Part 6

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] [SN: 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.” [SN: 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. [SN: 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. [SN: 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. [SN: 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]

[SN: 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.

[SN: Diseases of Women.]

It is remarkable that electricity should have been so little used in this country in the diseases of women. [SN: 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. [SN: 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.

[SN: 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._

[SN: Uterine Neuralgia.]

In my own hands an intractable case of uterine neuralgia was perfectly cured by the Voltaic current; and I have knowledge of a case of sterility which the localization of the Voltaic and Faradaic currents alternately would seem to have removed. [SN: Sterility.] One conductor was applied to the os, and two sponges from the second pole--one to the position of each ovary. The applications were made thrice a week for a fortnight before each menstrual period, and for a period of four months. Conception followed, and the patient, who had been married for thirteen years, in due course gave birth to her first child.

[SN: Paralysis of Nerves of Special Sense.]

The stimulant effects of electricity are occasionally beneficial in the treatment of paralysis of the nerves of special sense, especially of the optic and auditory nerves, while its use has been advocated in a multitude of diseases to which I shall not further refer, than by saying that a clear comprehension of the principles of electro-therapeutics will prevent the occurrence of difficulty in any special application of them; and let us shortly recapitulate the most important of these principles. [SN: Résumé of general principles of Electro-therapeutics.] We have seen that electricity is a stimulant, a sedative, a restorative, and an absorbent. Its stimulant properties are chiefly of use in diseases of debility, and notably in paralysis--its sedative properties in the alleviation and removal of pain and spasm, and notably in neuralgia--its restorative properties in fatigue diseases, notably writer’s cramp--and its absorbent properties in exudation diseases, and notably in gout and rheumatism. The dose of electricity consists of the addition of two factors--firstly, the strength of the current, whether Voltaic or Faradaic; secondly, its duration. It is of essential importance that we do not overdose our patient, but we are little likely to do this if we adhere to the two cardinal rules--to use the _minimum_ power which will produce the results we desire, and not to unduly prolong our application: and really this question of “dosage” forces us to consider how far it is advisable for the medical practitioner who prescribes electricity to sanction its administration by the patients themselves. While there is no doubt that the most explicit directions will often be misunderstood, or fail in being correctly carried out, yet it would be practically impossible (to say nothing of the expense to the patient) for any medical man to himself apply electricity daily for a lengthened period; and we are compelled, in certain cases, to do our best in instructing _some one attendant of the patient_ how to carry out the treatment, making her do this a few times in our presence, _and looking sharply after her afterwards_, and in addition explaining everything as fully as possible to the patient, or the patient’s friends. Moreover, we must not lose sight of the fact that, with electricity as with other remedies, the skill of the physician is shown in determining how, when, and in what dose to administer it, and his judgment in selecting those cases in which its administration may be wisely committed to others.

In conclusion, Gentlemen, allow me to thank you for the attention with which you have listened to these imperfect Lectures. I fear that I have failed in doing full justice to their subject; but I trust that I have succeeded in indicating the importance of electricity, as a supplement to, not as a substitute for, the more ordinary resources of therapeutics: in removing any doubt as to the class of cases calling for its employment; in supplying any want of information regarding details of its application; and especially in proving its claim to be more fully employed in your daily practice. A theoretical belief in its efficacy is widespread in our profession, its _frequent use_ is yet in the future, but I hope a not distant future. Gentlemen, with you rests the decision whether this shall or shall not be. You will decide it not by the dictum of any specialist, but by the general voice of the profession, declaring your verdict as founded alone on your own personal experience.

FOOTNOTES:

[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. [SN: _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.

[SN: _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. [SN: 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.

[SN: 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. [SN: 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.

[SN: 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.”

INDEX.

Bath, Electric, 42