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* * * * *
HOW TO USE A GALVANIC BATTERY IN MEDICINE AND SURGERY.
* * * * *
HOW TO USE A GALVANIC BATTERY IN MEDICINE AND SURGERY
A Discourse DELIVERED BEFORE THE HUNTERIAN SOCIETY.
BY HERBERT TIBBITS, M.D.
FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS IN EDINBURGH; HONORARY
MEMBER OF THE NEW YORK SOCIETY OF NEUROLOGY AND ELECTROLOGY; LATE
HONORARY MEDICAL SUPERINTENDENT OF THE NATIONAL HOSPITAL FOR THE
PARALYSED AND EPILEPTIC, OUEEN’S SQUARE, BLOOMSBURY, AND OF THE
MEDICAL SOCIETY OF LONDON; MEMBER OF THE CLINICAL, OPHTHALMOLOGICAL,
HARVEIAN AND PATHOLOGICAL SOCIETIES; FOUNDER OF, AND SENIOR PHYSICIAN
TO, THE WEST END HOSPITAL FOR DISEASES OF THE NERVOUS SYSTEM; AND
MEDICAL OFFICER FOR ELECTRICAL TREATMENT TO THE HOSPITAL FOR SICK
CHILDREN, GREAT ORMONDE STREET, ETC. ETC.
_THIRD EDITION_
REVISED, AND INCORPORATING THREE LECTURES UPON ELECTRO-THERAPEUTICS
DELIVERED BY THE AUTHOR AT THE NATIONAL HOSPITAL
[Illustration]
LONDON:
J. & A. CHURCHILL,
11 NEW BURLINGTON STREET.
1886.
NOTE TO THE THIRD EDITION.
This Discourse was first published in compliance with the request
of several of those who heard it delivered, and who expressed to me
an opinion that busy practitioners might perhaps be glad to have at
hand, and in small compass, such information as it contained. It was
obviously impossible to do more in so limited a time than to make a
general reference to the therapeutic uses of electricity; and the most
that I attempted in this direction was to recall to the recollection
of my audience those conditions of disease in which the application of
electricity would seem--without doubt--to be required; and to indicate
the methods of application most generally useful. The construction of
apparatus can not be understood from verbal or written description
alone; and I appended to the text certain notes, and illustrations of
the instruments which I submitted to the Society.
With the Second Edition I incorporated three Lectures which I delivered
at the National Hospital for the Paralysed and Epileptic; and to this
Edition I have appended such additional matter as I believe will prove
useful to the student.
I may add that I have endeavoured, as was said by a deceased physician,
“to paint electro-therapeutics not imperfectly, but, as it were, in
miniature:” and that while I have carefully revised every page, and
have noticed all real improvements introduced to the profession since
the First Edition, I have kept the book a small book: and I venture to
hope a book easily to be understanded by the multitude of practitioners
who ask daily what instruments to use, and when, and especially how, to
use them.
These questions I have endeavoured to answer in the following pages,
which contain such details, and such details only, as I believe it
essential for the practitioner to master.
68, WIMPOLE STREET, W.
_December, 1885_.
CONTENTS.
NOTE TO THE THIRD EDITION.
LECTURE I. ELECTRICAL INSTRUMENTS.
PRELIMINARY REMARKS.
THE DIFFERENT VARIETIES OF ELECTRICITY.
1. FRANKLINISM.
Method of Generating.
The Plate Machine.
Winter’s Machine.
Carré’s Machine.
The “Bischoff” Gas Engine.
The “Hand Fly-Wheel.”
Accessories Required.
Its Administration.
(_a_) Electro-Positive Bath.
(_b_) Electro-Negative Bath.
(_c_) by Sparks.
2. VOLTAISM.
Points of Distinction between the Voltaic and Faradaic Currents.
The Essentials of a Voltaic Battery.
The 40-Cell Battery.
The Galvanometer as an aid to the Dosage of Electricity.
3. FARADISM. The Essentials of a Faradaic Instrument.
Description of a Faradaic Instrument.
The Combined Hospital Battery.
THE ACCESSORIES OF ELECTRICAL APPARATUS.
LECTURE II. METHODS OF APPLYING ELECTRICITY.
RÉSUMÉ OF FIRST LECTURE.
GENERALIZED ELECTRIZATION.
The Positive Charge.
The Electric Bath.
General Faradization.
Central Galvanization.
LOCALIZED VOLTAIZATION AND LOCALIZED FARADIZATION.
Direct Muscular Electrization.
Indirect ” ”
Different kinds of Rheophores.
Importance of exactitude in administering a Constant
Current.
CUTANEOUS ELECTRIZATION.
(_a_) The Electric Hand.
(_b_) Metallic Conductors.
(_c_) The Wire Brush.
ELECTRIZATION OF INTERNAL ORGANS.
(_a_) of Rectum and Muscles of Anus.
(_b_) of Bladder.
(_c_) of Uterus.
(_d_) of Larynx.
(_e_) of Male Genitals.
ELECTRIZATION OF CENTRAL ORGANS OF NERVOUS SYSTEM.
(_a_) of the Brain.
(_b_) of the Sympathetic.
(_c_) of the Spinal Cord.
(_d_) of the Retina.
(_e_) of the Auditory Nerve.
