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Title: The Electric Bath
Author: Schweig, George M.
Language: English
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THE
ELECTRIC BATH
ITS MEDICAL USES, EFFECTS
AND APPLIANCE
BY
GEORGE M. SCHWEIG, M.D.
MEMBER OF THE NEW YORK COUNTY MEDICAL SOCIETY AND OF THE MEDICAL
JOURNAL ASSOCIATION OF THE CITY OF NEW YORK; ONE OF THE
PHYSICIANS TO THE NEW YORK LYING-IN ASYLUM, ETC.
NEW YORK
G. P. PUTNAM’S SONS
182 FIFTH AVENUE
1877
COPYRIGHT,
G. P. PUTNAM’S SONS,
1876.
PREFACE.
In No 216 of “The Medical Record” (Dec. 15th, 1874) was published an
article written by me, entitled “On some of the Uses of Galvanic and
Faradic Baths.”
The interest manifested in the subject, as evidenced by numerous letters
of inquiry since received from physicians in almost all parts of the
United States, and some in Europe, has induced me to write the present
treatise, in which I have endeavored to present to the profession, as
far as lies in my power, all that is necessary to a full comprehension
of the electro-balneological treatment.
When it is considered that in the employment of electric baths I have
been to a great extent groping in the dark, that I have been deprived of
the advantage of having the experience of others to guide me, it will
not appear surprising that I should have met with many disappointments.
My failures have been illustrative of the fact that the electric bath is
no more a panacea for all ills than any other remedial agent.
Applicable as it is to a great variety of pathological conditions, it
meets with many where it is destined to have negative or at best
imperfect results. Far from discouraging me, however, failures have
served to inspire me with fresh ardor to seek for light, and to
persevere in my efforts to establish on the basis of statistical truth,
the therapeutic merits of the agent which I employed.
In view of the imperfectness of the results thus far obtained, I should
consider the present work premature, did I not find a justification for
it in my desire to induce other and abler observers to investigate the
subject, and place it on whatever footing it may merit.
To say that I am fully conscious of the shortcomings of my work, would
be but feebly to express my convictions in this respect. I beg the
reader however to consider that the subject is not a hackneyed one, that
mine has not been the work of the compiler who remodels the brain-work
of others. It may be crude and rough, it may lack the gloss and polish
that is the result of much handling, but I have at least the
consciousness that it has the merits of originality and candor.
NEW YORK.
160 Second Avenue. November, 1876.
CONTENTS.
CHAPTER I.
THE APPARATUS.
PAGE
_a_)—The tub. _b_)—The electrodes and connections.
_c_)—The water. _d_)—Chemicals. _e_)—The batteries. 7
CHAPTER II.
MODE OF ADMINISTRATION 19
CHAPTER III.
PHYSIOLOGICAL EFFECTS.
Characteristic differences between the electric bath and
other methods of electrization—Effects on sleep; on general
sensation; on the change of matter; on the pulse and
temperature; as a stimulant and tonic; on general nutrition;
on the digestive apparatus; on the sexual apparatus—Sedative
influence—Affects cranial nerves—Cutaneous sensation—Its
freedom from pain—Muscular contractions—Effects on the mind 31
CHAPTER IV.
GENERAL THERAPEUTIC EFFECTS AND USES.
The electric bath as a diagnostic; as an equalizer of the
circulation; as a general counter-irritant; as a general
invigorant and tonic—Its hypnotic and sedative influence—Its
improvement of nutrition—As a prophylactic 52
CHAPTER V.
SPECIAL THERAPEUTICS AND CLINICAL RECORD.
General directions—Special diseases—Acute rheumatism—Subacute
rheumatism—Chronic rheumatism—Cases of rheumatism—Chorea,
with cases—Hysterical affections, with cases—Neurasthenia,
with cases—Agrypnia, with cases—Anæmia, with case—Paralyses
and Pareses, with cases—Neuralgiæ, with cases—Articular
effusions, with case—Impotency, with cases—Constipation, with
cases—Hydrargyrosis, with case—Locomotor ataxia, with
case—Cachexia, with case—Dyspepsia—Melancholia, with
case—Inequalities of the circulation—Affections of the
Sympathetic, with case—Miscellaneous conditions—Concluding
remarks 61
THE ELECTRIC BATH.
CHAPTER I.
THE APPARATUS.
To a proper comprehension of the succeeding chapters, it is necessary
first of all to be familiar with the apparatus employed in carrying out
electro-balneological treatment, and I therefore proceed to give a
description of this.[1] It may conveniently be divided as follows, viz.
_a._ The tub;
_b._ The electrodes and connections;
_c._ The water;
_d._ Chemicals;
_e._ The batteries.
(_a_) _The Tub._ This must be made of a non-conducting material. Of
substances that will answer, I will mention: wood, porcelain, soapstone,
vulcanized rubber, or glass. In choosing one of these materials, regard
should be had to the facility of attaching the electrodes. In this
respect wood deserves the preference over all the others mentioned.
Where economy is to be studied, it has a further item in its favor.
The tubs, which I have now in use for nearly three years are made of
wood, and I find them to answer very well. It must not be forgotten,
however, that a wooden tub requires to be well painted on the inside, in
order to prevent its becoming water-soaked, because in that event it
would become a conductor of electricity, and interfere to some extent,
with the administration of the electric current in the bath.
The shape and size of the tub may be the same as those of an ordinary
bath tub. To suit individual cases however, its length may be made to
vary. The only peculiarity in its construction is at the head. Here,
instead of slanting, it is made square, and the slightly concave (from
side to side) board against which the back of the bather is to rest, is
fitted in afterwards. This is necessary, because it is very difficult to
make a wooden tub with a slanting back water-tight. If the length of
the tub from outside to outside is made to measure about five feet ten
inches, the back-rest fitted in at a proper slant will bring the inside
of the tub to about the right length for an average male adult. All
around the upper edge of the tub runs a wooden coping, which must not be
fastened down however until all the attachments for conducting the
current are _in situ_. Along that portion of the top of the tub where
required—and this will depend on the situation of the binding posts
presently to be mentioned—and underneath the coping, runs a groove for
the reception of the wires that are to connect the carbon electrodes on
the inside of the tub with the binding posts on the outside. This groove
is continued vertically along the inside of the back-rest and foot of
the tub respectively, to communicate at either end with the bed for the
reception of the carbon plates. These vertical grooves should at their
lower end be a little over ¼ inch deep, in order to admit of the wires
being introduced beneath the carbons.
The face of the foot of the tub and that of the back-rest, should have
in their centres (from side to side) and commencing at about five inches
from the bottom of the tub, a bed for the reception of the carbons. The
dimensions of these receptacles must of course correspond to those of
the carbon plates to be employed as electrodes. Those which I use
measure 12×8″ at the head, 8×6″ at the foot of the tub. They are ¼″
thick. They are placed so as to have their long diameter correspond to
the height of the tub. The bed which is to receive the carbon at the
head of the tub must be deeper than ¼″ on account of the concavity of
the back-rest.
In order to adapt a tub to individuals of different lengths, it will be
found advantageous to have two small vertical cleats on each side of the
tub, near the foot and bottom, for the reception of a foot-board, which
will practically shorten the tub and adapt it to persons of different
lengths. This board may conveniently be six inches wide, and should have
a number of perforations about an inch in diameter, for the transmission
of the current to the feet. 1¼″ pine plank is the most suitable wood to
use in the construction of the tub. This is preferable to any of the
hard woods, because of the greater facility of fitting in the electrodes
etc. It is also the most economical.
(_b_) _The electrodes and connections._ These consist of two carbon
plates, two brass binding posts, and insulated wires to connect the
carbons with the binding posts, and these with the battery. The carbons
are such as are ordinarily employed in the construction of galvanic
batteries, and can, as well as the wire and binding posts, be procured
from any house that deals in telegraph material. Their size is to some
extent optional; the dimensions I have given above however answer very
well.
The inside of the tub having received one or preferably two coats of
paint, the carbons are now fitted in the receptacles provided for them.
The next step is the attaching of the binding posts. These should be of
the kind known as “single” binding posts with “wood screws.” The most
convenient location for them will be found on the coping covering the
horizontal portion at the head of the tub. Here the coping, as it has to
cover not only the upper edge of the head of the tub, but that of the
back-rest also, is of necessity much wider than at any other portion,
and thus affords most room for the binding posts.
Having marked out then a site for the binding posts, say in the centre
of the coping at the head of the tub—which should now be placed in
position—and about two inches apart, the posts are laid aside to be put
in place when the wires are all _in situ_, and the coping fastened down.
In order to facilitate the description of the placing of the wires by
means of which communication is to be established between the electrodes
and the binding posts, I shall term the end of the wire that is to be
attached to the electrodes the distal, that which is attached to the
binding posts the proximal end. A gimlet hole sufficiently large to
admit of the passage of one wire should be made half an inch outwards
from the centre of the site of each binding post. The best wire to use
is about No. 16 copper wire, coated with gutta percha or rubber. The
site of the posts being as above suggested, it will be found that the
wire which is to connect the head electrode with one post requires to be
about 18 inches long, that which runs from the other post to the
foot-electrode, between eight and nine feet. The distal ends of the
wires should be stripped of their coating for a length of about three
inches, the proximal ends for about two inches. The denuded portion of
the distal ends should be rolled up in the form of a spiral coil; this
will insure their constant impinging on the carbons more certainly than
could be expected from a simple straight end of wire.
The carbons having now been fitted in their beds, the distal end (coil)
of the head wire is placed beneath the carbon, and the wire itself
continued up along the vertical groove to either one of the gimlet
holes. Through this, from within outward, the proximal end of the wire
is now drawn and left for the present. The distal end of the second wire
having now been placed beneath the carbon at the foot of the tub, this
wire is continued up through the vertical groove, along the upper edge
of the foot of the tub to the side nearest the binding post to which the
wire is to be attached, along the groove on the upper edge of this side
to the head of the tub, and thence to the respective gimlet hole, and
through this, from within outward. The wires being now all in position,
all the coping is next screwed or nailed down firmly, care being taken
that the screws or nails used for this purpose do not injure any of the
wires. The coping fastened down, the binding posts are now screwed down
in the sites previously marked out for them. Before they are screwed
_entirely_ down, the denuded portion of the proximal end of each wire is
securely wound around the screw of the respective binding post, and the
posts are then _firmly_ screwed down, holding the proximal ends of the
wires in place. Connection is now established between the binding posts
and the head and foot electrodes respectively. The vertical grooves are
now to be filled in with putty and painted over, care being taken to
keep the carbon free from paint. The last step towards completing the
apparatus is to fasten the carbons in their beds. The simplest way of
doing this is by stretching over each carbon a piece of muslin, folded
double, and tacking this down around the edges. Zinc or galvanized iron
tacks are best. Copper tacks should be avoided on account of their
superior conductivity.
In order to be able when required to localize the current in special
portions of the body, it is well to be provided with what I have termed
a “surface board.” This is a piece of black walnut, say 14 in. long by 5
in. wide, ¾ thick, having in the centre a bed to accommodate a carbon
plate, say 5 in. long by 2 in. wide, ¼ thick. From the centre of this
bed a gimlet hole pierces the board. The denuded end of an insulated
wire is drawn through this gimlet hole from without inward (toward the
bed) and twisted in the form of a spiral to prevent its slipping back,
as well as to insure its more certain connection with the carbon. The
carbon is now placed in the bed, and kept there by a piece of muslin
drawn over it and tacked down. The wire should be of sufficient length
to reach the battery. I shall speak further on of the use to be made of
the surface board.
_c_) _The Water._ The quantity of water may be the same as that in an
ordinary bath. In those cases alone where it is intended to localize the
current by means of the surface board, and to concentrate it _very
strongly_ in one spot, the water in the tub should be left low enough to
leave the particular spot to be treated uncovered by this; the surface
board can then be applied to this spot without the loss to the current
of strength, through derived currents, inevitable in its application
under water.
The temperature of the water may range from 85° to 105° Fahrenheit. As a
rule the comfort of the patient may be consulted in this respect. There
are certain cases, however, where an especially high or low temperature
is indicated, and where the extremes mentioned have to be touched.
_d_) _Chemicals._ Where these are added to the water of the bath, it is
for one of three purposes: viz. 1)—To exercise a direct therapeutic
influence on the patient, either internally by being absorbed, or
externally by their action on the skin; 2)—Through chemical affinity to
aid in eliminating certain metallic substances from the body; or 3)—To
further the absorption of morbid deposits. The various indications in
these respects will be treated of in their proper places.
_e_) _The Batteries._ In the choice of this, the most important part of
the electro-balneological apparatus, the greatest circumspection is
necessary. Inferior instruments and such as are liable to get out of
order frequently, have time and again been the means of discouraging the
beginner in electro-therapeutics, and causing him to abandon the study
of an art, the pursuit of which would have well repaid him for all his
labor. Fortunately our manufacturers here in New York turn out very good
instruments, and if a physician purchases an inferior one, the fault is
his own.
Two different currents are required for the baths, viz. 1)—The
galvanic, which may be employed either in the constant or interrupted
(by means of a rheotome) form; and 2)—the faradic or induced current.
Several manufacturers of this city turn out good and serviceable faradic
instruments. Those which I have been in the habit of using for some
years past are manufactured by the Galvano-Faradic Manufacturing
Company, and they have given me unvarying satisfaction. By means of a
recently introduced attachment to their batteries, termed the “fine
adjustment,” a current of exquisite “fineness” (rapidity of
interruption) is obtained, thus removing the only inferiority that has
heretofore distinguished American from the best imported instruments.
The instrument is very easy of management, and its liability to get out
of order very small.
As however the galvanic current is of vastly greater importance in a
therapeutic respect, than the faradic, so also much greater care is
required in the choice of a galvanic than a faradic battery. In making
choice of a galvanic battery, we have to consider its relative quantity,
intensity, constancy, permanency, economy of running expenses, and
facility of management. We cannot be guided here by the same
considerations that guide us in the choice of a battery for office use,
where the _séances_ are usually brief and the elements taxed not nearly
so much as in the administration of baths. It is not within the scope of
this work to enter into a description of the various galvanic batteries
that are in use. Neither do I believe that, in a therapeutic sense,
there is much difference between the various batteries ordinarily found
described in text-books on electro-therapeutics.
Where the battery is to be stationary, a zinc-copper battery, such as
the Hill battery for example, is preferable both on account of its
constancy and the economy of running it. Of this there should be fully
sixty cells, communicating with the bath through a current selector, by
means of which the current from any desired number of cells can be
obtained. The electro-susceptibility of different individuals varies to
such an extent that this is absolutely necessary. Where a portable
battery is desired, the Stöhrer zinc-carbon battery will be found the
most useful.
I have mentioned these two batteries simply because I have them in use,
and they give me satisfaction. There are many others, however, that will
answer equally well. On the whole, any battery possessing quantity and
intensity in a medium degree will answer.
Footnotes:
[Footnote 1: A written description can never convey so true an
idea of anything, as an ocular inspection. I will therefore say
that it will afford me much pleasure to show any member of the
profession the apparatus I am about to describe, at my
residence.]
CHAPTER II.
MODE OF ADMINISTRATION.
I shall describe under this head the _modus operandi_ of administering a
routine galvanic or faradic bath. As it will become necessary to
describe special modes of administration when speaking of the
electro-balneological treatment of special diseases, the describing them
now would only lead to tautologies that I am desirous of avoiding.
Taking our cue from the indications to be met in each case, it becomes
necessary, according to circumstances, to use either the galvanic
current, the faradic, or both successively. As modifications of the
application of the currents we have to consider 1) their intensity; 2)
their direction, and 3) the duration of the application.
The intensity of the galvanic current corresponds directly to the number
of cells from which it is derived. It were vain however to attempt to
express this in figures, because the electro-motive force of different
batteries varies to so great an extent, that a number of cells of some
batteries of low intensity yield a current so feeble as to be barely
appreciable in the bath, while the same number of cells of a battery of
high intensity, furnish a current that few persons can bear without
pain. In thus comparing the Hill cell with the Stöhrer cell, I have
found the ratio to be about as 1 to 2½, i.e., as intense a current can
be derived from twenty-four Stöhrer as from sixty Hill cells—and this
is rather below than above the mark. Were all batteries alike in this
respect, however, still no particular number of cells could be given as
furnishing a current of suitable average intensity for the galvanic
bath, because of the excessively great variations in the degree of
electro-sensibility of different persons. This is so marked that I have
seen persons in the bath tub who could bear no more than six Hill cells,
diffused as was the current from these through the water and over the
entire body; while on the other hand I have met with male patients on
whom a current from thirty-two Stöhrer cells made not the slightest
impression, and where I was compelled to supplement the current by that
from a ten-cell quantity battery (zinc carbon elements 6 in. long by 4½
wide) in order to make them realize the presence of a current. These
gentlemen had no cutaneous anæsthesia.
In view of the facts just stated, I have found it impracticable, when
giving directions for the administration of a galvanic bath, to indicate
any certain number of cells to be used. I am in the habit of ordering
the administration of a “mild,” a “medium” or a “strong” current, as may
be required in the respective cases; and in every instance it is the
electro-sensibility of the patient that determines the number of cells
requisite to obtain the desired result as represented by one of these
terms. The same applies also to the faradic current.
