FOOTNOTES:
[1] See “Vital Motion as a Mode of Physical Motion.” By C. B. Radcliffe, M.D. Macmillan.
[2] See Mr. Netten Radcliffe upon the differential reaction of voltaic and induced currents of electricity. Note to page 331, vol. i., of Bazire’s translation of Trousseau’s “Clinical Medicine.” Hardwicke.
[3] This observation, made in 1873, requires some qualification now (1886). At several of the great medical schools, though not at all, electrical treatment has been transferred from the hospital porter to some member of the hospital staff; and at more than one a systematic course of lectures upon electro-therapeutics has been delivered.
[4] I speak feelingly upon this matter, for from an early period of my electrical experience I have suffered much from batteries—from instruments “striking work” at the most inconvenient moment—from spilling of corrosive acid upon fingers and clothing, to the detriment of both, and of temper too, I fear.
[5] So long ago as 1870, I was in the habit (at the suggestion of Dr. Radcliffe) of employing at an Institution for Resident Patients, a method of “charging” a patient which I believe to be unique.
|Unique method of charging a patient.|
During dry summer weather the patient reclined upon a couch in the gardens insulated by glass supports, and a sort of lightning conductor was improvised by attaching a 30-feet salmon-rod to the foot of the couch, a piece of ordinary “telegraph wire” being carried up the rod, its insulation being removed from about a foot which projected above the top of the rod.
Upon a fairly warm and dry day the patient became “charged” and sparks could be drawn from him as from a patient in ordinary connection with a Franklinic machine in rotation.
Upon more than one occasion in those ancient Static days, an attempt was made to insulate a patient for a whole night, and to maintain the charge by a relay of “rotating nurses;” but the human machines failed, and suitable gas engines were not then available; hence the procedure related above was, if conducted for three or four hours on a dry summer afternoon, a by no means bad substitute for a close room and a rotating Static machine. In New York, in winter, when the rooms are covered with thick carpets, and when the atmosphere is dry, it has been known that on shaking hands with a visitor, not only has the “shock,” which under similar circumstances occasionally occurs in England, been felt, but that a spark has passed; and children have been known to slide over the carpet towards each other and exchange sparks by way of sport. The influence of atmospheric and other ordinary electrical conditions has been far too little studied by electro-therapeutists.
[6] The Carré Machine can be obtained from Mr. Groves, 89 Bolsover Street; the Fly Wheel from Messrs. Hovenden and Co., Great Marlborough Street; and the Gas Engine from Messrs. Andrew and Co., Engineers, Stockport.
[7] Currents of electricity from large fixed batteries are most marked in their curative effects; but patients are not always movable!
[8] The Galvanometer as an aid to the Dosage of Electricity.—The dose of voltaic electricity is made up of two factors, (a) the strength of the current and (b), the time during which it is applied to the patient.|The Galvanometer as an aid to the Dosage of Electricity.| The strength of the current is directly dependent upon the number of cells employed, but, unfortunately, cells of dissimilar construction evolve currents of very unequal strength; while cells that have been freshly charged are more powerful than similar ones that have been partly exhausted by use; and, therefore, to speak of a current from “so many cells,” though, practically, a convenient method of dosage, fails to convey any exact idea of a measured and unvarying quantity. It is a comforting theory to electro-therapeutists that a galvanometer will enable them to administer their doses of electricity with as much exactitude as we daily prescribe so many grains, or so many minims of ordinary medicines; but, like some other theories which save us much trouble, when adopted as theories only, it fails us in practice (at least according to my experience), and chiefly so, because a galvanometer can be usefully employed only when it is included in the circuit of a continuous current, as, e.g., in aneurismal electro-puncture; and, I believe, I am within the mark in saying that electrizations, which even admit of its useful employment, are indicated in barely 5 per cent. of ordinary cases in electro-therapeutics; and that it is of no practical utility, where we most want aid, in measuring, not the current which leaves the battery terminals, but that which, after overcoming the very variable resistance of the human skin, really reaches the underlying muscular and nervous tissues, which, in 95 per cent. of our cases, we desire to influence, not by a constant, but by an interrupted Voltaic current; and the amount which really reaches these tissues depends largely upon the condition of the patient’s skin, and, I may also add, upon the kind and shape of the conductor, and its degree of moisture, &c.; and the operator will do well to graduate his dose of electricity by a consideration only of the three factors, number of cells, effect upon himself, and effect upon his patient, discarding entirely the use of any merely mechanical aids to graduation.
