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with a rough towel, and especial care should be taken to keep the limb warm with thick stockings; the muscles should also be systematically rubbed every night and morning.
The constant current should be used; both because it dilates the blood vessels of the part, and because the muscles will contract under it, and not under faradism.
The positive pole should be applied to the spine with a large, thick pad, well wet with salt and hot water, and the affected muscles should be brushed up and down with the negative pole, applied with an electrode two inches in diameter; the electrode should be taken off and reapplied at the end of each stroke, so as to make and break the current, the strength of which should be only just sufficient to produce a slight contraction in the muscle. The application should be made for fifteen minutes each day.
With children it is best to begin without any current at all and proceed, in the course of a week increasing every day by one or two cells till the proper strength is reached, or as much as the child can bear. In some children the application produces so much fright and general disturbance that it is best to discontinue it. Though electricity has probably no effect on restoring the functions of damaged cells in the anterior horns of the spinal cord, it is beneficial in keeping up the excitability of the muscles, so that should the cells recover, the muscles will be in the best condition to respond to impulses emanating from these cells.
As long as the muscles respond to the constant current, treatment may be continued; when this fails, it is useless.
DISCUSSION ON DR. KING'S paper.
Dr. J. W. Daniel, of Savannah: I would like to ask Dr. King a question. In his treatment of this disease he
mentioned that the electric current should be used. He stated that the object of the electric current is to dilate the blood vessels. He furthermore stated that the positive pole should be applied to the spine. Now, if the positive pole be applied to the spine, it will not dilate the blood vessels, but, on the contrary, it will contract them. The negative is the dilating, pole.
Dr. King (in closing): In reply to the remarks of Dr. Daniel, I will say that the current which should be used in the treatment of this disease is the constant current. The faradic current is rarely used, only as a test measure, but not as a curative measure. I use the constant current and break it.
A CASE OF PARAMYOCLONUS MULTIPLEX.
BY E. BATES BLOCK, M.D., ATLANTA.
The patient, a married woman, age eighteen years, came to me on the 12th of February, 1906, complaining of a sucking, jerking motion of the tongue.
Family history: The father disappeared suddenly eight years ago, and has not been heard of since. Mother is living and well. One brother died of typhoid fever. One sister, living and well. She has been married for two years, and has one child living and well.
Past history: Had measles in March, and her child was born last August. (The child has never had measles.) Whooping cough, chicken-pox. "Stomach dropsy" when a child, up to nine years ago, in which the stomach, legs, forearms and hands were much swollen. There has been no swelling since that time.
Present illness: Began on the 4th of April, 1905, three weeks after the measles. The tongue is stuck between the teeth and withdrawn quickly, making a sucking sound, from forty-two to forty-four times in ten seconds; that is, two hundred and fifty-two to two hundred and sixtyfour times a minute. This is much worse when she is excited or nervous. She can stop long enough to talk usually, but for three weeks in June she was rarely able to stop long enough to say a word. It keeps her awake at night, often as much as four hours, but stops during sleep, and she usually sleeps well. Ordinarily, it does not
interfere with eating, but in her worse attacks she was only able to take a little milk. She has only momentary control over the attacks when they are bad. She was free from it for three weeks after her baby was born and it is often absent for a few days or several weeks at a time, but is present more than half the time. Sometimes the head jerks, or one or the other arm, or both, or one or the other leg, or both, may alternately jerk, usually associated with tongue movements, but sometimes without it. For the first three weeks of this trouble only the hands and the feet were affected, and the trouble started in the right hand. Sometimes only the jaws work together, like the teeth are chattering, and this interferes with her chewing her food. The motion of the hands is like wringing the hands. They are not moved at the same time, but she wrings one and then wrings the other in an exactly similar fashion, and then may jerk one leg and then the other. She has frontal and nucheal aches frequently, worse when she is nervous. She says that her eyelids jerk at times, but I have never seen this. Her eyes are easily tired, and she can not read or sew long. Ears and nose good. She had some swelling on the right side of her larynx at her menstrual periods before she was married, from May, 1904, until about March, 1905, as big as a hen's egg and lasted each month about six days, accompanied by a prominence of her eyeballs, but there was no history of tachycardia. She is now nursing her baby and is not menstruating, but she was irregular after her mar riage and had much pain, lasting about five days.
She has had frequent crying spells all her life, but worse since her father left suddenly eight years ago and this trouble began. She has a large ringworn on the right side of her neck.
Her spasmodic movements stop when her attention is distracted by asking a question and preparatory to answering it, and jerking can sometimes be brought on in her hands and legs by suggestion. Her patella reflexes are exaggerated. When the tongue is in action tapping the muscles or tendons produces spasm of the legs always, and the spasm may sometimes also be produced in the legs when the tendon is struck, even when the tongue is not jerking. Her thyroid glands is not enlarged. She says that she knows when her attacks are coming on by having numbness in her hands and feet when she gets up in the morning. The trouble is least pronounced while standing up, worse sitting down and still worse lying. She has no pains anywhere. The patient is a poor woman, of less than ordinary intelligence.
The case is interesting not only on account of the rarity of the affection, but the rapidity of the muscular contraction far exceeds any other case that I have ever heard of. The greatest number of muscular contractions in any case reported heretofore to my knowledge has been 180. While many writers prefer to class this disease with hysteria, it seems very doubtful if this is the proper view to take of it, in that not only individual muscles may be seized with these shock-like contractions, but even portions of muscles may be so affected, and the violent muscular contractions may take place even without locomotor effect. Then, too, the other stigmata of hysteria may be absent. The disease is very commonly associated with epilepsy.
The disease is curiously different from chorea. In the latter disease on asking the patient a question the movements become more pronounced, whereas in the former they usually subside until after the question is answered. Also in chorea the face is more commonly affected than the