To determine the direction of the current is sufficiently simple. Where
a descending current is desired, the binding post which represents the
electrode at the head of the tub must be connected to the positive pole
of the battery, the other binding post to the negative pole; where an
ascending current is desired, the reverse of this is done.
The duration of the bath varies with different cases. The average is
about twenty minutes, though the time may range from ten minutes to an
hour and a half.
Where it is desired to give the patient a galvanic shock, it is only
necessary rapidly to reverse the current by means of the commutator. The
simultaneous contraction of almost the ENTIRE muscular system that
accompanies the reversal of a current of sufficient intensity in the
bath, affords a striking illustration of the _general_ effects of the
galvanic bath. In cases where paralyzed muscles have lost their faradic
irritability, galvanic interruptions are almost indispensable to
successful treatment.
I have before (page 14) described a “surface board,” which I have
devised for the purpose of localizing the current from one of the poles
in any portion of the body where required. This proceeding should by no
means be looked upon as a “local” method of electrization; on the
contrary, it is just as much “general” as the ordinary electric bath.
Whereas in local applications the current runs from one point of the
body to another, in this case, supposing the spot where the surface
board is applied to be the centre, and the rest of the body the
periphery, a current runs between _every point_ of the periphery and the
centre, its direction being centripetal when the surface board
communicates with the negative, centrifugal when with the positive pole
of the battery.
The current is felt more or less intensely in proportion to the
proximity to the body of the surface board. With the galvanic this is
less noticeable than with the faradic current. When, for example, a
faradic current of medium strength being employed, the surface board is
held about six inches from the abdominal surface, little or no current
is felt. Let the surface board be now gradually approximated to the
abdomen, and the current will be felt more and more sensibly, until,
when about an inch away from the skin, or touching this, its influence
becomes so strong as to cause more or less energetic contractions of the
abdominal muscles. Where the galvanic current is employed, the skin
beneath the surface board will be found more or less reddened after a
few minutes’ application; the burning sensation ordinarily accompanying
galvanic applications will also be experienced more or less intensely,
in proportion to the strength of the current employed.
Where the current is to be concentrated in a manner still more energetic
than that described, this can be effected by raising the objective part
above the surface of the water, and then applying the surface board. In
this way the _entire_ strength of the current is concentrated in one
spot, whereas, when the surface board is applied under water, a large
portion of current is absorbed by this.
This appears to me the fittest place to say a few words in regard to the
relative conductivity of the human body and water—the latter at the
temperature ordinarily employed in baths, say from 90° to 95°
Fahrenheit. BEARD and ROCKWELL, in their work on Medical and Surgical
Electricity,[2] state that “the human body is a better conductor of
electricity than water at the same temperature.” Certain phenomena
connected with the administration of electric baths having forced upon
me some doubts in this respect, I made very careful experiments, both
with and without the aid of the galvanometer (Bradley’s Tangent), to
satisfy these. Without wearying the reader with details, I will state
that the result of my experiments leaves no room for doubt that water at
the temperatures stated—and still more so at 98½°—is superior to the
human body as a conductor of electricity. I do not mean to be understood
that water is a better conductor than _every constituent_ of the human
body; blood, for example, is a better conductor. But when I speak of the
body in this connection, I take it as we find it practically, i.e., with
the resistance of the skin, and especially the epidermis, superadded to
internal resistances. I have no doubt that with a flayed individual it
would be otherwise. I will add, that it will give me great pleasure to
repeat these experiments, which are sufficiently simple, in the
presence of any of my _confreres_ who feel an interest in the subject.
Having thus cursorily considered the manner of using the electric
current in the administration of a “routine” bath, and there being no
remarks required concerning the water employed, in addition to what has
been said in the previous chapter, a few words are in place on the
subject of chemicals. As has been previously stated (page 13) these are
added: _a_) to be absorbed, and thus act medicinally on the patient;
_b_) to act on the skin; _c_) through chemical affinity to facilitate
the elimination from the body of certain metallic substances, and _d_)
to further the absorption of morbid deposits. Of the many drugs and
medicines that no doubt may be made to answer these various purposes, I
have had personal experience with but few, and of these I will mention
the leading ones only. A requisite of all chemicals to be employed is
their ready solubility in water. Of substances intended for
absorption[3] I have used but three, viz: iron, iodine, and extract of
malt. The first of these I have employed in anæmic and enfeebled
conditions generally, but especially in chlorosis and chlorotic
hysteria, with marked success. It has the advantage, when administered
in this manner, not only of sparing the alimentary canal the frequently
injurious task of becoming the medium of its assimilation, but, in
addition to this, I believe that it can in this way be introduced into
the blood much more rapidly and in larger quantities than when given by
the mouth. The preparation which I have found, all things considered,
the most eligible for this purpose, is the “tartrate of iron and
ammonia.” This is very readily soluble, leaving no deposit, is
assimilable, and not too expensive for the purpose. As, in my experience
at least, it leaves nothing to wish for, I would consider it superfluous
to discuss in this connection any of the other ferruginous preparations.
Iodine I have employed with a view to its absorption in rheumatism and
gout. I cannot speak favorably of it in this connection. I have not in a
single instance found a bath charged with iodine, either in the form of
the tincture or of iodide of potassium, followed by results in any way
differing from those of the simple galvanic bath employed in the same
cases.
Extract of malt I have employed as a roborant, either alone or in
conjunction with iron, in cases of debility and malnutrition, and found
it of service.
Where the absorption of substances is aimed at, the _galvanic_ current
must be employed.
Where we add substances to an electric bath with a view of producing
some special action on the skin, we may be guided by the same principles
that govern ordinary balneology. Thus to obtain counter-irritant
effects, we may add mustard or common salt; to render the bath alkaline,
bicarbonate of potassa or soda, etc., etc.
An important object to be furthered by the addition to the galvanic bath
of chemicals, is the elimination from the system of certain metallic
substances. It will be found here that in practice we have to deal
chiefly with two substances, viz: mercury and lead. That the elimination
of these bodies by means of the galvanic bath is feasible, I shall
endeavor to demonstrate further on. At present I have simply to consider
the chemicals adapted for the purpose, and the manner of using them.
To facilitate the extraction from the system of mercury, nitric-acid has
been recommended by those who have heretofore instituted this treatment.
While I cannot positively deny that this substance may aid in the
elimination of the metal, I am compelled to state, after its trial in
several cases, that I have obtained equally good results from the simple
galvanic bath. In the light of my own limited experience, therefore, I
cannot insist on the necessity of adding any chemical to a galvanic bath
which is administered for the purpose of extracting mercury from the
body.
Where the elimination of lead is the object aimed at, I am, on the other
hand, satisfied of the utility of adding certain chemicals to the water
of the bath. Sulphuric acid has been suggested and used for this
purpose. I can say nothing respecting its usefulness, as I have never
tried it. Indeed, the results with iodide of potassium added to the bath
have been so satisfactory, that I have had no occasion to try any other
chemical, although almost any other of the preparations of iodine would
probably answer equally well. The chemical affinity of iodine for lead
affords a ready explanation of its usefulness in this respect. One ounce
of iodide of potassium to each bath appears to me a suitable quantity.
I have had no personal experience with any other cases of chronic
metallic intoxication than those with lead and mercury.
The absorption of morbid deposits (plastic exudations, etc.) can be
materially furthered by adding to a galvanic bath some resolvent—above
all, iodine.
I have said above (page 26) that I had found no perceptible benefit from
the addition of this substance to the galvanic bath in cases of
rheumatism or gout. The contrary holds good however with respect to the
frequent sequence of these diseases—articular deposits. When the acute,
and to a great extent the subacute symptoms have subsided—and in
chronic cases especially, and the disease has left effusions in various
joints, iodine, which when employed in this manner, appears to have
little or no influence on the pain accompanying these complaints, is a
powerful adjuvant in promoting the absorption of the deposits. In
chronic synovitis and all other articular affections accompanied by
exudation, the same holds good.
I have no doubt that future advances in this branch of science will
develop the utility of numerous other drugs and chemicals as additions
to the galvanic bath.—Before leaving this subject I must call attention
to the influence which the addition to the bath of certain substances
has on the conductivity of the water, resp. thus: the action of the
current on the patient. I have found that when I caused salt or
bicarbonate of soda to be added to the bath, the conductivity of the
water became so much increased, so disproportionately greater than that
of the body, as to render necessary the employment of very powerful
currents in order to cause the patient to feel them.
Footnotes:
[Footnote 2: “Medical and Surgical Electricity.” New York. 1875.
Wm. Wood & Co. pp. 431 and 432.]
[Footnote 3: For some experiments concerning the cataphoric
effects of the galvanic current, see an article by MUNK,
entitled “Ueber die galvanische Einführung differenter
Flüssigkeiten in den unversehrten lebenden Organismus,” in the
Allgemeine Medicinsche Central-Zeitung, No. 16, 1875.]
CHAPTER III.
PHYSIOLOGICAL EFFECTS.
In accordance with the plan of the present work, the remarks I shall
offer under this head are by no means intended to comprise all that is
known at the present day of the physiological effects of electricity in
general. It was my purpose when I undertook to write these pages, to
offer to the profession a book confined to one subject; not a
compilation, but a volume made up almost if not wholly of original
matter, chiefly, if not entirely the result of my own observations and
experience. For the general physiological effects then of electricity as
well as for the theories of its action, I refer those interested to the
many excellent works on the subject that have appeared within the last
few years. I will treat here only of the physiological effects peculiar
to the electric bath.
The daily observations that I have had the opportunity of making in this
respect, extending as they do over a period of upwards of two years,
have not been as fruitful of results as might be expected. This is due
mainly to the circumstance that but a small percentage—and these took
the baths merely as a refreshing tonic—of those whom I have had the
opportunity of observing, were in a condition that might be called
normal. By far the greater majority were suffering from some complaint,
in most instances of a neurotic or rheumatic nature, the presence of
which, while it afforded admirable opportunity for observing therapeutic
results, modified more or less the physiological effects of the baths,
and served to deprive them of a uniformity which might to a great extent
justly be looked for in healthy organisms. If, therefore, what I now
contribute to the physiology of the subject is but little, it will I
trust be at least found of practical utility in its applicability to the
therapeutics of the subject.
Before entering into details, it is necessary in the first place to
inquire in what respects electric baths differ from other methods of
electrization—especially those recently introduced as “general”—that
their physiological effects should merit individual consideration. They
differ in two ways. One of these is self-evident. To the effects of
electricity are superadded those of the warm bath. The effects of the
warm bath _per se_ are too familiar to every physician to require
comment. Its effects in combination with electricity, however, may not
be so generally known; and I therefore feel justified in quoting here a
passage that bears directly on the subject, from a recent German work by
Dr. Hartmann[4] of Wiesbaden.
“The last question, whether mineral water acts also by contact
with the skin, leads us to one of its most important
effects—that through electricity.
“Although this question has not as yet been finally disposed of,
we have still advanced far toward its solution, through the
admirable researches of HEYMANN and KREBS. Both observers have
furnished proof that the contact of the water of the bath[5]
with the human body gives rise to electric currents, which
currents must be looked upon as being the excitors of the
nerve-currents, the body acting merely as a conductor. From
these experiments we conclude that no particular difference
obtains between artificial and transported waters on the one,
and natural waters on the other hand, the assertions of
SCOUTETTENS notwithstanding, who in regard to electricity
claimed to have found a difference between the artificial and
transported waters and the natural ones.
“We gather moreover from the experiments, that the electric
current generated through the contact of the body with the water
of the bath is modified chiefly by the gases, next by the
temperature of the water, and lastly only by its salts.
“The effects of the bath depend on the strength of the electric
current generated and on the condition of the peripheral endings
of the nerves; the effect may be stimulating or soothing. The
strength of the current is governed, as we have seen, by the
quantity of gases present, the temperature and the salts.
Ordinary lukewarm baths, indifferent baths containing a small
amount of gases, are less stimulating than mineral baths
containing a larger proportion of gases.
“With regard to the relative condition of the peripheral
nerve-ends, experiments on the motor nerves go to show that
swelling of the terminal ends of these nerves may diminish their
excitability to the point of its complete extinction, while it
becomes increased by their exsiccation. This fact as to the
motor nerves is adopted by HEYMANN likewise as applying to the
nerves of sensation. If, now, we presuppose absorption or even
imbibition on the part of the skin, a swelling of the nerve-ends
is comprehensible, as the imbibed fluid reaches them. But,
according to HEYMANN, the peripheral nerve-ends, i.e., the
terminal bulbs of KRAUSE, of the sensory nerves, and the tactile
corpuscles of MEISSNER, become even without this presupposition
sufficiently impregnated with water while in the bath, because
here all insensible perspiration must cease, and in a bath of a
temperature lower than blood-heat transpiration cannot take
place, so that all transudation to the skin being retained
during the bath, those termini are surrounded by moisture and
therefore swell up.
“From this the writer concludes with regard to the effects of
the baths, that all baths in which the electric current produced
by contact of the water with the body preponderates over the
swelling of the nerve-ends, have a stimulant effect, while
those baths where the swelling preponderates over the electric
current, act as a sedative.
“Taking a brief and comprehensive review therefore of the
effects of mineral water baths, we have those resulting from the
temperature, from the contents of carbonic acid and salts, and
lastly from the electric current generated in the bath water;
each effect however resolving itself into an excitation of the
peripheral nerve-ends, which leads in a reflex manner to an
enhancement of the change of matter.”
From the foregoing quotation may be realized the importance which is
attached to the electric current in the warm bath. And here let me ask
the question: May not the remedial superiority, in many cases, of the
mineral water bath over the ordinary warm bath be due mainly, if not
solely, to the more abundant generation in the former of electricity? Or
rather, is it not very likely that this is so? And if such is the case,
it would appear evident that the mineral water bath, the electric
properties of which, depending on the chemical changes going on between
the gases and salts of the water on the one, and the cutaneous
secretions and other constituents of the body on the other hand, are to
a great extent beyond our control, must in turn be vastly inferior to a
bath where the electric current is under our perfect control, and can be
modified in intensity, direction and quantity to meet the individual
requirements of every case. And such is the electric bath I am now
describing.
The second difference between the electric bath and all other methods of
applying electricity is, that _the bath is the only method by means of
which general electrization can be realized_. In making a distinction in
this respect, it becomes necessary for me to advert more especially to a
method first introduced to the profession in a systematized and
scientific manner by Drs. BEARD and ROCKWELL,[6] and termed by them
“General Faradization.” The undoubted good results that have been
obtained from this method—for the details of which I refer the reader
to the latest work of the authors[7]—have caused it to be extensively
adopted by the medical profession, both here and in Europe. It is,
however, not with its results that I have to do at present, but with its
appellation and true nature. General faradization, so-called, consists
of a series of local faradizations, administered during one and the same
séance, until the current has alternately been made to impinge upon and
traverse the entire or at least a large portion of the body. This
cumulative procedure, it is true, approaches general electrization, as
represented by the electric bath, more closely than any of the other
local methods; yet it is not that which its name would imply, and I do
not think it requires argument to make it apparent, that even this
procedure differs vastly from the electric (whether galvanic or faradic)
bath, where the current at one and the same time impinges directly on
every peripheral nerve-end (excepting those of the head and face) and
traverses every part of the body, obtaining—both as to reflex and
direct effects—as a whole that which the method known as general
faradization seeks to obtain by the cumulation of fractional portions.
Having thus, I trust, established the individuality of the bath as an
electric method, I will without further digression proceed to the
consideration of its physiological effects.
The physiological effects of the electric bath may be qualified on the
one hand as either “immediate,” or “remote,” on the other as either
“transient” or “permanent.” Strictly to classify these is impracticable,
and I will therefore be influenced in the order of their enumeration
principally by their importance in a therapeutic respect.
One of the most pronounced as well as uniform, and at the same time
most important, effects of the electric bath, is its property as an
HYPNOTIC.
This somniferous influence, which is to some extent exercised by local
electrization, is here distinguished by its far greater constancy as
well as by its greater degree of perfection. That this difference should
exist, appears quite natural, when it is considered that the same
topical influences which produce it in local electrizations, and which I
shall presently endeavor to analyze, are here brought to bear on the
entire system. The hypnotic effect is both immediate and remote, and
more or less permanent. When there is an immediate inclination to sleep,
which may make itself manifest during the bath or immediately after
this, it is generally accompanied by a
PLEASANT SENSE OF FATIGUE,
which cannot be likened to weariness, but rather to what we feel after
moderate exercise; it is only in some instances, where an individual
takes his first bath, or where, for therapeutic reasons, a strong
faradic current—accompanied by responsive muscular contractions—is
employed, that this feeling is intensified sufficiently to become
unpleasant, calling for rest and recuperation, and must here be looked
upon as analogous to the effects of _severe_ exercise. It invariably
disappears after a brief rest.
Experience and good judgment will enable us moreover in almost all cases
to avoid effects of this kind. The immediate inclination to sleep is
much more decided as well as constant when the bath is taken late in the
day, than when taken in the forenoon. When the latter is the case
however, the individual will as a rule become sleepy during the
afternoon, or else at an earlier hour than usual in the evening, and
sleep more soundly during the night. This is the effect of one bath. A
series of baths will however produce more or less marked and permanent
improvement in the sleep of individuals, where this has been below the
normal standard. And this is among the most invariable of the effects of
the electric bath, whether galvanic or faradic.
