IRRITABILITY. 
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- 
(Salar fibre is augmented. In hemiplegia, the 
nn is generally at once more paralytic and 
“More irritable than the leg. In chronic cases, 
however, the irritability becomes impaired, 
together with the nutrition. 
_ Iwill 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- 
_ tinetly 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 
_0n 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: 
_ 8d. Any sudden noise, or other causes of 
emotion, affect the paralytic side only—the leg, 
however, more than 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 
"7 
_ 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 
hemiplegia : 
_ 8th. Lastly, the paralytic hand and arm are 
a 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, 
_ I 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 in whom the facial nerve was partially 
cold hand; an example of the reflex action in\ 
41 
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. 
Cause 7.—On January the 23d, 1839, I passed 
the galvanic shock through the hands of a 
patient who had been gradually affected with 
paralysis of the right, 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 vertebre. 
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 nowallude. Disease of the cere- 
