230 LOCALIZED ELECTRIZATION. 



disturbance of nutrition, commonly followed by gradual loss of galvanic 

 irritability ; but in wbicli, in favourable cases, the motility, and frequently 

 also the faradic excitability, quickly return. The most effectual treatment 

 is by continuous currents. 



Fourth Degree. — The excitabihty of the nerves by volition, and by 

 electric currents of both kinds, is lost ; but the irritability of the muscles for 

 the continuous current is retained. Complete degeneration of the nerves to 

 their terminations in muscles. Results of treatment by continuoiis current 

 doubtful. 



Fifth Degree. — For nerves and muscles alike, the excitability for the 

 will or for both kinds of electric current, is wholly lost. Very severe dis- 

 turbance of nutrition both in nerves and muscles. Prognosis unfavourable. 



It is self-evident, Ziemssen adds, that this division is only superficial ; and 

 no one can sui^pose that a number of apparently paradoxical phenomena can 

 receive their explanation in this manner. 



For the present, the different condition of the excitability for the will, and 

 for the electric current in the third degree of disturbance of nutrition, remains 

 not imderstood; especially the complete return of the volitional influence 

 during the complete absence of excitability by the electric current ; further, 

 the opposite action of the two ciirrents in the course of the paralysis, and 

 the want of coincidence in the phenomena observed in the recorded cases. 

 Possibly inequalities or differences may exist in the changes in the anatomical, 

 physical, and chemical condition of the nerves, and may cause the various 

 phenomena, while they themselves escape our percejDtion. Possibly, also, as 

 Eulenburg assumes, the motor nerves may possess separate energies for the 

 different stimuli. 



Ziemssen also gives the notes of a case which affords evidence that the 

 difference of excitability for galvanic and induced currents, is displayed also 

 in diptheritic paralysis of the velum, and that it affords as little ground for 

 unfavourable prognosis in these as in other muscles, since the paralysis was 

 cured by galvanization in fourteen days. 



A like difference of reaction to the induced and galvanic currents has 

 been observed by my predecessor at the National Hospital for the Paralysed 

 and Epileptic, Mr. J. Netten Radcliffe, and by Professor Hammond, of New 

 York, in certain forms of infantile paralysis ; and by Mr. J. N. Radcliffe in 

 other forms of local paralysis than those described by Ziemssen. The thera- 

 peutical effect of the interrupted galvanic current in the treatment of infantile 

 paralysis, as observed in the National Hospital and by Professor Hammond, 

 will be discussed in the chapter devoted to this disease. The following 

 remarkably interesting case of successful treatment of paralysis of the deltoid 

 is recorded from the practice of ]\Ir. Radcliffe, in the 'Lancet' for 1866 

 (vol. ii. p. 5710- 



The patient was a blacksmith, aged 25 years. After several days' suffering 

 from severe " rheiimatic pains," so-called, in both shoulders, but particularly 

 in the left, he lost suddenly, while working with an ordinary sized hammer 

 one morning, the power of raising his right arm. When first seen, five weeks 

 after this occurred, the deltoid and infra-spinatus muscles of the right side 

 were found to be completely paralysed, and there was some wasting of the 

 former muscle. The contractility of both muscles under the induced ciu-rent 

 was annihilated; the electric sensibility was diminished ever the infra- 

 spinatus, and this form of sensibility, as well as the sensibility to heat, cold, 

 tickling, and touch, were absolutely wanting in a triangular space (the apex 

 pointing downwards) over the deltoid, meastiring two inches and a-half at 

 the base, and five inches from the base to the apex. Under powerful fara- 

 dization, seven times repeated at intervals of tlu-ee days, not a trace of 

 contraction could be excited in the paralysed muscles, and the wasting 

 evidently increased. Electro-pimcture was had recourse to several times, 

 but a dubious action of some superficial fibres was the only result, Mr. 

 Radcliffe then tried the interrupted galvanic current. With thirty-five cells 



