MODE OF ADMINISTRATION.
I shall describe under this head the _modus operandi_ of administering a
routine galvanic or faradic bath. As it will become necessary to
describe special modes of administration when speaking of the
electro-balneological treatment of special diseases, the describing them
now would only lead to tautologies that I am desirous of avoiding.
Taking our cue from the indications to be met in each case, it becomes
necessary, according to circumstances, to use either the galvanic
current, the faradic, or both successively. As modifications of the
application of the currents we have to consider 1) their intensity; 2)
their direction, and 3) the duration of the application.
The intensity of the galvanic current corresponds directly to the number
of cells from which it is derived. It were vain however to attempt to
express this in figures, because the electro-motive force of different
batteries varies to so great an extent, that a number of cells of some
batteries of low intensity yield a current so feeble as to be barely
appreciable in the bath, while the same number of cells of a battery of
high intensity, furnish a current that few persons can bear without
pain. In thus comparing the Hill cell with the Stoehrer cell, I have
found the ratio to be about as 1 to 2 1/2, i.e., as intense a current can
be derived from twenty-four Stoehrer as from sixty Hill cells--and this
is rather below than above the mark. Were all batteries alike in this
respect, however, still no particular number of cells could be given as
furnishing a current of suitable average intensity for the galvanic
bath, because of the excessively great variations in the degree of
electro-sensibility of different persons. This is so marked that I have
seen persons in the bath tub who could bear no more than six Hill cells,
diffused as was the current from these through the water and over the
entire body; while on the other hand I have met with male patients on
whom a current from thirty-two Stoehrer cells made not the slightest
impression, and where I was compelled to supplement the current by that
from a ten-cell quantity battery (zinc carbon elements 6 in. long by 4 1/2
wide) in order to make them realize the presence of a current. These
gentlemen had no cutaneous anaesthesia.
In view of the facts just stated, I have found it impracticable, when
giving directions for the administration of a galvanic bath, to indicate
any certain number of cells to be used. I am in the habit of ordering
the administration of a "mild," a "medium" or a "strong" current, as may
be required in the respective cases; and in every instance it is the
electro-sensibility of the patient that determines the number of cells
requisite to obtain the desired result as represented by one of these
terms. The same applies also to the faradic current.
To determine the direction of the current is sufficiently simple. Where
a descending current is desired, the binding post which represents the
electrode at the head of the tub must be connected to the positive pole
of the battery, the other binding post to the negative pole; where an
ascending current is desired, the reverse of this is done.
The duration of the bath varies with different cases. The average is
about twenty minutes, though the time may range from ten minutes to an
hour and a half.
Where it is desired to give the patient a galvanic shock, it is only
necessary rapidly to reverse the current by means of the commutator. The
simultaneous contraction of almost the ENTIRE muscular system that
accompanies the reversal of a current of sufficient intensity in the
bath, affords a striking illustration of the _general_ effects of the
galvanic bath. In cases where paralyzed muscles have lost their faradic
irritability, galvanic interruptions are almost indispensable to
successful treatment.
I have before (page 14) described a "surface board," which I have
devised for the purpose of localizing the current from one of the poles
in any portion of the body where required. This proceeding should by no
means be looked upon as a "local" method of electrization; on the
contrary, it is just as much "general" as the ordinary electric bath.
Whereas in local applications the current runs from one point of the
body to another, in this case, supposing the spot where the surface
board is applied to be the centre, and the rest of the body the
periphery, a current runs between _every point_ of the periphery and the
centre, its direction being centripetal when the surface board
communicates with the negative, centrifugal when with the positive pole
of the battery.
The current is felt more or less intensely in proportion to the
proximity to the body of the surface board. With the galvanic this is
less noticeable than with the faradic current. When, for example, a
faradic current of medium strength being employed, the surface board is
held about six inches from the abdominal surface, little or no current
is felt. Let the surface board be now gradually approximated to the
abdomen, and the current will be felt more and more sensibly, until,
when about an inch away from the skin, or touching this, its influence
becomes so strong as to cause more or less energetic contractions of the
abdominal muscles. Where the galvanic current is employed, the skin
beneath the surface board will be found more or less reddened after a
few minutes' application; the burning sensation ordinarily accompanying
galvanic applications will also be experienced more or less intensely,
in proportion to the strength of the current employed.
Where the current is to be concentrated in a manner still more energetic
than that described, this can be effected by raising the objective part
above the surface of the water, and then applying the surface board. In
this way the _entire_ strength of the current is concentrated in one
spot, whereas, when the surface board is applied under water, a large
portion of current is absorbed by this.
This appears to me the fittest place to say a few words in regard to the
relative conductivity of the human body and water--the latter at the
temperature ordinarily employed in baths, say from 90 deg. to 95 deg.
Fahrenheit. BEARD and ROCKWELL, in their work on Medical and Surgical
Electricity,[2] state that "the human body is a better conductor of
electricity than water at the same temperature." Certain phenomena
connected with the administration of electric baths having forced upon
me some doubts in this respect, I made very careful experiments, both
with and without the aid of the galvanometer (Bradley's Tangent), to
satisfy these. Without wearying the reader with details, I will state
that the result of my experiments leaves no room for doubt that water at
the temperatures stated--and still more so at 98 1/2 deg.--is superior
to the human body as a conductor of electricity. I do not mean to be
understood that water is a better conductor than _every constituent_ of
the human body; blood, for example, is a better conductor. But when I
speak of the body in this connection, I take it as we find it
practically, i.e., with the resistance of the skin, and especially the
epidermis, superadded to internal resistances. I have no doubt that
with a flayed individual it would be otherwise. I will add, that it will
give me great pleasure to repeat these experiments, which are
sufficiently simple, in the presence of any of my _confreres_ who feel
an interest in the subject.
