Part 5

FRANKLINIZATION.

Franklinization as the oldest form of electricity and as partaking more of a general application than a local, may be conveniently considered first.

Administered by the various methods described at pages 6 to 17, it has been found in the practice of the National Hospital for the Paralyzed and Epileptic, and in private cases coming under my own observation, of considerable value. [SN: Facial Neuralgia.] _Facial neuralgia_, for example, which has resisted other modes of treatment, may occasionally be relieved with rapidity and permanently by drawing sparks along the track of the affected branch or branches of the trifacial nerve. [SN: Sciatica.] [SN: Facial Spasms.] Sometimes also _obstinate sciatica_ has been partially or altogether removed; so also _facial spasm_, (tic convulsif), as in the following instance, for permission to quote which I am indebted to Dr. Radcliffe. A female, forty-eight years of age, had suffered for thirteen years from spasm of the muscles of the left side of the face. The distortion produced by the spasm was very great, and was apt to be so much exaggerated by slight emotion, even such as would be caused by having to address a stranger, as to make speaking difficult, and to prevent proper attention to her occupation as a small shopkeeper. An experimental trial was made of electrization by sparks along the lines of the nerves distributed to the affected muscles. After the third application the spasm was manifestly relieved, the distortion being diminished, and the paroxysms occurring less frequently. By persisting with this treatment thrice weekly over a period of two months, so great an amount of relief was obtained that little distortion of the face remained, and the patient was able to pursue her business with comfort. [SN: Emotional Aphonia.] Electrization by sparks over the larynx has been found so effective in the relief of cases of hysterical or _emotional aphonia_, even those of long standing, that it is well to use it in the treatment of these cases before having recourse to induced electricity. In six or seven recent cases, this form of application repeated twice or thrice effected a complete cure. One of these cases was of nine, another of six months’ duration. The remainder had lasted from four weeks to three months. The seventh case did not receive any benefit from the use of static electricity, and the other forms of the agent proved equally ineffective. The case recovered slowly under general treatment. [SN: Localized Excessive Sensitiveness.] Electrization by sparks over the affected spot has often proved of great benefit in removing the _localized excessive sensitiveness_ not unfrequently found in hysterical cases, particularly in the spinal region. [SN: Tremor.] _Tremor_, whether general or local, is sometimes largely relieved by insulating the patient, and charging him with positive electricity for a period of twenty minutes to half an hour. Other applications failing, I would advise always, in cases similar to the above, a fair trial, say half a dozen sittings, of Franklinization.[14]

ELECTRIZATION.

[SN: Electro-therapeutics.]

We have seen that if we send a shock of electricity through a motor nerve the nerve becomes excited, and responds by contraction of its muscles. One form of electricity, then, is a stimulant, but, unlike other stimulants, it admits of its action being exactly localized and its influence instantly withdrawn. [SN: Effects upon Nutrition.] There first results from such an application a larger flow of blood to the part, with subsequent increase of temperature and general improvement in nutrition. [SN: Electricity as a Stimulant.] If muscular contraction results, it acts in addition as an artificial gymnast, imitating natural muscular action in a way quite impossible to any agency but electricity. It is in cases where there is muscular response to it, but not to the will, that it is often of immense service, and it can then be replaced by no other remedy known to medicine. Need I say that in such cases its dosage is of importance; that only a certain amount of stimulation being needed, this may not be carried to the point of exhaustion, and that the application should not be continued for too long a time. From ten to twenty minutes for an entire application is usually sufficient. So much for the stimulant effects of electricity when administered under either of its forms in a series of intermittent “shocks.”

[SN: The Constant Current.]

But we get a very different result when we employ a constant current--that is, a continuous stream of electricity without interruption or break in it, and without appreciable variation in its strength. One effect of the administration of such a flow of electricity is that of a sedative, for it possesses the most remarkable power in relieving pain. We have all heard of the benefit of the “constant current” in neuralgia, and it is worthy of its reputation, and will not disappoint us if we administer it with the precautions noted in my last Lecture. (See foot-note, page 52.)[16]

[SN: Electricity possesses an influence _sui generis_.]

