contain (p. 39), and the other that the central organs of the nervous system, as well as nerve-branches in the large natural cavities of the body, escape the electric current on account of their envelopment in good conductors. He asserts, however, that with an extremely powerful current, these organs may be reached. (p. 12.) The latter point has been confirmed by M. F. Bonnefin,* who concludes from carefully conducted experiments, that it is possible to pass an electric current through the nervous centres, but that this current is always very feeble, even when a very powerful electro-magnetic apparatus is employed. He infers, further, that the influence exercised by those electro-magnetic currents which produce movements due to excitation of the spinal cord, only take place through the intervention of sensitive or excito-motor nerves. And hence, that in order to act upon the nervous centres, it is necessary to employ metallic conductors (and not moist sponges), so as to affect powerfully the cutaneous nerves. (p. 548.) In regard of the theory or explanation of these diverse physiological effects of galvanism, but little that is satisfactory has been proposed. Du Bois Reymond, Matteucci, Dr. Radcliffe and others, starting from another ground, viz., the galvanic properties of the living tissues, have endeavoured to supply a rationale for many of the phenomena. Dr. Radcliffe says truly, concerning "the action of the ordinary galvanic current upon muscle, it is to be expected that the existence of the muscular current is not to be ignored," and he arrives at the conclusion that "it is difficult, if not impossible, to find any reason for supposing that the contractions (of a muscle) are due to any direct action of the current, natural or artificial" . . . . but that on the contrary "there appears to be only one course open, and that is, to connect the contraction with the absence of the current." (p. 36.) The main facts upon which this opinion is based are these, 1, that during rest there is a galvanic current in the muscle; and 2, that during muscular contraction this current is weakened, or reduced to zero. This reduction takes place when the muscle is tetanised by an artificial current, and Dr. Radcliffe says, "there is no difficulty in connecting the contractions with that clashing and mutual neutralization of the muscular and artificial current” which takes place when the former is supplanted by the latter. There is, according to Dr. Radcliffe, a "moment of inaction" between the disappearance of the one (muscular current) and the establishment of the other (artificial); and the whole tenor of his argument is to this effect, that the muscle contracts by virtue of its own inherent property; but that its contraction, instead of being stimulated or occasioned by galvanism, is prevented from occurring by the presence of that agent. The "moment of inaction," galvanically, is the moment of action for the muscle. The argument so far amounts to this, because A disappears when B is produced, the disappearance of A is a condition for the production of B. Or, because the several prismatic colours not only disappear from the surface of a card when it is rotated rapidly, but reappear when the card is brought to rest, therefore the disappearance of the colours is a condition which allows the rotation to take place. Ingeniously as Dr. Radcliffe has developed his theory, and partially met numerous objections, we regard the balance of the whole evidence as opposed to the view he entertains. There is the radical error of mistaking for a causative condition of a certain phenomenon that which may be more justly regarded as its effect; and there are many circumstances attending muscular action which are not fully met by the hypothesis. Thus, the force of muscular contraction is in proportion to the strength of the stimulus which is brought to bear upon it; whether this is galvanic, chemic, mechanical, or vital; and if contraction is to be referred to the absence of the muscular current, there are causes of contractionsuch as pinching, percussion, and irritation with a non-conducting body-which cannot be shown to operate by producing this removal. Again, when we have on Recherches Exp. sur la possibilité du passage à travers le Centre Nerveux de Courants El-Magn. appliqués à la pean, chez l'Homme. Journal de la Physiologie. Par E. Brown-Séquard. tom. i. No. III. the one side a current so feeble that it requires an apparatus as delicate as that of Du Bois Reymond to demonstrate its existence; on the other, a current so powerful as to produce violent contraction of the muscles; and we advance to the idea of their bellicose "clashing" on the blood-stained field of a few muscular fibres, we cannot but think that the chances are very much against the result being a "drawn-battle;" a mere "neutralisation," and "moment of inaction," during which, and as the result of which, this most remarkable phenomenon of contraction occurs. The experiments of Weber, Pflüger, and Lister, show that entirely different effects are produced by currents differing only in intensity, and we must confess that in the present state of physiological science there is yet wanting a satisfactory rationale of the phenomena. For a perfectly successful therapeutic exhibition of electricity, such a comprehensive knowledge of the modus operandi of the agent, physiologically, is required; but while this is still a desideratum, much may be and has been done towards solving the problem of its practical utility. Attempts have been made to relieve many morbid conditions, and these, though sometimes directed by a true deduction, sometimes by à priori considerations, and at other times by simple empiricism, have met with varied, but in the main increasing success; and it is to these attempts and their results that we would now direct attention. There are four principal results which electricity may be called upon to effect: 1, restoration of contractility in the muscles; 2, re-establishment of sensibility; 3, reduction of augmented contractility; and 4, diminution of hyperæsthesia. 