PRECAUTIONS TO BE OBSERVED IN ALL MEDICAL APPLICATIONS OF
ELECTRICITY.
LECTURE III. ELECTRICITY IN DIAGNOSIS AND TREATMENT.
A.--_Electricity in Diagnosis._
LIMITATION OF ELECTRICITY IN DIAGNOSIS.
METHOD OF TESTING FARADO-IRRITABILITY.
” VOLTAO-IRRITABILITY.
RULE FOR STRENGTH OF CURRENT.
DIAGNOSIS WHEN IRRITABILITY IS NORMAL.
diminished.
increased.
diminished to Faradism and increased to Voltaism.
of Peripheral from Central Disease.
of commencing Paraplegia from Locomotor Ataxy.
of Real from Feigned Disease.
ELECTRICITY AS PROOF POSITIVE OF DEATH.
B.--_Electricity in Treatment._
LIMITATION OF ELECTRICITY AS A REMEDY.
FRANKLINIZATION.
(_a_) in Facial Neuralgia.
(_b_) in Sciatica.
(_c_) in Facial Spasm.
(_d_) in Emotional Aphonia.
(_e_) in Hysterical Hyperæsthesia.
(_f_) in Tremor.
NOTE UPON RECENT ADDITIONS TO OUR KNOWLEDGE OF THE
BENEFIT OF FRANKLINIZATION IN DISEASES OF DEBILITY.
VOLTAIZATION.
The “Constant Current.”
Possesses an Influence “_sui generis_.”
ELECTRIZATION in Neuralgia.
in Fatigue Diseases.
in Electrotonus.
its Resolvent Effects.
in Electrolysis.
in Impotence.
in Gout.
in Rheumatic Arthritis.
in Muscular Rheumatism.
in General Debility.
in Atrophic Paralysis.
in Infantile Paralysis.
in Traumatic Paralysis.
in Lead Palsy.
in Facial Paralysis.
in Wasting Palsy.
in Hemiplegia.
ELECTRIZATION as a Direct Application to the Brain.
in Spinal Paraplegia.
in Paraplegic Constipation.
in Incontinence of Urine.
in Hysterical Paralysis.
in Locomotor Ataxy.
in Insanity.
in Diseases of Women.
as an Emmenagogue.
in Inertia Uteri.
in Post-partum Hæmorrhage.
in Uterine Neuralgia.
in Sterility.
in Paralysis of Nerves of Special Sense.
RÉSUMÉ OF THE GENERAL PRINCIPLES OF ELECTRO-THERAPEUTICS.
CONCLUDING REMARKS.
* * * * *
HOW TO USE A GALVANIC BATTERY IN MEDICINE AND SURGERY.
LECTURE I. ELECTRICAL INSTRUMENTS.
MR. PRESIDENT AND GENTLEMEN,
[SN: Preliminary Remarks.]
When your Council did me the honour to ask me to bring before you
the subject of Electro-therapeutics, I felt that the invitation
was addressed rather to the Hospital to which I am attached than
to myself, seeing that to it belongs the merit of having been for
some years the pioneer and outpost, so to say, in this metropolis
of the scientific and methodical application of electricity to the
alleviation and removal of disease; and that we are indebted to one
of its distinguished physicians for a remarkable investigation into
animal electricity, and the demonstration that much of what we have
been accustomed to attribute to a “vital principle” may, in reality,
be the effect only of electrical charge and discharge[1] (a valuable
contribution to the correlation of the Physical Forces); and to my
predecessor for the discovery of the special influence of voltaic
currents in certain forms of paralysis.[2]
As it is one of our objects in our practice here to study the scope
and the limits of electricity as a remedy in disease, it seemed to me
not inappropriate to devote my first Lectures to electro-therapeutics;
and the more so, as few medical men have a practical knowledge of the
subject; and I fear that the profession generally, through lacking
this practical knowledge, are to some extent responsible for the utter
and astounding recklessness with which the laity--ever ready to rush
in where physicians fear to tread--are prone to apply painful and
dangerous electrization, not to themselves, but to their suffering
friends; while it is still too common for the medical practitioner (as
quoted by Golding Bird upwards of forty years ago) to consider that
when his fiat has gone forth “let the patient be electrified,” he has
done all that is necessary, while the patient usually carries out this
mandate by the purchase of a rotary magneto-electric machine, and by
using it according to the directions of its maker, who is generally
about as well fitted to teach its application in disease as is the
maker of an amputating knife to operate with it!
The almost complete absence in the medical schools of the
great hospitals of opportunities for an adequate study of
electro-therapeutics, the importance of the subject, and the widespread
attention that it is awakening throughout the profession, have also
determined me to sketch as briefly as is consistent with clearness the
present position of the science and practice of medical electricity,
and especially of its practice.[3]
Electricity, Gentlemen, is by no means one of those remedies that,
failing to do good, is little likely to do harm. On the contrary, in
injudicious hands, it is potent for evil, while the benefit to be
derived from it is in exact proportion to the judgment and care with
which it is administered. Moreover, the results of its employment
are dependent, more than with any other therapeutic agency, upon the
methods by which it is applied--methods that should be familiar, not
alone to a few specialists, but to every practitioner.
