FARADIZATION OF INTERNAL ORGANS. 101 



Bran's laryngo-electrode are convenient instruments, since after their intro- 

 duction the circuit can be made and broken at pleasure, by pressure of the 

 finger upon a contrivance for the purpose. Such a contrivance is especially 

 useful for the simultaneous introduction of both poles into the pharynx. An 

 operator who does not possess these instruments, may allow the circuit to be 

 completed, by an assistant, with a second electrode, furnished with a larger 

 sponge covering, and applied either to any distant part of the body, or, 

 in therapeutical procedures, to some selected spot of the surface over the 

 larynx, as soon as the laryngo-electrode is in its place. 



" The introduction of the laryngo-electrode should be accomplished quickly, 

 with the right hand, and without any avoidable contact with the teeth, 

 tongue, or faiices ; while its course is watched in the mirror held in the left 

 hand. 



" Among the immediate effects of the excitation, hyperaemia of the selected 

 spot and its vicinity, increased mucous secretion, transient hoarseness, 

 inclination to cough, and jmn in the neck, are unavoidable. These effects 

 mostly disappear in a few hours, or even sooner. The therapeutical effect, 

 where any such is to be exj)ected, shews itself after the disappearance of the 

 first effects ; but, after the early sittings, has usually itself disappeared by 

 the next morning. That the irritation of the mucous membrane of the 

 posterior surfaces of the aryteenoid cartilages, of the pyriform sinuses, or of 

 the vocal cords, in long continued treatment, may occasion acute inflamma- 

 tion, ulceration, or soreness, need not be feared, if pauses of a few days are 

 made, from time to time, between the otherwise daily applications. Even in 

 continuing the treatment for many months, I have never seen any injurious 

 local action. 



" The localization of the electric current upon the several muscles is to bo 

 accomplished as follows : — 



" The arytsenoid muscle (transversus) is the easiest to reach with the 

 electrode. As soon as the point of the electrode is placed upon the posterior 

 surface of the aryleenoid cartilage, the circuit should be closed by an assistant, 

 or in any other manner. By the shortening and contraction of the arytsenoid 

 muscle, the posterior surfaces of the arytsenoid cartilages are arched, and the 

 cartilages are approximated. On this account especial care is required, lest 

 the occurrence of the contraction should cause the point of the electrode to 

 slip from its place. The juxtaposition of the cartilages that is produced by 

 the aryteenoid muscle is very energetic. Absence or incompleteness of the 

 effect, in consequence of paralysis or paresis of the muscle, is a very important 

 and common cause of aphonia and hoarseness, especially in the hysterical. 

 The diagnosis of this condition presents no difficulty even to the inex- 

 perienced. 



The crico-arytcenoideus lateralis is to be reached at the bottom of the 

 pyriform sinus, in a direction backwards, in the immediate vicinity of 

 the outer margin of the plate of the cricoid cartilage ; but it requires great 

 dexterity and practice in laryngoscopic localization. The point of the 

 electrode must take a course directly downwards, and must be &mly pressed, 

 so as to reach the muscle by stretching the rather loose mucous membrane 

 that covers it. The tendency of beginners is to bring the point of the 

 electrode too far forwards in the pyriform sinus ; and, in order to counteract 

 this, I advise a larger and longer curve to be given to the electrode, and the 

 handle to be depressed during the action. 



" The effect of isolated excitation of the crico-arytsenoideus lateralis is to 

 produce slight rotation of the arytsenoid cartilages, with movement forwards 

 and inwards, so that the processus vocalis and the free edge of the vocal cord 

 approach the middle line. The glottis is little influenced by this, only so far 

 as the cartilage, and especially the vocal process, change their relative position 

 to their fellows. If the patient inspire quickly and deeply during continuous 

 contraction of the muscle, the vibration of the prominent, and yet lax, vocal 

 cords produces a loud jarring sound, and their vibrations may be clearly 

 seen. 



