LECTURE III.
ELECTRICITY IN DIAGNOSIS AND TREATMENT.
A.—Electricity in Diagnosis.
Gentlemen,
Our first two Lectures were devoted to a consideration of electrical instruments; the different varieties of electricity; and the most approved methods of applying them in therapeutics. To-day we have to study their uses in diagnosis, prognosis, and treatment.
The chief use of electricity in diagnosis is dependent upon its power of evolving muscular contraction. We have seen—as I demonstrated to you upon my left forearm—that both muscles and nerves, when in a normal condition, respond to the stimulus of electricity. In disease this response, or irritability, may remain unaltered, or it may be increased, decreased, or abolished; and our first step in electro-diagnosis should therefore be to ascertain the exact condition of electro-contractility. As in practically almost all our cases we have to do with altered reaction existing only in one nerve or muscle, or in one of two symmetrical groups of nerves or muscles, we possess a ready means of testing irritability by ascertaining its relative condition upon opposite sides of the body, as, for example, in an ordinary case of hemiplegia.|Test of Farado-Irritability.| In examining such a case electrically—and the principles of procedure are the same in all cases—it is convenient to commence our investigation with the Faradaic current, and to ascertain the lowest power which will call into action any one of the muscles of the healthy side, and then to apply this same strength of current to identical points of the corresponding muscle on the diseased side, noting whether it causes contraction. If so, we decrease the power of the current, when if contraction still occurs there is increased irritability, or vice versá, as the case may be. Having ascertained the condition of the muscle we proceed similarly to test its motor nerve, for we shall see hereafter that in certain diseased conditions muscle and nerve irritability are affected unequally. One conductor being held to an indifferent part of the body we apply a fine-pointed conductor to the most superficial point in the course of the nerve, in the way that, as you will recollect, I electrized my left median nerve. |Test of Voltao-Irritability.| We next submit the muscle and nerve to similar examination with the Voltaic current. Holding both conductors immovable, we interrupt the current for a moment by moving the “key” of our battery, or if it is not provided with a key, while one conductor is stationary, we break the current by lifting and reapplying the other. It is essential that on both sides there should be exact similarity in the application, and that the electrodes should be placed on identical points of the muscle, and this is especially important with the Voltaic current, for healthy muscle responds to it more readily when it flows down the limb, that is, with the positive pole nearest to the spine, and the negative farther from it than when it flows up, and consequently a reversal of the poles will influence the result.|Rule for strength of Current.| In testing a case in which there is equal disease upon both sides—as in some cases of paraplegia—we must be guided by a knowledge of the strength of current usually required to induce contraction. As a general rule, unless a current that causes energetic and painful action in the muscles of the ball of the thumb produces some contraction, irritability is impaired. If, in our examination of the muscle, we find irritability normal to both currents, we have proof of the integrity of the muscular tissue. If the muscle also responds by contraction to electrization of its nerve, we have further proof that the nerve is healthy, and also the spinal cord at the point of origin of the nerve.|Electro-Irritability diminished.| If we find the irritability lessened, there is disease of either muscular tissue, nerve or cord; and, as a rule, this will be in direct proportion to the amount of diminished irritability. |Electro-Irritability increased.| Increased irritability points to increased vascularity or irritative lesion; but in such cases we very seldom require the aid of electricity to complete our diagnosis.|Voltao-Irritability increased.| The reactions of Faradism and Voltaism are usually equal, but in some cases in which muscular response to Faradism is diminished or abolished the muscular reaction to an interrupted Voltaic current is not only preserved but increased. The diseased muscle will respond much more readily to the Voltaic current than the corresponding muscle of the healthy side; while at the same time it will be found on examining the nerve that there is equal diminution to both currents.|Diagnosis of Peripheral from Central Disease.| This increased muscle reaction is due to the special irritability of muscular tissue, and is quite independent of any nerve influence. It exists only in peripheral and never in central lesion, and by it we obtain an absolute diagnosis of such cases as local paralysis of the facial nerve from facial hemiplegia, paralysis of the extensors of the wrist and fingers, due to lead poisoning, from commencing muscular atrophy, or progressive muscular atrophy from paralysis from section of a nerve—all important questions as affecting treatment. |“The Degenerative Nerve Reaction.”| It is known as the “degenerative nerve reaction,” as it always follows when a nerve trunk is involved in the lesion. There is then diminution of Faradaic irritability through both nerve and muscle, diminution of reaction to the Voltaic current when the rheophores are applied over the nerve, and increase of reaction when they are applied over the muscle; but there is no relation between these interesting variations in the electrical condition of nerve and muscle, and the degree of paralysis to the will, for there may be perfect muscular paralysis, as in hemiplegia, when the electrical condition of both nerve and muscle is unchanged; but, on the other hand, in muscles equally paralyzed we may find absolute electrical changes in some, and none in others. We may often positively predict that these latter will rapidly recover—one instance of the use of electricity in prognosis.