Addressing you who are engaged in active practice, with little
time to devote to medical electricity, it will, I think, be more
acceptable for me not to weary you with a tedious discourse upon the
elementary principles of electricity, for the practical application of
these matters concerns rather the instrument-maker than the medical
practitioner, and I shall discuss none of them, except incidentally,
and _with precise reference to their application to medicine_. Besides,
we know little of them, and I cannot forget that Faraday said that
“he once thought he knew something about electricity, but the more
he investigated it the less he found he understood it.” Let us then
be content with its definition as a “FORCE,” “pervading all nature,
latent in every substance, and liable at any moment to be excited by
mechanical or chemical means.”
Nor do I propose to make these Lectures in any sense exhaustive,
but, on the contrary, to include in them only such information as is
essential, and such as you may readily, and without effort, retain in
your memory. I shall direct especial attention to practical points
which are of importance to the successful use of electricity; for
from non-observance of small details of application many failures
have resulted, the treatment getting a measure of discredit, which in
_strict justice_ should have attached only to the operator.
In the present Lecture I shall consider instruments, their
construction and management, a dry subject, but an essential one,
the first requisite of a good workman being complete familiarity
with his tools, lacking which he will be the victim of constantly
recurring annoyances and difficulties; for although the present
position of electro-therapeutics is largely due to improved methods
of administration, these methods would be impossible with faulty
instruments, while, on the other hand, the most perfect instruments
require a certain amount of skill and care in their management, and
some acquaintance with at least the mechanical details of their
construction; and without this rudimentary knowledge it is also
impossible to usefully compare one instrument with another.[4]
My second Lecture will be devoted to the different methods of applying
electricity, and my third and last to its uses in the diagnosis and
treatment of disease.
[SN: Varieties of Electricity.]
We make use of three varieties of electricity in medicine.
Firstly, of static or friction electricity, the electricity of
glass and amber, appropriately called from its early investigator,
_Franklinism_.
Secondly, of the electricity of chemical action, _Galvanism_, or
better, _Voltaism_, the “_Constant Current_.”
Thirdly, of _Faradism_, the induced currents of momentary duration,
which are generated or _induced_, in a coil of wire by the action upon
it, under certain circumstances, of a magnet, or of a Voltaic current.
FRANKLINISM.
Franklinism, sometimes of the utmost value, and far surpassing, in
certain cases, any other form of electricity, has some inconveniences
in its application, and has hitherto been little used but by
specialists. Recent improvements in Franklinic instruments have,
however, largely removed these inconveniences, and have placed at the
general service of the profession a remedy of much good and still
greater promise. The fundamental requisite in all Franklinic machines,
consists in the rotation of a glass plate against a leathern or other
rubber, and the accumulation of the resulting electricity upon a
metallic receiver, insulated by a non-conducting support, usually of
glass.
[SN: Franklinism]
Discarding the primitive cylinder machine, now long since disused,
we will firstly consider the plate machine in which the electricity
arising from the friction of the rotating glass plate against
the upper and lower cushions, is collected by two brass arms and
distributed to the brass conductor, from which they branch out, and
which is insulated by a glass support.
[Illustration: FIG. 1. Plate Electrical Machine and Glass-legged Stool.]
The machine should be fixed upon a firm stand that it may be quite
steady during rotation, and be screwed to a heavy painted deal table,
as is shown in Fig. 1.
[Illustration: FIG. 2. Winter’s Machine.]
When very seldom used, _and where expense is a consideration_, very
_fair_ results may be obtained from a Winter’s machine with a plate
of only 15 inches in diameter, and which is easily carried. In this
instrument, Fig. 2, the fact that the quantity of electricity which may
be accumulated upon a conductor is dependent upon its size has been
most ingeniously applied, the surface of the conductor being enormously
increased by the insertion into a large wooden ring of a core of thick
iron wire. Electricity accumulates upon the wire, and is prevented from
escaping by the insulating wooden covering.
But in the daily or frequent use of Franklinism it is essential,
equally for the comfort of the operator, as for the benefit of the
patient, that the most efficient apparatus should be provided. The
one delineated in Fig. 3, and which I habitually use, is that known
as Carrè’s, but I have modified it by having attached to it a second
accumulator, or conductor (the first time, I am led to understand,
that such an improvement has been added to any such machine). This
arrangement admits of the patient receiving the charge of either
positive or negative electricity--a condition said by some physicians
to be of primary importance.
[Illustration: FIG. 3. Static Machine with Gas Engine and Insulating
Stool.]
There are other machines, but I do not propose to weary you with their
descriptions.
When _any_ Franklinic apparatus is in use its plate or plates should be
evenly and uniformly rotated, and it is much better to have this done
mechanically rather than by a man or maid-servant.
I use a “Bischoff’s” gas engine, shown to the right hand in Fig. 3.
It consists of a cylinder, surmounted by a hollow column serving as
a guide to the piston. From the extremity of this column there is a
very long connecting rod which acts upon the crank of the shaft of
the fly-wheel and driving-pulley. When the piston ascends it draws
in during four-tenths of its course a mixture of air and gas from the
pipes. A little before the piston has ascended half-way a gas jet
ignites the mixture. There is a slight explosion without the least
effect on the sides of the cylinder, but sufficiently strong to push
the piston and cause it to complete its course. In consequence of this
movement the piston is raised and acts on the connecting rod, forcing
it upwards and half turning the fly-wheel. On account of the speed
acquired, and of the impulse given, the fly-wheel continues its course
by means of the crank and connecting rod, and sends the piston to the
starting-point again. Then it ascends again, taking in a fresh charge
of air and gas, motion being imparted anew to the driving shaft by
every revolution of the engine.
