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]
[SN: Electricity possesses an influence _sui generis_.]
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. [SN: 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. [SN: 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. [SN: 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.
[SN: Impotence.]
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. [SN: 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.
[SN: Rheumatic Arthritis.]
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.
[SN: Muscular Rheumatism.]
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.
[SN: General effects of Electrization.]
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.
[SN: General Debility.]
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.
[SN: Paralysis.]
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. [SN:
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.
[SN: 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. [SN: 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.
[SN: Importance of active and passive movements in Paralysis.]
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. [SN: 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.
[SN: Rigid form of Infantile Paralysis.]
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.
[SN: Traumatic Paralysis.]
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. [SN: 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.”
[SN: Wasting Palsy.]
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.
[SN: Hemiplegia.]
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] [SN: 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.” [SN: 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. [SN: 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. [SN: 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. [SN:
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]
[SN: Electricity in Mental Diseases.]
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.
[SN: Diseases of Women.]
It is remarkable that electricity should have been so little used
in this country in the diseases of women. [SN: 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. [SN: 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.
[SN: Faradization in Post-partum Hæmorrhage.]