PHYSIOLOGICAL EFFECTS.
In accordance with the plan of the present work, the remarks I shall
offer under this head are by no means intended to comprise all that is
known at the present day of the physiological effects of electricity in
general. It was my purpose when I undertook to write these pages, to
offer to the profession a book confined to one subject; not a
compilation, but a volume made up almost if not wholly of original
matter, chiefly, if not entirely the result of my own observations and
experience. For the general physiological effects then of electricity as
well as for the theories of its action, I refer those interested to the
many excellent works on the subject that have appeared within the last
few years. I will treat here only of the physiological effects peculiar
to the electric bath.
The daily observations that I have had the opportunity of making in this
respect, extending as they do over a period of upwards of two years,
have not been as fruitful of results as might be expected. This is due
mainly to the circumstance that but a small percentage--and these took
the baths merely as a refreshing tonic--of those whom I have had the
opportunity of observing, were in a condition that might be called
normal. By far the greater majority were suffering from some complaint,
in most instances of a neurotic or rheumatic nature, the presence of
which, while it afforded admirable opportunity for observing therapeutic
results, modified more or less the physiological effects of the baths,
and served to deprive them of a uniformity which might to a great extent
justly be looked for in healthy organisms. If, therefore, what I now
contribute to the physiology of the subject is but little, it will I
trust be at least found of practical utility in its applicability to the
therapeutics of the subject.
Before entering into details, it is necessary in the first place to
inquire in what respects electric baths differ from other methods of
electrization--especially those recently introduced as "general"--that
their physiological effects should merit individual consideration. They
differ in two ways. One of these is self-evident. To the effects of
electricity are superadded those of the warm bath. The effects of the
warm bath _per se_ are too familiar to every physician to require
comment. Its effects in combination with electricity, however, may not
be so generally known; and I therefore feel justified in quoting here a
passage that bears directly on the subject, from a recent German work by
Dr. Hartmann[4] of Wiesbaden.
"The last question, whether mineral water acts also by contact
with the skin, leads us to one of its most important
effects--that through electricity.
"Although this question has not as yet been finally disposed of,
we have still advanced far toward its solution, through the
admirable researches of HEYMANN and KREBS. Both observers have
furnished proof that the contact of the water of the bath[5]
with the human body gives rise to electric currents, which
currents must be looked upon as being the excitors of the
nerve-currents, the body acting merely as a conductor. From
these experiments we conclude that no particular difference
obtains between artificial and transported waters on the one,
and natural waters on the other hand, the assertions of
SCOUTETTENS notwithstanding, who in regard to electricity
claimed to have found a difference between the artificial and
transported waters and the natural ones.
"We gather moreover from the experiments, that the electric
current generated through the contact of the body with the water
of the bath is modified chiefly by the gases, next by the
temperature of the water, and lastly only by its salts.
"The effects of the bath depend on the strength of the electric
current generated and on the condition of the peripheral endings
of the nerves; the effect may be stimulating or soothing. The
strength of the current is governed, as we have seen, by the
quantity of gases present, the temperature and the salts.
Ordinary lukewarm baths, indifferent baths containing a small
amount of gases, are less stimulating than mineral baths
containing a larger proportion of gases.
"With regard to the relative condition of the peripheral
nerve-ends, experiments on the motor nerves go to show that
swelling of the terminal ends of these nerves may diminish their
excitability to the point of its complete extinction, while it
becomes increased by their exsiccation. This fact as to the
motor nerves is adopted by HEYMANN likewise as applying to the
nerves of sensation. If, now, we presuppose absorption or even
imbibition on the part of the skin, a swelling of the nerve-ends
is comprehensible, as the imbibed fluid reaches them. But,
according to HEYMANN, the peripheral nerve-ends, i.e., the
terminal bulbs of KRAUSE, of the sensory nerves, and the tactile
corpuscles of MEISSNER, become even without this presupposition
sufficiently impregnated with water while in the bath, because
here all insensible perspiration must cease, and in a bath of a
temperature lower than blood-heat transpiration cannot take
place, so that all transudation to the skin being retained
during the bath, those termini are surrounded by moisture and
therefore swell up.