An engine of 2-man power, with an altitude from the ground to the
top of the column of 4 feet, and with a fly-wheel measuring 2 feet 6
inches in diameter, is amply sufficient for every purpose. It works
evenly and without noise; it is absolutely free from danger, and
it is placed instantly in or out of action by merely igniting or
extinguishing a single gas jet. But it is remarkable that no one seems
to have suggested--even before the gas-engine era--that a “fly-wheel”
with a pulley would obviate the old difficulty of the unsatisfactory
rotation of the Plate machine. Going into a hair-cutter’s shop I found
the apparatus, figured to the left of Fig. 4, standing in the shop to
work the customary “hair brushing machinery” instead of its being, as
is usual, fixed upon an upper floor. I obtained one, and fitted it in
the manner shown, to a Carrè’s machine. The fly-wheel is so heavy that
it can be rotated by the operator without the aid of an assistant, by
his giving the handle an occasional “swing round.” Its momentum then
keeps it revolving a sufficient number of times before the next “swing”
is required, to enable him to leave it and attend to his patient. The
manner in which the band from it is attached to a small wheel in rear
of the Static machine is also shown in the Figure.
[Illustration: FIG. 4. Fly-Wheel and Static Machine.]
In Fig. 3 the patient is being “charged” with _positive_ electricity,
or, as the electro-therapeutists of fifty years ago would have
said, “he is taking an electro-positive bath,” by being insulated
and connected through the metallic rod held in his hand with the
accumulator upon which the positive electricity is stored, while the
negative electricity is “run off” by a brass chain leading from the
negative accumulator to the ground. If the process were reversed, the
positive accumulator, being connected with the ground, and the patient
with the negative one seen at the top of the machine, he would be
taking “an electro-negative bath;” for we make him, as it were, a part
of each accumulator as the case may be; its accumulated electricity
passes to him and he becomes _charged_. If the air were perfectly dry
he would continue (as he is insulated) in this charged condition, but
owing to its contained moisture the electricity rapidly leaves him, and
to maintain the charge it is necessary that the plate of the machine
should be kept in constant rotation. Indeed, the escape of electricity
is so rapid that to get the best action we must have a fire in the
room, and before use well rub the plate, the insulating supports, the
legs of the stool, and all the glass parts of the apparatus with a warm
and dry piece of flannel. This is of importance, and however dry the
day, should as a rule never be neglected.
By smearing the inside of the cushions of the machine with a little
paste, composed of an alloy of mercury and tin (technically known as
“amalgam”), mixed with a little tallow, the amount of electricity is
much increased, but care should be taken not to smear the cushions
with too much, which had better be bought ready prepared. A piece
about the size of a small grape for each of the cushions will be
enough, and no more need be added for two or three weeks. Always scrape
off old amalgam before adding new. The cushions should be screwed
sufficiently tight to slightly “grip” the plate, and if it is found
that notwithstanding having rubbed the glass of the apparatus as
above directed, the instrument is not supplying a sufficient quantity
of electricity, remove the cushions and warm them thoroughly. _It
is impossible to be too careful that everything is warm, clean, and
dry_, for the great obstacle that exists against the extended use of
Franklinism is found in this difficulty sometimes present, from neglect
of the above precautions, in getting efficient action. But even on a
foggy day the instrument, _with proper care_, may be made to act well.
The operator should also remember that dust must be sedulously guarded
against. A few drops of petroleum may be sprinkled upon the table, and
their vapour condensing upon the machine will aid in protecting it
against moisture.[5]
There will also be needed two or three lengths of brass chain, or of
copper wire, and a stool about 4 feet by 2 feet, with four glass balls
or legs. A stool of this size admits of a chair being placed upon it,
as in Fig. 3, and it will be also useful for certain applications of
voltaism, which will be mentioned later on. Four glass jars are also
needed with which to insulate an ordinary couch.
[Illustration: FIG. 5. Improved Dischargers and Connecting Rod. FIG.
5_a_.]
A chair, insulated by being screwed to a glass platform, as in Fig.
5_a_, _running on castors_, is an improvement upon the old-fashioned
glass-legged stool.
[SN: Franklinization by Sparks.]
In Fig. 3, the electricity is escaping from all points of the skin,
but if it is desired to localize somewhat this escape along the course
of certain nerve branches, or otherwise, but to avoid shock, a brush
may be slowly passed by the operator almost, but not quite, in contact
with the skin. A series of rapid and successive reunions of the
electricity with each bristle of the brush takes place, generating a
current of cold air perceptible to the patient. I habitually use for
this application an ordinary clothes-brush. If while in connection with
the conductor any object (the knuckles will do) is brought sufficiently
near to the patient for his contained electricity to overcome the
resistance of the intervening stratum of air, he is “_discharged_” with
a spark. This is _Franklinization by sparks_, and is accompanied by a
certain slight amount of “shock.”
In Fig. 5, improved “dischargers,” and a convenient metallic connecting
rod are shown.
