In non-atrophic paralysis—of which hemiplegia may be taken as a type—the propriety of electrization, and especially the proper moment for its application, requires careful consideration. In both brain and spinal cord disease muscular electrization is not advisable until some time after the attack, or until the muscles exhibit signs of impairment of nutrition from disuse. As long as there is rigidity—especially with increased reflex action—any stimulant application of electricity is not likely to do good, and may do harm; but in older cases—both hemiplegic and paraplegic—cases of from six to eighteen months’ duration—the immediate benefit to be derived from localized electrization is often remarkable, especially in those cases where, after a partial return of voluntary movement, the patient suddenly stops short, and for weeks or months makes no progress. As the sequel of electrization, the hemiplegic patient able to use the arm slightly, but not to feed himself, may regain this power, to his infinite comfort, and the paraplegic patient, able with difficulty to drag himself along by crutches, is enabled to walk by the aid of a stick. Some improvement is usually soon obtained, and it is progressive for, perhaps, two or three months, after which continued electrization fails to increase it; but at a subsequent period—six months afterwards—a renewed electrization may give rise to a new improvement; but be this as it may, whenever in these old-standing cases we see signs of impaired nutrition, it is wise to occasionally stimulate the muscles by Faradism. We should endeavour—in the words of the late Nestor of modern medicine, Sir Thomas Watson—“to preserve the muscular part of the locomotive apparatus in a state of health and readiness, until peradventure that part of the brain from which volition proceeds having recovered its functions, or the road by which its messages travel having been repaired, the influence of the will shall again reach and reanimate the palsied limbs.”[19] |Direct application of Voltaic Current to Brain.| In hemiplegia the propriety of a direct application of the constant Voltaic current to the brain must be thoughtfully considered. In selected cases, where the clot or softening is of limited extent, its removal may be accelerated by a carefully localized current—two or three cells—for two or three minutes to the injured hemisphere, followed by Voltaization of the cervical sympathetic (so-called) for four or five minutes. After such an application there follows—according to Althaus—“greater ease in the head, as well as in the limbs, and if there has been pain this is relieved.” |Electricity in Spinal Paraplegia.| Similarly the absorption of the inflammatory products may be promoted in the earlier stages of spinal disease, by localizing the Voltaic current in the parts affected, especially where pain is present, and we have reason to suppose that the myelitis is circumscribed. The daily application of the positive pole for about five minutes, and with from ten to fifteen cells, to the painful spot—the negative pole being held to an indifferent part of the body—is likely to promote absorption. At any rate it will sometimes relieve the pain. In the later stages of paraplegia, as soon as there is diminution of electro-irritability in the paralyzed muscles they should be sponged with the Voltaic current, or Faradized; and where anæsthesia is present, a good painting with the wire brush will often be of service. |Paraplegic Constipation.| Paraplegic constipation may frequently be relieved by Faradization of the abdominal muscles, and the troublesome dribbling of urine, so often present, by external Faradization of the bladder—one pole to the pubes, and two sponges from the second pole—one to the sacrum and the other to the perineum. Incontinence of urine in children may be similarly treated.|Emotional Paralysis.| Cases of hysterical or emotional paralysis may frequently be benefited by the application of the wire brush, which also sometimes acts like a charm in removing anæsthesia, which, although originally of central origin, continues after the removal of its cause. Anæsthesia from section of a nerve is sometimes persistent in this way after repair of the nerve lesion. |Locomotor Ataxy.| The wire brush is also useful in sometimes removing the anæsthesia present in locomotor ataxy, some cases of which may be largely benefited also by the constant current to the spine—one pole to nape of neck, and the other to the lower lumbar vertebræ.[20]
Electricity in Mental Diseases.
Electricity is coming into use in mental diseases. Faradism, and especially cutaneous irritation with the wire brush, would seem to be most suitable for cases accompanied by depression or torpor, the stimulating effects being of service in inspiriting the patient, while the soothing influence of a direct application of the constant Voltaic current to the brain may be employed in cases of over-excitement requiring a sedative.
Diseases of Women.
It is remarkable that electricity should have been so little used in this country in the diseases of women.|Electricity as an Emmenagogue.| According to Golding Bird, it is the only true emmenagogue that we possess. Be this as it may, all of its forms are serviceable in stimulating the secretions, and may be employed with success in cases of suppression of the catamenia from a torpid condition of the uterine organs. A generalized application will often suffice. Let the patient sit with her feet in tepid salt and water, in which is immersed a wire from one of the poles of an induction instrument in action, while a large sponge from the other pole is held applied to the lumbar region. Strength of current as much as she will bear. Time, ten to fifteen minutes. The application should be made twice daily for the three or four days preceding the usual catamenial period. If this method fails in its object, direct electrization must be resorted to; but Franklinization most often succeeds.
On the Continent electricity has been largely employed in the treatment of inertia uteri in the second stage of labour, also in producing premature labour; in the resuscitation of still-born children, and in uterine displacements. |The Advantages of Electrization over Ergot.| We possess other remedies for these conditions, but in labour its advantages over the administration of ergot, include the rapidity and certainty of its action, the exactness with which its dose can be regulated, and the strength and regularity of the contractions which it produces. It admits also of being used in extreme cases in which the power of swallowing has been lost, or where everything is rejected from the stomach, while it never exerts in any way—as ergot is said to do occasionally—any injurious effect upon the new-born child.
Faradization in Post-partum Hæmorrhage.
Gentlemen, it is my firm belief that if a Faradaic instrument were at hand, and properly used, there would never be another death from post-partum hæmorrhage. The Faradaic current, thoroughly localized in the uterus, will always produce its contraction, not only while life persists, but even for a limited time after death, but failure in localizing electricity in an organ, withdrawn from sight and covered with thick muscular tissue, is especially liable to occur, unless the details of application are conducted with extreme care. Assume the case to be an example of severe post-partum hæmorrhage, that the ordinary resources of medicine have failed the obstetrician, and that he fears every moment may be his patient’s last, but he has an induction instrument at hand. Let him waste no time, but at once introduce his right hand into the cavity of the uterus and grasp in his left the moistened sponge attached to one of the conductors of the instrument in action. Let an attendant, holding by its insulating handle the conductor from the other pole (which should be a well-moistened sponge) thoroughly paint with it, as it were, the abdominal parietes, pressing it with considerable force against the practitioner’s hand, and afterwards apply it to the lumbar region. Contraction of the uterus will invariably result if the current used be of sufficient power.
Uterine Neuralgia.