TREATMENT OF ABDUCTOR PARALYSIS. —The likelihood of cure corresponds with the degree of amenability to treat ment of the original cause. Whether it be syphilis, tuberculosis, aneurism, a cerebral neoplasm, etc., local treatment is absolutely subservient to that of the primary affection, and the treatment of the latter is therefore the first indication.
Measures must be adopted to stimulate the laryngeal muscles to action. _Fara dization is the most effective agent at our disposal. The laryngeal electrode (Morell Mackenzie's) is used as follows: The electrode being connected with the negative pole of a faradic battery, its extremity is introduced into the larynx, while the positive pole is connected with an ordinary surface electrode which the patient presses over the larynx externally, or with a necklet electrode. The extrem ities of both electrodes should be covered with sponge or kid, to prevent stinging. To insure penetration of the current the electrode-tip should be thoroughly wetted before each operation. The manipula tion of Mackenzie's electrode is like that of an ordinary laryngeal forceps, the mirror being employed to note and con duct the localization of the tip of the instrument. The nearer the paralyzed muscle the application, the better. The electrode being in position, the finger rest on the top of the handle is depressed, and firm pressure is exerted on the neck by the other electrode. At first this manipulation is quite difficult to per form, gagging and retching preventing the introduction of the instrument.
After a few trials, however, the parts be come more tolerant, and the application can be borne, in the majority of cases, without trouble. Cocaine anmsthesia may be used in difficult cases, at least the first few times. Each application of the current should last but a few seconds, and be repeated several times at short in tervals. One sitting every day should be obtained if possible.
The current may also be applied by placing one pole on each side of the neck externally. This method is very inferior to that just described. Better than it is electrical massage, which is carried out by placing the positive pole, thoroughly wetted, on one side of the larynx, and the fingers of the opposite hand (that holding the negative pole and in contact with the sponge) on the other side. The fingers, having become the conductors, are moved up and down and pressed into the sur face of the neck, in the manner practiced by masseurs. They must also be kept wet by occasional immersion in water.
Strychnine, nux vomica, and other nerve-tonics should be used, if possible, to assist the electrical stimulus. Strych nine is especially valuable, either by the mouth or hypodermically, beginning with grain at a dose, three times a day, and gradually increasing until grain is reached. This dose cannot be taken by all patients, however, and the physiolog ical effects of the drug should therefore carefully he watched.