The ball terminations of the dischargers should vary in size, for
within certain limits, the larger the ball the more intense the spark;
with the pointed end the spark is very small; with the discharger
terminating in many small metallic points still smaller, and with a
similar discharger made of wood, a luminous glow alone results, and no
spark.[6]
I shall discuss, in my third Lecture, the therapeutic values of
Franklinism.
VOLTAISM OR GALVANISM.
[SN: Voltaism.]
The Voltaic current is a _continuous_ current. Unless artificially
interrupted, the electricity flows in an unbroken stream until the
battery is exhausted. The current will gradually lessen in power until
it ceases, but there will be no break in it, and no change in its
direction, which is uniformly from the positive to the negative pole.
[SN: Points of distinction between the Voltaic and Faradaic Currents.]
It is important to recollect these points, for they constitute the
chief physical distinction between the Voltaic and the Faradaic--or,
as it is sometimes called, the Induced current. This latter is not,
strictly speaking, a “_current_,” but a rapid discharge or succession
of momentary shocks, each perfectly distinct in itself, and separated
by an appreciable interval of time from its fellows.
[SN: Voltaic Cells.]
In electrization, a source of electricity is of course necessary, and
this is furnished by a cell or cells, with contained elements and
chemicals; and, until a few years ago, it was impossible to get a
_portable_ cell that remained always in order and ready for use.[7]
[SN: Requisites of a Portable Battery.]
The requisites of a portable battery are that it should be really
portable, always ready for use, and little liable to get out of
order. Such batteries may be divided into two classes: firstly,
those in which the elements are either lowered into the exciting
fluid or the fluid is lifted to them, as in the instruments of
Stöhrer, Weiss, and almost all other makers; and, secondly, those in
which the elements remain immovable in their cells, and of these the
Leclanché, the Gaiffe-Clamond, and the chloride of silver, are to be
generally preferred to any of the first-named construction, for they
admit of the cells being so nearly sealed up that no fluid can be
spilt by any movement except turning the battery quite upside down;
while the somewhat common accident with batteries of the first-named
construction--viz., destruction of the plates by leaving them in the
acid, with its anything but agreeable result of a considerable expense
to replace them, is obviously impossible. The only disadvantage they
possess is that when exhausted it is necessary to send them to the
maker to be recharged, _while the owner can keep the first-named
variety in order himself_.
Efficient cells are, however, but a first step to the perfection of
electrical apparatus, and the mechanism by which the current is brought
into use and graduated, and the general accessories of the instrument,
are of at least equal importance. The instruments which I am about to
describe, have been designed by myself, and may be obtained from Mr.
Hawksley, Surgical Instrument Maker, Oxford Street. It is claimed for
them that they place at the service of the busy practitioner a battery
that with ordinary care (and no instrument will remain in order
without this) may be kept upon his consulting-room table, always as
available to his service as his stethoscope or ophthalmoscope.
Three kinds of batteries are constructed:--A Voltaic battery, with any
required number of cells, from 15 to 100; a Faradaic battery; and a
Combined battery, uniting both Voltaic and Faradaic currents.
[Illustration: FIG. 6. 40-Cell Voltaic Battery.
A. Guard preventing the lid being shut, unless the needle of the dial
points to “0”, and the instrument is out of action.
B. Cells shown by the removal of the compartment, H, for sponges and
accessories.
C. Bolt to secure the element board, which moves upon the hinges, D.
D, D. Hinges of element board.
E. Dial plate regulating the strength of the current. The needle, when
the battery is not in use, should cover the stud, “0,” seen to its left.
F. Commutator of the poles. The poles, N and P, are seen through holes
cut in the element board.
G. Key by which the current can be shut “off” or “on,” without change
of position of the conductors. It can also be used by vibrating it
backwards and forwards as an “interrupter.”
I, I. Binding screws, to which are attached the conducting wires and
sponge-holders, &c.]
[SN: The Voltaic Battery.]
_The Voltaic Battery_ (see Fig. 6, p. 20) has its cells arranged in the
interior of a mahogany case, and in use they are hidden from view and
from danger, but I now partially expose them by removal of the tray
for holding the sponges and accessories. Their connecting wires are
brought across the under surface of the element board, which is made
to move upon hinges that, when necessary, the cells may be examined,
but at other times this element board is held in position by a bolt,
and it should never be needlessly disturbed. These wires conduct the
current through the graduating dial, and the position of the needle of
this dial determines from how many of the cells the electricity shall
be allowed to reach the binding screws, and from them, by way of the
conductors, sponge-holders, or electrodes, the body of the patient,[8]
or whether it shall be entirely shut off, as is the case when the
battery is not in use, and when the needle stands at “0” (Fig. 7).
