There are very few, I think I may almost say not one, of the many disorders classed under the heading of paralysis, in which at some time or other of their progress some form of electrization is not essential to their most successful treatment. Where powerless to cure it will not unfrequently relieve the most distressing symptoms. Cases of functional paralysis from slight pressure are not uncommon, when power may usually be restored by a few Faradizations; but in paralysis from severe central or peripheral lesion progress must of necessity be slow. Such cases, regarded electrically, may be most conveniently considered under the two divisions of atrophic and non-atrophic paralysis.|Atrophic Paralysis.| In the great majority of atrophic cases there will be found abolition or modification of the normal electrical reaction of nerve and muscle, but whether this is so or not, in all cases of loss of power, in which any muscular wasting is visible, the localization of electricity in the wasting muscles is imperative, and in some varieties it is the only treatment which will arrest the disease. It is in these latter cases that its early administration is called for, before the degeneration and disappearance of the muscular tissue, and its early and judicious use will not seldom save the sufferer from being left for life with a powerless, or withered and deformed, limb.|Infantile Paralysis.| As an illustration, let us review the progress of a case of essential infantile paralysis, the most common of the paralyses of children; that form in which premonitory symptoms are often absent, or but slight, and where there is no rigidity. Very shortly after its onset, usually within a few days, the limb is found to be colder than its fellow, and its muscles to be rapidly wasting; the final result, if untreated, being the entire disappearance of some of them and the production of deformity. In fact, the larger number of cases of club-foot and analogous distortions are brought about by neglected infantile paralysis, and there is no doubt that by judicious treatment, of which early electrization is the foundation, the majority of them might have been prevented. The leading orthopædic surgeons are fully alive to this fact, but they are powerless, as they are rarely consulted until all the mischief has resulted.|Importance of early Electrical Treatment.| The early recognition and appropriate treatment of these cases must continue in the hands of the family practitioner, and he must decide whether or not they are to continue, as at present is unfortunately too commonly the case, without any serious attempts at restorative treatment until commencing deformity compels attention to them. As soon as the medical attendant is summoned—and this is frequently only because the parents have noticed that the child is lame—he should carefully examine the muscles electrically, and unless there are head symptoms present, and this is very seldom, he should electrize each muscle daily with that current to which it responds, and of a strength just sufficient to produce muscular contraction. If the powerless muscles have preserved their Farado-contractility it may be confidently predicted that they will rapidly recover; but it will almost invariably be found that while Farado-contractility is diminished or abolished, there is increased response to the interrupted Voltaic current. They should be treated then with this current alone. Hot spongings and shampooings should also be employed, and it is of great importance that in the intervals of treatment the temperature of the affected muscles should be maintained at as high a degree as possible. If the leg is affected, a stocking of pure spun silk should be constantly worn, day and night, in addition to the ordinary clothing; if the arm, a silken sleeve.
Importance of active and passive movements in Paralysis.
When in any form of paralysis ANY amount of voluntary power has been restored by electricity, it is most important that the patient should be encouraged to use the limb and practise various movements. Passive movements are of equal importance, and the paralyzed muscles should be frequently exercised by this mode to the fullest extent of their normal movements. For example, if the extensors of the hand and fingers are paralyzed, the hand and fingers should be passively flexed and extended completely, at intervals of a few seconds, for some minutes, and so on with all the paralyzed muscles in succession. |Rule for Muscular Electrization.| As soon as there is return of reaction to Faradization, Faradization should be alone used, and the rule in all cases of localized muscular electrization, muscular contraction being sought, is to use that current to which the muscles respond, and I do not know of any exception to this rule; but a successful result in severe cases of atrophic—not alone infantile paralysis, but all varieties of atrophic paralysis—is brought about by painstaking, daily, tedious, uninteresting treatment, with no chance of brilliant or rapid results, but which if thoroughly, faithfully, and patiently carried out, will reward us by progressive improvement, and sometimes—even in cases regarded not long ago as quite hopeless—complete recovery.
Rigid form of Infantile Paralysis.
There are certain forms of paralysis affecting children where the muscles are rigid. Localization of any form of electricity in these rigid muscles is quite useless; but if these cases depend upon adhesions or exudations into the medulla their absorption may possibly be promoted by localizing a Voltaic current in the superior cervical ganglia of the sympathetic; two small conductors, leather, tipped and well-moistened in connection with the poles of a Voltaic battery being applied for four or five minutes to the bottom of the auriculo-maxillary fossæ on both sides. There seems no doubt that such an application causes a dilatation of the blood-vessels of the base of the brain, and is likely therefore to promote absorption.
Traumatic Paralysis.
In all cases of traumatic lesion—as by section of a nerve—the paralysis is atrophic, and the treatment I have recommended in infantile paralysis should be assiduously employed. Mitchell, of Philadelphia, whose experience of military surgery is unrivalled, commences electrical treatment and shampooing within a fortnight of the wound, unless there are special circumstances to contra-indicate it. Lead palsy requires similar treatment; so does, perhaps, the commonest form of peripheral palsy—facial palsy from neuritis of the facial nerve.|Caution necessary in Electrizing Facial Muscles.| In electrizing the facial muscles there is one caution necessary—especially to observe the rule of electrizing the muscles equally—for I have several times met with a contraction resulting from a too energetic Faradization of some individual facial muscle, to the neglect of the group with which it is in correlative action. Such a contraction may sometimes be removed by localizing in it for about five minutes a constant Voltaic current from eight or ten cells; but in the most favourable cases an unnatural expression of countenance will generally persist for a long time, from the non-recovery by the muscles of their perfect “tone,” that quality which imprints upon each face its characteristic features, and which has been called the “Gymnast of the Soul.”
Wasting Palsy.
In that most distressing disease, Cruveilhier’s atrophy or wasting palsy, medication is altogether useless, and our one hope—not invariably a forlorn one—is in electricity. Localized Faradization to the muscles, alternately with Radcliffe’s Positive Charge, together with galvanization of the sympathetic or of the spinal cord, admit of trial.
Hemiplegia.