After long disuse of healthy muscles a slight degree of diminution of electric irritability may sometimes be present, but this is always restored by two or three Faradizations, and its existence is hardly likely to present any difficulty in diagnosis. |Central Paralysis.| With this qualification we find that in paralysis from brain disease electric irritability is normal, except when irritative lesion is present, and then it is increased.|Spinal Paralysis.| In paralysis from disease of the substance of the cord irritability is diminished, and this will sometimes aid us in the diagnosis—not always easy—between commencing paraplegia and locomotor ataxy. In ataxy—at least in its early stages—irritability is normal. In progressive muscular atrophy it is normal as long as any muscular tissue remains.|Hysterical Paralysis.| In hysterical or emotional paralysis irritability is normal, but electro-sensibility is often much impaired. |Diagnosis between Real and Feigned Disease.| |Electricity as Proof Positive of Death.| These variations will sometimes enable us to distinguish between real and pretended disease; and, finally, absolute abolition of electric irritability in all the muscles of the body is proof positive of death, so that those extraordinary people who are haunted by a fear of being buried alive may rest contented if they provide that after apparent death, and before burial, their bodies shall be submitted to thorough electrical examination.
Considered solely as an aid to diagnosis, we can get little more assistance from electricity than I have pointed out to you.
And now, Gentlemen, we come to the consideration of the last and most important branch of our subject—electricity as a therapeutic agent—its scope and its limitations as a remedy.
Is it needful for me to say that there is too much belief and too much unbelief in its therapeutic power?
The men who estimate it fairly are quite the minority. It is generally either much undervalued, or else believed to be a sort of modern “Elixir Vitæ,” capable of curing a hopeless hemiplegia from destruction of brain tissue, or a paralysis agitans from senile degeneration. Although electricity will do neither of these impossibilities, yet, considered as a remedy, it is of great value in a wide margin of diseases. It will either stimulate or soothe both nerve and muscle, according to its variety and mode of application; it will frequently restore voluntary movement, it will relieve pain, heighten temperature, recall sensation, coagulate the blood, and dissolve or slowly cause the absorption of tumours.
B.—Electricity in Treatment.
FRANKLINIZATION.
Franklinization as the oldest form of electricity and as partaking more of a general application than a local, may be conveniently considered first.