When the needle points to any stud numbered on the dial, the number
of cells marked on that stud are brought into action, and the needle
is made just wide enough to touch one of the studs before it breaks
contact with the preceding one, and thus the current may be increased
or decreased in power without shock, and while the electrodes are
held applied to the patient; but if it were not so made a series of
painful shocks would be communicated whenever the current was increased
or decreased. Should the needle, from forgetfulness, be left when
out of use in any other position than at “0,” a guard upon the lid
of the instrument prevents its being shut, and the operator has his
attention called to his inadvertence. A Voltaic alternative, or change
of direction of the current, is sometimes required in treatment, and
the commutator of the poles enables this to be accomplished without
alteration in the position of the conductors. By pushing forwards or
backwards the handle which moves a lever working below the element
board the current is instantly reversed, and the alternation of the
letters “P” and “N” seen through holes cut in the element board
indicates at once not only that there has been a change of poles,
but which pole is at the moment negative or positive; whereas in all
previous instruments, when the poles have been changed, there has
either been no letter marking them, or this letter has really been
wrong, and one has had to remember this; and under such circumstances,
and examining patients in rapid succession, momentary confusion of
the poles was very liable to occur, even to a practised operator. A
key enables the current to be shut off or on without removal of the
conductors. Dirt is a non-conductor of electricity, and the studs
of the dial must be kept clean with emery paper or plate-powder, as
also the under surface of the needle, key, and binding screws, which
unscrew to admit of removal. In the daily use of a battery the chief
work is usually thrown upon the first half (say in a battery of forty
cells, upon the first twenty-five), and various arrangements have
been added to batteries by ingenious instrument-makers to enable the
operator to vary his selection of the cells to be brought into use, and
thus to relieve the first half of his battery, or, in other words, to
equalize its work. But this unequal work question is more a theoretical
than a practical evil; for if the initial cells grow weaker a greater
number can be placed in use. I have carefully studied all the proposed
modifications, and have found in all of them the remedy worse than the
disease, unless the graduating dial be doubled (an original suggestion
of my own), so that the initial cells of one week may be made the
terminal cells of the next.
[Illustration: FIG. 7. Graduating dial with needle at “0”.]
When desired batteries can be constructed with this double dial (Fig.
8), but it adds to the complexity of the instrument, and I do not
myself use it.
[Illustration: FIG. 8. New form of Graduating Dial.]
In Fig. 9 a similar battery is shown to that just described; but the
elements consist of carbon and zinc, and are lifted into and out of
a bichromate solution. As it can be recharged by the owner without
the necessity of sending it to the maker, it is especially suited for
country and colonial practitioners.
[Illustration: FIG. 9. 40-Cell Voltaic Battery with zinc and carbon
elements, and lifting apparatus.]
[SN: Essentials of a Medical Voltaic Battery.]
To recapitulate. The essentials of a medical Voltaic battery are--
_a._ A constant supply of electricity of sufficient quantity and
quality.
_b._ A means by which this electricity may be administered in measured
doses.
_c._ A means by which the direction of its current may be changed.
_d._ A means by which it may be instantly discontinued.
FARADISM.
[SN: The Faradaic Current.]
The Faradaic, induced, interrupted, or electro-magnetic current, is
the third form of electricity employed in medicine. Faraday, as you
will recollect, discovered, that if two metallic wires were so fixed
as to be parallel and close to each other, but not to touch; and that
if then a current of Voltaic electricity were sent along the first
wire, another current appeared in the second. This _secondary_ or
_induced_ current, as it is called in contradistinction to the current,
the _primary_ or _inducing_ current sent along the first wire is only
momentary, but it appears again for a moment when the first current
ceases, but in a reverse direction. It is most convenient to wind
these two wires round two reels, so as to form separate coils, and to
place the primary within the secondary coil. Each single turn of the
primary then acts not only on the parallel turn of the secondary wire,
but on all the turns near it, and the power of such an apparatus is
much greater than that which would be obtained by the same lengths of
wire running side by side in a straight line. Our two coils being thus
arranged, we pass through our primary wire a succession of electrical
currents, and in practice this is accomplished by connecting its
extremities with a battery supplying a continuous current, which by an
ingenious mechanism we frequently break or interrupt.
[Illustration: FIG. 10. Faradaic Battery.
A. Cells shown by the removal of the compartment.
B. For conductors and accessories.
D. Screw regulating the pressure of a spring which modifies the
vibration of the hammer, E.
E. Hammer vibrating between the electro-magnet, F, and the point of a
platinized needle regulated by the screw, G.
F. Bundle of iron wires rendered an electro-magnet by the passage of
the Voltaic current from the cells, A, through the primary coil, K,
within which this bundle of wires is inserted.
G. Screw regulating position of a platinized needle.
H. The graduator, a stem to which is attached the movable secondary
coil, L. The front part of the case has been cut away in the engraving,
to show the construction of the induction apparatus.
I, I. Binding screws for attachment of the conducting wires, &c.
K. The primary coil, fixed upon a pedestal. In the figure, the
secondary coil, L, is wholly withdrawn from the action of the primary,
and its strength of current depending entirely upon the extent to
which it covers the primary, it is evident that the height which the
graduator, H, stands above the element board will exactly indicate this
strength.
L. Movable secondary coil.
M, M. Binding screws for attachment of the pedal rheotome, N, for
slow interruption. These interruptions are made by the pressure of
the operator’s foot upon the spring, P, but in practice they are very
seldom wanted, and the fittings are only added to the instrument when
specially ordered.
O. A spring retaining the secondary coil, L, in any desired position.]
[SN: The Faradaic Battery.]
_The Faradaic Battery._--In Fig. 10 (see p. 29), a Faradaic battery,
worked by two Leclanché cells, is shown; but I find it better to employ
either one or two ordinary bichromate cells instead of the Leclanché,
as the former can be kept in order by the operator himself without
much trouble. The primary coil is fixed upon a pedestal, the secondary
is movable, and can be lifted over or thrust away from the primary.
