Read Ebook: How to Use a Galvanic Battery in Medicine and Surgery A Discourse Delivered Before the Hunterian Society Third Edition by Tibbits Herbert

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To recapitulate. The essentials of a medical Voltaic battery are--

FARADISM.

Induction currents are also produced in coils of wire by the action upon them under certain conditions of a permanent magnet--as in the ordinary rotary magneto-electric machine--but these machines may be discarded from our consideration, for they are uncertain in action, painful in application, and do not admit of exact graduation.

An apparatus in which both currents are combined is extremely convenient if it is so constructed that either the Voltaic or Faradaic current can be brought to the same terminals, thus avoiding the trouble of changing the conductors--a point of the greatest possible convenience when examining patients for diagnostic purposes by both forms of electricity, either in succession or alternately.

We have now considered fully the birth and parentage of medical electricity, and we have conducted it to within almost a hair's breadth of our patient. The various methods of applying it will be considered in our next Lecture, which I trust, Gentlemen, to render more interesting; but the dry details we have been discussing are, I assure you, essential as a secure foundation for a practically useful survey of electro-therapeutics.

FOOTNOTES:

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.

This observation, made in 1873, requires some qualification now . 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.

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.

So long ago as 1870, I was in the habit of employing at an Institution for Resident Patients, a method of "charging" a patient which I believe to be unique.

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.

The Carr? 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.

Currents of electricity from large fixed batteries are most marked in their curative effects; but patients are not always movable!

GENTLEMEN,

We have already studied methods of applying Franklinism.

Voltaization and Faradization may both be applied either generally--as in the different forms of electrical baths--or locally.

There is another generalized application which has been much advocated, and remarkable statements have been put forth, not only of its curative power in almost every disease, but also of its purely physical and chemical effects--I refer to that by "Electric Baths," several establishments of which exist in London, but you need not send your patients to them. You can teach them how to take an electric bath in their own bed or bath-room. A bath sufficiently large for the patient to recline in it should be insulated by glass supports , and filled with water at a temperature of 95 to 100 degrees. A metallic plate in connection with one pole may be inserted at the head, and a second plate in connection with the other pole at the foot of the bath. The patient should be protected from direct contact with either plate by sitting upon a wooden framework. With a sufficiently powerful current, a portion of the electricity will pass through the body of the patient reclining thus between the poles. Another method is to connect the water with one pole, and for the patient to grasp in his unimmersed hands a copper bar covered with wet flannel, and in connection with the second pole of the battery; or a conductor from this second pole may be held almost, but not quite, in contact with any part of the body immersed in the water. Either the Voltaic or Faradaic current may be used. Ordinary water with the Faradaic current, but salt and water, or acidulated water, with the Voltaic.

Another more generalized application is that introduced by Beard and Rockwell, under the name of "General Faradization." The patient sits with his naked feet upon a sheet of copper connected with one pole, while the other pole is connected by a moistened sponge with the left hand of the operator, who passes his disengaged hand, slightly moistened, over the muscles of the patient, and sometimes over his whole body. The current, I need hardly say, passes through the body of the operator before it reaches the patient, and the sensation he feels is his chief guide to its graduation.

Another general application is the "Centralized Galvanization" of the same authors, in which their object is to bring the whole central nervous system under the influence of the Voltaic current.

They place one pole--usually the negative--at the epigastrium and pass a large moistened sponge from the positive pole over the forehead and top of the head, along the inner border of the sterno-mastoid, from the stylo-mastoid fossa to the sternum, and down the entire length of the spine, from the nape of the neck to the sacrum. The brain, sympathetic and spinal cord, and the pneumogastric nerves are thus submitted to the influence of the current.

It follows from these experiments that we may, at pleasure, arrest electricity in the skin, and that without puncture or incision we may make the current traverse the skin, and concentrate its action upon subcutaneous organs. It was at one time objected that the muscular contraction was the result--not of irritation limited to the muscle or its motor nerves--but of reflex action; but Duchenne demolished this objection by a vivisection. Having removed the skin from the face of a living rabbit--to whom chloroform had been administered--he divided the facial nerve of one side only, in order that the muscles supplied by it might be cut off from all connection with the cord. He then applied electric excitation to each muscle of the face, alternately, on the two sides. The muscles contracted separately and equally on both sides. He then destroyed the brain of the same animal, in order to place the cord in a condition favourable to the production of reflex action, and again excited the muscles as before. The results were absolutely the same.