Administered by the various methods described at pages 6 to 17, it has been found in the practice of the National Hospital for the Paralyzed and Epileptic, and in private cases coming under my own observation, of considerable value.|Facial Neuralgia.| Facial neuralgia, for example, which has resisted other modes of treatment, may occasionally be relieved with rapidity and permanently by drawing sparks along the track of the affected branch or branches of the trifacial nerve.|Sciatica.||Facial Spasms.| Sometimes also obstinate sciatica has been partially or altogether removed; so also facial spasm, (tic convulsif), as in the following instance, for permission to quote which I am indebted to Dr. Radcliffe. A female, forty-eight years of age, had suffered for thirteen years from spasm of the muscles of the left side of the face. The distortion produced by the spasm was very great, and was apt to be so much exaggerated by slight emotion, even such as would be caused by having to address a stranger, as to make speaking difficult, and to prevent proper attention to her occupation as a small shopkeeper. An experimental trial was made of electrization by sparks along the lines of the nerves distributed to the affected muscles. After the third application the spasm was manifestly relieved, the distortion being diminished, and the paroxysms occurring less frequently. By persisting with this treatment thrice weekly over a period of two months, so great an amount of relief was obtained that little distortion of the face remained, and the patient was able to pursue her business with comfort.|Emotional Aphonia.| Electrization by sparks over the larynx has been found so effective in the relief of cases of hysterical or emotional aphonia, even those of long standing, that it is well to use it in the treatment of these cases before having recourse to induced electricity. In six or seven recent cases, this form of application repeated twice or thrice effected a complete cure. One of these cases was of nine, another of six months’ duration. The remainder had lasted from four weeks to three months. The seventh case did not receive any benefit from the use of static electricity, and the other forms of the agent proved equally ineffective. The case recovered slowly under general treatment.|Localized Excessive Sensitiveness.| Electrization by sparks over the affected spot has often proved of great benefit in removing the localized excessive sensitiveness not unfrequently found in hysterical cases, particularly in the spinal region.|Tremor.| Tremor, whether general or local, is sometimes largely relieved by insulating the patient, and charging him with positive electricity for a period of twenty minutes to half an hour. Other applications failing, I would advise always, in cases similar to the above, a fair trial, say half a dozen sittings, of Franklinization.[14]
ELECTRIZATION.
We have seen that if we send a shock of electricity through a motor nerve the nerve becomes excited, and responds by contraction of its muscles. One form of electricity, then, is a stimulant, but, unlike other stimulants, it admits of its action being exactly localized and its influence instantly withdrawn.|Effects upon Nutrition.| There first results from such an application a larger flow of blood to the part, with subsequent increase of temperature and general improvement in nutrition.|Electricity as a Stimulant.| If muscular contraction results, it acts in addition as an artificial gymnast, imitating natural muscular action in a way quite impossible to any agency but electricity. It is in cases where there is muscular response to it, but not to the will, that it is often of immense service, and it can then be replaced by no other remedy known to medicine. Need I say that in such cases its dosage is of importance; that only a certain amount of stimulation being needed, this may not be carried to the point of exhaustion, and that the application should not be continued for too long a time. From ten to twenty minutes for an entire application is usually sufficient. So much for the stimulant effects of electricity when administered under either of its forms in a series of intermittent “shocks.”
But we get a very different result when we employ a constant current—that is, a continuous stream of electricity without interruption or break in it, and without appreciable variation in its strength. One effect of the administration of such a flow of electricity is that of a sedative, for it possesses the most remarkable power in relieving pain. We have all heard of the benefit of the “constant current” in neuralgia, and it is worthy of its reputation, and will not disappoint us if we administer it with the precautions noted in my last Lecture. (See foot-note, page 52.)[16]
Electricity, then, according to its variety and method of administration, is both a stimulant and a sedative; but although these words may be used as convenient distinctive terms, there is no doubt that it is something more, and that it possesses an influence quite sui generis, dependent, perhaps, upon its modification of the natural state of the electricity of the human body.|Restorative power of Voltaic Current.| The Voltaic current enjoys a remarkable restorative power, for it has been found that its prolonged action upon a nerve immediately after death will preserve its irritability for a length of time, and that even in a dead nerve the lost irritability may be again established. |Electricity in Fatigue Diseases.| Dr. Poore has particularly studied this restorative or refreshing effect of the Voltaic current, especially in its application to a class of diseases (termed by him “fatigue diseases”), and of which writer’s cramp is a type, chiefly characterized by an intense feeling of fatigue upon any attempt being made to execute certain muscular movements. This tired feeling is at once removed by the application of the Voltaic current, either to the muscles affected or to their nerves, and this result Dr. Poore believes to be explained by an increase in the susceptibility of the muscles to the stimulus of the will. Be this as it may, such an application is often most comforting, and it is not unusual for the patient to experience immediate and most grateful relief, and to beg for its repetition. Many electro-therapeutists will attribute this relief to the production of, as it is termed, a condition of electrotonus, about which, and its importance in electro-therapeutics, a great deal has been written and disputed. |Electrotonus.| Electrotonus is simply a name given to signify the state of a nerve while it is being traversed by an artificial Voltaic current. The effects of such an application, of course, depend chiefly upon the power of the current. If sufficiently powerful complete functional destruction of the nerve would result, as by a lightning flash; and as the tension of electricity is greater at one pole than the other, we naturally, with currents of a certain strength, discover modifications of irritability in the nerve when specially influenced by either pole. The irritability is increased in the half nearest to the negative pole (Katelectrotonus), decreased in the half nearest to the negative pole (Anelectrotonus), and unchanged at a point midway between the two poles (point of indifference). The production of the general electrotonic state is of importance. I believe these lesser variations of anelectrotonus and katelectrotonus to be practically of little moment, and I advise you to disregard them in therapeutics.