I have formed a theory as to the _rationale_ of this influence, which I
will offer as its probable explanation. We all know that sleep is a
process designed by nature for the recuperation of the system after a
certain period of activity. In other words, when the various functions
have been more or less exercised for their daily allotted time—say
seventeen hours—the respective organs need that profound rest which we
know as sleep. Now, it is pretty well conceded by physiologists, that
electricity stimulates the secretory as well as excretory organs; that
it furthers endosmosis and exosmosis—by its electrolytic influence in a
physical, by its influence on the nervous system in a catalytic manner,
in short, and by virtue of these properties, that it greatly
ENHANCES THE CHANGE OF MATTER
and incites the various organs to so great an activity as to cause them
to perform in a comparatively brief space of time—say an hour, the work
of several hours. The natural sequence is obvious: _The want of rest—of
sleep, is felt at a correspondingly earlier period._ I offer this as a
probable explanation of the immediate or almost immediate disposition to
sleep. As to the permanent improvement in sleep, where this has been
below the normal standard, it must always be due to the removal of some
morbid condition, and thus belongs among therapeutic results, rather
than physiological effects. It is true that in many instances of
_agrypnia_ we are unable to discover any pathological condition that
would account for this symptom; but the probability is that here there
is a sluggishness of some one or more of the functions, mental or
physical, too obscurely manifested to be discovered by our present means
of diagnosis, yet reached and rectified by a mode of electrization that
traverses and permeates _every_ portion of the body.
If this explanation of the hypnotic effect of the electric bath be not
the true one, it is at least—so far as I know—the first attempt at
accounting for a phenomenon that has been noticed as a result of even
local applications of electricity by many observers, and about the
pretty uniform occurrence of which there can be no doubt.
With respect to the effect on the
TEMPERATURE AND PULSE,
I have made a number of observations, of which I have recorded
twenty-two, made on persons where both were at or nearly at the normal
standard. With regard to the frequency of the pulse, the results were
conflicting and by no means reliable. In the majority of cases there was
an increase, immediately after the bath, ranging from four to eighteen
beats per minute. In others there was no change whatever, and in a few
there was an absolute diminution in frequency; this last I believe
however to be a therapeutic rather than physiological effect,
manifesting itself only where there is pneumogastric asthenia, and
attributable directly to electric stimulation of this nerve. Thus in one
instance, which occurred in the person of a physician of this city, who
had an intermittent pulse, the result was as follows: Immediately before
bath: pulse 70, two intermissions; at the expiration of 15 minutes,
during which he was under the influence of a descending galvanic
current: pulse 65, two intermissions; at the end of ten more minutes,
during which he received the faradic current: pulse 65, no
intermissions; ten minutes after leaving the bath: pulse 66, no
intermissions. As a rule then, we may look for an immediate and more or
less transient moderate increase in frequency of the pulse. As for any
permanent increase or reduction of the pulse, there is none as a
physiological effect. Where such an one does take place, it is by the
removal of some morbid influence on the heart, and must be looked upon
as a therapeutic result.
With respect to the temperature, the results were somewhat more uniform.
I have found that where this is either normal or slightly below, the
immediate but transient effect is to raise it from 2 to 6 tenths of a
degree (Fahrenheit)—in most instances 4 tenths. In a very few cases it
remained unchanged, and in one case, where before the bath the
temperature was 100, at the close of the bath it was 99-3/5. Of
permanent modifications of the temperature, the same holds good that I
have said of permanent changes in the pulse. It must not be forgotten
that the temperature of the water is undoubtedly an important factor in
modifying the temperature of the body. In almost all instances where my
observations were made, the temperature of the water was below that of
the body, being 95° or a little less. This, which has a tendency to
lower the bodily temperature, is to some extent counterbalanced by the
suppression of the insensible perspiration, so that modifications of
temperature resulting from electric baths, the water of which is but few
degrees below 98½°, may justly be attributed to the influence of the
electric current. The importance of the electric bath as a
PHYSIOLOGICAL STIMULANT AND TONIC
cannot be overrated. I deem it superior in this respect to any other
known agent. This effect manifests itself _immediately_ by a feeling of
exhilaration and unwonted vigor, _remotely_ by an improvement—where
there is a margin for such—in the performance of some or all of the
physiological functions, as well as by a gradual but nevertheless marked
_increase in weight_.
Most striking among the tonic influences of the baths, are those that
occur within the sphere of the digestive and sexual apparatuses. I will
first consider the effects on
THE DIGESTIVE APPARATUS,
which may be subdivided into those on _a_) the appetite, _b_) digestion,
absorption and assimilation, and _c_) alvine excretion. The improvement
of the appetite under electro-balneological treatment is one of the most
constant effects of this. While a series of baths will produce permanent
results in this respect, an increase of the appetite, in some instances
amounting to positive hunger, is a tolerably uniform and more or less
immediate result of each separate bath. The permanent improvement of the
appetite is relative. Not very appreciable where this is normal, it
becomes most marked where the appetite has from some cause been
impaired. The effect on the appetite is _definite_. The effects on
absorption and assimilation are _presumptive_; but when we couple the
absence of any corresponding difficulty in digesting the increased
supply of food, with the increase before alluded to in the weight of the
body, their assumption becomes fully justifiable. It is these combined
influences that make the electric bath so valuable a remedy in almost
all forms of dyspepsia.
The influence on the alvine process is if anything even more marked than
that on the assimilative process. Where the action of the bowels is
normal, it is not modified permanently by the electric bath, although we
often have, as an immediate consequence, a cathartic effect that
manifests itself as a more or less watery evacuation, either a few hours
after the bath or on the succeeding day. Where the fecal process however
is sluggish, the improvement resulting from the baths is very striking.
I shall recur more fully to this subject under the head of constipation.
The effects on the various functions connected with digestion are due
doubtless to the combined influences of stimulation of the secretions of
the alimentary canal and stimulation of the muscular coats of the
stomach and intestines, as well as permanent tonization of the
_muscularis_. While the enhancement of the secretions is undoubtedly due
chiefly to the electric stimulus to the secreto-motor nerves, and the
increased activity of the muscular coats to a like influence transmitted
to their motor nerves, I believe the permanent tonization and
invigoration of the muscular fibres to be mainly attributable to the
direct trophic influence of the current traversing the parts
themselves; and I have no doubt that this direct influence has much to
do with the stimulation of the secretions and _peristalsis_ also. At any
rate, I have never obtained from galvanization of the nervous centres,
which I have practiced in a great number of cases, the striking effects
on the alimentary processes which are so uniform a result of the baths.
The influence on the
SEXUAL APPARATUS
of the electric bath does not manifest itself in so striking a manner as
in the case of the organs of digestion. It is true I have seen
individuals whose sexual functions were normal, have _stysis_ in the
bath, but the mere cutaneous irritation of the electric current is here
sufficient to account for a phenomenon which, where sexual irritability
is intact, will follow any other local irritations.
If not as immediately perceptible, the stimulant and permanent tonic and
invigorating influences on the sexual organs are not much less constant
than the corresponding influences on digestion. Careful observation,
however, of a considerable number of cases where the sexual function was
more or less impaired, has convinced me that while there can be no
doubt that _direct_ influence on the innervation, tone and nutrition of
the respective parts as well as the stimulus which the electric current
furnishes to the seminal secretion, bear a share in the improvement that
takes place, permanent beneficial results must be looked upon as chiefly
the expression of improved nutrition and tonization of the system at
large. I do not mean to be understood as wishing to put in negation the
beneficial results that the local influence of electricity is capable of
sometimes accomplishing in the sexual sphere. These results, however,
are not of a physiological, but rather of a purely therapeutic nature,
and are obtained there only where local morbid conditions exist. Now, in
the great majority of the cases that have come under my observation, the
causes of deterioration of the sexual capacity, though frequently
obscure and indefinable, were certainly not local, but to be sought for
in the general—most probably the nervous—system. In none but perhaps
the very mildest and recent cases have I ever seen _rapid_ results
follow electrical treatment of any kind whatsoever. In support of my
assertion however that in the majority of cases the sexual sphere can be
influenced only through the system at large, I will state _first_, that
I have seen cases where local electrical treatment had utterly failed
to do the slightest good, respond favorably to the baths, and _second_,
that where success was met with, it was only after persistent treatment,
continued long enough to modify favorably the condition of the entire
organism, and through this the objective sphere.
The stimulant and tonic effects under consideration, although shared to
some extent by other methods of electrization, are here far more
comprehensive and pronounced, a fact which is not surprising, when we
reflect that in the electric bath not only are all the organs
_indirectly_ influenced through stimulation of the nervous centres, but
each separate organ is at the same time _directly_ acted upon by the
current.
A direct sequence of the stimulant and tonic effects of the electric
bath is its
SEDATIVE INFLUENCE.
This sedative effect, whereof the hypnotic effect already spoken of is
the supreme manifestation, must not be associated for a moment with any
idea of depression, for here we have none such. In addition to what I
have already said in endeavoring to account for the hypnotic influence
of the baths, I refer the reader for further information to the
admirable and lucid remarks on this subject by BEARD and ROCKWELL.[8]
The _galvanic_ bath shares with other galvanic applications made in the
cranial and upper spinal region, the effect of producing the galvanic
_taste_, as also the _flashes_ when the current is interrupted, showing
that the
CRANIAL NERVES
come within the sphere of its influence.
A further effect peculiar to the galvanic bath is a sense of
ITCHING,
felt chiefly in the lower extremities and about the neck, and
proportioned to the intensity of the current. Rather pleasant when mild
or medium currents are used, under the influence of strong currents it
may become so intense as to create an irresistible desire on the part of
the bather to scratch especially the legs.
A negative effect of the galvanic bath, even where very intense currents
are used, is the
ABSOLUTE FREEDOM FROM PAIN
throughout the entire process. I wish this to be understood of course
as holding good only when currents within the ordinary limits of
intensity are employed. The strongest that I have used, and on which I
base my statement, was that from 48 Stöhrer or 60 Hill cells. As
stronger currents are not required for therapeutic purposes, what I have
asserted remains practically true as applied within these limits.
This absence of pain, which cannot be claimed for correspondingly
intense local applications, is to be attributed to the _diffusion_ of
the current throughout the body and its surface, as well as through the
water of the bath. The redness of the _entire_ back after a galvanic
bath, is among the proofs of this diffusion.
Freedom from pain is a characteristic likewise of the faradic bath,
_properly administered_. When too strong a faradic current however is
incautiously administered, the resulting muscular contractions are
accompanied by an amount of local pain proportioned to the violence of
the contractions. By keeping the faradic current within proper limits,
all pain can be avoided.
With respect to
MUSCULAR CONTRACTIONS,
the effects of the electric bath may be distinguished from those
obtained by other modes of faradization by their comprehensiveness.
Many groups of muscles may be made simultaneously to contract by this
means. The practical bearing of this on the therapeutics of _pareses_
and _paralyses_, renders it an important characteristic of the bath.
The physiological effects on
THE MIND
of electric baths, is a natural result of the enhanced tone and vigor of
the physical system, and keeps pace with this. Mental buoyancy and even
exhilaration are among the most common sequences of electric baths.
Although indirect, these results are none the less decided.
It has been my aim in the foregoing remarks to give the reader, as
concisely as possible and within the limits which I set for myself in
the beginning of the present chapter, a summary of the more important
physiological effects of electric baths. As the isolated results of
observations made in a limited field by one unaided individual, I trust
the shortcomings of this chapter will be viewed indulgently. If what I
have said of the physiological effects of electric baths proves the
means of stimulating to further investigation more competent observers
than myself, my labor, whatever its imperfections, will not have been in
vain.
Footnotes:
[Footnote 4: Dr. Franz Hartmann; “Der acute and chronische
Gelenkrheumatismus,” Erlangen, 1874; pp. 194 et seq.]
[Footnote 5: The Author here refers to mineral-water. Dr. S.]
[Footnote 6: The Medical Use of Electricity, with special
reference to general electrization as a tonic, etc. New York,
1867.]
[Footnote 7: Beard and Rockwell; Medical and Surgical
Electricity. N. Y. 1875.]
[Footnote 8: Op. cit. pp. 253. et seq.]
CHAPTER IV.
GENERAL THERAPEUTIC EFFECTS AND USES.
The therapeutic uses of a remedy are based on what we know of its
physiological effects. Many—or rather most—of the therapeutic effects
of this as well as of most other remedies, correspond to certain
physiological effects. Those therapeutic effects whereto we find none
analogous among the physiological effects, are yet the results of the
physiological tendencies of the remedy, and where these tendencies do
not manifest themselves as results, it is because they find no field for
action in the healthy organism. When they meet with the requisite
pathological conditions, these tendencies make themselves manifest in
the shape of definite results, commonly known as therapeutic effects.
NOTHNAGEL, in his classical work,[9] recognizes this theory by excluding
from his book the term “therapeutic effects” altogether. Where he finds
it necessary to say anything of the physiological effects of a remedy,
in addition to those “on man in health,” he speaks—still under the head
of “physiological effects”—of those “on man when sick.” When, setting
aside its empirical employment, we come then to inquire what it is that
furnishes us with the true indications for the use of a remedy, analysis
of the question leads us invariably back to its physiological effects.
If I have failed nevertheless to include the few effects which I am
about to touch on, under the head of “physiological effects,” I have
done so simply in compliance with universal usage, and as a matter of
convenience for reference.
I will now, without further digression, proceed to the consideration of
those effects of electric baths not yet enumerated.
As a fitting precursor to the enumeration of the therapeutic properties
of the remedy under consideration, it may be well to dwell for a moment
on what is among its most prominent characteristics; I have reference to
its great value as a
DIAGNOSTIC.
In explanation of this, I will state that in a very large number of
cases of disease of an obscure nature, and where, to be candid, the
electric bath was employed empirically, or, if you please, tentatively,
it has served to point out the _locus morbi_. The number of cases in
which I have made this observation, has been sufficiently large to
establish beyond a doubt the fact, that as a rule the electric current
makes itself more decidedly and often even painfully felt in any part
where a morbid condition exists; whether this be of an inflammatory,
neuralgic, rheumatic, traumatic, congestive or other nature, the result
is the same. It appears to be somewhat analogous to the “tenderness on
pressure” that we find present in many of these conditions. In
_anæsthesiæ_ even the current makes itself conspicuous by the _absence_
of its normal effects. The value of this will at once be recognized in
connection with a method of electric application which at one and the
same time acts on every portion of the body. Local electrization is
accompanied by like phenomena, _when we happen to strike the right
spot_. The superiority of the bath as a means of diagnosis is found in
the circumstance that here we _must_ touch it.
The great importance of this feature of the electric bath will at once
be realized by every physician of much experience, for there can be none
such who has not frequently met with subacute or chronic conditions the
etiology of which was more or less obscure.
One of the most important effects in its therapeutic application of the
electric bath, is its superior excellency as an
EQUALIZER OF THE CIRCULATION;
so far as I know, it is more potent, constant and comprehensive in this
respect than any other agent. Where an imperfect circulation of the
blood is due to irremovable organic causes, the results obtained will of
course be transient only. In all other cases, however, favorable
results, more or less perfect according to the nature of the case, may
be reliably looked for. Both currents act very well in this respect,
though on the whole I look upon the galvanic as superior to the faradic
current.
As a theory of this effect of the currents I would offer the following,
viz: That the galvanic current acts by stimulating the vasomotor centres
and peripheral nerves, by giving tone to the mucular coats of blood
vessels, and by counter-irritation. That the _faradic_ current
stimulates the vasomotor centres little, if at all, does not influence
the coats of vessels, except such as are close to the skin, but
tonicizes these latter more effectually than the galvanic current; that
it stimulates the peripheral nerves to some extent, though far inferior
in this respect to the galvanic current; but that when employed of
sufficient intensity it superadds to those mentioned a strictly
mechanical action, which consists in forcing static blood from the
capillary into the general circulation through the medium of muscular
contractions.
As a
GENERAL COUNTER-IRRITANT
the _galvanic_ bath has few if any superiors. The degree of
counter-irritation can be very nicely determined by regulating the
intensity of the current. The characteristic tingling sensation of the
galvanic current is felt over the entire surface, corresponding in
degree of course to the intensity of the current; while the redness of
the skin, bearing a like relation to the intensity of the current, is
observable more especially near the electrodes, being particularly
conspicuous over the entire back. Concentrated local counter-irritation
can be obtained by the use of the surface board.
The counter-irritant effects of the galvanic bath, differ from those of
ordinary counter-irritants in their freedom from pain, even the slight
burning sensation accompanying strong currents ceasing with the
application. The redness remains quite a while and the stimulus to the
peripheral circulation causes the persistence for some time of a
“glowing” sensation all over the body.