For direct excitation of the larger muscles it is convenient to use well-moistened sponges, contained in cylinders of different sizes, or metallic disks, covered with wet leather and having conveniently shaped handles. A useful size of cylinder is one such as this , having a depth of about 1-1/2 by 1-1/8 inches, which allows the sponge to fairly fill it, while in such forms as this--6 inches by 1--when the sponge is inserted the lower three-fourths of the cylinder is empty, and the conduction of the current liable to become imperfect. Such a cylinder as this, without any insulating handle at all, is worse than useless, and is a still persisting relic of the barbarous time when the patient was invariably electrized by causing him to hold the conductors one in each hand, a proceeding extremely dangerous in certain pathological conditions, and in other cases not likely to be of benefit to him. The insulating handles should be well hollowed out, that they may be used, lying comfortably between the fingers, when holding two in the same hand. The disk rheophore , a metallic button covered with wash-leather, is extremely useful; it has the advantage over the sponge of allowing firm pressure to be made without the inconvenience of water being squeezed out, while by using its edge it may be made to answer in the majority of cases for a pointed conductor, which is fitted chiefly for application to very small muscles, such as the interossei and some of those of the face. The wire is attached to the conductor by being screwed into the socket . A conducting cord is very apt to get frayed at the point of juncture, and that the wire which I recommend is not open to this objection is not the least of its advantages. In direct electrization the rheophores should be firmly pressed down upon all points of the surface of the muscle, that all of its fasciculi may be equally electrized. With the Faradaic current it is convenient to apply the rheophores, held in the same hand , for from twenty to thirty seconds, to every part of the surface of the muscle, or group of muscles, promenading them as nearly as may be in lines from the origin to the insertion of the muscles. If the rheophores are not held in the same hand care should be taken to keep them near to one another, for the tension or penetrating power of Faradism is so great, that without this precaution there will be liability to excite reflex action. With the interrupted Voltaic current this liability does not exist, and a better plan when using it is to hold the sponge from the positive pole stationary, near to the origin of the muscles, and to stroke or paint as it were the entire muscular surface with the sponge from the negative pole, gliding it in lines from the position of the positive. In using the constant Voltaic current both sponges must be held quite immovable, and so applied it differs altogether in its effects from the very same strength of current interrupted by moving the conductors. I will demonstrate these different applications upon the extensors of my left wrist and fingers--Faradism--Voltaism--Constant Current.

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 , 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. 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. 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.

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 faecal matter.

The chemical action of a continuous Voltaic current is sometimes useful in the removal or dispersal of tumours, and in the consolidation of aneurisms, one or more needles being introduced into the tumour, and connected with a Voltaic battery. I shall discuss this subject in our next Lecture, but I have here some of the most generally useful needles , and I have had made for them holders with eyelet-holes for the attachment of conducting wires which render the operator independent of special conducting cords, for with a coil of insulated wire and a pocket knife he can fit up his needles in a few minutes in any way best adapted to his proposed operation.

We have now studied, Gentlemen, medical electricity, electrical instruments, and methods of application. In our next and concluding Lecture I propose to discuss the assistance that electricity affords us in diagnosis, prognosis, and treatment.

FOOTNOTES:

See pages 6-17.

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. 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.

Published by Churchill.

GENTLEMEN,

Our first two Lectures were devoted to a consideration of electrical instruments; the different varieties of electricity; and the most approved methods of applying them in therapeutics. To-day we have to study their uses in diagnosis, prognosis, and treatment.

After long disuse of healthy muscles a slight degree of diminution of electric irritability may sometimes be present, but this is always restored by two or three Faradizations, and its existence is hardly likely to present any difficulty in diagnosis. With this qualification we find that in paralysis from brain disease electric irritability is normal, except when irritative lesion is present, and then it is increased. In paralysis from disease of the substance of the cord irritability is diminished, and this will sometimes aid us in the diagnosis--not always easy--between commencing paraplegia and locomotor ataxy. In ataxy--at least in its early stages--irritability is normal. In progressive muscular atrophy it is normal as long as any muscular tissue remains. In hysterical or emotional paralysis irritability is normal, but electro-sensibility is often much impaired. These variations will sometimes enable us to distinguish between real and pretended disease; and, finally, absolute abolition of electric irritability in all the muscles of the body is proof positive of death, so that those extraordinary people who are haunted by a fear of being buried alive may rest contented if they provide that after apparent death, and before burial, their bodies shall be submitted to thorough electrical examination.

Considered solely as an aid to diagnosis, we can get little more assistance from electricity than I have pointed out to you.

And now, Gentlemen, we come to the consideration of the last and most important branch of our subject--electricity as a therapeutic agent--its scope and its limitations as a remedy.

Is it needful for me to say that there is too much belief and too much unbelief in its therapeutic power?

FRANKLINIZATION.

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

ELECTRIZATION.

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. 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. 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."

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.

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; and a third in the removal or absorption of gouty and rheumatic deposits. 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.

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.

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.

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 than localized applications of electricity. The statement that metallic poisons can be eliminated from the body by its agency has not yet been established.

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 fossae 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.

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. 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."

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.

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." 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 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." 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 anaesthesia is present, a good painting with the wire brush will often be of service. 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. 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 anaesthesia, which, although originally of central origin, continues after the removal of its cause. Anaesthesia from section of a nerve is sometimes persistent in this way after repair of the nerve lesion. The wire brush is also useful in sometimes removing the anaesthesia 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 vertebrae.

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