I am induced to speak thus strongly because men of scientific reputation have advocated the habitual use of the galvanometer, not alone by medical men trained to precision of observation, but by private patients as “enabling them to carry on the treatment at home with all the accuracy desirable!” The prospect of the ordinary patient provided with a battery, the use of which he is complicating by a galvanometer, is anything but reassuring to those physicians who not only prescribe electricity, but are themselves habituated in applying it—which, by the way, is a very different thing—and who have had frequent experience of the manner in which patients misunderstand, or fail in correctly carrying out, the most explicit directions. Electricity will be left in the hands of specialists, and necessarily do but a tithe of the good it is capable of affecting, until the mass of the profession can be induced to master the few preliminary details essential to its successful application, and I fear that the suggestions that have been made—suggestions which I believe to be entirely without foundation—that there exist practical difficulties to its dosage, will tend to postpone rather than to accelerate its more extended use.
Should any of you desire to use a galvanometer, that patented by Sprague, of Birmingham, is the one most adapted for use in medicine. Electricity is a force, and as with other forces it has its standard of measurement. In mechanics we know that the power sufficient to raise one pound to the height of one foot is the basis of measurement. Similarly in electricity the unit of measurement is the force which will raise one gramme to the height of one metre, and the standard multiple of this was called a “British Association Unit,” or shortly, a “B.A.” unit, and it is now called an “Ohm” when used to measure the resistance offered to the current, and a “Veber” when used to measure the strength of the current itself. The ordinary galvanometer is founded on the principle that a magnetic compass needle has a tendency to place itself at right angles to a current of electricity, and the degree to which the needle is deflected is a measure of the quantity of electricity, but the angle of deflection is not proportionate to the current strength, and it differs in different galvanometers; but in “Sprague’s Galvanometer” the dial is divided, not into degrees, but into divisions of thousandths of Vebers—divisions which were obtained by noting the deflections given by the needle with currents of known strength. I am indebted to Mr. Sprague for his courtesy in endeavouring to so modify his galvanometer as to render it available as a graduator of doses of interrupted Voltaic electricity, but although he has not succeeded in doing this, he has constructed for me an instrument which, supposing that a battery be partially exhausted, will indicate with precision the absolute strength of, say, twelve of its cells as compared with twelve newly-charged cells, and also the condition of each individual cell, points often of much practical convenience in an Hospital Electrical Room.
[9] A little care is needed to regulate the vibrating needle. The spring should but barely touch the hammer, the adjustment being almost entirely regulated by the protrusion or retraction of the needle by the action of its screw; and the slightest twist of this screw will be sufficient. When the vibration is uneven or stops, and careful manipulation of the needle fails to re-establish it, remove the needle and clean its point as directed in the text.
[11] See Duchenne (de Boulogne) “On Localized Electrization and its Applications to Pathology and Therapeutics” (English Edition). Part I., pp. 38-40. London: Churchill.
[12] It is often of imperative importance in the administration of the “constant” current that we should really localize it—not in name only, but in fact—in some special nerve; and this is not always quite so easy in practice as in theory. |Importance of exactitude in administering a constant current.| To secure the result we desire, we must see that the cord or wire from the terminals of the battery to the electrodes is without flaw; that the electrodes are well moistened and placed firmly in the position determined upon; and especially that they are held quite immovable during the entire application, for if not maintained immovable, we shall be using not a “constant” but an “interrupted” current with totally dissimiliar physiological and therapeutical effects! We must satisfy ourselves that the current from our battery is also constant, and that we so apply it to our patients that the affected nerve shall be—as it is called—included in the circuit—that is, between the poles, and that the current circulates through this nerve as perfectly and continuously as it would through a piece of wire connecting the terminals of the battery.
[13] Published by Churchill.