The restorative effect of the Voltaic current is frequently of benefit in sexual weakness. In functional cases, the current may be applied to the spine—positive pole to mid-dorsal region; negative well painted over lumbar twice daily for ten minutes upon getting up and going to bed. This treatment was adopted in the case of a gentleman, fifty years of age, who consulted me for gradual decrease of sexual power, ending in complete impotence. Six weeks’ treatment resulted, the patient informed me, in the complete restoration of the normal function.
Very marked absorbent or resolvent effects are also exerted by the Voltaic current, and are probably chiefly due to its powerful chemical action, for a current of great strength will dissolve or destroy any animal tissue whatever. One application of this chemical action is found in the electrolysis of tumours; another in the coagulation of blood in aneurisms;[18] and a third in the removal or absorption of gouty and rheumatic deposits. |Rheumatic Gout.| In Rheumatic Gout, Dr. Poore has recorded a very successful result from the use of localized galvanization. The disease had existed for three months, but the severity of the pain had much diminished, excepting towards evening, when exacerbations occurred. The wrist was considerably swollen, and absolutely stiff, the hand pronated and could not be supinated, and the hand and fingers were immensely swollen, so as completely to obscure their anatomy, while the fingers were extended, stiff, pale, and cold, and the nutrition of the entire limb impaired. The whole limb, and especially the hand, was thoroughly sponged with the negative pole, the positive being held in the patient’s other hand. After the third application the swelling rapidly subsided, and in about a fortnight the hand, although still stiff, had resumed its natural aspect. The muscles were then faradized and shampooed.
Rheumatic arthritis with nodosities is best treated by passing as strong a Voltaic current as the patient will submit to through each swollen joint for a few minutes, the direction of the current being frequently changed by the movement of the commutator of the poles.
The pains of muscular rheumatism are almost invariably removed or mitigated by cutaneous faradization, and so rapidly as in many cases to appear marvellous. In cases that had resisted all other treatment, an instantaneous cure has resulted, and sufferers whose pain has for a long time obliged them to keep the arm immovable have been able directly after the faradization to execute any movement with ease. With these rheumatic patients it is especially of importance that the current should be strictly limited to the skin, carefully dried and powdered, and should produce no muscular contraction, or the suffering will be aggravated instead of relieved. Begin with a current readily bearable on your own hand, and increase afterwards. The above remarks are applicable to all varieties of muscular rheumatism, but not to arthritic disease.
So much for the general effects of electricity. All the structures of the body respond to its application; the muscles and motor nerves, as we have seen, by contraction; the nerves of common sensation by a burning or pricking; and of the nerves of special sense; the retina by a flash of light; the auditory nerve by a sound; the olfactory nerve by a peculiar smell; and the gustatory by a metallic taste, differing at the two poles. The action of the Voltaic current upon the brain is exceedingly powerful, and the greatest care must be exercised when it is applied to any part of the head or face. Not more than two or three cells should be commenced with. Its effect should be noted, and any increase should be made gradually. With a very moderate current giddiness is produced, and upon the sudden application of a sufficiently powerful one the patient falls down as if struck by a blow.
