presented premonitory symptoms of general paresis -great excitability, inequality of pupils, congestion to the head and headache, loss of memory, fibrillary contractions of the tongue and of the facial muscles, insomnia, frightful dreams, diminished knee-jerk. I treated him with galvanization of the brain and cervical sympathetic, and in explaining to him his condition, advised a quiet, healthy, regular mode of living, if possible in the

country. The patient followed my advice and has entirely recovered.

The effects of galvanization of the brain are soothing and invigorating; any unpleasant or painful sensation diminishes or disappears, impeded movements become easier, choreatic twitchings cease and patients enjoy refreshing sleep.

Miss S., fifteen years old, only child of wealthy parents, was affected with a severe form of chorea, which resisted every treatment, including arsenic and iron, etc. I saw the patient in 1873. She was thin, very pale, chloro-anæmic, and continuously agitated by more or less violent clonic movements of the head and extremities which seriously interfered with every voluntary movement and were often the cause of alarming accidents. Thus, the day before she came to me the end of a parasol she held in the hand was violently thrust into the nostril and caused a profuse hemorrhage, which was arrested with great difficulty. I treated her for a couple of months with daily galvanization of the brain, under the influence of which she gradually recovered, had no relapse and still remains a healthy lady.

Mrs. L., about sixty-five years old, thin and decrepit, of a sallow complexion, with senile tremor of head and hands, resembling the initial stage of paralysis agitans, complained of dyspepsia, insomnia, backache, and general debility. I treated her with galvanization of the brain until the disappearance of all the morbid symptoms, including the tremor She is still in good health, although now an octogenarian; goes out even in winter, and comes occasionally to be treated with galvanization of the brain.

Mr. B., a cultivated gentleman of this city, controlling large business interests and generally respected for his benevolence and philanthropy. When a young married man he used to have hemorrhages from the lungs and other symptoms of pulmonary phthisis, which, however, gradually subsided, although he always remained in delicate health and very thin. Later he became subject to dyspepsia and diarrhoea with occasional attacks of gastralgia. In 1869 I was called to treat him during the most severe attack of gastralgia and vomiting, which, lasting nearly two weeks, deprived him of night's rest and prevented the taking of nourish After he had recovered from this protracted illness he came to my office asking advice in order to prevent similar attacks. I employed galvanization of the brain for several months, with occasional interruptions, until the patient's improvement in every respect became steady. He said that his general health had become better than ever before, and, he continued, for about twenty-five years, to come now and then for a short course of treatment, being always active and cheerful, and retaining all his mental powers at his great age. In consequence of exposure he died of pneumonia in his ninety-seventk year.

ment.

In elderly persons a methodical galvanization of the brain is marked by a change in their general appearance. It acts as a natural stimulant and tonic, abolishes tremor, and prevents senile decrepitude; it actually prolongs life and preserves the normal functions and the mental faculties.

The Sympathetic Nervous System.-The galvanization of the sympathetic is important because of the large number of its vasomotor secretory, accelerating and inhibitory nerves and ganglia, influencing the circulation and nutrition of the viscera and controlling their involuntary and peristaltic move

disease, migraine, epilepsy, etc., and in the incipient stages of some organic cerebral affections (general paresis).

The cervical sympathetic may be galvanized either by applying one electrode to the superior and the other to the inferior cervical ganglion, or by the polar method, when the active button-shaped electrode is applied to the superior cervical ganglion and the indifferent, a large flat electrode, to the nape of the neck with a very mild current of not more than half a minute's duration, avoiding sudden fluctuations in order to prevent cerebral symptoms. This generally accepted rule is often useful, although sometimes its effect is insignificant or fails altogether. In these cases I use the following method, especially in anæmic or decrepit persons; I rapidly increase the current to a considerable strength with sudden fluctuations and occasional voltaic alternations, decrease it in the same way to zero, cautiously watching the effect.

Rev. Mr. C., aet. fifty-eight, emaciated and anæmic, with symptoms of severe neurasthenia, suffered for years from general debility, insomnia, nervous dyspepsia, gastralgia, dull headache, backache, vertigo, and exhaustion after the slightest mental effort. He was constantly under medical treatment. I, too, treated him at different times with various methods, including galvanization of the cervical sympathetic according to the usual method with mild currents, but with little general improvement, except the backache that yielded to strong faradization of the spine. I then concluded to modify the galvanization of the sympathetic and asked the patient to inform me at once of every sensation he experienced during the application of the current. A flat anode was applied to the nape of the neck and a button-shaped cathode to the superior cervical ganglion; the current was rapidly increased, in a few seconds reversed and decreased with considerable fluctuations to zero. The same procedure repeated on the other side. During the application the patient felt flashes of light, taste, sound, disturbed equilibrium with inclination toward the anode, etc. Immediately after the application he felt general relief, and reported the next day that he had slept soundly all night, had no headache or any other morbid symptom, felt entirely well and was free from gastralgia, although he had imprudently eaten with great appetite. I continued for a fortnight the same treatment.