[14] Since writing as above, in 1873, our knowledge of the beneficial effects of Franklinism has been very largely added to and the improved apparatus, described at [page 10], has enabled the treatment to be conducted with a degree of precision and success impossible with the comparatively imperfect instruments in use at that date. |Importance of distinguishing between the Positive and Negative Charge of Franklinism.| Dr. Radcliffe has contended for many years that the effect of a charge of positive electricity differs altogether therapeutically from that of a negative charge; and Giacomini (quoted by Duchenne[15]) attributes a hyposthenic influence to the negative charge. He contends that this charge is derived from the nerves of the patient instead of from the ground as is the positive charge, and it is ranked by the Italian School among their most valuable hyposthenisants. According to Giacomini the “patient is de-electrized, is consequently deprived of a greater or less quantity of a stimulant analogous to heat and undergoes a real hyposthenisant effect. Erysipelatous tissues may be seen to become blanched under its influence, and chronic inflammations undergo an unquestionable improvement. Headaches and neuralgic pains have been instantly relieved by this kind of electric flux as by the application of ice, which abstracts heat, and perhaps at the same time electricity also.”
In reference to the above it has been proved by various physicists that the natural electrical nerve current is strengthened by the positive charge, and weakened by the negative—and hence it would seem to be established that Dr. Radcliffe’s contention is the right one; and that these two charges are literally “wide as their poles asunder” not only physically, but therapeutically, and this divergence is more important when we recall to mind that when a patient is insulated, not only does the electricity accumulate upon the surface of the skin but that the whole body is saturated with it as a sponge may be with water.
|Franklinization in Conditions of Debility.|
In my own experience the positive charge has been of great good as a most potent restorer when the organism from any cause has become enfeebled. In the general weakness of old age it would seem to have been beneficial upon several occasions in resuscitating vital action and in imparting new force and energy. I have also used it with the best results in conditions of debility following acute diseases, as for example in convalescence from fevers; in cases of general prostration from overwork or anxiety—and in some cases of phthisis and other wasting diseases. In certain varieties of mental disease—notably melancholia—it is often of service, and in cerebral anæmia, in asthma, in inveterate insomnia, and in all functional uterine irregularities it should be employed before, not after, all other therapeutic agencies have been exhausted.
[15] See “Duchenne on Localized Electrization,” English Edition, page 4. Churchill.
[16] In the treatment of Neuralgia by the constant current the electrodes should be so applied as to include between them the part or nerve affected—the number of cells the highest number that can be borne without pain, i.e., the current to be distinctly but not painfully felt, both electrodes being immovable. |Electricity in Neuralgia.| Time, five to ten minutes. Frequency, as often as the attacks of pain recur. I am satisfied that in severe cases this rule of application is essential—that the influence of the current shall be maintained as much as may be in the irritable nerve during the intervals of pain. In one case under my care the patient was galvanized with benefit 27 times in the 24 hours; but in milder cases one or two applications daily will generally suffice. A weak current from two or three cells—the electrodes being applied to each temple for one or two minutes—will sometimes dissipate a severe headache. This soothing influence of the current is often useful in allaying Spasm, as, for example, in spasmodic torticollis. The current should be localized in the irritable muscles: and it is generally advisable to energetically Faradize their antagonists and to conjoin with the electrical treatment appropriate gymnastic exercises, alternating with periods of perfect rest. I may mention that the only recorded case of improvement in that remarkable condition of spasm first described by Hammond under the name of Athetosis resulted from the Voltaic current. The case was brought before the Medico-Chirurgical Society by Dr. Gowers, and is published in the 49th volume of their Transactions. The reader will find the subject of neuralgia very exhaustively considered in Dr. Anstie’s work.[17] He quotes some extremely severe cases in which the effect of Electrization was to arrest the pain in a few sittings, and to procure a remission for several days or even weeks; and I have had several cases which I believe to have been as fairly cured as an ague fit may be said to be cured by quinine. Dr. Russell Reynolds also quotes the case of a patient, a lady, who for twenty years had suffered from an extremely severe neuralgia of the ophthalmic branch of the fifth nerve, which recurred daily and from which her health had greatly suffered. It was not only relieved but removed by a single application.
[17] “Neuralgia and the Diseases that resemble it.” By Francis E. Anstie, M.D., &c. London: Macmillan and Co. 1871.