In the chapter on physiological effects enough has been stated to make
it apparent that as a
GENERAL INVIGORANT AND TONIC
the electric bath can have few if any superiors. In the healthy
organism, however, the stimulant and tonic effects of the baths are much
less marked than they are where the general condition is “below par.” In
health there is little or no margin for improvement. The results
obtained are _temporary_ stimulation, and a permanent invigoration which
partakes more of artificial development than anything else. It is
analogous to the development by gymnastic or other exercise of a
previously healthy set of muscles. Where we meet with atonic conditions
however, with debility, malnutrition, want of energy or general asthenia
of an obscure nature, and amenable to electric influence, the tonic
effects of the baths become striking and brilliant. I have observed
cases where patients fairly bloomed up under their influence and
acquired actually more physical strength and weighed more than before
they became sick. When we consider how in such conditions as those
mentioned, patients are made to swallow pills and mixtures for months or
years, or, more appropriately, and if they can afford it, are sent
abroad, we can realize the importance of an agent by means of which the
desired end can be obtained more conveniently, certainly, economically
and in a shorter time than by any other means. There is no rule without
its exceptions, and I freely admit that in many instances where persons
are, as the saying is, “run down,” a sojourn in some mountainous region
or a course of sea-bathing, etc., would do them more good than anything
else, electric baths included. The results obtained from these last are
however sufficiently uniform to justify us in looking for very favorable
results in every case.
In the preceding chapter I have already dwelt on the
HYPNOTIC AND SEDATIVE INFLUENCE
of the baths. It is only necessary to state here that this influence
manifests itself still more decidedly in corresponding morbid conditions
than in health. The greater the degree of restlessness, irritability or
wakefulness, the more strikingly does the soothing and hypnotic
influence of the baths—appropriately administered, of course—become
apparent.
IMPROVEMENT OF NUTRITION,
as manifested by rapid increase of weight, and which I have likewise
touched upon in the preceding chapter, is a reliable, constant effect of
electric baths. Where previous loss of weight is due to an incurable
organic disease, it is, if at all obtained, of course much less in
degree, as well as transient. When due, however, as is frequently the
case, to causes that are amenable to electrical influence, the increase
in weight is marked, and has a tendency to be permanent.
It will be seen that the few therapeutic effects which I have here
enumerated, are in reality nothing more than intensified physiological
effects, there being about them nothing that might be termed specific.
It may be asked in reply: why then did I devote any space to them at
all? I will answer that I thought best to point out some general
therapeutic USES for which electric baths may be made available, and the
indications for which are furnished by so great a number of pathological
conditions, that omitting special reference to them would have led to a
great deal of tautology in the chapter on “special therapeutics.”
Before leaving the subject of “general uses” of the baths, I will dwell
for a moment on their admirable adaptability as a
PROPHYLACTIC.
Every physician is fully aware of the fact that disturbances of the
circulation constitute one of the most frequent causes of disease. There
are, indeed, comparatively few pathological conditions that do not bring
with them congestion of some more or less important organ. A remedy then
which more than any other has a tendency to equalize the circulation,
and thus counteract a condition which as cause or effect, or both, is an
almost universal concomitant of disease, and which in addition to this
is so admirable and physiological a stimulant and tonic, can hardly be
surpassed as a prophylactic by any other uncombined remedy.
Footnotes:
[Footnote 9: Dr. Hermann Nothnagel: Handbuch der
Arzneimittellehre. Berlin, 1870.]
CHAPTER V.
SPECIAL THERAPEUTICS AND CLINICAL RECORD.
I have thought it best for practical purposes, to accompany the
consideration of the treatment of special diseases by the histories of
illustrative cases, where I had such at command.
Before entering on the subject proper, I wish to offer some general
considerations that may influence and guide us in determining when,
where and why to employ electric baths as a remedy.
To realize thoroughly the indications in given cases for the employment
of electric baths, we must first of all be more or less familiar with
the effects and uses of the electric current as well as those of the
ordinary warm bath. We must realize the fact that here we not only have
these two forces united, but that the more important of the two, the
electric current, here acts directly (locally) as well as indirectly
(through the nervous centres) on every portion of the body—a
circumstance of great importance in differentiating indications on the
one hand for the baths, on the other for local electrization. In view
of these circumstances we are fully justified in looking for results far
more comprehensive than any that might be obtained singly from either of
the two remedies that are here combined. There can be no doubt that in
many cases the resisting power of a disease is sufficient to withstand
two remedies brought singly and alternately to combat it, whereas the
simultaneous combined action of these remedies may be fully adequate to
overcome this resisting power.
Approaching in its effects more closely to the electric bath than any
other remedy, is the process known as “general faradization,” to which I
have already alluded (p. 36). In choosing between this and the bath, I
state it as my conviction that, while there may be a small proportion of
cases in which general faradization, so-called, is preferable, in almost
all the cases where both these remedies are applicable, the faradic bath
deserves the preference—it is a _more complete_ faradization.
We need never be afraid of ordering electric baths on the score of any
imagined exertion or discomfort attaching to them. The most delicate,
the aged and children alike, bear them with far more ease, comfort and
impunity than any ordinary warm bath, or any but the mildest local
electrization. The entire absence of shock or pain of any kind
whatsoever, is always an agreeable surprise to those who, urged by their
physicians, have with fear and trembling submitted themselves to a
treatment, the mere name of which filled their minds with
extravagant—and, it is useless to say, groundless—visions of painful
shocks. Thanks to the tonic effects of the current, they are by the
feeble and infirm borne much better than the ordinary warm bath. There
is likewise much less liability to get cold after the electric bath. The
stimulus which the current furnishes to the peripheral circulation is a
powerful protection against cold, so that even in midwinter I see people
daily take electric baths at an average temperature of 95°, and enjoy
apparent immunity from colds.
Having once determined on the use of the baths in a given case, we have
to observe certain points in their application.
In the first place, guided by what we know of the relative effects of
galvanism and induced electricity, we must decide which of these two
currents to use, and if both, in which order. We must determine on the
direction and intensity of the currents, as well as on the duration of
the baths.
Next we must use our judgment as physicians, in deciding whether a
given case promises to get well under electro-balneological treatment
alone, or whether auxiliary treatment may not be required to bring it to
a favorable issue.
With respect to the frequency of the applications, I will say that while
there are some cases where a bath twice a week is sufficient, and others
where a bath every day is imperatively necessary, in far the greater
majority of cases suitable for electro-balneological treatment, a bath
every alternate day is _sufficient_, but a bath every day is
_better_—it leads to more rapid as well as certain results.
In most of the cases, a daily bath for a few days or a week, followed by
one every other day for a time, and, when the cure is about completed, a
bath twice a week, to _consolidate_ and _confirm_ the good results
obtained, has done me the best service.
I would dwell particularly on the necessity of _perseverance_ in this
treatment. The majority of cases that have come under my observation in
this connection, have been of a more or less chronic nature. In many of
these, where medicinal and other treatment had been unavailingly gone
through with for weeks, months and even years, I have found existing the
most absurd expectations with regard to the effects of the baths. People
who had made the tour of almost all the watering-places of Europe
without obtaining the slightest benefit, have come to me imbued with the
idea—whence derived I know not—that one or two baths should greatly
improve, and two or three more cure them; and when these expectations
were not realized, they would promptly discontinue treatment, fully
satisfied that electric baths were no more capable of benefiting them
than “all the other things.” I do not mean to be understood for a moment
as intending to imply that ideas of this nature are shared by the
profession; I mention them simply in order to show the necessity on the
part of physicians to disabuse in this respect the minds of those
patients whom they may send for electro-balneological treatment.
In appropriate cases, the use of the bath should not be too long
deferred. I have had frequent occasion to become cognizant of the fact,
that cases have been sent by physicians to take the baths only after
prolonged ineffectual treatment of another nature had been gone through
with, and where negative or at best tardy results took the place of the
brilliant results that might have been obtained, had the cases been sent
earlier. I do not mention this in a fault-finding spirit; to do so would
be unjust. The remedy under consideration has up to the present time
been too little known, the indications for its employment—in the
absence of statistics—on too uncertain a basis, to expect from any but
specialists the early realization in any case of its appropriateness. I
trust however that in the future, from being a “dernier ressort,” it
will come to take its proper place among other remedies, to be
administered “when it will do the most good.” When this comes to pass,
the results obtained, satisfactory as they are even now, will become as
brilliant and well-authenticated as those of every other remedy from
which experience has taught us how to reap the greatest advantage.
In the following “clinical record” I shall not omit to cite cases where
the baths were unsuccessful, wherever it shall appear to me that the
citation of such cases may be of assistance in arriving at a true
estimation of the therapeutic value of the remedy.
In giving the histories of cases, it will scarcely be necessary to enter
very minutely into details; the demands of the present work will be
fully met if sufficient is said of a case to illustrate the effects of
the baths in the class of cases that it represents.
Finally, I wish it understood that in a few of the conditions in which
I shall advise the employment of the baths, I have had no personal
experience in their use, but base my opinions on what I know of their
effects, together with what is known of the results obtained in
analogous conditions by local electrical methods.
SPECIAL DISEASES.
RHEUMATISM.
Its great frequency, the pain and discomfort which it occasions, and its
many, often dangerous _sequelæ_, added to its frequent obstinacy under
the most varied treatment, render rheumatism one of the most formidable
diseases that we have to encounter. The long list of remedies that have
from time to time been employed in its treatment, bear witness by their
very number to the little reliance that can be placed in any one of
them. A remedy then which can be _relied on_ to exercise a favorable
influence in all the forms of rheumatism—acute, subacute and
chronic—as well as on most of its sequelæ, should of right become a
welcome addition to our armamentarium in the treatment of this disease;
and such is the electric bath. The treatment of the sequelæ I shall
speak of under separate heads. The disease itself I will divide into
three classes, viz: _a_) acute, _b_) subacute and _c_) chronic
rheumatism.
_a_) ACUTE RHEUMATISM.—A few years ago the use of electricity in acute
inflammatory conditions was scouted by most of the profession, and had
it not been for the quiet and patient labors of a few progressive
spirits, we would at the present day be still deprived of the benefits
which we reap from it in these conditions. Even to-day, the number of
those who are satisfied of the utility of electricity in this respect is
comparatively small. Only two years ago, I attended a gentleman who was
suffering from a very severe attack of rheumatic gout. I had both a
galvanic and a faradic battery at his house, which, in addition to
appropriate medicinal treatment, I applied daily to the affected
joints,—using mainly the faradic current. Being compelled at the time
to go to the country, the case during my absence drifted into the hands
of a gentleman, a professor at one of the medical colleges, of high
standing in the profession and considered one of our leading medical
men, who ridiculed and promptly discontinued the use of electricity in
the case. He gave it as his opinion that it did more harm than good, and
I have no doubt he did so conscientiously—however unprofessional his
conduct may have been, in this as well as other respects. The
contributions of others have since then vindicated my views in this
respect. Among others, Dr. Drosdoff[10] of St. Petersburg has given a
number of cases of acute articular rheumatism from the clinique of
Professor Botkin, in which the faradic current was employed either alone
or in conjunction with other treatment. From among the deductions which
he makes from a series of careful experiments in this respect, I quote a
few—such as bear directly on our subject, and to which I affix my own
numbers.
1) “The sense of pain as the result of electric irritation is
considerably diminished, and sometimes entirely lost, in joints
attacked by acute articular rheumatism, so that the patient
experiences no pain, even when the distance between the coils
equals naught[11], and both closure and opening are accompanied
by the evolution of numerous sparks. At the same time the
slightest pressure of the affected parts gives rise to the most
intense pain.”
“The diminution of the electro-sensibility appears in the
majority of cases to be in inverse proportion to the severity of
the disease and the intensity of the pain produced by mechanical
irritation.”
2) “The enhanced tactile and thermic sensibility of the diseased
joints is diminished by a faradization lasting from 5 to 10
minutes.”
3) “From 5 to 10 minutes faradization causes a reduction of the
previously heightened temperature of the diseased joints to the
normal standard, or even below this.”
4) “The subjective rheumatic pains which are augmented by
pressure and motion, are diminished by faradization. This
diminution is sometimes so considerable, that the joint, which
prior to the faradization admitted of no movement, is able to
execute passive and active movements with tolerable facility.”
5) “The rheumatic pains as well as the temperature of the
affected joints remain diminished after the faradization for 3,
4 and even 5 hours; they then gradually return to the previous
height. At the same time the duration of the paroxysms of pain
becomes shortened, and the intensity of this diminished.”
6) “Although the rheumatic process takes a more rapid course
under the influence of faradization, and incommodes the patient
less, we have nevertheless made the observation in one case,
that the tendency to recurrence is not diminished. The attacks
however become more brief and milder.”
7) “From what has here been said it follows, that daily
faradizations, lasting 5-10 minutes, diminish the severity of
acute articular rheumatism, restore the perverted cutaneous
sensibility, and cause a reduction of the temperature of the
affected joints.”
8) “Several of those suffering from the pathological processes
mentioned, received no medication in addition to the
faradization, and yet made a tolerably rapid recovery.”
I might adduce further testimony of the value of electricity in recent
cases of rheumatism, were it necessary to do so. The results in my own
cases however have long since satisfied me of the utility in this
respect of faradic not only, but also of mild constant currents.
Accepting this as matter of fact, let us next inquire where and why we
are to give _general_ electrization—in other words, the electric
bath—the preference over local applications.
Where the manifestations of the disease are limited to a single joint,
or at best a very few joints, or where we have to do with a case of
muscular rheumatism—to one group of muscles, local electrization, as
_symptomatic_ treatment, will answer. Where on the one hand however many
joints, on the other the muscles of entire limbs, or even more, are
involved, the advantages of a method by means of which we reach all the
affected parts at once, thus effecting in, say ten minutes, that which
where, for example, six joints are involved, would by the ordinary
method require sixty minutes, are readily realized. There is, however,
another reason why the baths are preferable in rheumatism to local
applications. Rheumatism is a constitutional disease with local
manifestations. The metastatic character of muscular rheumatism
especially appears to indicate the greater importance of general as
compared to local treatment. Pre-supposing, then, that electricity
exercises the favorable influence on rheumatism which clinical results
would appear to demonstrate, it follows that the electric bath, while it
furnishes symptomatic (local) treatment equally well with local
applications, does something more; it meets the _indicatio morbi_
likewise. The warm bath no doubt contributes its due share in bringing
about the favorable results obtained.—Where the disease then does not
confine the patient to bed, the electric bath will be found a most
valuable remedy.
The following directions will be found to answer best in the great
majority of cases: The temperature of the water should range from 90° to
98° F; a mild constant current, descending, should be applied for ten
minutes; this to be followed by a faradic current of as great an
intensity as the patient can bear _without the slightest degree of
discomfort_. In the application of the faradic current, the surface
board (see p. 12) may advantageously be had recourse to for the purpose
of more concentrated influence on affected parts, to each of which it
may be applied for a few minutes; the entire faradization may last from
ten to fifteen minutes. When coming from the bath, the patient should be
received in a warm blanket, anything like a chill being carefully
guarded against. In cases where the cutaneous secretion is of an
abnormally acid character (which is often so marked as to become
apparent through the sense of smell), bicarbonate of soda or potassa may
be added to the bath. As appears from the foregoing, the entire duration
of the bath is from twenty to twenty-five minutes. The baths should be
taken daily until all urgent symptoms have disappeared; after this,
every two or three days as required, until an entire cure is wrought.
As the results of this or similar treatment, conjoined with the
requisite medicinal or other measures, I may state:
_a_) Considerable abridgment of the period of the disease;
_b_) Sequelæ are less constant;
_c_) The tendency to recurrence is very much diminished;
_d_) A relapse, if it does occur, is comparatively mild.
With regard to _b_ and _c_, let it be understood that I speak within the
restrictions of a period of observation extending over two and a half
years only.
_b_) SUBACUTE RHEUMATISM.
In the subacute variety, the electro-balneological treatment is similar
to that in acute cases, with the difference however, that here not so
much care is necessary with regard to the intensity of the currents.
Muscular contractions, as induced by strong faradic currents, are to be
dreaded in direct proportion to the acuteness of the inflammation,
_resp._ the sensitiveness of the inflamed tissues.
It will be understood, I hope, that the electro-balneological treatment
as laid down above, though it applies to the majority, does not apply to
all cases. Special complications may make it expedient in individual
cases to modify the treatment more or less. The course to be pursued in
these instances may however be safely left to the judgment of the
attending physician.
_c_) CHRONIC RHEUMATISM. In this affection the course to be pursued
varies from that indicated in the acute and subacute varieties. We have
here little or no constitutional disturbance, and need have no fear of
doing any harm by strong currents. On the contrary, I have found that
mild currents rarely do any good. By far the greater majority of the
cases that have come under my observation were of the muscular type, the
algic portion of the symptoms approaching those of neuralgia rather than
subacute rheumatism. Of chronic articular rheumatism I have treated but
very few cases. Although in some of the cases the treatment under
consideration was attended with brilliant results, I freely admit that
in some instances the results were imperfect, in others again entirely
negative. This I found true more especially of cases that involved
tendons. I must add, however, that in perhaps the greater majority of
the unsuccessful cases the fault lay with the patients themselves, who,
finding they were not benefited as rapidly as they had expected,
discontinued treatment before this had had time to effect any thing.