"From this the writer concludes with regard to the effects of
the baths, that all baths in which the electric current produced
by contact of the water with the body preponderates over the
swelling of the nerve-ends, have a stimulant effect, while
those baths where the swelling preponderates over the electric
current, act as a sedative.
"Taking a brief and comprehensive review therefore of the
effects of mineral water baths, we have those resulting from the
temperature, from the contents of carbonic acid and salts, and
lastly from the electric current generated in the bath water;
each effect however resolving itself into an excitation of the
peripheral nerve-ends, which leads in a reflex manner to an
enhancement of the change of matter."
From the foregoing quotation may be realized the importance which is
attached to the electric current in the warm bath. And here let me ask
the question: May not the remedial superiority, in many cases, of the
mineral water bath over the ordinary warm bath be due mainly, if not
solely, to the more abundant generation in the former of electricity? Or
rather, is it not very likely that this is so? And if such is the case,
it would appear evident that the mineral water bath, the electric
properties of which, depending on the chemical changes going on between
the gases and salts of the water on the one, and the cutaneous
secretions and other constituents of the body on the other hand, are to
a great extent beyond our control, must in turn be vastly inferior to a
bath where the electric current is under our perfect control, and can be
modified in intensity, direction and quantity to meet the individual
requirements of every case. And such is the electric bath I am now
describing.
The second difference between the electric bath and all other methods of
applying electricity is, that _the bath is the only method by means of
which general electrization can be realized_. In making a distinction in
this respect, it becomes necessary for me to advert more especially to a
method first introduced to the profession in a systematized and
scientific manner by Drs. BEARD and ROCKWELL,[6] and termed by them
"General Faradization." The undoubted good results that have been
obtained from this method--for the details of which I refer the reader
to the latest work of the authors[7]--have caused it to be extensively
adopted by the medical profession, both here and in Europe. It is,
however, not with its results that I have to do at present, but with its
appellation and true nature. General faradization, so-called, consists
of a series of local faradizations, administered during one and the same
seance, until the current has alternately been made to impinge upon and
traverse the entire or at least a large portion of the body. This
cumulative procedure, it is true, approaches general electrization, as
represented by the electric bath, more closely than any of the other
local methods; yet it is not that which its name would imply, and I do
not think it requires argument to make it apparent, that even this
procedure differs vastly from the electric (whether galvanic or faradic)
bath, where the current at one and the same time impinges directly on
every peripheral nerve-end (excepting those of the head and face) and
traverses every part of the body, obtaining--both as to reflex and
direct effects--as a whole that which the method known as general
faradization seeks to obtain by the cumulation of fractional portions.
Having thus, I trust, established the individuality of the bath as an
electric method, I will without further digression proceed to the
consideration of its physiological effects.
The physiological effects of the electric bath may be qualified on the
one hand as either "immediate," or "remote," on the other as either
"transient" or "permanent." Strictly to classify these is impracticable,
and I will therefore be influenced in the order of their enumeration
principally by their importance in a therapeutic respect.
One of the most pronounced as well as uniform, and at the same time
most important, effects of the electric bath, is its property as an
HYPNOTIC.
This somniferous influence, which is to some extent exercised by local
electrization, is here distinguished by its far greater constancy as
well as by its greater degree of perfection. That this difference should
exist, appears quite natural, when it is considered that the same
topical influences which produce it in local electrizations, and which I
shall presently endeavor to analyze, are here brought to bear on the
entire system. The hypnotic effect is both immediate and remote, and
more or less permanent. When there is an immediate inclination to sleep,
which may make itself manifest during the bath or immediately after
this, it is generally accompanied by a
PLEASANT SENSE OF FATIGUE,
which cannot be likened to weariness, but rather to what we feel after
moderate exercise; it is only in some instances, where an individual
takes his first bath, or where, for therapeutic reasons, a strong
faradic current--accompanied by responsive muscular contractions--is
employed, that this feeling is intensified sufficiently to become
unpleasant, calling for rest and recuperation, and must here be looked
upon as analogous to the effects of _severe_ exercise. It invariably
disappears after a brief rest.