All, or some of the more or less generalized applications, such as Beard and Rockwell’s generalized electrization, the common Faradaic and Voltaic Baths, or Radcliffe’s Charge, are of occasional benefit in conditions of general debility, and where general stimulation of the nervous centres is indicated. The electric bath is an elegant and pleasant mode of administering electricity, but it is less generally beneficial (except in certain gouty or rheumatic cases) than localized applications of electricity. The statement that metallic poisons can be eliminated from the body by its agency has not yet been established.
There are very few, I think I may almost say not one, of the many disorders classed under the heading of paralysis, in which at some time or other of their progress some form of electrization is not essential to their most successful treatment. Where powerless to cure it will not unfrequently relieve the most distressing symptoms. Cases of functional paralysis from slight pressure are not uncommon, when power may usually be restored by a few Faradizations; but in paralysis from severe central or peripheral lesion progress must of necessity be slow. Such cases, regarded electrically, may be most conveniently considered under the two divisions of atrophic and non-atrophic paralysis.|Atrophic Paralysis.| In the great majority of atrophic cases there will be found abolition or modification of the normal electrical reaction of nerve and muscle, but whether this is so or not, in all cases of loss of power, in which any muscular wasting is visible, the localization of electricity in the wasting muscles is imperative, and in some varieties it is the only treatment which will arrest the disease. It is in these latter cases that its early administration is called for, before the degeneration and disappearance of the muscular tissue, and its early and judicious use will not seldom save the sufferer from being left for life with a powerless, or withered and deformed, limb.|Infantile Paralysis.| As an illustration, let us review the progress of a case of essential infantile paralysis, the most common of the paralyses of children; that form in which premonitory symptoms are often absent, or but slight, and where there is no rigidity. Very shortly after its onset, usually within a few days, the limb is found to be colder than its fellow, and its muscles to be rapidly wasting; the final result, if untreated, being the entire disappearance of some of them and the production of deformity. In fact, the larger number of cases of club-foot and analogous distortions are brought about by neglected infantile paralysis, and there is no doubt that by judicious treatment, of which early electrization is the foundation, the majority of them might have been prevented. The leading orthopædic surgeons are fully alive to this fact, but they are powerless, as they are rarely consulted until all the mischief has resulted.|Importance of early Electrical Treatment.| The early recognition and appropriate treatment of these cases must continue in the hands of the family practitioner, and he must decide whether or not they are to continue, as at present is unfortunately too commonly the case, without any serious attempts at restorative treatment until commencing deformity compels attention to them. As soon as the medical attendant is summoned—and this is frequently only because the parents have noticed that the child is lame—he should carefully examine the muscles electrically, and unless there are head symptoms present, and this is very seldom, he should electrize each muscle daily with that current to which it responds, and of a strength just sufficient to produce muscular contraction. If the powerless muscles have preserved their Farado-contractility it may be confidently predicted that they will rapidly recover; but it will almost invariably be found that while Farado-contractility is diminished or abolished, there is increased response to the interrupted Voltaic current. They should be treated then with this current alone. Hot spongings and shampooings should also be employed, and it is of great importance that in the intervals of treatment the temperature of the affected muscles should be maintained at as high a degree as possible. If the leg is affected, a stocking of pure spun silk should be constantly worn, day and night, in addition to the ordinary clothing; if the arm, a silken sleeve.
When in any form of paralysis ANY amount of voluntary power has been restored by electricity, it is most important that the patient should be encouraged to use the limb and practise various movements. Passive movements are of equal importance, and the paralyzed muscles should be frequently exercised by this mode to the fullest extent of their normal movements. For example, if the extensors of the hand and fingers are paralyzed, the hand and fingers should be passively flexed and extended completely, at intervals of a few seconds, for some minutes, and so on with all the paralyzed muscles in succession. |Rule for Muscular Electrization.| As soon as there is return of reaction to Faradization, Faradization should be alone used, and the rule in all cases of localized muscular electrization, muscular contraction being sought, is to use that current to which the muscles respond, and I do not know of any exception to this rule; but a successful result in severe cases of atrophic—not alone infantile paralysis, but all varieties of atrophic paralysis—is brought about by painstaking, daily, tedious, uninteresting treatment, with no chance of brilliant or rapid results, but which if thoroughly, faithfully, and patiently carried out, will reward us by progressive improvement, and sometimes—even in cases regarded not long ago as quite hopeless—complete recovery.
