ELECTRICITY.
By Dr. James C. Gill,
Rush Medical College, Chicago, Ill.
Electricity is a useful and important therapeutic agent, and an understanding of its effect when applied to the human body is as essential as a knowledge of any other therapeutic measure. Too often the therapeutic use of electricity is committed to those having very little knowledge of it, and consequently good results are not obtained.
It is a great mistake to allow or advise patients to use electricity themselves; no greater mistake would be made or more harmful results follow if they were advised to go to the drug store, and help themselves to any drugs they might choose. Electricity should be administered by a physician, or under the directions of a physician by a nurse who has been thoroughly taught its use.
In medicine we have usually considered three different forms of electricity: First, Galvanism or Chemical Electricity; Second, Faradism or Induced Electricity; Third, Franklinic or Static Electricity. Now, we add a fourth and a very important one—namely, X-ray. A nurse should have a general knowledge of these different manifestations of electricity and their effect when applied to the body.
In electricity we have units of measurements as we do in weights and measures. For instance, the force that drives the current of electricity along, as we might express it, is called the electromotive force, and its unit of measurement is a volt. The resistance which the current must overcome is measured in ohms, and the strength of the current is measured in amperes, or, as we measure it in medical electricity, the thousandth part of an ampere, a milliampere.
Galvanic or chemic electricity has certain properties not obtainable in the other forms. Comparatively speaking, it is a current of considerable quantity, but low electromotive force. The galvanic current passes always from the positive to the negative pole. It possesses the power to decompose various compounds, such as water, the tissues of the body, etc. This is called the electrolytic action, and may be used to destroy certain tumors, for the removal of superfluous hair, etc. Again this current has the power to convey certain substances in solution into the tissues. This is called cataphoresis, and is used to produce local anesthesia by the use of cocain applied to the positive pole. This is one of the best methods we possess of obtaining local anesthesia.
The effect of iodin may be obtained by the use of a solution of potassium iodid, and the negative pole may be used to affect local swellings, etc. Muscular tissue may be made to contract by the application of the current, either when applied to the motor nerve supplying the muscle or when applied directly to the muscle. Upon sensory nerves the positive pole is sedative, and may be used to relieve pain in cases of neuralgias, etc. The negative pole is stimulating, and may be used in conditions requiring increased nutrition, etc.
In using galvanism a good battery and outfit are essential. First, it is necessary to have a milliampere meter, an instrument to measure the strength of current used. The quantity of electricity used should be measured the same as the quantity or dosage of drugs prescribed. Another essential instrument is the rheostat, by which the current strength may be gradually increased or decreased without interrupting the current. The electrodes which are attached to the poles of the battery may be metal, metal covered with sponge, cotton, etc., preferably cotton, which may be renewed with each application, thus avoiding the possibility of infection, always present in the use of a sponge-covered electrode, which cannot be changed with each application.
In the use of galvanism we may speak of two different methods. First, what is called cerebral galvanism, second general. By experimentation it has been clearly demonstrated that all the deeper tissues and organs of the body, such as the brain, spinal cord, liver, etc., may be influenced by galvanism. In cerebral galvanism the object is to influence the brain and spinal cord. In applying it to the head, a sponge or cotton-covered electrode 4-5” in diameter may be used. The positive electrode is applied to forehead, the negative at nape of neck, using a current of 5-10 milliamperes for from five to fifteen minutes, care being taken not to suddenly make or break the current, as this would produce a disagreeable shock to the patient. The circulation of the brain may be affected also by placing an electrode at the nape of the neck, and a smaller electrode (1-2” in diameter) passed up and down along the border of the sternocleidomastoideus muscle, using a current of 3-5 milliamperes. Galvanism used in this way is beneficial in such conditions as cerebral anemia, neurasthenia, insomnia, etc. In applying to the spine, one electrode may be used at the upper and the other at the lower part of the spine; or a large-sized electrode may be placed over the abdomen, and the other electrode moved up and down the spine without breaking or interrupting the current, the strength of which may be from 10-20 milliamperes, and the duration of each application varied to suit the condition of the patient. This treatment is indicated in such disorders as neurasthenia, infantile spinal paralysis, locomotor ataxia, etc.
General galvanization may be given by placing a large-sized electrode at the spine, over the abdomen, or at the soles of the feet, the other electrode, smaller in size, being passed over the entire surface of the body without interrupting the current, which may be from 5-8 milliamperes. This procedure will stimulate the peripheral circulation, elimination, and nutrition. The muscles may be exercised by using an interrupted current of sufficient strength only to cause contraction. General galvanization is very beneficial in such conditions as neurasthenia requiring the rest treatment, convalescence from various diseases, paralysis, multiple neuritis, etc. In the use of electricity it should be remembered that patients show idiosyncrasies as in the use of drugs, so that each case should be given the amount of electricity best suited to individual peculiarities. Unless this point be kept in mind, we will be surprised to find at times that the use of electricity aggravates the patient’s condition.
Faradism, or the induced current, is characterized by a high electromotive force and a low amperage or quantity. It is an interrupted current, and from the secondary coil it is an alternating current. It cannot be used like the galvanic for electrolytic-cataphoric purposes. Its effect upon the body is almost entirely mechanical; also unlike the galvanic, there is practically no polarity. It cannot be used to affect the deep-lying structures, such as the brain, spinal cord, etc. The current-strength is not measured by a milliampere meter. It will produce muscular contraction only through the motor nerve supplying the muscle. This is a point to be remembered. Its use is confined largely to exercising muscles and stimulating peripheral circulation, and is useful in such conditions as paralysis where the cause of the paralysis is in the brain (because where the lesion producing the paralysis is in the spinal cord or peripheral nerves the muscle will not contract when faradism is applied), and in convalescence and all conditions requiring exercise which cannot be obtained actively. In applying this form of electricity (if the object be to stimulate circulation), the strength of the current should be regulated to suit the feelings of the patient. The technic is practically the same as described above for general galvanization. If we wish to exercise the muscle, then that current should be used which is just strong enough to produce muscular contraction and no stronger, care being necessary not to over-stimulate and exhaust the muscle. As a means of muscular exercise only this current is preferable to galvanism, being easier of application and less likely to produce harm.
Franklinic, or static electricity, is seldom administered by a nurse unless in a hospital or in a physician’s office. The current is produced by machines of various makes, such as glass and mica. The plates vary in diameter from twenty inches to three feet or more, and in number from two to sixteen or more. Its current then generated is characterized by an enormously high electromotive force, but a very minute quantity or amperage. Unlike the other two forms of current described, its use does not necessitate the removal of clothing. It may be used by placing the patient on an insulated platform and charging him with this current of high electromotive force, which very markedly stimulates circulation; or it may be used by applying or drawing sparks directly from the patient’s body, in this manner producing counterirritation, stimulating circulation, relieving localized pains, etc. It has been found useful in such conditions as chorea, neurasthenia, muscular rheumatism, lumbago, chronic inflammation of nerves, etc.
Nurses probably will never be called upon to use the x-ray, but this most wonderful manifestation of electro-force has recently taken a prominent position as a diagnostic and therapeutic agent. Parts of the human body heretofore only revealed by the use of the knife or post mortem are now plainly discernible during life through the use of this force. The field of its therapeutic application is a large one, and disorders which have been considered incurable or difficult of cure by other means now yield readily to the x-ray.