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 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 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 1.5th 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 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, 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 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 uow allude. Disease of the cere brum itself,--disatse of the dorsal portion of the spinal inarrow,—induces cerebral paralysis, hem i plegia, or paraplegia; disease compressing or destroying the facial nerve, or the cauda equina in the lumbar region, induces both cerebral and spinal paralysis. In the former case we shall observe augmented, in the latter diminished irritability of the muscular fibre.