This method from the first application aften changes the entire character and course of a chronic disease and makes it more manageable and yielding to a proper treatment.

I galvanize the thoracic and abdominal sympathetic, including the spinal cord, by the polar method-applying the active large electrode to the dorsal and lumbar vertebræ and the indifferent large electrode to the hypogastric region, beginning with a moderate current and increasing it so far as the patient can comfortably bear. Both electrodes are first kept steadily, then the active electrode is moved slowly without breaking the current, along the vertebral column and its sides, while the indifferent electrode is kept at the hypogastrium; from time to time voltaic alternations are made, while both electrodes remain stable.

The principal vasomotor nerves are the splanchnic nerves; their vascular territory could contain almost the whole blood of the body. As they control the circulation, nutrition and other functions of the abdominal and pelvic viscera, I galvanize the splanchnic nerves in all chronic affections of these organs.

Here I will speak only of a special class of very

painful and otherwise intractable affections within the sphere of the abdominal sympathetic, which readily yield to my method.*

Under certain morbid conditions of a neurotic character (general or local) the surface of the excretory canals is in a state of hyperæsthesia, and the mere passage of the normal contents, menstrual flow, urine, fæces, produces spasmodic contractions and intense pain in the terminal part of the excretory canals.

Mrs. H. of Richmond, Va., twenty-five years old, suffered from intense dysmenorrhoea with headache, backache, etc., notwithstanding various treatments and two operations performed by Dr. J. Marion Sims, who asked me to try electricity to alleviate the pain. I commenced the treatment immediately after the period, by my method of galvanization of the splanchnic nerves, and continued it daily until the next period, which was painless, as were all the following. Her general health still remains excellent.

Dr. M., a physician of this city, suffered, for many years, from painful defecation, which prostrated him every morning and disabled him for the day. He could not attend to his practice and was obliged to postpone the movement of the bowels until bedtime. All the usual medicinal and surgical methods, severe stretching of the anus under an anæsthetic, etc., failed, but repeated galvanization of the splanchnic nerves brought relief.

Cases of painful micturition in male patients which had not been relieved by incision of the orifice yielded to the same method of galvanization.

Galvanization of the Pneumogastric Nerves.-Asthmatic attacks caused by a spasm of the bronchial tubes (reflex neurosis) are relieved by galvanization of the pneumogastric nerve.

W., twelve years old, whose father, a clergyman, died of asthma, suffered from the same disease and was brought to me by his mother in 1882. The first attacks were each caused by a cold in his ninth year and became gradually more frequent and severe; later they followed indigestion, overexertion or a cold, and soon began to appear without any apparent cause and last many days, a new attack coming on before he could recuperate from the preceding one. He was pale and emaciated and weakened by the suffering and sleepless nights, insufficient nourishment, lack of outdoor exercise. Having regulated his diet, corrected the digestion and the action of the bowels, I commenced the galvanization of the vagus. A rod-like anode about two inches long was applied along the nerve on one side of the neck, a large flat cathode to the nape of the neck, both electrodes were kept in their places while the current was gradually increased to a moderate intensity and slowly decreased. The same was repeated at the vagus of the other side. I treated the patient daily for more than a month. Several times an abortive attack or rather a premonition of an attack would appear but would quickly yield to the current. His general health visibly improved, the pallid cyanotic complexion gave way to a natural color, sleep and all other functions became normal, and he returned to Cambridge, resuming the treatment twice annually the following three years with the most satisfactory results. The attacks never returned. He pursued his studies, graduated from college and now occupies a responsible position as engineer. He is exceedingly active and enjoys excellent health.

In treating the pneumogastric nerve a bifurcated *Neftel: "Beiträge zur Kenntniss und Behandlung der Visceralen Neuralgien," Archiv für Psychiatrie und Nervenkrankheiten, Bd. X, Heft 3.

anode can be used on both sides, with the cathode at the nape of the neck. Care must be taken with regard to the intensity and duration of the current, to avoid symptoms of irritation of the vagus, retardation of the pulse, fainting, etc. In the above described case I had to reduce the morbid excitability of the vagus by producing a state of anelectrotonus, which was followed by cessation of the asthmatic attacks. But in other cases the contrary takes place, the cathode relieves the attack, probably owing to the abnormal reaction of the diseased vagus.

In some cases the exciting cause of the asthma is a congestion and swelling of the nasal mucous membrane; faradic current is then indicated—the anode introduced into the nasal cavity and the cathode applied to the nape of the neck, gradually increasing the current so far as the patient can bear and diminishing it to zero, repeating several times this procedure in one nostril and the same in the other. The treatment should be continued daily until the attacks cease to reappear. Sometimes as after-treatment a mild galvanization of the pneumogastric may be necessary.