Having thus cursorily considered the manner of using the electric
current in the administration of a "routine" bath, and there being no
remarks required concerning the water employed, in addition to what has
been said in the previous chapter, a few words are in place on the
subject of chemicals. As has been previously stated (page 13) these are
added: _a_) to be absorbed, and thus act medicinally on the patient;
_b_) to act on the skin; _c_) through chemical affinity to facilitate
the elimination from the body of certain metallic substances, and _d_)
to further the absorption of morbid deposits. Of the many drugs and
medicines that no doubt may be made to answer these various purposes, I
have had personal experience with but few, and of these I will mention
the leading ones only. A requisite of all chemicals to be employed is
their ready solubility in water. Of substances intended for
absorption[3] I have used but three, viz: iron, iodine, and extract of
malt. The first of these I have employed in anaemic and enfeebled
conditions generally, but especially in chlorosis and chlorotic
hysteria, with marked success. It has the advantage, when administered
in this manner, not only of sparing the alimentary canal the frequently
injurious task of becoming the medium of its assimilation, but, in
addition to this, I believe that it can in this way be introduced into
the blood much more rapidly and in larger quantities than when given by
the mouth. The preparation which I have found, all things considered,
the most eligible for this purpose, is the "tartrate of iron and
ammonia." This is very readily soluble, leaving no deposit, is
assimilable, and not too expensive for the purpose. As, in my experience
at least, it leaves nothing to wish for, I would consider it superfluous
to discuss in this connection any of the other ferruginous preparations.
Iodine I have employed with a view to its absorption in rheumatism and
gout. I cannot speak favorably of it in this connection. I have not in a
single instance found a bath charged with iodine, either in the form of
the tincture or of iodide of potassium, followed by results in any way
differing from those of the simple galvanic bath employed in the same
cases.
Extract of malt I have employed as a roborant, either alone or in
conjunction with iron, in cases of debility and malnutrition, and found
it of service.
Where the absorption of substances is aimed at, the _galvanic_ current
must be employed.
Where we add substances to an electric bath with a view of producing
some special action on the skin, we may be guided by the same principles
that govern ordinary balneology. Thus to obtain counter-irritant
effects, we may add mustard or common salt; to render the bath alkaline,
bicarbonate of potassa or soda, etc., etc.
An important object to be furthered by the addition to the galvanic bath
of chemicals, is the elimination from the system of certain metallic
substances. It will be found here that in practice we have to deal
chiefly with two substances, viz: mercury and lead. That the elimination
of these bodies by means of the galvanic bath is feasible, I shall
endeavor to demonstrate further on. At present I have simply to consider
the chemicals adapted for the purpose, and the manner of using them.
To facilitate the extraction from the system of mercury, nitric-acid has
been recommended by those who have heretofore instituted this treatment.
While I cannot positively deny that this substance may aid in the
elimination of the metal, I am compelled to state, after its trial in
several cases, that I have obtained equally good results from the simple
galvanic bath. In the light of my own limited experience, therefore, I
cannot insist on the necessity of adding any chemical to a galvanic bath
which is administered for the purpose of extracting mercury from the
body.
Where the elimination of lead is the object aimed at, I am, on the other
hand, satisfied of the utility of adding certain chemicals to the water
of the bath. Sulphuric acid has been suggested and used for this
purpose. I can say nothing respecting its usefulness, as I have never
tried it. Indeed, the results with iodide of potassium added to the bath
have been so satisfactory, that I have had no occasion to try any other
chemical, although almost any other of the preparations of iodine would
probably answer equally well. The chemical affinity of iodine for lead
affords a ready explanation of its usefulness in this respect. One ounce
of iodide of potassium to each bath appears to me a suitable quantity.
I have had no personal experience with any other cases of chronic
metallic intoxication than those with lead and mercury.
The absorption of morbid deposits (plastic exudations, etc.) can be
materially furthered by adding to a galvanic bath some resolvent--above
all, iodine.
I have said above (page 26) that I had found no perceptible benefit from
the addition of this substance to the galvanic bath in cases of
rheumatism or gout. The contrary holds good however with respect to the
frequent sequence of these diseases--articular deposits. When the acute,
and to a great extent the subacute symptoms have subsided--and in
chronic cases especially, and the disease has left effusions in various
joints, iodine, which when employed in this manner, appears to have
little or no influence on the pain accompanying these complaints, is a
powerful adjuvant in promoting the absorption of the deposits. In
chronic synovitis and all other articular affections accompanied by
exudation, the same holds good.
I have no doubt that future advances in this branch of science will
develop the utility of numerous other drugs and chemicals as additions
to the galvanic bath.--Before leaving this subject I must call attention
to the influence which the addition to the bath of certain substances
has on the conductivity of the water, resp. thus: the action of the
current on the patient. I have found that when I caused salt or
bicarbonate of soda to be added to the bath, the conductivity of the
water became so much increased, so disproportionately greater than that
of the body, as to render necessary the employment of very powerful
currents in order to cause the patient to feel them.
Footnotes:
[Footnote 2: "Medical and Surgical Electricity." New York. 1875.
Wm. Wood & Co. pp. 431 and 432.]
[Footnote 3: For some experiments concerning the cataphoric
effects of the galvanic current, see an article by MUNK,
entitled "Ueber die galvanische Einfuehrung differenter
Fluessigkeiten in den unversehrten lebenden Organismus," in the
Allgemeine Medicinsche Central-Zeitung, No. 16, 1875.]