Electricity, then, according to its variety and method of administration, is both a stimulant and a sedative; but although these words may be used as convenient distinctive terms, there is no doubt that it is something more, and that it possesses an influence quite _sui generis_, dependent, perhaps, upon its modification of the natural state of the electricity of the human body. [SN: Restorative power of Voltaic Current.] The Voltaic current enjoys a remarkable restorative power, for it has been found that its prolonged action upon a nerve immediately after death will preserve its irritability for a length of time, and that even in a dead nerve the lost irritability may be again established. [SN: Electricity in Fatigue Diseases.] Dr. Poore has particularly studied this restorative or refreshing effect of the Voltaic current, especially in its application to a class of diseases (termed by him “fatigue diseases”), and of which writer’s cramp is a type, chiefly characterized by an intense feeling of fatigue upon any attempt being made to execute certain muscular movements. This tired feeling is at once removed by the application of the Voltaic current, either to the muscles affected or to their nerves, and this result Dr. Poore believes to be explained by an increase in the susceptibility of the muscles to the stimulus of the will. Be this as it may, such an application is often most comforting, and it is not unusual for the patient to experience immediate and most grateful relief, and to beg for its repetition. Many electro-therapeutists will attribute this relief to the production of, as it is termed, a condition of electrotonus, about which, and its importance in electro-therapeutics, a great deal has been written and disputed. [SN: Electrotonus.] Electrotonus is simply a name given to signify the state of a nerve while it is being traversed by an artificial Voltaic current. The effects of such an application, of course, depend chiefly upon the power of the current. If sufficiently powerful complete functional destruction of the nerve would result, as by a lightning flash; and as the tension of electricity is greater at one pole than the other, we naturally, with currents of a certain strength, discover modifications of irritability in the nerve when specially influenced by either pole. The irritability is increased in the half nearest to the negative pole (Katelectrotonus), decreased in the half nearest to the negative pole (Anelectrotonus), and unchanged at a point midway between the two poles (point of indifference). The production of the general electrotonic state is of importance. I believe these lesser variations of anelectrotonus and katelectrotonus to be practically of little moment, and I advise you to disregard them in therapeutics.

[SN: Impotence.]

The restorative effect of the Voltaic current is frequently of benefit in sexual weakness. In functional cases, the current may be applied to the spine--positive pole to mid-dorsal region; negative well painted over lumbar twice daily for ten minutes upon getting up and going to bed. This treatment was adopted in the case of a gentleman, fifty years of age, who consulted me for gradual decrease of sexual power, ending in complete impotence. Six weeks’ treatment resulted, the patient informed me, in the complete restoration of the normal function.

Very marked absorbent or resolvent effects are also exerted by the Voltaic current, and are probably chiefly due to its powerful chemical action, for a current of great strength will dissolve or destroy any animal tissue whatever. One application of this chemical action is found in the electrolysis of tumours; another in the coagulation of blood in aneurisms;[18] and a third in the removal or absorption of gouty and rheumatic deposits. [SN: Rheumatic Gout.] In Rheumatic Gout, Dr. Poore has recorded a very successful result from the use of localized galvanization. The disease had existed for three months, but the severity of the pain had much diminished, excepting towards evening, when exacerbations occurred. The wrist was considerably swollen, and absolutely stiff, the hand pronated and could not be supinated, and the hand and fingers were immensely swollen, so as completely to obscure their anatomy, while the fingers were extended, stiff, pale, and cold, and the nutrition of the entire limb impaired. The whole limb, and especially the hand, was thoroughly sponged with the negative pole, the positive being held in the patient’s other hand. After the third application the swelling rapidly subsided, and in about a fortnight the hand, although still stiff, had resumed its natural aspect. The muscles were then faradized and shampooed.

[SN: Rheumatic Arthritis.]

Rheumatic arthritis with nodosities is best treated by passing as strong a Voltaic current as the patient will submit to through each swollen joint for a few minutes, the direction of the current being frequently changed by the movement of the commutator of the poles.

[SN: Muscular Rheumatism.]