[18] Electrolysis is, of course, chiefly applicable to tumours which, from their nature or situation, are difficult or impossible to be removed by the knife; and, perhaps, also to malignant tumours; for whether or not the Voltaic current exerts a special destructive influence upon diseased germs, it seems certainly proved that there is a less frequent return of cancerous growths removed by its agency than by ordinary operative procedures or by caustics.
|Electrolysis of Tumours.|
This treatment of malignant tumours by electrolysis is yet sub judice, but the evidence in its favour has recently much accumulated, and its full and exhaustive trial by competent observers possessing the opportunities of large hospital practice ought not to be much longer delayed.|Electrolysis of Malignant Tumours.| Neftel, of New York, who is its chief advocate, contends that malignant tumours are at first entirely local, and he explains their recurrence, after removal by the knife, from the fact of the impossibility of the whole of the diseased mass being excised, as apparently healthy parts when microscopically examined show that they have already become infected. Electrolysis he considers acts not only on the tumour but also on the surrounding tissues, the current being diffused to some distance in all directions. After electrolysis he applies a mild and not painful current for from a quarter to half an hour daily to the locus morbi, and continues this for some months. In one of his cases a mammary tumour existed of the size of a small orange. Three needles, from the negative pole of thirty-five cells, were inserted for half an hour under chloroform, and the operation was repeated thrice at intervals of a week, daily external galvanization being also used. The tumour gradually became smaller, and at last disappeared, but external treatment was continued for several months. At the end of a year there had been no relapse. In another case, in which the tumour had been excised by Marion Sims, it reappeared, and was again removed by the same surgeon, and pronounced cancerous. It again reappeared and was then electrolyzed, upon three occasions, by two, three, and four needles respectively, and with a current gradually increased from ten to thirty cells. The tumour by degrees grew less, and in three months was entirely dispersed; while, when the patient died from another disease three years afterwards, there had been no recurrence.
|Aneurismal Electro-puncture.|
Electrolysis has been successfully employed in several cases of aneurism. Where pressure and ligature admit of application, it is hardly necessary to say that the preference should be given to them; but many internal aneurisms, and especially aortic aneurisms, cannot be thus treated, and in such cases the question of electro-puncture should be carefully considered, and, when called for, it should not be too long delayed. Two fine, sharp, and carefully insulated needles, one connected with each pole, should be introduced into the aneurismal sac, and the current allowed to pass for from half an hour to an hour, the needles carefully withdrawn, and their punctures covered with a bit of lint soaked in collodion or styptic colloid. Authorities are divided as to the kinds of aneurism calculated for electro-puncture, but there is no doubt than an aneurism pressing on the parietes, but not having actually perforated them, is the best adapted for this treatment, and that it is contra-indicated where the sac is of large size, or where large trunks issue from it.
[19] The following is an illustrative case:—
A lady, forty-one years of age, had suffered from right hemiplegia for eighteen months, and described her condition as having remained without improvement for the past six months. She had recovered sufficiently to walk with the aid of a stick, but the movements of the arm were very weak, especially those of the deltoid, extensors of the fingers, and individual muscles of the hand. Faradic contractility was somewhat lowered, but there was no rigidity. The muscles were carefully Faradized with a current just sufficiently strong to produce their contraction. The entire application occupied about fifteen minutes, and was made once daily. After a fortnight’s electrization she was able to raise the arm to a right angle with the body, and to use the hand to feed herself, neither of which had she been able to do before treatment.
[20] The following is an extract from Dr. Sturge’s Report of the results of treatment at the National Hospital for the Paralyzed and Epileptic:—
“In the division of Muscular Atrophies some striking cases have occurred, and in all of these the improvement is mainly due to the electrical treatment prescribed.
“A patient, with atrophy of some of the muscles of both arms of six months’ standing, which incapacitated her from dressing herself or cutting her food, or doing much household work, was discharged at the end of three and a half months, able to feed and dress herself, sew, and perform almost any domestic duty.
“Another woman, with atrophy of the muscles of the forearm of several years’ standing, and who was similarly incapacitated from almost all use of the hands, went out, after a month’s treatment, able to dress and feed herself, and to perform many actions that were before impossible for her.
“A man came to the hospital with atrophy of many muscles in various parts of the body, more especially in the left arm, which he was unable to move from the side. He went out able to lift his arm well over his head, and with much increased strength in the limb.
“Another man, in a very similar condition, was also greatly benefited; and whereas on admission he could barely bend the right arm at the elbow, after three months’ treatment he was able to use a hammer with the arm.”