Experience and good judgment will enable us moreover in almost all cases
to avoid effects of this kind. The immediate inclination to sleep is
much more decided as well as constant when the bath is taken late in the
day, than when taken in the forenoon. When the latter is the case
however, the individual will as a rule become sleepy during the
afternoon, or else at an earlier hour than usual in the evening, and
sleep more soundly during the night. This is the effect of one bath. A
series of baths will however produce more or less marked and permanent
improvement in the sleep of individuals, where this has been below the
normal standard. And this is among the most invariable of the effects of
the electric bath, whether galvanic or faradic.
I have formed a theory as to the _rationale_ of this influence, which I
will offer as its probable explanation. We all know that sleep is a
process designed by nature for the recuperation of the system after a
certain period of activity. In other words, when the various functions
have been more or less exercised for their daily allotted time--say
seventeen hours--the respective organs need that profound rest which we
know as sleep. Now, it is pretty well conceded by physiologists, that
electricity stimulates the secretory as well as excretory organs; that
it furthers endosmosis and exosmosis--by its electrolytic influence in a
physical, by its influence on the nervous system in a catalytic manner,
in short, and by virtue of these properties, that it greatly
ENHANCES THE CHANGE OF MATTER
and incites the various organs to so great an activity as to cause them
to perform in a comparatively brief space of time--say an hour, the work
of several hours. The natural sequence is obvious: _The want of rest--of
sleep, is felt at a correspondingly earlier period._ I offer this as a
probable explanation of the immediate or almost immediate disposition to
sleep. As to the permanent improvement in sleep, where this has been
below the normal standard, it must always be due to the removal of some
morbid condition, and thus belongs among therapeutic results, rather
than physiological effects. It is true that in many instances of
_agrypnia_ we are unable to discover any pathological condition that
would account for this symptom; but the probability is that here there
is a sluggishness of some one or more of the functions, mental or
physical, too obscurely manifested to be discovered by our present means
of diagnosis, yet reached and rectified by a mode of electrization that
traverses and permeates _every_ portion of the body.
If this explanation of the hypnotic effect of the electric bath be not
the true one, it is at least--so far as I know--the first attempt at
accounting for a phenomenon that has been noticed as a result of even
local applications of electricity by many observers, and about the
pretty uniform occurrence of which there can be no doubt.
With respect to the effect on the
TEMPERATURE AND PULSE,
I have made a number of observations, of which I have recorded
twenty-two, made on persons where both were at or nearly at the normal
standard. With regard to the frequency of the pulse, the results were
conflicting and by no means reliable. In the majority of cases there was
an increase, immediately after the bath, ranging from four to eighteen
beats per minute. In others there was no change whatever, and in a few
there was an absolute diminution in frequency; this last I believe
however to be a therapeutic rather than physiological effect,
manifesting itself only where there is pneumogastric asthenia, and
attributable directly to electric stimulation of this nerve. Thus in one
instance, which occurred in the person of a physician of this city, who
had an intermittent pulse, the result was as follows: Immediately before
bath: pulse 70, two intermissions; at the expiration of 15 minutes,
during which he was under the influence of a descending galvanic
current: pulse 65, two intermissions; at the end of ten more minutes,
during which he received the faradic current: pulse 65, no
intermissions; ten minutes after leaving the bath: pulse 66, no
intermissions. As a rule then, we may look for an immediate and more or
less transient moderate increase in frequency of the pulse. As for any
permanent increase or reduction of the pulse, there is none as a
physiological effect. Where such an one does take place, it is by the
removal of some morbid influence on the heart, and must be looked upon
as a therapeutic result.
With respect to the temperature, the results were somewhat more uniform.
I have found that where this is either normal or slightly below, the
immediate but transient effect is to raise it from 2 to 6 tenths of a
degree (Fahrenheit)--in most instances 4 tenths. In a very few cases it
remained unchanged, and in one case, where before the bath the
temperature was 100, at the close of the bath it was 99-3/5. Of
permanent modifications of the temperature, the same holds good that I
have said of permanent changes in the pulse. It must not be forgotten
that the temperature of the water is undoubtedly an important factor in
modifying the temperature of the body. In almost all instances where my
observations were made, the temperature of the water was below that of
the body, being 95 deg. or a little less. This, which has a tendency to
lower the bodily temperature, is to some extent counterbalanced by the
suppression of the insensible perspiration, so that modifications of
temperature resulting from electric baths, the water of which is but few
degrees below 98 1/2 deg., may justly be attributed to the influence of
the electric current. The importance of the electric bath as a
PHYSIOLOGICAL STIMULANT AND TONIC
cannot be overrated. I deem it superior in this respect to any other
known agent. This effect manifests itself _immediately_ by a feeling of
exhilaration and unwonted vigor, _remotely_ by an improvement--where
there is a margin for such--in the performance of some or all of the
physiological functions, as well as by a gradual but nevertheless marked
_increase in weight_.