The pains of muscular rheumatism are almost invariably removed or mitigated by cutaneous faradization, and so rapidly as in many cases to appear marvellous. In cases that had resisted all other treatment, an instantaneous cure has resulted, and sufferers whose pain has for a long time obliged them to keep the arm immovable have been able directly after the faradization to execute any movement with ease. With these rheumatic patients it is especially of importance that the current should be strictly limited to the skin, carefully dried and powdered, and should _produce no muscular contraction_, or the suffering will be aggravated instead of relieved. Begin with a current readily bearable on your own hand, and increase afterwards. The above remarks are applicable to all varieties of muscular rheumatism, but not to arthritic disease.

[SN: General effects of Electrization.]

So much for the general effects of electricity. All the structures of the body respond to its application; the muscles and motor nerves, as we have seen, by contraction; the nerves of common sensation by a burning or pricking; and of the nerves of special sense; the retina by a flash of light; the auditory nerve by a sound; the olfactory nerve by a peculiar smell; and the gustatory by a metallic taste, differing at the two poles. The action of the Voltaic current upon the brain is exceedingly powerful, and the greatest care must be exercised when it is applied to any part of the head or face. Not more than two or three cells should be commenced with. Its effect should be noted, and any increase should be made gradually. With a very moderate current giddiness is produced, and upon the sudden application of a sufficiently powerful one the patient falls down as if struck by a blow.

[SN: General Debility.]

All, or some of the more or less generalized applications, such as Beard and Rockwell’s generalized electrization, the common Faradaic and Voltaic Baths, or Radcliffe’s Charge, are of occasional benefit in conditions of general debility, and where general stimulation of the nervous centres is indicated. The electric bath is an elegant and pleasant mode of administering electricity, but it is less generally beneficial (except in certain gouty or rheumatic cases) than localized applications of electricity. The statement that metallic poisons can be eliminated from the body by its agency has not yet been established.

[SN: Paralysis.]

There are very few, I think I may almost say not one, of the many disorders classed under the heading of paralysis, in which at some time or other of their progress some form of electrization is not essential to their most successful treatment. Where powerless to cure it will not unfrequently relieve the most distressing symptoms. Cases of functional paralysis from slight pressure are not uncommon, when power may usually be restored by a few Faradizations; but in paralysis from severe central or peripheral lesion progress must of necessity be slow. Such cases, regarded electrically, may be most conveniently considered under the two divisions of atrophic and non-atrophic paralysis. [SN: Atrophic Paralysis.] In the great majority of atrophic cases there will be found abolition or modification of the normal electrical reaction of nerve and muscle, but whether this is so or not, in all cases of loss of power, in which any muscular wasting is visible, the localization of electricity in the wasting muscles is _imperative_, and in some varieties it is the only treatment which will arrest the disease. It is in these latter cases that its early administration is called for, before the degeneration and disappearance of the muscular tissue, and its early and judicious use will not seldom save the sufferer from being left for life with a powerless, or withered and deformed, limb. [SN: Infantile Paralysis.] As an illustration, let us review the progress of a case of essential infantile paralysis, the most common of the paralyses of children; that form in which premonitory symptoms are often absent, or but slight, and where there is no rigidity. Very shortly after its onset, usually within a few days, the limb is found to be colder than its fellow, and its muscles to be rapidly wasting; the final result, if untreated, being the entire disappearance of some of them and the production of deformity. In fact, the larger number of cases of club-foot and analogous distortions are brought about by neglected infantile paralysis, and there is no doubt that by judicious treatment, of which early electrization is the foundation, the majority of them might have been prevented. The leading orthopædic surgeons are fully alive to this fact, but they are powerless, as they are rarely consulted until all the mischief has resulted. [SN: Importance of early Electrical Treatment.] The early recognition and appropriate treatment of these cases must continue in the hands of the family practitioner, and he must decide whether or not they are to continue, as at present is unfortunately too commonly the case, without any serious attempts at restorative treatment until commencing deformity compels attention to them. As soon as the medical attendant is summoned--and this is frequently only because the parents have noticed that the child is lame--he should carefully examine the muscles electrically, and unless there are head symptoms present, and this is very seldom, he should electrize each muscle daily with that current to which it responds, and of a strength just sufficient to produce muscular contraction. If the powerless muscles have preserved their Farado-contractility it may be confidently predicted that they will rapidly recover; but it will almost invariably be found that while Farado-contractility is diminished or abolished, there is increased response to the interrupted Voltaic current. They should be treated then with this current alone. Hot spongings and shampooings should also be employed, and it is of great importance that in the intervals of treatment the temperature of the affected muscles should be maintained at as high a degree as possible. If the leg is affected, a stocking of pure spun silk should be constantly worn, day and night, in addition to the ordinary clothing; if the arm, a silken sleeve.