1. Treatment of Paralysis. Becquerel states that when this is dependent upon a persistent lesion of the brain, spinal cord, or nerves, electricity is "tout-à-fait contre-indiquée, elle ne pourrait qu' être nuisible." (p. 125.) This is substanti ally the same as Duchenne's statement made many years ago; but M. Becquerel goes on to affirm that when the central lesion is cured, "et que le diagnostic permet d'établir que cette cicatrisation s'est òperée” (a nice point for diagnosis!), then electricity may be employed with advantage. When cerebral hemorrhage has been the cause of paralysis, the experience of M. Becquerel is, that in the "immense majority of cases" electricity exerts no favourable influence. (p. 138.) It appears, as the result of experience in the treatment of paralysis from cerebral hemorrhage, (a) that nothing electric ought to be attempted for many months after the attack; (b) that a certain proportion of cases get quite well at the end of that time without any treatment of this kind; (e) that others at that period present paralysis to the will, but the irritability of muscles to electricity persists; and in such cases the application of electricity is not wanted, does no good, and sometimes is mischievous in its results; and (d) that in other cases the electric irritability is diminished, and here electric treatment is of use. M. Becquerel agrees with Drs. Marshall Hall and Duchenne, that in the great majority of cases the contractility of the muscles persists; but he states that, in old paralysis, the "prolonged inaction of the muscles almost always diminishes" that property. According to our own experience the electric contractility of the muscles is more frequently diminished than either increased or unaffected; and further, this diminution has not appeared related to the length of time during which the paralysis has lasted. With regard to paralysis dependent upon cerebral softening, M. Becquerel states that the contractility is preserved in recent cases, but lost in those of longer standing. He gives no results of practical experience on the matter, but asserts that the utility or uselessness of galvanism depends upon a recognition of the persistence or "cicatrisation" of the softening! When paralysis depends upon the existence of an intra-cranial tumour, M. Becquerel says that galvanism should be rejected altogether. (p. 146.) When paralysis is caused by an injury or disease of the spinal cord, there may or may not be loss of muscular contractility. The original statement of Dr. Marshall Hall upon this question has been, in reality, confirmed by every subsequent observer. It is, that when the muscle is functionally separated from the cord, there is diminution and loss of irritability; and this is Dr. Hall's "spinal paralysis." But a disease in the spinal cord, although it may cause paralysis,―i.e., separation of the muscles from the will ("cerebral paralysis")-need not, and often does not, sever the functional relationship of those muscles and the cord itself. Such cases Dr. Hall did not term "spinal paralysis," but "cerebral."* If a disease destroys a portion of the medulla, the muscles supplied by nerves coming from that disintegrated portion present "spinal paralysis" and loss of irritability; but those muscles which are supplied by nerves arising from that portion of the cord which remains uninjured below the lesion, present only "cerebral paralysis," and retain their irritability. Nothing appears more distinct than Dr. Hall's statements upon this question; and it is not less distinct that their truthfulness has been abundantly confirmed even by those modern electricians who, while recognising the facts, seem, curiously enough, but almost universally, to mistake the meaning of Dr. Hall. In a former article in this journal a true statement of the case was made, and we should not again have referred to the matter, had not the misstatement been recently reiterated both in England and France. M. Becquerel does not escape the error, but he gives some further information on the subject, in affirming that the degree of electric irritability which persists is in direct proportion to that of the capacity for volitional exercise. (p. 152.) Further, that the treatment of paraplegia by electricity is positively injurious when the paralysis is progressing, and is of service only when this symptom is either stationary or diminishing. In complete paraplegia with irritability diminished, electricity does no good, and it is useful only in those cases of incomplete paralysis in which there is no diminution. of irritability. (p. 155.) In "traumatic paralysis," or true "spinal paralysis," electricity is