There are certain forms of paralysis affecting children where the muscles are rigid. Localization of any form of electricity in these rigid muscles is quite useless; but if these cases depend upon adhesions or exudations into the medulla their absorption may possibly be promoted by localizing a Voltaic current in the superior cervical ganglia of the sympathetic; two small conductors, leather, tipped and well-moistened in connection with the poles of a Voltaic battery being applied for four or five minutes to the bottom of the auriculo-maxillary fossæ on both sides. There seems no doubt that such an application causes a dilatation of the blood-vessels of the base of the brain, and is likely therefore to promote absorption.
In all cases of traumatic lesion—as by section of a nerve—the paralysis is atrophic, and the treatment I have recommended in infantile paralysis should be assiduously employed. Mitchell, of Philadelphia, whose experience of military surgery is unrivalled, commences electrical treatment and shampooing within a fortnight of the wound, unless there are special circumstances to contra-indicate it. Lead palsy requires similar treatment; so does, perhaps, the commonest form of peripheral palsy—facial palsy from neuritis of the facial nerve.|Caution necessary in Electrizing Facial Muscles.| In electrizing the facial muscles there is one caution necessary—especially to observe the rule of electrizing the muscles equally—for I have several times met with a contraction resulting from a too energetic Faradization of some individual facial muscle, to the neglect of the group with which it is in correlative action. Such a contraction may sometimes be removed by localizing in it for about five minutes a constant Voltaic current from eight or ten cells; but in the most favourable cases an unnatural expression of countenance will generally persist for a long time, from the non-recovery by the muscles of their perfect “tone,” that quality which imprints upon each face its characteristic features, and which has been called the “Gymnast of the Soul.”
In that most distressing disease, Cruveilhier’s atrophy or wasting palsy, medication is altogether useless, and our one hope—not invariably a forlorn one—is in electricity. Localized Faradization to the muscles, alternately with Radcliffe’s Positive Charge, together with galvanization of the sympathetic or of the spinal cord, admit of trial.
In non-atrophic paralysis—of which hemiplegia may be taken as a type—the propriety of electrization, and especially the proper moment for its application, requires careful consideration. In both brain and spinal cord disease muscular electrization is not advisable until some time after the attack, or until the muscles exhibit signs of impairment of nutrition from disuse. As long as there is rigidity—especially with increased reflex action—any stimulant application of electricity is not likely to do good, and may do harm; but in older cases—both hemiplegic and paraplegic—cases of from six to eighteen months’ duration—the immediate benefit to be derived from localized electrization is often remarkable, especially in those cases where, after a partial return of voluntary movement, the patient suddenly stops short, and for weeks or months makes no progress. As the sequel of electrization, the hemiplegic patient able to use the arm slightly, but not to feed himself, may regain this power, to his infinite comfort, and the paraplegic patient, able with difficulty to drag himself along by crutches, is enabled to walk by the aid of a stick. Some improvement is usually soon obtained, and it is progressive for, perhaps, two or three months, after which continued electrization fails to increase it; but at a subsequent period—six months afterwards—a renewed electrization may give rise to a new improvement; but be this as it may, whenever in these old-standing cases we see signs of impaired nutrition, it is wise to occasionally stimulate the muscles by Faradism. We should endeavour—in the words of the late Nestor of modern medicine, Sir Thomas Watson—“to preserve the muscular part of the locomotive apparatus in a state of health and readiness, until peradventure that part of the brain from which volition proceeds having recovered its functions, or the road by which its messages travel having been repaired, the influence of the will shall again reach and reanimate the palsied limbs.”[19] |Direct application of Voltaic Current to Brain.