Most striking among the tonic influences of the baths, are those that
occur within the sphere of the digestive and sexual apparatuses. I will
first consider the effects on
THE DIGESTIVE APPARATUS,
which may be subdivided into those on _a_) the appetite, _b_) digestion,
absorption and assimilation, and _c_) alvine excretion. The improvement
of the appetite under electro-balneological treatment is one of the most
constant effects of this. While a series of baths will produce permanent
results in this respect, an increase of the appetite, in some instances
amounting to positive hunger, is a tolerably uniform and more or less
immediate result of each separate bath. The permanent improvement of the
appetite is relative. Not very appreciable where this is normal, it
becomes most marked where the appetite has from some cause been
impaired. The effect on the appetite is _definite_. The effects on
absorption and assimilation are _presumptive_; but when we couple the
absence of any corresponding difficulty in digesting the increased
supply of food, with the increase before alluded to in the weight of the
body, their assumption becomes fully justifiable. It is these combined
influences that make the electric bath so valuable a remedy in almost
all forms of dyspepsia.
The influence on the alvine process is if anything even more marked than
that on the assimilative process. Where the action of the bowels is
normal, it is not modified permanently by the electric bath, although we
often have, as an immediate consequence, a cathartic effect that
manifests itself as a more or less watery evacuation, either a few hours
after the bath or on the succeeding day. Where the fecal process however
is sluggish, the improvement resulting from the baths is very striking.
I shall recur more fully to this subject under the head of constipation.
The effects on the various functions connected with digestion are due
doubtless to the combined influences of stimulation of the secretions of
the alimentary canal and stimulation of the muscular coats of the
stomach and intestines, as well as permanent tonization of the
_muscularis_. While the enhancement of the secretions is undoubtedly due
chiefly to the electric stimulus to the secreto-motor nerves, and the
increased activity of the muscular coats to a like influence transmitted
to their motor nerves, I believe the permanent tonization and
invigoration of the muscular fibres to be mainly attributable to the
direct trophic influence of the current traversing the parts
themselves; and I have no doubt that this direct influence has much to
do with the stimulation of the secretions and _peristalsis_ also. At any
rate, I have never obtained from galvanization of the nervous centres,
which I have practiced in a great number of cases, the striking effects
on the alimentary processes which are so uniform a result of the baths.
The influence on the
SEXUAL APPARATUS
of the electric bath does not manifest itself in so striking a manner as
in the case of the organs of digestion. It is true I have seen
individuals whose sexual functions were normal, have _stysis_ in the
bath, but the mere cutaneous irritation of the electric current is here
sufficient to account for a phenomenon which, where sexual irritability
is intact, will follow any other local irritations.
If not as immediately perceptible, the stimulant and permanent tonic and
invigorating influences on the sexual organs are not much less constant
than the corresponding influences on digestion. Careful observation,
however, of a considerable number of cases where the sexual function was
more or less impaired, has convinced me that while there can be no
doubt that _direct_ influence on the innervation, tone and nutrition of
the respective parts as well as the stimulus which the electric current
furnishes to the seminal secretion, bear a share in the improvement that
takes place, permanent beneficial results must be looked upon as chiefly
the expression of improved nutrition and tonization of the system at
large. I do not mean to be understood as wishing to put in negation the
beneficial results that the local influence of electricity is capable of
sometimes accomplishing in the sexual sphere. These results, however,
are not of a physiological, but rather of a purely therapeutic nature,
and are obtained there only where local morbid conditions exist. Now, in
the great majority of the cases that have come under my observation, the
causes of deterioration of the sexual capacity, though frequently
obscure and indefinable, were certainly not local, but to be sought for
in the general--most probably the nervous--system. In none but perhaps
the very mildest and recent cases have I ever seen _rapid_ results
follow electrical treatment of any kind whatsoever. In support of my
assertion however that in the majority of cases the sexual sphere can be
influenced only through the system at large, I will state _first_, that
I have seen cases where local electrical treatment had utterly failed
to do the slightest good, respond favorably to the baths, and _second_,
that where success was met with, it was only after persistent treatment,
continued long enough to modify favorably the condition of the entire
organism, and through this the objective sphere.