In accordance with a theory which I have formed in regard to the
pathology of chronic rheumatism, and which I am not yet prepared to
promulgate (nor is it necessary here), I have of late been in the habit
of administering in this disease, baths calculated to stimulate as much
as possible the circulation of the blood. The best manner of applying
the baths to this end will be found further on, under “Inequalities of
the Circulation.” In addition to this I cause the galvanic (anode) as
well as strong faradic currents to be applied to the affected parts by
means of the surface board. Where there is any thickening, effusion or
other similar concomitant of the disease, iodine may be added, as
hereinbefore directed.
In chronic rheumatism it is not necessary to use the baths daily. Two
or three times a week is quite sufficient. Indeed, the daily use of
strong currents, as employed here, might in some instances be productive
of evil rather than good. Although transient benefit may be experienced
from a few baths—sometimes even from one bath, permanent progressive
improvement need never be looked for from less than about a month’s
treatment—more or less, according to the nature etc. of the case.
I regret that I have no cases of acute rheumatism to offer. As a rule, a
person suffering from this disease is not in a condition to leave the
house; and in the cases that have occurred to me in private practice,
the difficulty of introducing an electric bath at the patient’s
residence has been in every instance sufficiently great to induce me to
forego this plan of treatment. While I have thus had frequent occasion
here to employ local electrization, I have had but one case of acute
rheumatism where I had the opportunity to employ the baths. The local
symptoms in this case being limited to one arm and shoulder, the patient
was enabled to locomote, and thus became an office-patient. At present
the case is still under treatment; and although the results thus far
have been eminently satisfactory, it would yet be premature to cite it
before I shall be able to state the final result.[12]
CASE I.*[13]—SUBACUTE RHEUMATISM. Mr. F., from the _clientele_
of Dr. Alexander Murray, about 32 years of age, of robust
appearance, large, vigorous frame, had an attack of acute
inflammatory rheumatism in the spring of 1873, from which he
recovered in a short time. In the winter of 1874 he experienced
a second attack, for which he had had treatment for about two
months prior to coming under Dr. M.’s care. After treating him
by other methods, including local galvanic applications to the
affected parts (joints as well as muscles were involved) for two
weeks, Dr. M. sent patient to take electric baths. On May 25th
Mr. F. was brought in a carriage. He was unable to walk; had to
be assisted up the steps by two attendants. His arms were in a
scarcely better condition, the wrist joints especially being
exceedingly tender and painful. The first and second baths,
administered respectively on May 25th and 29th, did not effect
much change in his condition. The third bath was taken May 30th,
with the happiest results. On June 1st patient was able to come
for his fourth bath alone and on foot, and thenceforth his
recovery was very rapid. The seventh bath, taken June 7th, left
him perfectly cured, not a trace of the disease remaining. He
has been free from rheumatism since. In the first three baths
the galvanic current was employed exclusively, the muscles and
tendons being in too tender a condition to bear the
contractions induced by the faradic current. In the subsequent
baths both currents were used, according to indications.
CASE II.*—SUBACUTE RHEUMATISM. Mr. B—y, aet. 22, came for
treatment on August 27th, 1874. Had subacute rheumatism, with
considerable swelling of ankle-joints. The acute attack dated
back six weeks. Locomotion was very painful, and could be
accomplished only with the aid of a cane. A galvanic bath on the
27th and one on the 28th of August were sufficient to remove
both swelling and pain, enabling the patient to resume his
avocation.
CASE III.—SUBACUTE RHEUMATISM. J. H. K., aet. 29. In the summer
of 1873 had a very severe attack of cephalalgia, which, judging
from his subsequent history, was probably of rheumatic origin.
The attack confined him to bed four days, after which it
troubled him continuously for three months. It then abruptly
left him, to make way, apparently metastatically, for enteralgia
coupled with diarrhœa. This clung to him for five months—until
May, 1874. He was then well for a time. Late in the summer of
1874 he began to experience pain in the soles of the feet, which
shortly culminated in a more pronounced rheumatic attack than
any to which he had previously been subject. It affected chiefly
the lower extremities. When he first came under my observation
(7th October, 1874) he had been confined to the house five
weeks. The left knee and both feet and ankle joints were much
swollen. The affected joints were exquisitely sensitive. Both
legs were very feeble, and coupled with this was great general
debility. Locomotion was rendered difficult to such an extent
that even the aid of two stout canes did not enable him to
dispense with additional help in mounting my doorsteps. The
first bath (Oct. 7th) was followed by no favorable results.
Indeed, the patient thought he felt worse, if anything. He
followed my directions, however, to take a bath every other day.
From the first three baths he received little or no benefit. The
fourth bath however had a very marked beneficial effect.
Immediately after it he was able to dispense with one of his
canes, and thenceforth improved steadily and rapidly. He took
his last bath Nov. 10th 1874, having taken in all fourteen
baths. He made a perfect recovery. At present (December 1875) he
has had no return of the disease, nor any other illness; says he
never felt better in his life.
CASE IV.—CHRONIC RHEUMATISM. Mr. K., from the _clientele_ of
Dr. Lusk, had been a sufferer from chronic rheumatism for a long
time. As far as I could gather, the disease originated in an
acute attack some two years ago. He came for his first bath on
June 21st, 1875. Between that date and July 16th following he
took twelve baths, which resulted in a complete cure.
CASE V.—CHRONIC RHEUMATISM. Mr. L., aet. 60, had been subject
to chronic rheumatism for many years. When he presented himself
for treatment (19th June, 1874) his health in other respects was
fair. The flexor tendons of the fingers of both hands were more
or less contracted, the result of previous rheumatic attacks. I
ordered him the baths, without any adjuvant treatment
whatsoever. His improvement was rapid. Between June 19th and
July 15th he took fifteen baths, a perfect and (thus far)
permanent cure resulting. Mr. L. has frequently taken baths
since then, solely however for the sake of their general tonic
effects.
CHOREA.
The utility in this disease of electricity has been for some time past
almost universally conceded. While some vaunt the faradic, others prefer
the galvanic current in its treatment. It appears that thus far the best
results have been obtained on the one hand by galvanization of the
spine, on the other by general faradization. It occurred to me, when I
began to devote myself to electro-balneological treatment, that a method
which combines the electrical procedures alluded to, must needs also
combine their virtues. Accordingly, I discontinued my previous practice
of spinal galvanization in this disease, and had recourse to the baths
in almost every case that applied to me for treatment. I am happy to
state that in no instance where the baths were employed was anything
short of a perfect result obtained. I will state on the other hand, that
in every case medicinal treatment was had recourse to at the same time.
It is equally true however, that in all the cases medicinal treatment
_without_ the baths had proved of no avail. The best method of employing
the bath is as follows: For the first ten minutes a constant current of
medium intensity should be passed, one pole communicating with the
head-electrode, the other connected with the surface board, applied for
five minutes to the epigastrium, five minutes to the sacral region. In
anæmic persons the current should be descending, in all others,
ascending. This concluded, a strong general[14] faradic current should
be employed for five minutes. By this means all the muscles of the lower
extremities will be very thoroughly contracted. The pole of the battery
attached to the foot-electrode should now be transferred to the surface
board, and the hands of the patient made to hold this, under water, an
additional five minutes. In routine cases this method of administering
the baths will be found very efficient. In special cases it may be
modified as expedient in the judgment of the practitioner.
CASE VI.* Hugh O—l, aet. 12 years, from the _clientele_ of Dr.
J. O. FARRINGTON, came for treatment February 5th, 1874. This
was one of the most severe and obstinate cases of chorea that I
have ever met with. Internal medication, ether spray, change of
air etc. had been of no avail. Between the date above mentioned
and March 23d the boy had seventeen baths, steadily improving.
He made a complete and (thus far) permanent recovery. His
intellect, which had been somewhat impaired, was considerably
improved.
CASE VII. J. G., aet. 9 years, was sent for electrical treatment
on September 22d, 1874, by Dr. KREHBIEL. He had been under
medicinal treatment for a long time, the choreic manifestations
dating back upwards of a year. When I first saw him, the choreic
movements were so continuous and violent as to preclude the
possibility of administering electric baths. The attempt was
indeed made; but no sooner had we managed to place the boy in
the tub, than he splashed the water freely about, and by the
violence of his movements bid fair to injure himself. I
therefore deferred for a time the electro-balneological
treatment, and had course to ordinary spinal galvanizations.
These, together with internal medication—which Dr. K. attended
to—had by the 8th of October diminished sufficiently the
violence of the movements to admit of the administration of the
baths. Accordingly the local applications were discontinued, and
from Oct. 8th to Nov. 27th the boy had seventeen baths, when,
all traces of the disease having disappeared, treatment was
discontinued.
HYSTERICAL AFFECTIONS.
If there is any one disease that more frequently than any other tempts
the physician to have recourse to empirical treatment, it surely is
hysteria. The obscurity, in many cases, of its etiology, as well as its
frequent obstinacy under the most diverse methods of treatment,
successively employed, are alone sufficient to warrant us in having
recourse to electricity, where this has not already been employed.
Where we can establish the etiology of a given case, we cannot of course
be in doubt as to the remedy; and in many instances of this kind we find
in electricity our most potent curative agent. But even where we are in
doubt or positively ignorant as to the origin of the symptoms, we are
justified in giving preference empirically to electricity, not only
because, the disease being essentially of a nervous character, we find
in electricity the most powerful of neurotics, but also because _recent_
statistics, those that embrace a period when electricity has been
permitted to participate, if not duly, at least more largely than
heretofore, in the treatment of disease, go to show that by means of
this remedy better average results have been obtained than with any
other. Again, where there are no positive indications to employ any
special method of electrization, either central or local, it appears
rational to give the preference to a method that is at the same time
central and peripheral, that admits of the application of either current
with the utmost facility, and is susceptible of so many modifications
that, with at best two or three tentative applications, it can be
suitably adapted to almost any given case. The results I have thus far
obtained justify me in asserting that, of the cases that are merely
functional in their nature, by far the greater majority will yield
completely to judicious electro-balneological treatment.
As to the mode of administration in this affection, I can suggest
nothing. There is so little uniformity in the manifestations of
hysteria, that it were idle to even attempt to establish anything like a
routine electro-balneological treatment. Each case must make its own
laws.
CASE VIII.* Mrs. A., aet. 28, married, sterile, from the
_clientele_ of Dr. KREMER, was referred to me on June 12th,
1874. She had been a sufferer from hysteria for a number of
years. Among the more prominent symptoms were intense
_pruritus_, transient flushing and heat of the entire surface,
with pricking sensations and headache. Six baths, in each of
which both currents were employed, sufficed to effect a complete
and permanent cure.
CASE IX.* Mrs. E., from the _clientele_ of Dr. KREHBIEL, aet.
28, married, of an exceedingly nervous temperament, had suffered
from excessive nervous irritability and prostration since her
last confinement (about a year previous to my seeing her). There
was no organic trouble, the symptoms pointing to pure functional
hysteria. She was sent for electro-balneological treatment April
21st, 1874. Six baths, in which both currents were employed,
restored her to perfect health.
NEURASTHENIA.
(NERVOUS EXHAUSTION.)
Those who are familiar with the pre-eminent qualities as a neurotic of
electricity, will not be surprised to be told of the beneficial effects
in the condition under consideration of electric baths. It is not only
in _general_ nervous exhaustion, however, that electric baths exercise
this salutary influence, but in the condition known as _cerebral
exhaustion_ likewise. Judging from my own experience, their efficacy in
this latter condition is far greater than that of local applications,
whilst they are unattended with any of the irritant and other
disagreeable effects that even with the greatest care and caution we
cannot always disassociate from galvanization of the brain. They no
doubt act here in two ways, i.e., first and chiefly, through reflex
influence from the entire periphery; second, by derived currents on the
brain directly. Whatever their mode of action, the results obtained are
of the most gratifying kind. The pitiable condition in which some
patients of this class present themselves, is familiar enough to every
physician; but it appears that the greater the degree of exhaustion and
the more prostrate the various functions, the more striking are the
effects of the baths. The patients seem to live up anew under their
influence. While in many if not most other complaints that come under
electro-balneological treatment, a certain number of baths are requisite
in order to get discernible effects, in the disease under consideration
each bath, except perhaps the first, is followed by more or less
immediate improvement, which, if the treatment is persevered in, remains
permanent.
It is almost unnecessary to say, that in the more advanced cases great
care is requisite in the administration of the baths. By
over-stimulation at first, much harm may be done, and the patient,
instead of getting better, get worse. In such cases very mild currents
should be employed in the beginning. As recuperation advances, stronger
currents may be gradually introduced. The intensity of the currents
should be carefully regulated to keep pace with the gradually increasing
capacity of the various organs to respond to the electric stimulus
without detriment. Both currents may be used from the first. The
galvanic current should precede the faradic, and be employed for not
more than ten minutes. Where irritability is a feature of the case, the
current should be descending; otherwise ascending. This may be followed
by the faradic current, not of sufficient intensity for the first few
baths, however, to cause any but _slight_ muscular contractions. In most
of these cases iron may be advantageously added to the bath. The
duration of the baths should at first not exceed fifteen minutes; in
some cases this even is too long, the patient complaining of being
fatigued perhaps after the lapse of ten minutes. When this is the case,
the bath should be at once terminated. It is in these instances not the
electric current, but the warm water bath, that gives rise to the sense
of fatigue. Later on in the treatment, the duration of the baths may be
from twenty to twenty five minutes, according to indications.
CASE X. _Cerebral Exhaustion._—K. S., aet. 42, lawyer. First
consulted me on June 2d, 1874. The salient points in the history
of this most interesting case are as follows: Ten years prior to
his calling on me he was engaged in some very heavy law cases
and other duties requiring intense mental application. At that
time he began to manifest occasional symptoms of cerebral
exhaustion; was unable to endure mental exertion with same force
as theretofore. These attacks, commencing in 1864, supervened at
various times until 1868, sometimes incapacitating him for
business for a few days at a time, and accompanied by intestinal
catarrh, flatulence and gastric disturbances—probably the
results of loss of nerve-power. In 1868, having been subject for
a time to extra heavy mental strain, he was completely
prostrated, and compelled to retire from the pursuit of his
profession. By the advice of his physician he went to the
country. There, without any premonitory symptom whatsoever, he
suffered an attack of (left) hemiplegia. I quote from his
recital as follows: “While standing in the office of the hotel
registering my name in the book, I suddenly dropped down,
retaining full consciousness. I lost the power of speech for
some hours. After twenty-four hours the paralysis began to
recede, and in a few days I had made a spontaneous recovery. I
then went further into the interior. Two weeks subsequently I
had a similar, but milder attack; retained full consciousness
and mental control. Returned to city (New York) two weeks after
this, in a very debilitated condition. On the third day after my
return, I had a more violent attack than either of the
preceding—again on the left side. I felt as if a line were
drawn perpendicularly through my body, dividing it in halves. My
stools were clay-colored. With this attack for the first time I
became unconscious, and passed into a delirious state. So far as
I know, no diagnosis of my condition was made. I was confined to
bed for a month, at the end of which I was in a very feeble
state. I then went to Europe, where I spent some years. While
there I consulted the first physicians of London and Paris, with
but little benefit, however. Both mind and body remained feeble.
My normal weight is upwards of 120 pounds, but has for a long
time past been in the neighborhood of 90 pounds.”
When Mr. S. came to consult me, he had but lately returned from
Europe, whence, he stated, his physicians had sent him home to
die. His complexion was sallow, sickly; skin of face plentifully
wrinkled; features wearing the air of suffering and anxiety that
so frequently accompanies painful chronic conditions. He had for
some time past suffered from excessive cerebro-spinal
irritability, for the relief of which cantharidal collodion had
been employed in the cervico-spinal region (the same had also
been used in the hepatic region, to meet the diagnostic views of
some one of his medical attendants). He had a remittent chronic
intestinal catarrh, with—noticeably during the periods of
exacerbation—abundant discharge of a glairy mucus. The appetite
was very capricious—not to say poor, and he was obliged to be
exceedingly careful in his diet. He was not capable of any
continued mental application. The muscular system was weak and
flabby. All the vegetative functions were more or less impaired.
On June 3d, 1874, Mr. S., by my directions, took an electric
bath. He continued the baths daily for some weeks; then every
two or three days, all the time steadily improving. He had some
adjuvant medicinal treatment, probably similar to what he had
already had in Europe. He states, however, that his improvement
commenced with the first bath he took; and the baths certainly
constituted the main treatment throughout. He gained daily in
every respect. Mind and body were invigorated; his muscles
increased in size and hardness; color gradually returned to his
cheeks, etc. He continued the baths with more or less regularity
until the close of the year, taking in all sixty-one baths. He
was then in a better condition than he had been for many years.
Thinking a trip to Europe would benefit him, I advised him to go
there and remain a few months. He left early in January and
returned in the beginning of April, 1875. He had been very well
during his absence, until within a few weeks prior to his
departure from Europe, when he experienced a severe attack of
cerebro-spinal congestion, which caused him much suffering. On
his return he resumed the baths, and continued them throughout
the spring, continually gaining in strength and weight. At the
beginning of last summer he was practically well. He has
regained his normal weight (120 pounds). As a criterion of his
bodily vigor, I will simply state that I have seen him lift,
with ease, 350 pounds, which, for a person of his weight, is not
bad. His mental force is as good as it has ever been. The
digestive disturbances have disappeared; he can eat things which
for years he had been compelled to eschew. To use his own words:
“I am well.” In view of the fact that he had already received,
at the hands of competent men, all sorts of internal as well as
external treatment, I believe I am justified in attributing his
cure almost entirely if not solely to the baths.