The degree of action in the secondary coil being proportionate to the
extent to which it is brought under the influence of the primary, this
arrangement admits of the most perfect graduation of the current; and
it has been for some time in use in all well-constructed instruments.
The innovation I have made consists in limiting the primary coil to
its legitimate purpose of induction, and rendering the secondary alone
available for application to a patient. I have been long satisfied
that therapeutically the distinction between the primary and secondary
coil entirely consists in the greater tension of the current of the
secondary coil enabling it to penetrate easily several thicknesses
of muscle, but there is no therapeutic indication that cannot be
fulfilled by this secondary coil; and at its lowest power I have
frequently applied it to the conjunctiva. The rapidity of vibration
of the interrupting hammer is varied by increasing or decreasing the
distance between the point of the needle and the electro-magnet by
the protrusion or retraction of the screw, of which the needle forms
the end--that is, by increasing or decreasing the space through which
the hammer passes in its vibration, and also by altering the pressure
of its spring, but there is seldom therapeutic need for change of
vibration; and unless this exists it is better _not to alter the
adjustment so long as the instrument acts well_.[9] After considerable
use the point of the needle, and the exact spot of the platinum disk of
the hammer against which this needle impinges, become oxidized, causing
weakening or stoppage of the current. This platinum disk has been
constructed to rotate, and a hole has been drilled in its circumference
(Fig. 11). By inserting a little lever furnished with the instrument
into this hole, the slightest twist given to the disk is sufficient to
bring a new surface of platinum into contact with the needle point.
This will usually be all that is required, but, if not, the needle can
be unscrewed, and its point cleaned with emery paper. When in course of
time the disk becomes dotted over with spots of oxidation, the screw
fixing the hammer in position must be unscrewed, the hammer lifted out,
and its surface similarly cleaned.
[Illustration: FIG. 11. The Platinum Disk and Lever.]
Induction currents are also produced in coils of wire by the action
upon them under certain conditions of a permanent magnet--as in the
ordinary rotary magneto-electric machine--but these machines may be
discarded from our consideration, for they are uncertain in action,
painful in application, and do not admit of exact graduation.
An apparatus in which both currents are combined is extremely
convenient if it is so constructed that either the Voltaic or Faradaic
current can be brought to the same terminals, thus avoiding the
trouble of changing the conductors--a point of the greatest possible
convenience when examining patients for diagnostic purposes by both
forms of electricity, either in succession or alternately.
[SN: The Hospital Combined Battery.]
In the _Hospital Combined Battery_ (see Fig. 12), constructed from
my designs, the two currents are thus united, and its details are
precisely similar to those of the separate batteries, with the
exception of the Dial being furnished with an additional stud lettered
_Coil_. When the needle points to this stud the current from the
Faradaic coil is brought into action; when it points to the numbered
studs, the cells numbered thereon as in my Voltaic instrument, and
when it points to “0,” both currents are shut off.
[Illustration: FIG. 12. Hospital Combined Battery.
A. Guard block.
K. Tray for holding accessories.
E. Dial plate.
C. Bolt securing element board.
G. Key for interrupting current.
M. Hammer.
F. Commutator of the poles.
I, I. Binding screws for conducting wires.
L, L. Hinges of element board.
H. Graduator of coil.
N. Electro-magnet.
R. Screw regulating position of needle.
D. Screw regulating spring of hammer.
]
Other instruments, such as those of Stöhrer and Weiss, are excellent,
and were unsurpassed until the invention and improvement of the
Leclanché and other cells. But I might talk upon instruments for hours
without exhausting the list; and I have felt obliged to limit myself
to a description of those I believe best fitted to our requirements;
but it, of course, must be understood that my further _observations
will apply equally to currents of electricity furnished by any properly
constructed and reliable apparatus_.
[SN: Accessories of the Battery.]
We have now brought the electricity to the terminals of our battery,
and we must next consider the best means of conveying it to the
sponges, conductors, or, as they are generally termed, rheophores or
current carriers, by which it is finally applied to our patient. [SN:
Conducting Cords.] Our first necessary accessory is a conducting cord
or wire, and it is of the first importance that this should really
be what it is called--“_a conductor_”--for any fault or break of
connection in it will, of course, nullify the best and most perfect
battery. It must also be sufficiently pliable, and be insulated by
being coated with some non-conducting material that the electricity
may not escape from it to any conducting substance with which it
may accidentally come into contact. The conducting cords sold by
instrument-makers are sometimes not insulated at all, and then they are
quite useless, but they are more commonly composed of several strands
of metallic wire of about the diameter of sewing thread, the whole
enclosed in some silken or woollen material, and nothing can be better
than these latter when quite new. Their disadvantages are that they
become frayed after a little use, and are liable to be constantly out
of order, causing interruptions in the current, while they will only
fit one kind of machine. I have had endless trouble with them; and
for some years I have used nothing but thin copper wire, coated with
gutta percha in the same way as that known as “telegraph wire.” This is
perfectly insulated, sufficiently pliable for all practical purposes;
it is cheap, and can be made to fit any sort of connection. Its one
disadvantage is, that it is liable to break at the point where it is
received into the terminals of the battery, or the screw socket of
the rheophore. Should this happen, all that is necessary is to scrape
off the gutta percha coating with a pocket knife for an inch from the
broken end, by which we get practically a new conducting cord.
