IRRITABILITY. 



41 



I have observed, in regard to strychnine, in 

 some cases of hemiplegia. These facts must 

 be borne in mind in making our observations. 



Another circumstance must also be noticed. 

 The more perfect the paralysis, generally 

 speaking, the more the irritability of the mus- 

 cular fibre is augmented. In hemiplegia, the 

 arm is generally at once more paralytic and 

 more irritable than the leg. In chronic cases, 

 however, the irritability becomes impaired, 

 together with the nutrition. 



I will now adduce a few cases which, how- 

 ever succinctly detailed, will exemplify and 

 substantiate the preceding observations. 



Case 2. On January the 16th, 1839, I 

 visited a patient who had been seized with 

 hemiplegia nine months before : the arm was 

 perfectly paralytic, the leg less so, the face less 

 so still. On passing the galvanic influence 

 through the arms, the left or paralytic arm was 

 much more affected than the right, and dis- 

 tinctly affected by a force which induced no 

 effect whatever on the right, the tendons start- 

 ing on each completion of the galvanic circle; 

 the contraction of the muscles of the left side 

 of the face was seen in its effect on the features ; 

 and that of the left gastrocnemius, in its effect 

 on the tendo Achillis, when no effect was per- 

 ceptible on the right side of the face, or in the 

 right leg. 



In this patient other and very interesting 

 phenomena were observed : 



1st. The arm has, from the beginning, been 

 much more paralytic than the leg or the face : 



2d. The influence of strychnine was observed 

 in the paralytic arm and leg only, in the latter 

 more than in the former : 



3d. Any sudden noise, or other causes of 

 emotion, affect the paralytic side only the leg, 

 however, more man the arm : 



4th. Yawning and sneezing move the para- 

 lytic limbs ; the former the arm, the latter the 

 leg, principally: 



5th. The act of stretching, and the act of 

 raising the right arm above the head, induce 

 unconscious movements of the left or paralytic 

 arm : 



6th. During sleep, the left or paralytic arm 

 and hand are greatly contracted and painfully 

 pressed to the side : 



7th. The paralytic arm shrinks from the 

 application of cold, as the sudden contact of a 

 cold hand ; an example of the reflex action in 

 hemiplegia : 



8th. Lastly, the paralytic hand and arm are 

 constantly in a state of contraction. 



I repeated the trials with the galvanic shock, 

 with the same results, on February the 14th. 



Case 3. On January the 15th and 22d, 1839, 

 1 passed a slight galvanic shock through the 

 orbicularis of each side of the face, in a patient 

 affected with paralysis of the left facial nerve 

 from exposure to cold, of six weeks' duration. 

 Here the right eyelid was forcibly closed, the 

 left or paralytic eyelid being totally unaffected. 



Case 4. On February the 13th, I passed 

 the galvanic shock through the two orbiculares 

 in a patient whom I visited with Mr. Burford, 

 and m whom the facial nerve was partially 



paralyzed by the removal of a considerable 

 branch of the nerve, together with a tumour 

 which had formed in its course along the cheek. 



The muscle of the paralytic side was un- 

 affected, whilst that of the healthy side closed 

 the eyelids on every application of the galvanic 

 influence. 



Case 5. I have more recently performed the 

 same experiment on a patient affected with 

 paralysis of the facial nerve, from otitis and 

 disease of the temporal bone, with precisely 

 the same result. 



Case 6. On February the 9th, I compared 

 the galvanic influence in two patients at 

 the St. Pancras Infirmary : both were affected 

 with complete muscular paralysis of the arm ; 

 the first case was cerebral, being hemiplegia; the 

 second was an injury of the brachial plexus, 

 having resulted from dislocation of the shoulder; 

 the results were what I had anticipated ; in the 

 case of hemiplegia, the irritability of the 

 muscles of the paralytic limbs was greater than 

 that of the muscles of the healthy limb ; in the 

 case of injured brachial plexus, the opposite 

 state of things was observed, the irritability of 

 the muscles of the paralytic hand and fore-arm 

 being greatly diminished. 



Case 7 On January the 23d, 1839, 1 passed 

 the galvanic shock through the hands of a 

 patient who had been gradually affected with 

 paralysis of the rijit, from handling leaden 

 types, as a compositor. Here, again, the para- 

 lytic muscles were unaffected by a degree of 

 galvanism, which induced an evident effect on 

 the muscles of the healthy limb. 



Cases 8 and 9. On January the 10th, 1839, 

 I galvanized a little boy with paralysis of the 

 left leg; the muscles were more irritable than 

 those of the healthy leg ; the affection had fol- 

 lowed pertussis, and I concluded that it was 

 cerebral. This conclusion was confirmed by a 

 fact which I learnt afterwards, viz. that in the 

 commencement there was imperfect closure of 

 the eyelids during sleep. On the same day I 

 tried the galvanic influence in a case of partial 

 paraplegia in a little girl, a patient of Mr. Bur- 

 ford ; in this case the muscles of the paralytic 

 limbs were less irritable than those of the 

 healthy limbs; I concluded that the disease 

 was seated in the course of the nerves, and 

 probably within the lumbar vertebrae. 



Case 10. It has been suggested to me that 

 the loss of irritability in the cases of spinal 

 paralysis might be owing to the defective nutri- 

 tion of the muscles. I therefore tried the effect 

 of galvanism in a case of chronic cerebral 

 paralysis, or hemiplegia, with much emaciation 

 of the paralytic muscles. I found these muscles, 

 as before, much more irritable than those of the 

 unaffected limb. 



I must repeat, that I am perfectly aware of 

 the sketchy manner in which these notes of 

 cases are given ; but I have thought it better to 

 leave the further details for another form of 

 communication. 



In the meantime we may conclude, that by 

 the test afforded by the galvanic trough, we are 

 enabled to effect a diagnosis between the cases 

 to which I now allude. Disease of the cere- 