| In hemiplegia the propriety of a direct application of the constant Voltaic current to the brain must be thoughtfully considered. In selected cases, where the clot or softening is of limited extent, its removal may be accelerated by a carefully localized current—two or three cells—for two or three minutes to the injured hemisphere, followed by Voltaization of the cervical sympathetic (so-called) for four or five minutes. After such an application there follows—according to Althaus—“greater ease in the head, as well as in the limbs, and if there has been pain this is relieved.” |Electricity in Spinal Paraplegia.| Similarly the absorption of the inflammatory products may be promoted in the earlier stages of spinal disease, by localizing the Voltaic current in the parts affected, especially where pain is present, and we have reason to suppose that the myelitis is circumscribed. The daily application of the positive pole for about five minutes, and with from ten to fifteen cells, to the painful spot—the negative pole being held to an indifferent part of the body—is likely to promote absorption. At any rate it will sometimes relieve the pain. In the later stages of paraplegia, as soon as there is diminution of electro-irritability in the paralyzed muscles they should be sponged with the Voltaic current, or Faradized; and where anæsthesia is present, a good painting with the wire brush will often be of service. |Paraplegic Constipation.| Paraplegic constipation may frequently be relieved by Faradization of the abdominal muscles, and the troublesome dribbling of urine, so often present, by external Faradization of the bladder—one pole to the pubes, and two sponges from the second pole—one to the sacrum and the other to the perineum. Incontinence of urine in children may be similarly treated.|Emotional Paralysis.| Cases of hysterical or emotional paralysis may frequently be benefited by the application of the wire brush, which also sometimes acts like a charm in removing anæsthesia, which, although originally of central origin, continues after the removal of its cause. Anæsthesia from section of a nerve is sometimes persistent in this way after repair of the nerve lesion. |Locomotor Ataxy.| The wire brush is also useful in sometimes removing the anæsthesia present in locomotor ataxy, some cases of which may be largely benefited also by the constant current to the spine—one pole to nape of neck, and the other to the lower lumbar vertebræ.[20]
Electricity is coming into use in mental diseases. Faradism, and especially cutaneous irritation with the wire brush, would seem to be most suitable for cases accompanied by depression or torpor, the stimulating effects being of service in inspiriting the patient, while the soothing influence of a direct application of the constant Voltaic current to the brain may be employed in cases of over-excitement requiring a sedative.
It is remarkable that electricity should have been so little used in this country in the diseases of women.|Electricity as an Emmenagogue.| According to Golding Bird, it is the only true emmenagogue that we possess. Be this as it may, all of its forms are serviceable in stimulating the secretions, and may be employed with success in cases of suppression of the catamenia from a torpid condition of the uterine organs. A generalized application will often suffice. Let the patient sit with her feet in tepid salt and water, in which is immersed a wire from one of the poles of an induction instrument in action, while a large sponge from the other pole is held applied to the lumbar region. Strength of current as much as she will bear. Time, ten to fifteen minutes. The application should be made twice daily for the three or four days preceding the usual catamenial period. If this method fails in its object, direct electrization must be resorted to; but Franklinization most often succeeds.
On the Continent electricity has been largely employed in the treatment of inertia uteri in the second stage of labour, also in producing premature labour; in the resuscitation of still-born children, and in uterine displacements. |The Advantages of Electrization over Ergot.| We possess other remedies for these conditions, but in labour its advantages over the administration of ergot, include the rapidity and certainty of its action, the exactness with which its dose can be regulated, and the strength and regularity of the contractions which it produces. It admits also of being used in extreme cases in which the power of swallowing has been lost, or where everything is rejected from the stomach, while it never exerts in any way—as ergot is said to do occasionally—any injurious effect upon the new-born child.