We have now considered fully the birth and parentage of medical
electricity, and we have conducted it to within almost a hair’s
breadth of our patient. The various methods of applying it will be
considered in our next Lecture, which I trust, Gentlemen, to render
more interesting; but the dry details we have been discussing are, I
assure you, essential as a secure foundation for a practically useful
survey of electro-therapeutics.
FOOTNOTES:
[1] See “Vital Motion as a Mode of Physical Motion.” By C. B.
Radcliffe, M.D. Macmillan.
[2] See Mr. Netten Radcliffe upon the differential reaction of voltaic
and induced currents of electricity. Note to page 331, vol. i., of
Bazire’s translation of Trousseau’s “Clinical Medicine.” Hardwicke.
[3] This observation, made in 1873, requires some qualification now
(1886). At several of the great medical schools, though not at all,
electrical treatment has been transferred from the hospital porter to
some member of the hospital staff; and at more than one a systematic
course of lectures upon electro-therapeutics has been delivered.
[4] I speak feelingly upon this matter, for from an early period of
my electrical experience I have suffered much from batteries--from
instruments “striking work” at the most inconvenient moment--from
spilling of corrosive acid upon fingers and clothing, to the detriment
of both, and of temper too, I fear.
[5] So long ago as 1870, I was in the habit (at the suggestion of Dr.
Radcliffe) of employing at an Institution for Resident Patients, a
method of “charging” a patient which I believe to be unique.
[SN: _Unique method of charging a patient._]
During dry summer weather the patient reclined upon a couch in the
gardens insulated by glass supports, and a sort of lightning conductor
was improvised by attaching a 30-feet salmon-rod to the foot of the
couch, a piece of ordinary “telegraph wire” being carried up the rod,
its insulation being removed from about a foot which projected above
the top of the rod.
Upon a fairly warm and dry day the patient became “charged” and sparks
could be drawn from him as from a patient in ordinary connection with a
Franklinic machine in rotation.
Upon more than one occasion in those ancient Static days, an attempt
was made to insulate a patient for a whole night, and to maintain
the charge by a relay of “rotating nurses;” but the _human machines
failed_, and suitable gas engines were not then available; hence the
procedure related above was, if conducted for three or four hours on a
dry summer afternoon, a by no means bad substitute for a close room and
a rotating Static machine. In New York, in winter, when the rooms are
covered with thick carpets, and when the atmosphere is dry, it has been
known that on shaking hands with a visitor, not only has the “shock,”
which under similar circumstances occasionally occurs in England, been
felt, but that a spark has passed; and children have been known to
slide over the carpet towards each other and exchange sparks by way
of sport. _The influence of atmospheric and other ordinary electrical
conditions has been far too little studied by electro-therapeutists._
[6] The Carré Machine can be obtained from Mr. Groves, 89 Bolsover
Street; the Fly Wheel from Messrs. Hovenden and Co., Great Marlborough
Street; and the Gas Engine from Messrs. Andrew and Co., Engineers,
Stockport.
[7] Currents of electricity from large fixed batteries are most marked
in their curative effects; but patients are not always movable!
[8] _The Galvanometer as an aid to the Dosage of Electricity._--The
dose of voltaic electricity is made up of two factors, (_a_) the
strength of the current and (_b_), the time during which it is applied
to the patient. [SN: The Galvanometer as an aid to the Dosage of
Electricity.] The strength of the current is directly dependent upon
the number of cells employed, but, unfortunately, cells of dissimilar
construction evolve currents of very unequal strength; while cells
that have been freshly charged are more powerful than similar ones
that have been partly exhausted by use; and, therefore, to speak of
a current from “so many cells,” though, practically, a convenient
method of dosage, fails to convey any _exact_ idea of a measured and
unvarying quantity. It is a comforting theory to electro-therapeutists
that a galvanometer will enable them to administer their doses of
electricity with as much exactitude as we daily prescribe so many
grains, or so many minims of ordinary medicines; but, like some other
theories which save us much trouble, when adopted as theories _only_,
it fails us in practice (at least according to my experience), and
chiefly so, because a galvanometer can be usefully employed only when
it is included in the circuit of a continuous current, as, _e.g._,
in aneurismal electro-puncture; and, I believe, I am within the
mark in saying that electrizations, which even admit of its useful
employment, are indicated in barely 5 per cent. of ordinary cases in
electro-therapeutics; and that it is of no practical utility, where
we most want aid, in measuring, not the current which leaves the
battery terminals, but that which, after overcoming the very variable
resistance of the human skin, really reaches the underlying muscular
and nervous tissues, which, in 95 per cent. of our cases, we desire to
influence, not by a constant, but by an interrupted Voltaic current;
and the amount which really reaches these tissues depends largely upon
the condition of the patient’s skin, and, I may also add, upon the
kind and shape of the conductor, and its degree of moisture, &c.; and
the operator will do well to graduate his dose of electricity by a
consideration only of the three factors, number of cells, effect upon
himself, and effect upon his patient, discarding entirely the use of
any merely mechanical aids to graduation.