How to Use a Galvanic Battery in Medicine and Surgery / A Discourse Delivered Before the Hunterian Society, Third Edition

by Herbert Tibbits

Fig. 14. Metallic Disk, covered with Wash-leather.

Fig. 15. Method of holding Sponge-holders with Sponges inserted.

Indirect Electrization.

Indirect, or extra-muscular electrization, next claims our attention. You will recollect that it is produced by acting upon the special nerve trunk and its branches, instead of by placing the rheophores upon the muscle itself. We may thus call a motor nerve into action without affecting the cutaneous nerves, and with a minimum of power of current, and necessarily a minimum of sensation which hardly ever need amount to actual pain. This method is preferable, therefore, in cases where we desire to produce muscular contraction and as little sensation as may be, and again when the sedative influence of the constant Voltaic current is required to be localized in any special nerve. In its application it is convenient to place a good-sized sponge connected with one pole upon an indifferent part of the body, such as the sternum, and to apply a pointed conductor from the second pole directly over the course of the nerve it is desired to act upon. Speaking generally, these motor points as they are called may be selected by reference to a good anatomical plate, but only approximately, for we know that it is common to find variations in the course of the nerves and in the mode of their distribution among the muscles, and this being so, it is well when we propose to act upon a motor or mixed nerve (which is not paralyzed), to make sure that we are localizing the current in it by producing for a moment the contraction of its muscles and then marking the spot by touching it with a pencil of nitrate of silver. This, of course, is only necessary where in our subsequent electrization we do not wish muscular contraction, as in the treatment of neuralgia.[12] I will demonstrate indirect electrization by Faradizing the median nerve in my left forearm above the wrist, and before it passes beneath the annular ligament of the carpus. It lies a little below the surface, between the tendons of the flexor carpi radialis and palmaris longus. You observe that its muscles powerfully contract and oppose the thumb to the other fingers, at the same time abducting it. There occurs also a slight flexure of the first phalanges of the index and middle fingers. Professor Ziemssen in his work on Medical Electricity has published some extremely accurate plates of the motor points of the body, and I have grouped together the more important of them in a chart or map for convenient reference.[13] Ziemssen’s method of procedure was to find out experimentally the points where the application of electricity most readily produced muscular contraction. He then marked these points with coloured chalk, and after a sufficient number of trials with nitrate of silver. Photographs of the parts thus marked were taken and afterwards transferred to the wood blocks. These figures may therefore claim to be true to Nature, although they may not be absolutely correct for every individual. Ziemssen verified their approximate exactitude by following the course of the nerves very accurately in the dissecting-room and observing their points of entrance into, and their course within, their muscles, with constant reference to the surface of the body; but he was not completely satisfied until he had determined the motor points upon the skin immediately after death, and before the reaction to electricity had disappeared, and submitted these points to the scalpel. The results of the three methods coincided perfectly.

Cutaneous Electrization.

We will next consider cutaneous electrization. I have already shown you that when the skin and the conductors are both quite dry, a Faradaic current of moderate power (and practically this form of electricity is always employed in cutaneous electrization) does not penetrate the skin, but is localized upon its surface. There are three methods of applying cutaneous Faradization—the method that we employed—that of “Metallic Conductors;” the “Electric Hand,” as it is called, in which the operator having applied one conductor to some little sensitive part of the patient’s body, holds the second in his left, and passes the back of his right hand over the points he wishes to excite, these points of the patient’s skin and the back of his hand being dry, and sprinkled with absorbent powder; and the “Wire Brush,” a brush of metallic wire, which replaces one of the conductors, and which is moved over the skin. With a strong Faradaic current this wire brush becomes the most powerful of all the excitants of the skin which do not disorganize its structure; in fact it was proposed by some scientific parliamentary philanthropist as a substitute for flogging in the navy, and I have no doubt that more intense pain may be produced by it than by any application of the cat, however well laid on!

Electrization of Internal Organs.

The methods of electrizing internal organs need not detain us long. The rectum and muscles of the anus may be electrized by introducing into the rectum the rectal rheophore, a metallic stem insulated by gum elastic, and moving it over the internal surface, bringing it also into contact with the levator and sphincter ani. A well-moistened sponge connected with the other pole may be applied to the abdominal muscles or to the neighbourhood of the anus. The rectum must be first freed from fæcal matter.

The bladder is most readily electrized by the introduction into the rectum of the rectal rheophore, and into the bladder—previously emptied—of a curved metallic sound insulated by an elastic catheter to within an inch of its vesical extremity. This sound must be brought into contact successively with all points of the neck of the bladder. The uterus by the introduction of the rectal rheophore, connected with one pole, to the os uteri, and by the application of two sponges from the other pole, one to the abdominal parietes, the other to the lumbar region. The larynx, externally by one sponge to the nape of the neck, and the second to the exterior of the larynx; or, internally, a sponge to the neck as before, and the introduction by the aid of the laryngoscope of a small bit of sponge at the end of a curved metallic stem, insulated by a gum-elastic catheter, the current not being allowed to pass until it is seen by the laryngeal mirror that the sponge is in the desired position. The male genital organs by moist rheophores to the scrotum over the testicle; but if it be desired to excite the vesiculæ seminales, the bowel is first emptied, the rectal rheophore is then introduced and so directed that its olive-shaped termination may be brought into relation with the vesiculæ. For this purpose it is sufficient to move the rheophore from right to left and vice versá. A powerful current will penetrate the intestine and reach the vesiculæ, exciting them energetically. The circuit is completed by a second rheophore placed on an unsensitive part of the body.