CASE XI. Mr. * * *, aet. about 50, lawyer, of large, vigorous
frame, came to consult me January 4th, 1875. He complained of
symptoms that are the frequent results of prolonged mental
over-taxation. His intellect was as good as ever, but he lacked
his wonted mental endurance and power of application. His mind
was perfectly clear, but unable to work. It was a case of
“_limited_ cerebral exhaustion.” Physical nutrition was pretty
good; yet his color was not normal, being rather paler than it
had been and has since become again. His flesh was flabby. There
were vague neurotic disturbances, etc., etc. He had until
recently occupied a leading public position, and the onerous
duties that devolved on him in connection with this, evidently
stood in direct etiological relation to his trouble. I ordered
an electric bath every other day. This was complied with until
the end of February, when the patient had apparently entirely
recovered his health, mentally as well as physically. I saw him
not very long ago; he looked the picture of health, and told me
that he was and had been since I saw him, perfectly well in
every respect.
CASE XII. Mr. L., aet. 23, presented himself for treatment in
October, 1874. He had at various times made the attempt to study
some profession, but had never been able to concentrate his mind
sufficiently on any object to enable him to persevere in its
pursuit. He was fretful, irritable and vacillating; would desire
one thing to-day, another to-morrow; never long of the same
mind. Melancholia, digestive disturbances and hypochondriacal
phenomena accompanied this condition. No organic disease was
discoverable. On October 1st he took his first bath. Very
shortly after this he commenced the study of medicine. He
improved rapidly in every respect. During the month of October
he had six baths, which resulted in complete and permanent
relief of all the symptoms. He progressed satisfactorily in his
studies, and is at the present time taking his second course in
one of our city medical colleges.
AGRYPNIA.
(INSOMNIA; SLEEPLESSNESS).
Although, as a rule, but the symptom of some definite pathological
condition, agrypnia is of such frequent occurrence, and so detrimental
to the general health, that it appears to me to merit special
consideration. This holds good especially in this connection, because,
even where electric baths fail to influence the disease giving rise to
the insomnia, they almost invariably remove this, irrespective of its
cause. Even where, the disease itself remaining uncured, the insomnia
must return sooner or later, the sleep is very much improved while the
baths are being had recourse to. We must of course endeavor in all cases
to relieve the original disease, and, where the baths are not adapted to
this purpose, resort to other and appropriate means. It will be found of
no small service to us in the therapeutical management of every case, to
be enabled to procure for the patient, without the aid of medicinal
hypnotics, sufficient of sleep during treatment.
CASE XIII. Mr. A., from the _clientele_ of Dr. LEONARD WEBER,
was sent by Dr. W. to take electric baths. He suffered from
chronic spinal congestion. Among the most prominent and annoying
symptoms was _agrypnia_. It was for the relief of this symptom
chiefly that Dr. W. ordered him the baths. He began to improve
in this respect from the time he took his first bath, and
although the disease itself remained uncured, he enjoyed good
sound sleep while he was under treatment, his general health
improved, and he frequently spoke of the notable benefits that
he received from the baths. He continued them until his
departure for Europe, where, by direction of his physician, he
went last spring. I have not seen him since, but Dr. W. tells me
that he is doing well.
CASE XIV. Mr. D. was brought on Sept. 30th, 1874, by his
physician, Dr. HOGAN. He was in the incipient stage of _delirium
tremens_. Had not slept for some nights. Dr. H. had administered
successively opiates, chloral and bromides in full doses,
without effect. On the evening of above date the patient had a
bath, in which the descending galvanic current was used. As a
result, he slept well that night. The baths were repeated on the
two succeeding days, with like effect. As the disease developed
however it became necessary to send the patient to an asylum,
whence he returned cured in a short time. The effect of the
baths in this case, where full doses of the most powerful
hypnotics of the materia medica had failed, was remarkably
illustrative of their hypnotic power.
ANÆMIA.
As is well known to the profession, anæmia forms the basis of a great
number of morbid conditions. Hysteria, general debility, emaciation,
sterility, various nervous affections, phthisis, in short, a perversion
of almost any of the various physiological functions may be the direct
result of anæmia. On the other hand, anæmia may be only a symptom or
sequel of some other morbid condition—but of such cases I do not now
speak. I have to do here only with those cases where anæmia is the
primary and etiological of a group of symptoms, and where therefore it
is to this that the treatment must be mainly directed. Now let us see
what this treatment is. Dr. FLINT[15] suggests the following therapeutic
measures: “_first_, a nutritious alimentation, into which meat should
enter largely; _second_, the use of tonics and stimulants to render the
digestive functions more active; _third_, iron as a special remedy—the
effect of which is often remarkable; and, _fourth_, a regimen calculated
to increase the energy of the assimilative functions, consisting of
exercise in the open air, recreation, etc.” This agrees mainly with the
views of other writers. It may conveniently be condensed under two
heads, instead of four, namely: _first_, to secure for the patient
appropriate food and adopt the best means to insure its assimilation;
_second_, the administration of iron. As to the ingestion of appropriate
food, open air exercise, etc., patients are of course to receive the
necessary directions. The remainder of the therapeutic indications, as
given above, are admirably met by electric baths. As we have seen in a
preceding chapter (p. 43 et seq.), they are a tonic and stimulant of the
first order, and as nearly as possible a specific for the furtherance of
the digestive and assimilative processes. When impregnated with iron,
they constitute a treatment for anæmia which, in conjunction with the
requisite diet and other hygienic measures, is inferior to no other. It
will moreover be found very efficacious in counteracting secondary
anæmia, and thus, by maintaining the general strength of the patient,
often enable nature and appropriate treatment to cope successfully with
the original disease.
CASE XV. Mrs. S., aet. 22, four years married. I was called to
see her on October 2d, 1874. She then had a spontaneous
miscarriage, the fifth since her marriage. She asked me whether
nothing could be done to enable her to carry a child to full
term, as both she and her husband were very desirous to have
offspring. In pursuance of my directions, she presented herself
at my office about ten days after I first saw her. On
examination I found no organic trouble, no uterine displacement,
nor any other local trouble to account for her premature
confinements. Involution had progressed normally. The only
deviation from the normal that I could discover about the uterus
was undue paleness of the cervical portion. Her appearance was
very decidedly anæmic; features pale, flabby; lips whitish blue;
physical energy much depressed. She had had but very slight loss
of blood on the occasion of her recent miscarriage; certainly
not enough to account for her anæmic appearance. Viewing her
case as one of idiopathic anæmia, I ordered her electric baths
strongly impregnated with iron. In addition to this, the regimen
usual in such cases, and also strychnia and phosphorus
internally. She took her first bath on Oct. 14th; then one bath
weekly until she had taken six baths, the last of which was
administered on the 24th of November. During all this time she
kept steadily improving. The anæmic appearance and symptoms
gradually receded, and, soon after she had taken her last bath,
I discharged her, as far as the anæmia was concerned—cured.
While she was under treatment she had, by my advice, refrained
entirely from sexual intercourse. Early in the spring of 1875
she called to tell that she was again pregnant, and in November,
1875, I delivered her of a healthy male child, at full term.
PARALYSES AND PARESES.
I include these under one head, because not only is their origin
frequently identical, but, chiefly, because the therapeutic indications
are almost always the same in both. Whatever the cause in any given
case, whether cerebral, spinal or peripheral, organic or functional;
whatever the treatment that may be indicated—and this should never be
neglected—for the primary trouble, the direct electrical treatment of
the paralysis, sub-paralysis or paresis, being purely _symptomatic_
treatment, remains in the great majority of cases essentially the same.
The objects to be aimed at are two, viz: _first_, a normal state of
nutrition of the affected muscles; _second_, their normal contractility.
In other words, we are to endeavor to prevent atrophy of the affected
muscles, or, where this has already taken place to some extent, to
restore their normal bulk; and, _second_, we must strive to restore the
more or less impaired contractility of the paralytic or paretic muscles.
Even where symptomatic treatment for these purposes is the _only_
treatment employed in a case, we frequently meet to a great extent the
_indicatio morbi_, by favorably influencing, either in a reflex or
direct manner, the primary disease. This is true of _local_
electrizations of the affected parts; it holds good much more strongly
however of _electric baths_, because here, in addition to the reflex
influence that we get from local applications, we have also the direct
influence of the electric current on the spinal cord and posterior
portion of the brain not only, but on the sympathetic system and all the
important organs contained in the thoracic and abdominal cavities. The
great importance of this is apparent, when we reflect that in very many
if not most cases of disease of the nervous system, central or
peripheral, electricity in an appropriate form is a useful therapeutic
agent, and that moreover the great majority of functional paralytic
disorders respond favorably to its influence. As for any harm being done
by it in those rare cases where its use may be contra-indicated, I admit
that such may accrue from the administration of electric baths without
medical supervision; it is entirely obviated however where the baths are
under the supervision of a physician, who does not, like a layman,
indiscriminately admit to their use any and everybody who is willing to
pay for their administration, but will carefully discriminate, and
conscientiously exclude those cases in which general electrization might
result injuriously. In such cases a tolerably accurate diagnosis is as
a rule readily made, and will enable the physician to separate the
suitable from the unsuitable cases.
As to the mode of administration of the baths in cases of the class
under consideration, the use of both currents is requisite; the galvanic
as a nutrient, the faradic as an excito-motor agent. Where, as is
sometimes the case, faradic irritability is extinct, or so slight as to
be practically unavailable, the (slowly) interrupted galvanic current
must take the place of the faradic, until faradic irritability has
become re-established. As to the intensity, direction, etc., of the
currents, each individual case has its own laws, which must be
recognized by the supervising physician.
CASE XVI.—_Infantile paralysis._ Albert Pichl, aet. 22 months,
was sent me by Dr. LILIENTHAL, October 3d, 1874. Had complete
paralysis of right leg (of four weeks standing), with
considerable atrophy of the entire leg as well as the gluteal
region of the corresponding side. The temperature of the leg was
much lower than that of the healthy limb. _Faradic irritability
was entirely extinct._ The treatment was begun by galvanizations
of the lower (lumbar and sacral) portion of the spinal cord, and
the use of the interrupted galvanic current on the affected
muscles. This was at first done daily. The contractility of the
muscles gradually but slowly improved, but neither the atrophy
nor temperature of the limb appeared visibly affected by the
treatment. With a view to favorably influencing these
conditions, I ordered him galvanic baths. He had a bath every
alternate day. The result was favorable and rapid. The leg
became sensibly and permanently warmer after each bath, and
commenced steadily to increase in bulk. Faradic irritability
soon returned. The local applications were continued several
times a week for some time, and then gradually abandoned, the
baths being meantime continued regularly. The boy very soon
began to walk, and in December active treatment was
discontinued. At that time, faradic irritability having long
since become completely re-established, I caused the child’s
father to purchase a faradic battery to use at home. The limb
was eventually entirely restored in every respect, with the
exception of a slight abduction of the foot, for which I
referred the patient to Dr. GIBNEY. I saw the child recently; he
remains well.
CASE XVII.* _Sub-hemiplegia from cerebral hemorrhage._ Mrs. S.,
aet. 30, married, from the practice of Dr. KREHBIEL, was sent by
Dr. K. to take baths, July 3d, 1874. It was a routine case,
differing in no respect from what is ordinarily witnessed as a
sequence of cerebral hemorrhage. Six baths, taken at intervals
of two and three days, restored almost entirely the muscular
power of the affected side. The patient subsequently made a
complete recovery without further treatment.
CASE XVIII. _Paralysis from insolation._ Mr. P., proof-reader
aet. about 40, had suffered for some time from sub-paraplegia,
the result of insolation. He was sent to take baths in May,
1874, by his physician, Dr. SCHIRMER. Electro-balneological
treatment in this case met with no success.
CASE XIX. _Lead paralysis._ Mr. M., aet. about 35, painter, was
referred to me for treatment May 15th, 1874, by Dr. MOHN. The
extensors of one (I believe it was the right) arm were
paralyzed. The characteristic blue line about the gums was
clearly defined. I ordered an electric bath daily. The
descending galvanic current was used for twenty minutes each
bath. From half to one ounce of iodide of potassium was added to
each bath. The blue line became less distinct from day to day,
until, after eleven baths, it had entirely disappeared. The
object for which I had ordered the baths having now been
accomplished, I treated the affected muscles with the faradic
current. A short course of this treatment sufficed to remove the
paralysis from all but one finger (it was either the middle or
ring finger), the extensors of which had probably undergone
fatty degeneration.
NEURALGIÆ.
The great variety of causes that may give rise to neuralgia, precludes
the possibility of any specific for this symptom. In discussing its
electro-balneological treatment, I would observe _a primo_ that I
cannot, in the light of my personal experience, agree with those who
claim for electrical treatment good results in a _majority_ of
cases.[16] On the other hand it cannot be denied that, either as a
palliative or curative measure, electricity, employed in an appropriate
form and manner, is of inestimable value in many cases, and frequently
succeeds where all other remedies are of no avail. Where we know the
cause of a neuralgia, it is of course comparatively easy for us to
determine whether or not electricity promises to avail anything. But
even where the nature of the cases appeared to indicate its use, the
failures, in my hands at least, have outnumbered the successes. The
brilliant results—sometimes almost instantaneous—that we obtain now
and then, should not lead us into overlooking our failures. Undoubtedly
the circumstance that most of the cases that have come under my
observation were of a very obstinate nature, referred to me by other
physicians after varied unsuccessful treatment, has much to do with the
formation of my views as expressed above, and future experience may
perhaps lead me to modify them.
Speaking still from my own experience, I will state that the cases that
have proven the most amenable to treatment were, _first_, those of
rheumatic origin; _second_, hysterical neuralgiæ, and, _third_, cases
where no assignable cause could be elicited. The most obstinate
varieties were those of a malarial type (even when quinine in large
doses or arsenic were employed in conjunction with galvanism) and those
that depended on some form of chronic inflammation—_neuritis_,
_periostitis_, etc. Of central neuralgiæ, I have had excellent results
in the sympathetic variety and in the pains of posterior spinal
sclerosis, while in the neuralgiæ of cerebral origin (diffuse cerebral
sclerosis, tumors, etc.) I have never met with any appreciable success.
Where, then, we are able accurately to diagnose a case, there cannot be
much doubt as to the appropriateness or not of electrical treatment, and
in cases whose origin is obscure, which may be considered practically
functional and therefore treated more or less empirically, electricity
holds out as much or more hope than any other remedy. Whether
electricity should be employed locally or in the form of baths, must
depend on the features presented by each individual case. In neuralgia
of the fifth pair—excepting those reflex cases where the _point
d’origine_ is to be sought for somewhere in the trunk or extremities,
and those that depend on cerebral hyperæmia or anæmia, where the
equalizing effects of the baths on the circulation are frequently of
great benefit—these are generally useless. Of other neuralgiæ, I have
found the baths less successful in those of the superior than in those
of the inferior spinal nerves. Lumbo-abdominal neuralgia and sciatica
have yielded much more readily than brachial or dorso-intercostal
neuralgia, etc., etc.
The mode of administering the baths in neuralgiæ does not possess enough
of uniformity to render suggestion in this respect of any value. I will
state however that, as a rule, the best results have been obtained from
the descending galvanic current.
In chronic cases the baths should be administered daily, and should not
be discarded as unavailing until at least a dozen have been successively
taken.
CASE XX. _Sciatica._ Mr. R., a middle aged man, mechanic, was
sent by Dr. ARCULARIUS Nov. 9th, 1874. Had post-rheumatic
sciatica of some six weeks’ standing. There were no remarkable
features about the case, which however was sufficiently severe
to disable him from pursuing his avocation. He took his first
bath on the date above-mentioned. Another bath was administered
next day, and three more every alternate day. He was then almost
well. On Nov. 25th he returned, there remaining still some
traces of the affection. Four more baths, the last of which was
administered on Dec. 4th, sufficed to complete the cure.
CASE XXI. _Sciatica._ Mr. G., aet. about 35, saddler, was sent
by Dr. WAECHTER, March 6th, 1875. Had suffered from sciatica
without discoverable cause for several years. For one year prior
to his visit had been unable to work, and was confined to bed a
great portion of the time. There was slight atrophy of the
affected limb. He had had considerable medical (including local
electrical) treatment, without avail. The baths were faithfully
and persistently tried in this case, effecting however but
slight improvement. Subsequent hypodermic injections, first of
strychnia, then of atropia and finally of chloroform, the latter
in doses ranging from 30 to 60 minims, gave him only temporary
relief. The patient was finally discharged uncured.
CASE XXII. _Lumbo-abdominal neuralgia._ Mr. W., aet. about 40,
was brought by Dr. MARVIN S. BUTTLES in June, 1875. He had been
in poor health for a number of years, and was then in a very
cachectic condition. There was considerable gluteal atrophy on
the affected side. At Dr. B.’s suggestion he took a course of
electric baths, with the happiest result. He improved steadily,
and on the occasion of a late inquiry after I had not seen him
for some months, Dr. B. told me that the patient had entirely
recovered. His general condition as well as the neuralgia had
been very favorably modified by the baths, and he is now in far
better health than he has been for many years.
