ELECTEIZATION BY REFLEX ACTION. 139 



and so intermittent that six or eight successive i^iilsations were often wanting ; 

 by ansciiltation of the heart it was impossible to recognize the rythm of 

 the movements, and I heard only some slight dull sounds, unequal and 

 much disordered. There was no elevation of temperature, but a paralysis 

 of the pharynx and the soft palate, dating from a time much anterior to 

 the appearance of the symptoms for which I had been sirmmoned. 



I recognized, in the whole of these cardiac and respiratory disorders, the 

 characteristic phenomena of paralysis of the pneumogastric nerves ; and I 

 conceived that, in this patient, the diphtheritic poison exercised a morbid 

 influence over that part of the nervous centre — the fourth ventricle — that 

 governs the innervation of the heart. 



According to this hyi^othesis, what should be the therapeutic action of 

 faradization ? Excitation of the phrenic nerve, in a case where the diaphragm 

 was not paralysed, and where there was no sign of asphyxia, did not seem 

 to me likely to exert a beneficial influence upon the disturliance of the 

 cardiac circulation, and iipon the feeling of suffocation. Faradization of 

 the pneumogastric and superior laryngeal, at the i^oint where these nerves 

 are in relation with the sides of the pharynx, might, indeed, modify favour- 

 ably the innervation of the heart and lungs ; but the proceeding, although 

 very easy of performance, is extremely dangerous ; and, even in small doses, 

 may arrest the heart's action and the breathing. It was not even to be 

 thought of. 



As, however, it was needful to act, I determined to endeavour to modify 

 the morbid state of the centre, which gives origin to the nerves of the 

 heart and lungs, by the electro-cutaneous excitation of a region in relation 

 with it. 



Was it not possible, however, that the diphtheritic poison, in modifying 

 the dynamic state of the patient, had rendered her unusually sensitive to 

 electric excitation ? Should I not expose myself, by acting a little too 

 powerfully, to a risk of stopping the heart ? 



After having well weighed the value of these and other considerations, I 

 performed cutaneous faradization, by means of the electric hand (see page 

 90), over the i)recordial region, principally at the region of the apex of 

 the heart, being careful to commence with an extremely feeble dose. I 

 then gradually increased the intensity of the induced current, the inter- 

 missions of which were rapid, until it produced slight tingling of the skin. 

 We then had the satisfaction of seeing my anticipations realized ; for, after 

 a few minutes, and during the passage of the current, the jmlse diminished 

 in rapidity, and became more full and regular ; and after a while the pre- 

 cordial weight and sense of suffocation disappeared. It was necessary, 

 however, to return to the cutaneous faradization several times during the 

 day, in order to dispel definitively the diphtheritic perturbation of the in- 

 nervation of the heart, which had shown a tendency to recur. 



In order to omit nothing, I should mention that, together with the precor- 

 dial faradization, we employed and continued, during the whole course of the 

 treatment, the diffusible stimulants internally, and the peripheral stimulants 

 externally, which alone, had failed to improve the innervation of the heart ; 

 that oxygen was frequently inspired ; and that tonics and such alimentation 

 were given as the paralysis of the soft palate and the dysphagia would allow. 



On the following days, no disorder of the circulation or respiration re- 

 appeared; and our patient suffered only from the palatal and laryngeal 

 paralysis, against which I could do nothing under such serious conditions. 

 We thought life no longer in danger, when, on the 29th of March, about 

 foiir o'clock, the diphtheritic poisoning announced its return by a diplopia 

 that lasted an hour. Then, about five o'clock, Madame X. was suddenly 

 struck by complete hemiplegia of the left side, with loss both of sensation 

 and of motion, but with no impairment of the inteUigence, of the heart's 

 action, or of the respiration. 



Considering this jjaralysis to be an evidence of a new invasion, by the 

 diphtheritic poison, of a portion of the right half of the medulla oblongata 