sometimes of service. Professor Oré relates a case of cure of facial paralysis of eight and a half years' duration, in which all muscular irritability was lost. In our own practice we have seen notable improvement of a case of facial paralysis after fourteen years' duration; but in this case, although the distortion of features and lagophthalmia were extreme, some slight electric contractility remained. Duchenne states that, in cases of traumatic paralysis it is sometimes observed that volitional power remains partially while electric contractility is destroyed. But this M. Becquerel appears to doubt (p. 159), stating that, in a great number of cases, he has observed that the two properties "marchent ensemble." When there is not a complete loss of both, there may be one of the two following conditions:-1, voluntary power lost completely; sensibility diminished or not; electric contractility intact or diminished; 2, voluntary power incompletely lost; sensibility diminished or not; electric contractility intact or diminished. The first class of cases is curable, but the second curable much more readily. With regard to hysteric paralyses there is nothing new; they are well known to be amenable to this kind of treatment, and M. Becquerel says truly, "le traitement de ces affections a fait la fortune de plus d'un electriseur!" (p. 175.) The paralyses which is symptomatic of such genito-urinary lesions as nephritis, calculus, stricture of the urethra; and which persists after the removal of its remote cause, may be rapidly cured by electricity. The paralysis remaining after the inaction of a limb from rheumatism, may likewise be treated successfully in the same manner; and M. Becquerel describes an essential or idiopathic paralysis, which is amenable to this agent. The characters of this form of paralysis are, A, positive;-paraplegia, complete or not; anæsthesia, or not; digestive and urinary functions natural; other "nervous" phenomena present; embonpoint normal; contractility completely preserved. B, negative;-no spinal pain; no feeling of cord round the trunk; no tonic contraction; no paralytic affection of bladder or rectum. A case somewhat resembling this kind of paralysis was successfully treated by Dr. Althaus.§ Medico-Chir. Transactions, vol. xxx. p. 207. Quoted from Journal de Bord. Avril, 1856, in Schmidt's Jahrb., 1856. vol. iv. p. 55. § Med. Times and Gazette, December 26, 1857, p. 656. In lead palsy, M. Becquerel states, in opposition to Duchenne, that the contractility is not lost unless the palsy has come on slowly, and there is atrophy of the muscles; and further, the contractility which remains is in direct proportion to the voluntary power remaining. (p. 190.) Writer's cramp may be completely cured.* Intestinal atony has appeared in some instances to be overcome by galvanism; and notwithstanding the peculiar inhibiting influence of the splanchnic nerves it seems probable, from Ziemssen's observations, that this agent may be hereafter usefully employed upon the intestines. The latter observer states that powerful contractions of the intestinal walls may be produced, and that these persist after removal of the electrodes, and the only pain so caused is in the skin at the point of contact" diese äusserst stürmischen Actionen"-continued for one quarter of an hour-" aber ganz schmerzlos." (p. 13.) But as for the action of the galvanic current upon the bowels, Becquerel gives his experience thus: after placing one pole in the mouth, and another in the rectum, and trying all sorts and directions of currents, "je n'ai jamais obtenu aucun résultat." (p. 202.) Duchenne has cured three cases of prolapsus ani; and M. Stacquezt relates cases of impotence cured by powerful shocks from a Leyden phial, passed from the lower part of the vertebral column to the tip of the penis-" de manière à produire l'explosion à ce dernier point." The individual who would submit to this operation could not be impotent, we should think, through "want of nerve." In "wasting palsy," or progressive muscular atrophy, "The most effective remedy," says Mr. Roberts, "is galvanism applied locally to the wasting muscles. . . . It has generally, indeed nearly always, been found to yield encouraging results: too often the amendment has been but temporary, but in several instances it has brought about arrest, and in a few, re-establishment of the bulk and power of the wasted muscles, either wholly or in part." In a case of this kind, however, under the care of Dr. Hare, galvanism was applied twice daily, from the 20th July to the 24th August, the result being that the patient is described as "not deriving much benefit from this treatment." And in a case under our own care, four years ago, localised galvanism was negative in its effects. 2. Treatment of Anaesthesia. Not much that is of value has been added to our information on this subject. When an anesthesia depends upon some general morbid condition, such as, for example, amaurosis in Bright's disease, electricity can accomplish nothing. When it is but the symptom of a distinct organic lesion, intra-cranial tumour, hæmorrhage, &c., there is the same negative result. But when the anesthesia is idiopathic or essential, then, say the electricians, much may be accomplished. In such cases, however, the phenomenon frequently disappears with some general alterative treatment, or without any treatment at all. With regard to analgesia, which may be regarded rather as a boon than a misfortune, M. Becquerel makes the very sensible remark that, "s'il y a anelgésie seule on la laissera parfaitement tranquille." (p. 220.) 