The stimulant and tonic effects under consideration, although shared to
some extent by other methods of electrization, are here far more
comprehensive and pronounced, a fact which is not surprising, when we
reflect that in the electric bath not only are all the organs
_indirectly_ influenced through stimulation of the nervous centres, but
each separate organ is at the same time _directly_ acted upon by the
current.
A direct sequence of the stimulant and tonic effects of the electric
bath is its
SEDATIVE INFLUENCE.
This sedative effect, whereof the hypnotic effect already spoken of is
the supreme manifestation, must not be associated for a moment with any
idea of depression, for here we have none such. In addition to what I
have already said in endeavoring to account for the hypnotic influence
of the baths, I refer the reader for further information to the
admirable and lucid remarks on this subject by BEARD and ROCKWELL.[8]
The _galvanic_ bath shares with other galvanic applications made in the
cranial and upper spinal region, the effect of producing the galvanic
_taste_, as also the _flashes_ when the current is interrupted, showing
that the
CRANIAL NERVES
come within the sphere of its influence.
A further effect peculiar to the galvanic bath is a sense of
ITCHING,
felt chiefly in the lower extremities and about the neck, and
proportioned to the intensity of the current. Rather pleasant when mild
or medium currents are used, under the influence of strong currents it
may become so intense as to create an irresistible desire on the part of
the bather to scratch especially the legs.
A negative effect of the galvanic bath, even where very intense currents
are used, is the
ABSOLUTE FREEDOM FROM PAIN
throughout the entire process. I wish this to be understood of course
as holding good only when currents within the ordinary limits of
intensity are employed. The strongest that I have used, and on which I
base my statement, was that from 48 Stoehrer or 60 Hill cells. As
stronger currents are not required for therapeutic purposes, what I have
asserted remains practically true as applied within these limits.
This absence of pain, which cannot be claimed for correspondingly
intense local applications, is to be attributed to the _diffusion_ of
the current throughout the body and its surface, as well as through the
water of the bath. The redness of the _entire_ back after a galvanic
bath, is among the proofs of this diffusion.
Freedom from pain is a characteristic likewise of the faradic bath,
_properly administered_. When too strong a faradic current however is
incautiously administered, the resulting muscular contractions are
accompanied by an amount of local pain proportioned to the violence of
the contractions. By keeping the faradic current within proper limits,
all pain can be avoided.
With respect to
MUSCULAR CONTRACTIONS,
the effects of the electric bath may be distinguished from those
obtained by other modes of faradization by their comprehensiveness.
Many groups of muscles may be made simultaneously to contract by this
means. The practical bearing of this on the therapeutics of _pareses_
and _paralyses_, renders it an important characteristic of the bath.
The physiological effects on
THE MIND
of electric baths, is a natural result of the enhanced tone and vigor of
the physical system, and keeps pace with this. Mental buoyancy and even
exhilaration are among the most common sequences of electric baths.
Although indirect, these results are none the less decided.
It has been my aim in the foregoing remarks to give the reader, as
concisely as possible and within the limits which I set for myself in
the beginning of the present chapter, a summary of the more important
physiological effects of electric baths. As the isolated results of
observations made in a limited field by one unaided individual, I trust
the shortcomings of this chapter will be viewed indulgently. If what I
have said of the physiological effects of electric baths proves the
means of stimulating to further investigation more competent observers
than myself, my labor, whatever its imperfections, will not have been in
vain.
Footnotes:
[Footnote 4: Dr. Franz Hartmann; "Der acute and chronische
Gelenkrheumatismus," Erlangen, 1874; pp. 194 et seq.]
[Footnote 5: The Author here refers to mineral-water. Dr. S.]
[Footnote 6: The Medical Use of Electricity, with special
reference to general electrization as a tonic, etc. New York,
1867.]
[Footnote 7: Beard and Rockwell; Medical and Surgical
Electricity. N. Y. 1875.]
[Footnote 8: Op. cit. pp. 253. et seq.]