CASE XXIII.—_Lumbo-abdominal neuralgia._ Mr. G., aet. 40, came
to consult me in October, 1875. He had suffered from neuralgic
pains, more particularly in the renal region of both sides, but
also in the neighboring parts, for only one week. The case being
so recent, I entertained a very favorable prognosis, which
subsequently was amply verified. A bath on the 12th of October
and one on the 16th sufficed to effect a complete cure.
ARTICULAR EFFUSIONS.
It would appear at a first glance as though local galvanization of
affected joints should be more directly and powerfully instrumental than
electric baths in promoting the absorption of morbid deposits. To
suppose so would however be a mistake—even where a single joint is
concerned. Where many joints are involved, the advantages over local
galvanization of the baths is sufficiently obvious. Where but a single
joint is involved, the current can by means of the surface board be
concentrated on the affected joint, while by the general galvanization a
stimulus is furnished to the absorbents, that in itself is probably
fully as important as any local treatment could be. In this manner
absorption is made to progress much more certainly and rapidly, and this
course is therefore to be given the preference in all cases where no
special contra-indication exists.
The ascending general galvanic current should be employed for from 5 to
10 minutes. The surface board, connected with the negative pole, should
then be applied for a few minutes successively to each of the affected
joints. Iodine in some form should be added to the baths.
CASE XXIV.* _Specific synovitis of knee-joint, with considerable
articular and peri-articular effusion._ Mr. C., from the
practice of Dr. SHEPPARD, aet. about 35. First saw patient at
his house on Nov. 9th, 1873, in consultation with Dr. S. and Dr.
HUTCHINSON, of Providence, R. I. Had been on mercury and iodide
of potassium for a long time. When I first saw him, he had been
incapacitated from work for about a year. Had been unable to
leave the house for three months. The affected joint was very
much enlarged, with little or no mobility, the condition being
practically the same as true ankylosis. It was decided to
substitute tonics for the specific treatment, and to administer
galvanic baths. On Nov. 11th the first bath was administered,
another on the 15th, and a third on the 19th. Considerable
improvement in motility was then apparent. Two more baths, taken
respectively on the 22d and 29th, effected some reduction in the
size of the knee. The baths were continued to January 3d, 1874,
when the effusion had become almost entirely absorbed, and the
joint perfectly mobile. The patient then had been for some time
taking daily walks, unassisted. He now (Jany. 3d) walks without
any difficulty, has regained his normal vigor, and is perfectly
well.
IMPOTENCY.
The frequent obstinacy of this distressing condition under every variety
of non-electrical treatment, is the cause of the frequency with which
cases present themselves to the specialist. Unfortunately however but
few of the referred cases are of recent origin. In almost all instances
they have gone through a vast amount of medication and other treatment,
and finally, either through their attending physicians or of their own
accord, they come as a _dernier ressort_ to seek relief from electrical
treatment. I have already (p. 47) spoken of the comparative merits in
this disease of local and general electrization. A few years ago I was
ignorant of the good effects of the baths in male impotency. I came to
test and employ them here from two causes. In the first place, patients
were sent me specially for electro-balneological treatment, ordered by
their physicians; and, second, I began, when I became familiarized with
the effects of the baths, to have recourse to them in cases where with
local electrical and other treatment I had been unable to accomplish
anything. My average results, without becoming uniformly successful,
became so very much better, that after a brief but abundant experience
with this treatment, I have come to consider it the most important we
possess in this affection; one that will frequently succeed when
everything else, including local electrization, has failed, and which,
in cases where no incurable organic changes underlie the affection,
will, if properly persisted in, either cure or improve to a great extent
a large majority of the cases. I have even seen instances where, the
sexual power having receded as the legitimate result of advancing age,
it returned almost or quite perfectly and with seeming permanency under
the influence of the baths. In the class of cases—and they are quite
numerous—in which impotency (loss of the power of erection) occurs as a
purely nervous symptom in comparatively young men; where its cause is
sometimes purely imaginative, at others the result of early excesses,
the baths are attended with the most gratifying average results. Where
the cause is purely psychical, a very few baths are sometimes sufficient
to dispel the morbid phenomena. Where masturbation or excessive venery
are at the bottom of the trouble, there is always a probability of more
or less organic change in the lower portion of the spinal cord, and
frequently also a secondary enfeeblement of the digestive functions,
which render requisite a long and steadily continued use of the baths.
Patients whose sexual power was intact, who took the baths for other
purposes, have time and again called my attention to their aphrodisiac
effects.
While here the _general_ electric influence is the main remedial agency,
there is no reason why the possible—or, I should say, probable—good to
be obtained from its _local_ influence should not be realized—the less
so that it is so facile to obtain this in the bath, by means of the
surface board. While individual cases will undoubtedly call for
modifications, I have found the following plan to answer best in
certainly more than half the cases that have come under my observation:
The first five minutes of the bath may be occupied by a general galvanic
current of medium intensity, _descending_ where the patient is of an
irritable, _ascending_ where of a phlegmatic temperament. The pole
connected with the foot electrode should now be detached, and the
surface board substituted. The second five or ten minutes may be
consumed by running a galvanic current between the head electrode and
the surface board, the latter applied alternately to the penis, scrotum,
perineum and, where thought best, also to the lumbo-sacral region.
Where, as is usual, the impotency is accompanied by a certain degree of
cutaneous anæsthesia of the penis, but especially where the seminal
secretion is scanty, the board should be positive (ascending current);
where however nocturnal spermatorrhœa, premature discharges (before
coition is possible) or other irritable phenomena characterize a case,
the surface board should be negative (descending current). The head of
the patient should rest on a sponge thoroughly saturated with water, and
communicating with the water of the bath, so as to include the
cerebellum in the direct circuit. The last five or ten minutes of the
bath should be devoted to passing the faradic current between the head
electrode and the surface board, this last applied about the genitals,
but chiefly about the perineum, the current to be of sufficient
intensity to contract the perineal muscles. With anæmic patients iron
should be added to the baths. These should be taken at first daily,
later on every other day, then three times a week, and so on until it
becomes apparent that all the good that can be obtained from them has
been obtained—whether this be a perfect cure or only a certain degree
of improvement. Where it is thought requisite, internal medication and
various hygienic measures may be advantageously resorted to as
adjuvants. While these will do no good when employed alone, they may
serve to enhance the effects of the baths.
In the following cases, I will include some where the impotency was not
perfect, where the conditions were merely those of sexual debility. As
there is here merely a difference in degree, it would be superfluous to
separate the two conditions under distinct heads.
CASE XXV.* _Perfect impotency._—Mr. F., from the practice of
Dr. CARO, a robust gentleman, aet. thirty-six, full of muscular
vigor. Had had syphilis, the symptoms of which had disappeared
under Dr. C.’s treatment. For two years the power of erection as
well as sexual appetite had become extinct—if we except an
occasional imperfect spontaneous erection on waking up in the
morning, and even this was of rare occurrence. Ordinary
medication proving inadequate, Dr. C. sent patient to take
electric baths. From March 7th to July 16th, Mr. F. used the
baths, averaging about two weekly. He was then, and still
remains, perfectly restored.
CASE XXVI. _Perfect impotency._ A. E. K., aet. 23, commercial
traveler, applied to me for treatment in the spring of 1873. His
general health was very good. He had masturbated but little. Had
been in full possession of his sexual power until almost
twenty-two years of age, when he found that, without assignable
cause, he had lost the power of erection. His general condition
being, as far as discoverable, perfect in every respect, I
instituted a local electrical treatment. This was continued for
some time without avail. Strychnia was then administered with no
better result, and after some months’ treatment I told him that
I could do nothing for him. He remained without any treatment
whatever until the spring of 1874, when I advised him to try
electric baths. He took in all about half a dozen baths, which
resulted in his complete and thus far permanent restoration.
CASE XXVII. _Sexual debility._ Mr. W., aet. 32, married,
manufacturer, consulted me in February 1875. Had gradually for
about a year past lost sexual power. Was able to perform the
marital act at rare intervals only, and when he did, felt
exhausted the whole of the succeeding day. I ordered him
electric baths. He took the first on February 22d, 1875. Between
this date and March 22d, he took six baths. The sexual power had
then fully returned. I must not omit to state that during the
time he was under treatment he took, by my direction, gr. 1/25
phosphorus twice daily, which may have somewhat accelerated the
result.
CONSTIPATION.
Atony of the _muscularis_ of the intestine is admittedly the direct
cause, in most instances, of constipation. It is the condition known as
“torpor of the bowels.” It is ordinarily due to abnormal innervation of
the parts. The inefficient innervation may be—and in females frequently
is—reflex, or its cause may be sought for in the central nervous
system. The condition of the voluntary abdominal muscles is likewise a
factor in the alvine process. Sluggishness of the abdominal (portal)
circulation is a not infrequent etiological concomitant of constipation,
and, finally, the conditions grouped as “dyspepsia” may form the
causative feature of a case. I have mentioned these different causes
simply in order to account to some extent for the almost wonderful
effects in this condition of electric baths. When we consider that in
every one of the morbid conditions here enumerated, electricity is a
very efficient remedy, and that for the resulting muscular atony it may
be called a specific, it will not appear surprising that a mode of
application which brings the electric influence to bear on both cause
and effect—often on a combination of several of the causes enumerated,
should be attended with such brilliant results. I have thus far met with
no failure in the electro-balneological treatment of constipation.
In the majority of cases the following method has proven the most
efficient. The first ten minutes of the bath should be devoted to the
administration of a galvanic current, as intense as can comfortably be
borne by the patient. The one pole should be connected with the
head-electrode, the other, by means of the surface board, applied
alternately, to the epigastrium, chiefly, and to the hypogastric region.
The current should a portion of the time be ascending, the rest
descending. Occasionally the current should be rapidly reversed by means
of the commutator, the intensity however having been previously reduced,
in order to avoid too severe a shock; this will cause efficient
contractions of the abdominal _parietes_, and probably also of the
intestinal _muscularis_. The second ten minutes of the bath should be
devoted to faradization, employed in the same manner as the previous
galvanization, only that here the direction of the current is
immaterial, and no reversals are requisite. The current should be of
sufficient intensity to produce energetic but not painful contractions
of the abdominal parietes.
CASE XXVIII. Mrs. * *, aet. 55, in average health, without
however being robust, had suffered from constipation for about
thirty years. She had had every possible medicinal treatment,
with no avail. Nothing had ever ameliorated her condition.
Without the aid of a cathartic, her bowels moved but once every
week or ten days. She was of course compelled frequently to
resort to laxatives. In the fall of 1873 I ordered her electric
baths. She was not very energetic in anything, and this lack of
energy caused her to take the baths less frequently than I
desired her to. Had she taken them regularly, she would probably
have been restored in as many weeks as it took months to effect
her restoration. As it was, she took some thirty baths in the
course of about fifteen months. For nearly a year past she has
had a passage every day with the utmost regularity. No adjuvant
treatment was employed in this case.
CASE XXIX.* Emil Miller, a bright child two years of age, was
brought for treatment July 7th, 1874. He had suffered from
obstinate constipation almost from his birth. Had been under the
care of several physicians, but had never received any benefit
from treatment. Even with the aid of powerful cathartics, given
in doses suitable for an adult rather than a child, defecation
took place only once every three or four days, and was so
exceedingly painful as to elicit cries of pain from the child.
The feces were always hard and lumpy, and of an abnormally light
color. A digital examination per rectum revealed considerable
flaccidity. My diagnosis was _paresis of the muscularis of the
intestine_. I ordered faradic baths. On July 12th the first bath
was administered, and I must confess that the result was a
perfect surprise to me. True, I had expected a cure to take
place; but I had looked for gradual improvement, and was not
prepared for a result such as was here obtained. _From the time
the first bath was taken, defecation took place regularly once a
day, without pain; the feces became perfectly normal both as to
color and consistency, and the boy continues to the present day
to defecate regularly and in every respect normally._ To insure
permanency, the baths were continued, at first twice, then once
a week. They have now been discontinued for upwards of a year,
there being no occasion for their further use. No other
therapeutic measures, internal or external, were resorted to in
this case, nor was any change made in the diet of the child.
HYDRARGYROSIS.
The etiology of this condition requires no comment. I will simply relate
a case illustrative of the eliminative effects of galvanic baths.
CASE XXX.* _Mercurial Stomatitis._ Mr. S., about 35 years of
age, came to me for treatment in the fall of 1872. He then had
indurated chancre, two buboes and syphilitic sore throat. He had
had the chancre for six weeks before applying to me, but had
been, he said, ashamed to consult a physician. Before medication
had had time to make any impression on the disease, roseola
appeared. The syphilis was very obstinate in this patient,
compelling me to keep him under the influence of mercury for a
long time. In October 1873, the patient presented himself with a
very aggravated mercurial stomatitis. The customary remedies,
internal as well as external, made little or no impression on
the affection. On November 11th, I discontinued all other
treatment, and ordered a course of galvanic baths. He took his
first bath on the same day. This was repeated every alternate
day until six baths had been taken, when all symptoms of the
disease had disappeared. He has had no mercurial trouble since
then. The descending galvanic current from a zinc-carbon battery
was used throughout.
LOCOMOTOR ATAXIA.
Were it not for the remarkable results obtained in the following case, I
should not have felt justified in devoting any space to an allusion to
this formidable disease. I insert the case as it was published in No.
216 of the “Medical Record.” I have to add that the patient, some six
months ago, suffered a relapse, which however is not nearly as
aggravated as his former condition, nor are the symptoms so
pathognomonic. I had a letter from him about a week previous to my
writing this, in which he states that he intends soon to come to the
city for the purpose of taking another course of treatment. Even if the
treatment however has not had the effect of curing the disease—and this
I do not claim for it, it has been of sufficient importance if it has
resulted in arresting for a time its progress, giving the patient
temporary comfort, and prolonging life. Further trial may possibly have
better results—in more recent cases—with respect to permanency.
CASE XXXI.* Mr. W., aet. 48, came to consult me January 12th,
1874. He had then felt the symptoms of locomotor ataxia for
about six years. Had been unable for several years to walk
without the aid of a cane. When walking he dragged his right
leg along in a semicircle, and was able to accomplish very short
distances only. There were almost complete anæsthesia and great
paresis of the bladder. The same conditions were observable in
regard to the bowels. Anæsthesia of both lower extremities
existed, complete in every respect in the right leg, almost so
in the left. Dyspepsia and general debility and emaciation
accompanied the disease. Treatment was begun on January 15th. I
prescribed phosphorus and cod-liver oil, and passed a strong
galvanic current through the spine for probably ten minutes.
January 16th, a galvanic bath was administered. Towards the
close of the bath (which occupied twenty minutes), patient
thought he felt some sensation in his legs. The baths were taken
every two or three days, alternating with strong galvanizations
of the spine. While taking his second bath, patient remarked
that “his right leg felt warm for the first time in six years.”
The treatment as described was continued for about six weeks,
during the latter part of which the local applications were
gradually diminished in frequency, the baths being continued
regularly. Medication was discontinued about this time. About
the middle of March. Mr. W. was enabled to resume his occupation
(paymaster’s assistant on the Erie Railway). His improvement had
been rapid and steady. All the symptoms gradually disappeared,
and in the beginning of April the patient was, with the
exception of some feebleness, consequent on his protracted
illness, as well as ever. He continues so to the present
day.[17] He still takes two or three baths a month, but has had
no other treatment since May (1874). He walks freely without a
cane, and talks jocosely of running footraces. All functions are
performed normally.
Although in this case the baths were not employed exclusively,
yet they predominated in the treatment; and if the judgment of
the patient, a very intelligent gentleman, is to be relied on, a
large share of the success is due to the baths.
CACHEXIÆ.
After what has been said in a preceding chapter of the tonic effects of
electric baths, it would scarcely appear necessary to introduce the
subject of cachexiæ. If I do so nevertheless, it is only to be afforded
the opportunity of relating the following case, which possesses
sufficient interest to render its introduction here desirable. The first
portion of it has already been published (Med. Record, No 216), but to
this I have to add what occurred subsequently.
CASE XXXII.* _Mercurio-syphilitic Cachexia._—Mr. L., aet. 27,
had primary syphilis about four years ago. Subsequently had
inveterate constitutional symptoms, for which he was under
medical treatment both here and in Europe. When he had sojourned
in the latter country some time, he was pronounced cured by his
physicians. He married, and returned to this country in the fall
of 1872. A few weeks after his return he fell into a gradual
decline, which confined him to the house—and part of the time
to bed—for eight months, during the latter portion of which he
had discontinued all medical treatment. It was with difficulty
that, assisted by his wife, he managed to reach my office. I
found him terribly enfeebled; greatly emaciated; sallow
complexion. He was much annoyed by rheumatic pains, which I
considered specific. His condition was so exceedingly low, that
I decided to postpone all medication until he should be
stronger. I ordered galvano-faradic baths, i.e. the galvanic
current in the bath as an eliminative, the faradic as a tonic.
The first bath was taken on November 20th, 1873. For one month
he took the baths, and nothing else. He was then so much
stronger, that I felt justified in instituting a mild specific
course of treatment, the baths being continued as theretofore.