3. Treatment of Spasm, or augmented muscular contractility generally. With regard to convulsions and contractions, M. Becquerel states that, notwithstanding the physiological and pathological basis for the employment of electricity, he has failed to obtain a cure. Others have been more successful. Dr. Remak states as follows: "I was induced in July, 1856, to apply the constant current as a means of treatment of contractions of muscles, in cases of hemiplegia from cerebral apoplexy. The most important result of this application was the fact, that the continued current, applied for a few minutes to a contracted muscle, had the effect of immediately relaxing it to a certain extent, and rendering it amenable to the influence of volition."T Becquerel and Remak. Becquerel, p 81. Med. Times and Gazette, April 24, 1858, p. 426. Ueber die Lösung paralytischer Contracturen. 1858, p. 479. † Archives Belges de Méd. Militaire, 1849. Deutsche Klinik, 1856, No. 28. Med. Times and Gazette, May 8 Another mode of reducing permanent contraction of the muscles is that commonly employed by Duchenne, viz., the excitation of those muscles which are their natural antagonists. By this method Duchenne treated three cases of torticollis, but although there was improvement there was no cure. The curability of cases of tonic contraction, when this has been of long duration, appears to us at best to be extremely doubtful; for in such cases there is reason to suspect the existence of a central lesion, which electricity has not yet been shown to be capable of affecting, even though it may temporarily suspend or counteract the symptom. And further, these tonic contractions, when produced artificially, are among the most persistent results of central injury, even when the latter has been of very trifling extent. 4. Treatment of Hypercesthesia. Of late the activity of the professional mind has been especially directed towards the cure of neuralgia, or the artificial production of anesthesia by means of electricity. In regard of the former there has been considerable success. Dr. Hiffelsheim presented to the Academy of Sciences a paper detailing the results of his experience in thirty-six cases in the wards of M. Rayer, and these are highly satisfactory.* Dr. Althaus has published some of the results of his own experience, which are also satisfactory.t And M. Becquerel speaks with confidence of the good effects of galvanism in cases of this kind. But the utility of galvanism as an anesthetic agent has yet to be shown. Dr. B. W. Richardson performed careful and painful experiments upon himself, but the result at which he arrived was "that the electric current cannot, according to our present knowledge of its application, be made practicable for the production of local anesthesia." To him replied Dr. Althaus, that when the current is applied in a different manner, "the sensibility is notably diminished." But Dr. Althaus further states that "the result is much more striking if there is a morbid increase of sensibility in a nerve, as in neuralgia, than if a nerve in its normal state is acted upon." And in the same number of the journal is a letter from Mr. Harry W. Lobb, which reminds us somewhat of the character of proceeding adopted by those individuals who present themselves "where angels fear to tread;" for Mr. Lobb, after stating with regard to electricity "I have never used it to prevent pain during the extraction of teeth," displays his qualifications for being a scientific observer by going on to say, "but from what I know of its success in toothache, the following plan will, no doubt, be found perfectly successful. Procure a 60-link &c., &c." 66 Mr. Eden, of Brighton, did "procure a 60-link &c. &c.," and "follow minutely the directions in Mr. Lobb's letter," but was sorry to say" that he "did not obtain any diminution of sensibility.' اوو Thus, then, stands the question of "Electrical Anaesthesia." It appears that hyperesthesia may be reduced; and even that the normal sensibility may be diminished; but there is no evidence that the reduction can be carried so far as to render electricity a useful anaesthetic agent. There are two modes in which electricity operates in obtaining this therapeutic effect, first, by direct reduction of the nervous sensibility, and secondly, by counter-irritation of the skin. M. Brown Séquard refers the beneficial results of electrical or other irritation of the skin, in the treatment of neuralgia, to a reflex action upon the vessels of the irritated nerve, producing temporary anæmia therein. The other uses to which electricity has been applied, such as the treatment of amenorrhoea, of atrophy, and of aneurism, and its employment as a cautery for the removal of tumours, or for other purposes in which the actual cautery is required, need no comment now, as nothing of much value has been added to our knowledge upon the question. But the mode in which electricity is applied has probably much, if not every * Extract from the Minutes of the Meetings of the Academy, vol. xlvi. + Med. Times and Gazette, Aug. 14, 1858. Ibid., Sept. 11, 1858. Ibid., Sept. 18, 1858. Ibid., Sept. 18, 1858. Ibid., Oct. 9, 1958. |