Either the method of Moritz Meyer or of Benedikt may be employed.

Moritz Meyer places a narrow electrode, connected with the negative pole, at the angle of the maxilla near the hyoid bone, and directed upward and backward toward the vertebral column. The positive pole, in the form of quite a large plate, is applied at the opposite side against the spinous processes of the fifth and sixth cervical vertebræ. The current used should be of medium intensity, and may be either continuous or interrupted. We may also reverse its direction. The application is short, lasting from one to three minutes. We may treat one side or both sides alternately.

In Benedikt's method the positive pole, in the form of a buttonshaped electrode, is applied at the site of the jugular fossa, and the negative pole is applied at a point corresponding to the superior cervical ganglion. No action is exerted upon the cord in this way, and Moritz Meyer's method is for this reason preferred.

Galvanization performed in the neck has been applied in very different cases. It has been proposed in hemiplegia of central origin, neuralgias of the trigeminus, migraine, paralyses and contractures of the muscles of the face, neuro-retinitis and atrophy of the optic nerves, Basedow's disease, epilepsy, progressive muscular atrophy, chronic deforming rheumatism, scleroderma, and certain chronic skin affections, such as prurigo and eczema. The favorable results that have so far been published require confirmation.

We should likewise cite among trophic actions the effects which may be produced at a distance while we are making use of some measure capable of stimulating strongly the sensory nerves of the skin. Many of these reflex effects simply produce temporary vasomotor phenomena analogous to those which we have mentioned in speaking of revulsion and other kinds of cutaneous stimulation. They are no less important to know, since it seems as if one should refer to them, at least in part, the therapeutic results obtained in the treatment of certain congestive or inflammatory diseases of the central organs, in which we confine ourselves to stimulating certain regions of the skin, especially by means of faradization.

In the application of the principal local measures which we have just described it is necessary in order to succeed in accurately localizing the electric action, to pay attention to the precepts given by Duchenne and by von Ziemssen. A rapid sketch of the facts that are the most important to be acquainted with in practice will

FIG. 90.

therefore be given, it being presupposed that we have to work by

means of faradization.

of the facial nerve, a part where we have occasion most often to work. In the head the part that has been principally studied is the region

It is useful in most cases to look, in the first place, for the tru the nerve. We get at it by means of a slender electrode, whi direct in front of the external auditory meatus against the pos border of the inferior maxilla (Fig. 90). When the curre strong we get a complete and well-marked contraction of the facial region.

For the other branches of the nerve Erb shows three pri rami, or rather three ramifications-the upper branch, which sponds to the muscles situated above the palpebral fissure; the dle branch, which supplies the muscles situated between the e and the mouth; and the lower branch. In other details and f muscles the schematic plate (Fig. 89) will tell more than any de tion.

The points of stimulation of the muscles vary much accordi the subject. We should look for them with a very slender elec which is lightly applied, and with a current of the lowest po intensity, for this exploration is rendered painful if we meet branches of the trigeminus.

In the neck we find a great number of important nerves an rious muscles.

The hypoglossal nerve may be stimulated by means of a s electrode carried deep in, above, and behind the corner of the bone. A strong current must be used. The muscles of the to of the velum palati, and of the upper regions of the isthmus m stimulated directly by means of a suitably curved electrode.

The spinal accessory is accessible in the greater part of its co the two muscles which it innervates (sterno-cleido-mastoid and t zius) can readily be stimulated separately. The same is true o splenius and levator anguli scapula muscles. We shall less quently have occasion to make the current act upon the muscles; it is, however, possible to get at them.

In the supra-clavicular fossa are found the brachial plexus, wi its branches, and the phrenic nerve. This latter cannot be reached rately. It must be looked for along the external border of the st cleido-mastoid, a slender electrode which slides smoothly being us account of possible contraction of the scalenus. Erb advises th of a slender bifurcated electrode attached to the negative pole. St lation of this nerve produces an abrupt inspiratory movement, ac panied by rising of the epigastrium and an inspiratory lary sound. Rhythmic faradization of this nerve, aided by artificial

piration-a method pointed out by Duchenne-has been used with success by Von Ziemssen and various practitioners since, to combat

asphyxia and the accidents occurring in the administration of chloro

form.

With a little care it is easy enough to get at the various branches of the brachial plexus (see the schematic plan, Fig. 89). By placing the electrode upon a circumscribed spot, about two or three centimetres above the clavicle and a little to the outer side of the posterior border of the sterno-mastoid, at the level of the transverse process of the sixth cervical vertebra, we can produce a simultaneous contraction of the deltoid, biceps, brachialis anticus, and supinator longus, and also of the subscapularis and supra-scapularis. This spot, known by the name of Erb's point (or the supra-clavicular point), has some practical importance.

In the region of the upper limb we note on the flexor aspect (Fig. 91) the ulnar and median nerves, which can be stimulated through their whole course along the internal border of the biceps muscle. The point where the ulnar nerve can be stimulated most readily is situated a little above the internal condyle; the stimulation-point of the median nerve is situated at the bend of the elbow, at the spot where the nerve lies quite horizontally upon the muscular bundle of the flexors. When these nerves are stimulated the arm ought to be kept slightly flexed and the muscles should be relaxed as completely as possible. A weak current should be used.

The musculo-cutaneous nerve is readily got at near the anterior border of the axilla, between the coraco-brachialis and the biceps.

On the forearm the ulnar and median nerves are accessible a short distance above the wrist, the ulnar nerve being very close to the tendon of the flexor carpi ulnaris, and the median nerve being situated between the tendons of the flexor carpi radialis and of the palmaris longus and brevis. (Fig. 92.)