Galvanization of the spinal cord is indicated in all its chronic affections. I give here as an instance the method I employ in tabes dorsalis. This disease is generally considered a typical primary systematic affection of the spinal cord (gray degeneration of the posterior columns) and a parasyphilitic disease, i.e. it is not genuine syphilis nor is it curable by antisyphilitic treatment, and yet it is alleged that no one can have tabes unless previously affected with syphilis. In spite of these theories it has always seemed to me that the spinal affection was a secondary degeneration in consequence of a primary cerebral affection. This is corroborated by the presence in tabes of various cerebral symptoms: optic atrophy and other ocular troubles, loss of the muscular sense and coordination, whose centers are in the brain, and the occasional combination of tabes with general paralysis of the insane. That syphilis is not an essential integral part of tabes, but only a frequent predisposing cause, is proven by authentic cases of tabes without any inherited or acquired syphilis. Again, were syphilis the cause of tabes, the latter would have been more commonly met with, owing to the prevalence of syphilis. During a scientific expedition in Central Asia in 1857 I was struck with an almost general prevalence of syphilis among the nomadic tribes, and although I had the opportunity to observe many thousands of the native population while studying the immunity from tuberculosis and the effects of kumyss,* I never saw a case of tabes in the steppes of Central Asia.

The tabic process may occasionally originate in the peripheric nerves and extend to the spinal cord (pseudotabes).

I combine the galvanization of the spinal cord with the galvanization of the brain and sometimes treat the peripheric nerves with a faradic brush.

Rev. C. G., over fifty years old, was affected with tabes in its advanced stage, which at first was taken for lead poisoning. He suffered from lancinating pains in the lower extremities and had bladder trouble and constipation; could walk with great difficulty (atactic gait), using two canes; had strabismus, diplopia, and presented the phenomena of Romberg, Westphal, Argyll Robertson. I treated him, placing a large anode to the lower

*Neftel: "Beobachtungen aus den Kirghizen Steppen," Verhandlungen der Physikalisch-Medicinishen Gesellschaft su Würzburg, 1859.

Transactions of the International Medical Congress, London, 1881.

vertebræ and a cathode of the same size to the nape of the neck, which were kept steadily for several minutes, while the mild galvanic current was gradually increased so far as the patient could bear it comfortably. Then the anode was slowly moved with a certain pressure several times up and down the vertebral column and its sides, the cathode remaining in its place. This was followed by the galvanization of the brain and an application of the faradic brush to the painful parts. The treatment was continued daily, or three times a week, during eight months with very beneficial effect; the pains, which formerly gave way only to morphine injections, entirely disappeared, along with the other troubles. He returned home, could walk comfortably for hours with one cane, rode on horseback and for all practical purposes considered himself well.

The prognosis in locomotor ataxia is favorable in the incipient stage. When more advanced, its further development may be arrested by the galvanic treatment and the patient enabled to attend to his ordinary occupations without suffering, but he could not be considered cured.

In treating cases of tabes I observed an abnormal galvanic reaction of the sensitive nerves. In the normal condition under a mild current and the electrodes of equal dimensions, a slight burning sensation is felt at the cathode only, where it increases with the current intensity, whilst at the anode no sensation is felt, unless the current is strong, and even then the irritation is felt more keenly at the cathode than at the anode. In some morbid conditions, as in tabes. the reaction is reversed-the anode produces the painful sensation, while the cathode is less felt (degenerative reaction of sensitive nerves).* With the improvement of the disease the reaction becomes normal.

Neuralgia.-Neuralgias are generally treated with the polar method, the anode being applied to the painful spot, the cathode either to the nape of the neck, or the hypogastric region, or some other distant part, the current flowing steadily for several minutes commencing with a very mild current, which is gradually increased to a moderate intensity avoid ing sudden fluctuations and metallic reversions, and as carefully decreased.

This method is modified according to the exigency of the case. I often use my polar symmetrical method, applying the anode to the painful spot and the indifferent electrode to the corresponding part on the other side. I sometimes combine the local treatment with galvanization of the brain.

When neuralgia is complicated with neuritis the faradic brush allays the pain.

Mrs. C., seventy-three years old with an organic heart disease, suffered for many years from severe neuralgia of the left trigeminus, including all its branches, especially the second. I began treatment by the usual galvanic method, but soon had to change it in the following way. I introduced a cylindrical positive electrode of a faradic current into the left nostril and a flat negative to the nape of the neck or the left cheek alternately; increased the current intensity so far as the patient would stand it and gradually decreased, repeating the procedure several times during one or two minutes. She felt better after each application and in a fortnight the neuralgia disappeared. I continued the galvanic treatment for another fortnight with mild

currents, applying a large pliable anode, covering the painful left side and the cathode to the corresponding right side of the face. The patient *Archiv für Psychiatrie und Nervenkrankheiten. Bd. XVI, Heft 1.