At the end of two months the patient was nearly as strong as
ever, was able to resume his occupation, and had gained
twenty-seven pounds in weight.
Thus far this case was published as above stated. For the sake
of the interest attaching to it, I will now proceed to give its
further history. Mr. L. remained to all appearances well until
July, 1874, when he commenced to suffer from headache and
constipation. On the 23d of August following, while I was absent
from the city, he presented himself to the gentleman who
attended to my practice during my absence, with paralysis of the
external rectus muscle of the left eye. He also consulted a
specialist, who pronounced the paralysis rheumatic. When I
returned from the country he presented himself for treatment. I
commenced a series of daily electric applications to the
affected muscle, which failed to respond to the faradic current,
but contracted very readily when the slowly interrupted galvanic
current was employed. As I had strong suspicions that syphilis
was at the bottom of the trouble, I also administered iodide of
potassium in gradually increasing doses—not however until
electrization and strychnia employed for some weeks had failed
to do any good. The administration of the iodide met with no
better success. The patient’s general health gradually declined.
On October 22d, he complained of numbness in the left leg, which
gradually increased, the leg at the same time becoming paretic,
so that the patient required the aid of a cane for ordinary
locomotion. His condition now became rapidly worse. His
movements became ataxic. Anæsthesia of the bladder, paresis of
this and the intestine, with obstinate constipation, loss of
appetite, emaciation, etc., rapidly supervened. I suspected the
development of _gummata_ on the meninges of the brain and cord,
and advised him to use the inunction cure, and to remain at home
until he should be well. This, on account of the business losses
which it involved, he was very much averse to doing. He
consequently proposed a consultation with an eminent physician,
which was had. This gentleman pronounced the case one of spinal
(either multiple or posterior) sclerosis, and discarded the
syphilitic theory. A consultation two days subsequently with
another physician had a like result. In deference to the opinion
of these gentlemen, I treated the patient in accordance with
their diagnosis. This was in the second week of November. The
patient became rapidly worse. He soon ceased to walk—he tumbled
about. After six days’ treatment, considering his life in
imminent danger, I reiterated my advice to institute the
inunction cure, and the patient then acquiesced. Nov. 24th I
ordered a drachm of Unguent Hydrarg. to be used every evening; I
could not however prevail on the patient to remain at home
during the treatment. He continued to grow worse. Nov. 26th he
had complete retention from vesical paralysis, and sent for me
at night to relieve him. Thenceforth until he got nearly well he
was obliged to use the catheter regularly. A few days after
this, fortunately for himself, he fell down as he was leaving a
horse car, and sprained his ankle. I say _fortunately_, for this
accident _compelled_ him to remain at home. From this time he
began to improve. December 2d I substituted for the ointment a
twenty per cent solution of the oleate of mercury, of which he
used a drachm morning and evening. The improvement from this day
was exceedingly rapid. On the 4th of December he had regained
control of the bladder. The constipation, which had been very
obstinate, also began to yield. From this date he used the
oleate only once daily, and discontinued it entirely on the
14th. On the 10th he had already resumed his avocation, and the
same month absolutely danced at a ball. He took iodide of
potassium for a time after his mercurial course. He has since
been and is now in perfect health.
DYSPEPSIA.
The remedies for this disease are unfortunately so numerous, there is so
much temptation to try another where one remedy has failed, that it is
seldom or never that an uncomplicated case of dyspepsia applies for
electrical treatment. As a rule, the disease that furnishes cause for
referring a case to the specialist, is some nervous trouble secondary to
the dyspepsia.
In regard to the influence of electric baths on dyspeptic conditions,
whether complicated or not, I can however speak unqualifiedly in their
favor. I know of no one other remedy that can at all approach them in
this respect. Whatever the secondary or other troubles of patients, any
co-existing dyspepsia was in every instance either cured or greatly
ameliorated. The improvement usually begins at once—after the first or
second bath, and continues steadily. As I have not had occasion to treat
by means of electric baths any uncomplicated cases of dyspepsia, I can
adduce none. I may safely claim however for the baths a reliability and
bespeak for them a confidence that I might claim or bespeak for no other
remedy or plan of treatment whatsoever—assertions which would appear
rash and venturesome, had I not at my command abundant clinical evidence
to warrant my making them.
MELANCHOLIA.
A case of melancholia, highly illustrative of the effects in this
condition of electric baths, came under my notice very recently. It may
serve as a guide in the treatment of this and kindred conditions.
CASE XXXIII. Mr. F., aet. 22, single, butcher, consulted me Oct.
21st, 1875, for melancholia and loss of memory, from which he
had suffered for upwards of a year. He had frequently
entertained the idea of suicide. A thorough examination revealed
no trouble of any of the viscera. All functions appeared normal.
He had never masturbated. There were no collateral symptoms to
furnish any evidence of organic cerebral trouble. I prescribed
phosphorus and strychnia, and galvanized the brain twice a week.
Two weeks of this treatment had completely negative results. I
then ordered electric baths. Four baths resulted in a complete
cure.
INEQUALITIES OF THE CIRCULATION.
As a very fruitful source of morbid conditions of almost every nature,
abnormities of the circulation of the blood are well worthy our
attention. As is the case with dyspepsia, so here likewise patients
seldom present themselves for treatment unless some definite secondary
pathological condition has supervened. We find these patients
complaining of cold hands and feet, irregular and disturbed sleep,
occasional local congestions, with vague, usually slight pains here and
there, etc., etc. Where organic cardiac disease is at the bottom of the
trouble, we cannot of course expect much permanent improvement. Although
even here considerable relief is often afforded while the baths are
being used, their discontinuance will in all probability be soon
followed by a return of the former condition. Where, however, cases are
not complicated by organic disease, where we have a “sluggishness” of
the circulation, due either to vasomotor inertia or atony of the
muscular coats of vessels, the electric bath will be found reliably
efficient. I have already (p. 55) alluded to this subject, and explained
the probable “mode of action” here of the baths. I will now offer some
suggestions as to the best method of administering them with a view to
equalizing the circulation.
We must here seek to stimulate the vasomotor system, both central and
peripheral; to give tone to the coats of vessels, both by direct and
indirect electric influence; through counter-irritation to relieve
internal congestions, by causing an afflux of blood to the skin. These
objects are best attained by means of the galvanic current, which should
be employed of sufficient intensity to produce a rubefacient effect. The
faradic current acts in the same direction, but far less energetically,
if we except the vessels near the surface, the muscular coats of which
are probably more efficiently tonicised by this than by the constant
current. The faradic current however is applicable here in another way,
and for a very important object. I refer to the _mechanical_
counter-action of a sluggish circulation, through the agency of
prolonged muscular contraction. This mechanical effect is not of course
peculiar to the faradic current; it is shared by gymnastic and other
exercises; but obtained in any other way whatsoever (with the exception,
perhaps, of _massage_, which is however much more troublesome as well
as inferior, and moreover not always admissible) it involves, in order
to produce perfect results, a considerable amount of bodily exertion,
often beyond the physical power of persons who are in ill health, and
bringing with it the risk of positive injury, through over-exertion,
which with the _passive_ contractions obtained by means of the faradic
current, is entirely obviated. By administering the _general_ faradic
current in the bath, of sufficient intensity to _maintain_ muscular
contraction as long as the circuit remains closed, any stagnant blood in
the lower extremities will be efficiently forced into the general
circulation. After from three to five minutes of this faradization, the
surface board may be successively applied for a minute or two each to
the arms, abdomen, pectoral and dorsal muscles. I believe the _best_
results can be obtained by first going through the faradic process, then
subjecting the patient to general galvanization, as above indicated, and
concluding by another but brief faradization.
AFFECTIONS OF THE SYMPATHETIC.
Last, but not least, I have some remarks to offer on the treatment by
the electric bath of certain affections of the sympathetic nerve. While
I do not in any such cases accord to the baths the rank of an exclusive
remedy or even a specific, their importance as an adjuvant is sufficient
to entitle them to special consideration in this connection. In those
neuroses of the sympathetic where electricity (galvanism) is indicated,
the _greatest_ benefit can be obtained from local applications. On the
other hand the baths, employed in addition to local applications, will
be found a very important factor in the treatment, possessing, as they
do, two advantages, viz: _first_, by their means, the electric influence
is brought to bear—in a much less concentrated form it is true—on the
entire sympathetic system, from the _ganglion impar_ to the _ganglion
cervicale supremum_, and, by derived currents, on the cephalic ganglia
also, at one and the same time; _second_, the rest of the body
participates in the general nutrient and tonic effects of the bath
equally with the sympathetic, the latter thus receiving a reflex benefit
which local applications fail to furnish. There are, moreover, cases
where hyperæsthetic conditions of the nerve do not admit of local
applications, and where yet electricity is urgently called for. Thus I
have at present under treatment a lad sixteen years of age, in whom both
supreme cervical sympathetic ganglia as well as the ganglion impar were
until recently so susceptible that the mere adjustment of the
electrodes caused him great pain, while on the other hand he bore the
baths exceedingly well. In such cases, electric baths, suitably
administered, frequently constitute in conjunction with proper
medication, the most useful treatment.
As to the mode of administration in sympathetic neuroses of the baths,
the most direct manner in which to influence the diseased nerve, is by
connecting one pole of a _galvanic_ battery (I consider the faradic
current next to useless here) to the head electrode, the other to the
surface board, the latter applied portion of the time to the epigastrium
(solar plexus), the balance to the coccyx (_ganglion impar_). This will
include in the direct circuit the main portion of the sympathetic, the
position in the tub of the bather bringing the cilio-spinal centre very
close to the head-electrode. The direction of the current must be
determined by the individual features presented by each case, as also
the duration of the bath.
CASE XXXIV. Mr. S., aet. 31, merchant, was referred to me April
3d 1874, by Dr. KREHBIEL. In January, 1874, Mr. S., until then
in the enjoyment of good health, woke up one morning to find, as
he expressed it, “everything dark before his eyes.” He groped
his way to the window, in order to open the blinds. When at the
window, he felt as though about to fall out—probably vertigo.
He soon returned to an apparently normal condition, and went
about his business as usual. A week after, he had a much more
serious attack, which he describes as follows: “I had been
playing whist during the evening (several hours), when suddenly,
without premonition, I felt as though a champagne cork popped
against the top of my head, inside. Accompanying this was an
indefinable sensation about the heart as though the blood all
rushed thence down to the feet. I did not lose consciousness;
did not fall. I trembled all over, and a great fear came over
me. Felt very weak all night; my pulse was very slow.” About two
months subsequently, patient was referred to me, as above
stated. He then had an uneasy look; an indefinable continual
sense of fear; was excessively nervous in the forepart of the
day; had brief attacks of tremor—usually every alternate
morning, but not typical as to time of occurrence. The history
exhibited neither syphilis, malaria nor intemperance. Had never
had headache. Sleep good; appetite likewise. The most
pathognomonic symptom, however, related to his pulse. This was
abnormally slow, ranging from 44 to 54 (the latter only when
standing or after walking) per minute. It was full and regular.
There was no organic heart trouble. In the absence of any other
symptom whatsoever pointing to irritation of the pneumogastric
or spinal accessory, I was justified in excluding this as the
possible cause of the cardiac infrequency. On the other hand,
the pathogenetic manifestations appeared all to point to
“asthenia of the sympathetic”—at any rate the portion of this
whence the cardiac nerves take their origin, and I formed my
diagnosis accordingly. In the beginning, the treatment consisted
of bilateral ascending (from cilio-spinal centre to both mastoid
fossæ) galvanizations of the sympathetic, and galvanic baths
(head electrode negative, surface board positive, to
epigastrium) on alternate days. Improvement in every respect was
steady, though not rapid. At the end of three weeks, I
supplemented this treatment by the administration of ergotin and
nux vomica. At the expiration of two more weeks, the patient
being nearly recovered, I discontinued these medicaments,
substituting the valerianates of zinc and iron, and steadily
maintaining meanwhile the electrical treatment as above
indicated. After a short time recovery appeared complete, and
patient was discharged from treatment. He returned however a few
months subsequently, complaining of “faint spells” in the
mornings, accompanied with excessive nervousness, and a renewed
though moderate cardiac infrequency. Electrical treatment,
similar to that above described, soon restored him. One or two
more slight relapses occurred during the next six months. For
over a year past however Mr. S. has been in the enjoyment of
perfect and undisturbed health. His normal pulse ranges from 72
to 80.
Whoever is familiar with the physiological effects of electric baths,
will readily concede their great utility in a variety of conditions that
I have not thus far specially alluded to. Of such I would mention
ASTHENIÆ, ATONIC AND DEBILITATED CONDITIONS GENERALLY, including the
state of CONVALESCENCE FROM ACUTE DISEASES and the DECLINE OF ADVANCING
AGE; many cases of CHRONIC HEADACHE; some INCLASSIFIABLE CONDITIONS OF
MARASMUS and MALNUTRITION, etc., etc. In all such cases, when purely
functional and uncomplicated by incurable organic disease, good results
may be confidently looked for.
* * * * *
With these remarks I conclude my subject. Whichever the errors that a
too limited experience may have engendered—and I doubt not there are
many, I cannot on reviewing my work accuse myself of lack of candor nor
yet of undue enthusiasm. I have cited but a small proportion of the
successful cases whereof I possess records; still I believe that I have
adduced amply sufficient clinical proof of the great value as a remedial
agent of electric baths, and of the desirability of their more general
adoption. I would more especially call attention to the
inappropriateness of deferring their employment until almost all other
remedies have been exhausted; and when I reflect that pretty much all
those cases that had been referred to me by other physicians had already
had the doubtful benefit of almost every other conceivable treatment,
while many of those who came of their own accord, had in addition made
the rounds of all the quacks, and exhausted nearly all the nostrums that
are to be found advertised in the columns of our daily papers, the
wonder seems that the results obtained were as good as they have been. I
sincerely trust that in the future physicians will avail themselves
more frequently than heretofore of a remedy that is certainly capable of
accomplishing much good; and I hope that in addition to myself there
will be found others, more competent, to devote themselves to the study
of the subject. To these, and perhaps to myself at a future time, I
relegate the task of correcting my errors and promulgating hitherto
undiscovered truths.
Footnotes:
[Footnote 10: Centralblatt für die medicinischen Wissenschaften,
No. 17, 1875.]
[Footnote 11: The apparatus used in these experiments was that
of Du Bois-Reymond, with a Grove’s element.]
[Footnote 12: Since writing the above, this case has had an
entirely favorable termination.]
[Footnote 13: The cases distinguished by an asterisk were
published in No. 216 of the “Medical Record.”]
[Footnote 14: Wherever I use the word “general” as descriptive
of an electric current used in the bath, it is not as a
characteristic, but merely to distinguish it from the instances
where the surface board is employed.]
[Footnote 15: Austin Flint, M.D. A Treatise on the Principles
and Practice of Medicine. Philadelphia, 1873. 4th ed. pp. 63 and
64.]
[Footnote 16: See Beard and Rockwell, op. cit., 2d ed. p. 472.]
[Footnote 17: This was written a year ago. See remarks preceding
the case.]
INDEX.
A.
PAGE
Agrypnia 92
Anæmia 93
Apparatus for baths 7
Articular effusions 105
B.
Bath-tub 8
Batteries 16
C.
Cachexiæ 118
Chemicals in baths 15
Chorea 80
Circulation, effects on 55
" inequalities of 123
Clinical Record 61
Conductivity of water, etc. 13
Constipation 112
Counter-irritant effects 56
D.
Debility, general 129-130
Diagnostic uses 53
Digestive apparatus, effects on 44
Dyspepsia 121
E.
Electric Bath compared with other
electrical methods 32
Electrodes 10
G.
General Therapeutics 52
H.
Hydrargyrosis 115
Hypnotic effects 38-58
Hysterical affections 82
I.
Impotency 106
Insomnia 92
Invigorant properties 57
L.
Locomotor Ataxia 116
M.
Melancholia 122
Mind, effects on 51
Miscellaneous disorders 129-130
Mode of administration 19
Muscular contractions 50
N.
Nervous Exhaustion 84
Neuralgiæ 100
Neurasthenia 84
Nutrition, effects on 59
P.
Paralyses 96
Pareses 96
Physiological effects 31
Prophylactic influence 60
Pulse, effects on 41
R.
Rheumatism 67
" acute 68
" chronic 74
" subacute 73
" cases of 77
S.
Sedative effects 48-58
Sexual apparatus, effects on 46
Sexual debility 106
Sleep, effects on 38
Special therapeutics 61
Stimulant effects 43
Surface board 14
Sympathetic, affections of 126
T.
Temperature, effects on 41
Tonic properties 43-57
[Transcriber’s Notes: The table below lists all corrections applied to
the original text.
p. 029: [normalized] the sub-acute symptoms -> subacute
p. 056: GENERAL COUNTER IRRITANT -> COUNTER-IRRITANT
p. 056: [normalized] the use of the surface-board -> surface board
p. 059: does ... became apparent -> become apparent
p. 067: [normalized] acute, sub-acute and chronic -> subacute
p. 073: [normalized] bi-carbonate of soda or potassa -> bicarbonate
p. 107: ordered by their physicians: -> physicians; ]
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