AFFECTIONS OF THE SYMPATHETIC.

Last, but not least, I have some remarks to offer on the treatment by the electric bath of certain affections of the sympathetic nerve. While I do not in any such cases accord to the baths the rank of an exclusive remedy or even a specific, their importance as an adjuvant is sufficient to entitle them to special consideration in this connection. In those neuroses of the sympathetic where electricity (galvanism) is indicated, the greatest benefit can be obtained from local applications. On the other hand the baths, employed in addition to local applications, will be found a very important factor in the treatment, possessing, as they do, two advantages, viz: first, by their means, the electric influence is brought to bear—in a much less concentrated form it is true—on the entire sympathetic system, from the ganglion impar to the ganglion cervicale supremum, and, by derived currents, on the cephalic ganglia also, at one and the same time; second, the rest of the body participates in the general nutrient and tonic effects of the bath equally with the sympathetic, the latter thus receiving a reflex benefit which local applications fail to furnish. There are, moreover, cases where hyperæsthetic conditions of the nerve do not admit of local applications, and where yet electricity is urgently called for. Thus I have at present under treatment a lad sixteen years of age, in whom both supreme cervical sympathetic ganglia as well as the ganglion impar were until recently so susceptible that the mere adjustment of the electrodes caused him great pain, while on the other hand he bore the baths exceedingly well. In such cases, electric baths, suitably administered, frequently constitute in conjunction with proper medication, the most useful treatment.

As to the mode of administration in sympathetic neuroses of the baths, the most direct manner in which to influence the diseased nerve, is by connecting one pole of a galvanic battery (I consider the faradic current next to useless here) to the head electrode, the other to the surface board, the latter applied portion of the time to the epigastrium (solar plexus), the balance to the coccyx (ganglion impar). This will include in the direct circuit the main portion of the sympathetic, the position in the tub of the bather bringing the cilio-spinal centre very close to the head-electrode. The direction of the current must be determined by the individual features presented by each case, as also the duration of the bath.

Case XXXIV. Mr. S., aet. 31, merchant, was referred to me April 3d 1874, by Dr. Krehbiel. In January, 1874, Mr. S., until then in the enjoyment of good health, woke up one morning to find, as he expressed it, “everything dark before his eyes.” He groped his way to the window, in order to open the blinds. When at the window, he felt as though about to fall out—probably vertigo. He soon returned to an apparently normal condition, and went about his business as usual. A week after, he had a much more serious attack, which he describes as follows: “I had been playing whist during the evening (several hours), when suddenly, without premonition, I felt as though a champagne cork popped against the top of my head, inside. Accompanying this was an indefinable sensation about the heart as though the blood all rushed thence down to the feet. I did not lose consciousness; did not fall. I trembled all over, and a great fear came over me. Felt very weak all night; my pulse was very slow.” About two months subsequently, patient was referred to me, as above stated. He then had an uneasy look; an indefinable continual sense of fear; was excessively nervous in the forepart of the day; had brief attacks of tremor—usually every alternate morning, but not typical as to time of occurrence. The history exhibited neither syphilis, malaria nor intemperance. Had never had headache. Sleep good; appetite likewise. The most pathognomonic symptom, however, related to his pulse. This was abnormally slow, ranging from 44 to 54 (the latter only when standing or after walking) per minute. It was full and regular. There was no organic heart trouble. In the absence of any other symptom whatsoever pointing to irritation of the pneumogastric or spinal accessory, I was justified in excluding this as the possible cause of the cardiac infrequency. On the other hand, the pathogenetic manifestations appeared all to point to “asthenia of the sympathetic”—at any rate the portion of this whence the cardiac nerves take their origin, and I formed my diagnosis accordingly. In the beginning, the treatment consisted of bilateral ascending (from cilio-spinal centre to both mastoid fossæ) galvanizations of the sympathetic, and galvanic baths (head electrode negative, surface board positive, to epigastrium) on alternate days. Improvement in every respect was steady, though not rapid. At the end of three weeks, I supplemented this treatment by the administration of ergotin and nux vomica. At the expiration of two more weeks, the patient being nearly recovered, I discontinued these medicaments, substituting the valerianates of zinc and iron, and steadily maintaining meanwhile the electrical treatment as above indicated. After a short time recovery appeared complete, and patient was discharged from treatment. He returned however a few months subsequently, complaining of “faint spells” in the mornings, accompanied with excessive nervousness, and a renewed though moderate cardiac infrequency. Electrical treatment, similar to that above described, soon restored him. One or two more slight relapses occurred during the next six months. For over a year past however Mr. S. has been in the enjoyment of perfect and undisturbed health. His normal pulse ranges from 72 to 80.