Gentlemen, it is my firm belief that if a Faradaic instrument were at hand, and properly used, there would never be another death from post-partum hæmorrhage. The Faradaic current, thoroughly localized in the uterus, will always produce its contraction, not only while life persists, but even for a limited time after death, but failure in localizing electricity in an organ, withdrawn from sight and covered with thick muscular tissue, is especially liable to occur, unless the details of application are conducted with extreme care. Assume the case to be an example of severe post-partum hæmorrhage, that the ordinary resources of medicine have failed the obstetrician, and that he fears every moment may be his patient’s last, but he has an induction instrument at hand. Let him waste no time, but at once introduce his right hand into the cavity of the uterus and grasp in his left the moistened sponge attached to one of the conductors of the instrument in action. Let an attendant, holding by its insulating handle the conductor from the other pole (which should be a well-moistened sponge) thoroughly paint with it, as it were, the abdominal parietes, pressing it with considerable force against the practitioner’s hand, and afterwards apply it to the lumbar region. Contraction of the uterus will invariably result if the current used be of sufficient power.
In my own hands an intractable case of uterine neuralgia was perfectly cured by the Voltaic current; and I have knowledge of a case of sterility which the localization of the Voltaic and Faradaic currents alternately would seem to have removed.|Sterility.| One conductor was applied to the os, and two sponges from the second pole—one to the position of each ovary. The applications were made thrice a week for a fortnight before each menstrual period, and for a period of four months. Conception followed, and the patient, who had been married for thirteen years, in due course gave birth to her first child.
The stimulant effects of electricity are occasionally beneficial in the treatment of paralysis of the nerves of special sense, especially of the optic and auditory nerves, while its use has been advocated in a multitude of diseases to which I shall not further refer, than by saying that a clear comprehension of the principles of electro-therapeutics will prevent the occurrence of difficulty in any special application of them; and let us shortly recapitulate the most important of these principles. |Résumé of general principles of Electro-therapeutics.| We have seen that electricity is a stimulant, a sedative, a restorative, and an absorbent. Its stimulant properties are chiefly of use in diseases of debility, and notably in paralysis—its sedative properties in the alleviation and removal of pain and spasm, and notably in neuralgia—its restorative properties in fatigue diseases, notably writer’s cramp—and its absorbent properties in exudation diseases, and notably in gout and rheumatism. The dose of electricity consists of the addition of two factors—firstly, the strength of the current, whether Voltaic or Faradaic; secondly, its duration. It is of essential importance that we do not overdose our patient, but we are little likely to do this if we adhere to the two cardinal rules—to use the minimum power which will produce the results we desire, and not to unduly prolong our application: and really this question of “dosage” forces us to consider how far it is advisable for the medical practitioner who prescribes electricity to sanction its administration by the patients themselves. While there is no doubt that the most explicit directions will often be misunderstood, or fail in being correctly carried out, yet it would be practically impossible (to say nothing of the expense to the patient) for any medical man to himself apply electricity daily for a lengthened period; and we are compelled, in certain cases, to do our best in instructing some one attendant of the patient how to carry out the treatment, making her do this a few times in our presence, and looking sharply after her afterwards, and in addition explaining everything as fully as possible to the patient, or the patient’s friends. Moreover, we must not lose sight of the fact that, with electricity as with other remedies, the skill of the physician is shown in determining how, when, and in what dose to administer it, and his judgment in selecting those cases in which its administration may be wisely committed to others.
In conclusion, Gentlemen, allow me to thank you for the attention with which you have listened to these imperfect Lectures. I fear that I have failed in doing full justice to their subject; but I trust that I have succeeded in indicating the importance of electricity, as a supplement to, not as a substitute for, the more ordinary resources of therapeutics: in removing any doubt as to the class of cases calling for its employment; in supplying any want of information regarding details of its application; and especially in proving its claim to be more fully employed in your daily practice. A theoretical belief in its efficacy is widespread in our profession, its frequent use is yet in the future, but I hope a not distant future. Gentlemen, with you rests the decision whether this shall or shall not be. You will decide it not by the dictum of any specialist, but by the general voice of the profession, declaring your verdict as founded alone on your own personal experience.