[SN: Importance of active and passive movements in Paralysis.]

When in any form of paralysis ANY amount of voluntary power has been restored by electricity, it is most important that the patient should be encouraged to use the limb and practise various movements. Passive movements are of equal importance, and the paralyzed muscles should be frequently exercised by this mode to the fullest extent of their normal movements. For example, if the extensors of the hand and fingers are paralyzed, the hand and fingers should be passively flexed and extended completely, at intervals of a few seconds, for some minutes, and so on with all the paralyzed muscles in succession. [SN: Rule for Muscular Electrization.] As soon as there is return of reaction to Faradization, Faradization should be alone used, and the rule in all cases of localized muscular electrization, muscular contraction being sought, is to use that current to which the muscles respond, and _I do not know of any exception to this rule_; but a successful result in severe cases of atrophic--not alone infantile paralysis, but all varieties of atrophic paralysis--is brought about by painstaking, daily, tedious, uninteresting treatment, with no chance of brilliant or rapid results, but which if thoroughly, faithfully, and patiently carried out, will reward us by progressive improvement, and sometimes--even in cases regarded not long ago as quite hopeless--complete recovery.

[SN: Rigid form of Infantile Paralysis.]

There are certain forms of paralysis affecting children where the muscles are rigid. Localization of any form of electricity in these rigid muscles is quite useless; but if these cases depend upon adhesions or exudations into the medulla their absorption may possibly be promoted by localizing a Voltaic current in the superior cervical ganglia of the sympathetic; two small conductors, leather, tipped and well-moistened in connection with the poles of a Voltaic battery being applied for four or five minutes to the bottom of the auriculo-maxillary fossæ on both sides. There seems no doubt that such an application causes a dilatation of the blood-vessels of the base of the brain, and is likely therefore to promote absorption.

[SN: Traumatic Paralysis.]

In all cases of traumatic lesion--as by section of a nerve--the paralysis is atrophic, and the treatment I have recommended in infantile paralysis should be assiduously employed. Mitchell, of Philadelphia, whose experience of military surgery is unrivalled, commences electrical treatment and shampooing within a fortnight of the wound, unless there are special circumstances to contra-indicate it. Lead palsy requires similar treatment; so does, perhaps, the commonest form of peripheral palsy--facial palsy from neuritis of the facial nerve. [SN: Caution necessary in Electrizing Facial Muscles.] In electrizing the facial muscles there is one caution necessary--especially to observe the rule of electrizing the muscles equally--for I have several times met with a contraction resulting from a too energetic Faradization of some individual facial muscle, to the neglect of the group with which it is in correlative action. Such a contraction may sometimes be removed by localizing in it for about five minutes a constant Voltaic current from eight or ten cells; but in the most favourable cases an unnatural expression of countenance will generally persist for a long time, from the non-recovery by the muscles of their perfect “tone,” that quality which imprints upon each face its characteristic features, and which has been called the “Gymnast of the Soul.”

[SN: Wasting Palsy.]

In that most distressing disease, Cruveilhier’s atrophy or wasting palsy, medication is altogether useless, and our one hope--not invariably a forlorn one--is in electricity. Localized Faradization to the muscles, alternately with Radcliffe’s Positive Charge, together with galvanization of the sympathetic or of the spinal cord, admit of trial.

[SN: Hemiplegia.]