Whoever is familiar with the physiological effects of electric baths, will readily concede their great utility in a variety of conditions that I have not thus far specially alluded to. Of such I would mention ASTHENIÆ, ATONIC AND DEBILITATED CONDITIONS GENERALLY, including the state of CONVALESCENCE FROM ACUTE DISEASES and the DECLINE OF ADVANCING AGE; many cases of CHRONIC HEADACHE; some INCLASSIFIABLE CONDITIONS OF MARASMUS and MALNUTRITION, etc., etc. In all such cases, when purely functional and uncomplicated by incurable organic disease, good results may be confidently looked for.

With these remarks I conclude my subject. Whichever the errors that a too limited experience may have engendered—and I doubt not there are many, I cannot on reviewing my work accuse myself of lack of candor nor yet of undue enthusiasm. I have cited but a small proportion of the successful cases whereof I possess records; still I believe that I have adduced amply sufficient clinical proof of the great value as a remedial agent of electric baths, and of the desirability of their more general adoption. I would more especially call attention to the inappropriateness of deferring their employment until almost all other remedies have been exhausted; and when I reflect that pretty much all those cases that had been referred to me by other physicians had already had the doubtful benefit of almost every other conceivable treatment, while many of those who came of their own accord, had in addition made the rounds of all the quacks, and exhausted nearly all the nostrums that are to be found advertised in the columns of our daily papers, the wonder seems that the results obtained were as good as they have been. I sincerely trust that in the future physicians will avail themselves more frequently than heretofore of a remedy that is certainly capable of accomplishing much good; and I hope that in addition to myself there will be found others, more competent, to devote themselves to the study of the subject. To these, and perhaps to myself at a future time, I relegate the task of correcting my errors and promulgating hitherto undiscovered truths.

Footnotes:

[10] Centralblatt für die medicinischen Wissenschaften, No. 17, 1875.

[11] The apparatus used in these experiments was that of Du Bois-Reymond, with a Grove’s element.

[12] Since writing the above, this case has had an entirely favorable termination.

[13] The cases distinguished by an asterisk were published in No. 216 of the “Medical Record.”

[14] Wherever I use the word “general” as descriptive of an electric current used in the bath, it is not as a characteristic, but merely to distinguish it from the instances where the surface board is employed.

[15] Austin Flint, M.D. A Treatise on the Principles and Practice of Medicine. Philadelphia, 1873. 4th ed. pp. 63 and 64.

[16] See Beard and Rockwell, op. cit., 2d ed. p. 472.

[17] This was written a year ago. See remarks preceding the case.

INDEX.

A.
PAGE
Agrypnia[92]
Anæmia[93]
Apparatus for baths[7]
Articular effusions[105]
B.
Bath-tub[8]
Batteries[16]
C.
Cachexiæ[118]
Chemicals in baths[15]
Chorea[80]
Circulation, effects on[55]
"inequalities of[123]
Clinical Record[61]
Conductivity of water, etc.[13]
Constipation[112]
Counter-irritant effects[56]
D.
Debility, general[129]–[130]
Diagnostic uses[53]
Digestive apparatus, effects on[44]
Dyspepsia[121]
E.
Electric Bath compared with
other electrical methods[32]
Electrodes[10]
G.
General Therapeutics[52]
H.
Hydrargyrosis[115]
Hypnotic effects[38]–[58]
Hysterical affections[82]
I.
Impotency[106]
Insomnia[92]
Invigorant properties[57]
L.
Locomotor Ataxia[116]
M.
Melancholia[122]
Mind, effects on[51]
Miscellaneous disorders[129]–[130]
Mode of administration[19]
Muscular contractions[50]
N.
Nervous Exhaustion[84]
Neuralgiæ[100]
Neurasthenia[84]
Nutrition, effects on[59]
P.
Paralyses[96]
Pareses[96]
Physiological effects[31]
Prophylactic influence[60]
Pulse, effects on[41]
R.
Rheumatism[67]
"acute[68]
"chronic[74]
"subacute[73]
"cases of[77]
S.
Sedative effects[48]–[58]
Sexual apparatus, effects on[46]
Sexual debility[106]
Sleep, effects on[38]
Special therapeutics[61]
Stimulant effects[43]
Surface board[14]
Sympathetic, affections of[126]
T.
Temperature, effects on[41]
Tonic properties[43]–[57]

Transcriber’s Notes: The table below lists all corrections applied to the original text.