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Transcriber’s Notes:

Text enclosed by underscores is in italics (_italics_), and text
enclosed by equal signs is in bold (=bold=).

Sidenotes are identified as: [SN: text of sidenote].

Additional Transcriber’s Notes are at the end.

       *       *       *       *       *

HOW TO USE A GALVANIC BATTERY IN MEDICINE AND SURGERY.

       *       *       *       *       *




HOW TO USE A GALVANIC BATTERY IN MEDICINE AND SURGERY


  A Discourse DELIVERED BEFORE THE HUNTERIAN SOCIETY.

  BY HERBERT TIBBITS, M.D.

  FELLOW OF THE ROYAL COLLEGE OF PHYSICIANS IN EDINBURGH; HONORARY
  MEMBER OF THE NEW YORK SOCIETY OF NEUROLOGY AND ELECTROLOGY; LATE
  HONORARY MEDICAL SUPERINTENDENT OF THE NATIONAL HOSPITAL FOR THE
  PARALYSED AND EPILEPTIC, OUEEN’S SQUARE, BLOOMSBURY, AND OF THE
  MEDICAL SOCIETY OF LONDON; MEMBER OF THE CLINICAL, OPHTHALMOLOGICAL,
  HARVEIAN AND PATHOLOGICAL SOCIETIES; FOUNDER OF, AND SENIOR PHYSICIAN
  TO, THE WEST END HOSPITAL FOR DISEASES OF THE NERVOUS SYSTEM; AND
  MEDICAL OFFICER FOR ELECTRICAL TREATMENT TO THE HOSPITAL FOR SICK
  CHILDREN, GREAT ORMONDE STREET, ETC. ETC.

  _THIRD EDITION_

  REVISED, AND INCORPORATING THREE LECTURES UPON ELECTRO-THERAPEUTICS
  DELIVERED BY THE AUTHOR AT THE NATIONAL HOSPITAL

  [Illustration]

  LONDON:
  J. & A. CHURCHILL,
  11 NEW BURLINGTON STREET.
  1886.




NOTE TO THE THIRD EDITION.


This Discourse was first published in compliance with the request
of several of those who heard it delivered, and who expressed to me
an opinion that busy practitioners might perhaps be glad to have at
hand, and in small compass, such information as it contained. It was
obviously impossible to do more in so limited a time than to make a
general reference to the therapeutic uses of electricity; and the most
that I attempted in this direction was to recall to the recollection
of my audience those conditions of disease in which the application of
electricity would seem--without doubt--to be required; and to indicate
the methods of application most generally useful. The construction of
apparatus can not be understood from verbal or written description
alone; and I appended to the text certain notes, and illustrations of
the instruments which I submitted to the Society.

With the Second Edition I incorporated three Lectures which I delivered
at the National Hospital for the Paralysed and Epileptic; and to this
Edition I have appended such additional matter as I believe will prove
useful to the student.

I may add that I have endeavoured, as was said by a deceased physician,
“to paint electro-therapeutics not imperfectly, but, as it were, in
miniature:” and that while I have carefully revised every page, and
have noticed all real improvements introduced to the profession since
the First Edition, I have kept the book a small book: and I venture to
hope a book easily to be understanded by the multitude of practitioners
who ask daily what instruments to use, and when, and especially how, to
use them.

These questions I have endeavoured to answer in the following pages,
which contain such details, and such details only, as I believe it
essential for the practitioner to master.

  68, WIMPOLE STREET, W.
  _December, 1885_.




CONTENTS.


  NOTE TO THE THIRD EDITION.

  LECTURE I. ELECTRICAL INSTRUMENTS.

  PRELIMINARY REMARKS.

  THE DIFFERENT VARIETIES OF ELECTRICITY.

  1. FRANKLINISM.
    Method of Generating.
    The Plate Machine.
    Winter’s Machine.
    Carré’s Machine.
    The “Bischoff” Gas Engine.
    The “Hand Fly-Wheel.”
    Accessories Required.
    Its Administration.
      (_a_) Electro-Positive Bath.
      (_b_) Electro-Negative Bath.
      (_c_) by Sparks.

  2. VOLTAISM.
    Points of Distinction between the Voltaic and Faradaic Currents.
    The Essentials of a Voltaic Battery.
    The 40-Cell Battery.
    The Galvanometer as an aid to the Dosage of Electricity.

  3. FARADISM. The Essentials of a Faradaic Instrument.
    Description of a Faradaic Instrument.
    The Combined Hospital Battery.

  THE ACCESSORIES OF ELECTRICAL APPARATUS.

  LECTURE II. METHODS OF APPLYING ELECTRICITY.

  RÉSUMÉ OF FIRST LECTURE.

  GENERALIZED ELECTRIZATION.
    The Positive Charge.
    The Electric Bath.
    General Faradization.
    Central Galvanization.

  LOCALIZED VOLTAIZATION AND LOCALIZED FARADIZATION.
    Direct Muscular Electrization.
    Indirect   ”           ”
    Different kinds of Rheophores.
    Importance of exactitude in administering a Constant
      Current.

  CUTANEOUS ELECTRIZATION.
    (_a_) The Electric Hand.
    (_b_) Metallic Conductors.
    (_c_) The Wire Brush.

  ELECTRIZATION OF INTERNAL ORGANS.
    (_a_) of Rectum and Muscles of Anus.
    (_b_) of Bladder.
    (_c_) of Uterus.
    (_d_) of Larynx.
    (_e_) of Male Genitals.

  ELECTRIZATION OF CENTRAL ORGANS OF NERVOUS SYSTEM.
    (_a_) of the Brain.
    (_b_) of the Sympathetic.
    (_c_) of the Spinal Cord.
    (_d_) of the Retina.
    (_e_) of the Auditory Nerve.

  PRECAUTIONS TO BE OBSERVED IN ALL MEDICAL APPLICATIONS OF
      ELECTRICITY.

  LECTURE III. ELECTRICITY IN DIAGNOSIS AND TREATMENT.

  A.--_Electricity in Diagnosis._

  LIMITATION OF ELECTRICITY IN DIAGNOSIS.

  METHOD OF TESTING FARADO-IRRITABILITY.

         ”          VOLTAO-IRRITABILITY.

  RULE FOR STRENGTH OF CURRENT.

  DIAGNOSIS WHEN IRRITABILITY IS NORMAL.
    diminished.
    increased.
    diminished to Faradism and increased to Voltaism.
    of Peripheral from Central Disease.
    of commencing Paraplegia from Locomotor Ataxy.
    of Real from Feigned Disease.

  ELECTRICITY AS PROOF POSITIVE OF DEATH.

  B.--_Electricity in Treatment._

  LIMITATION OF ELECTRICITY AS A REMEDY.

  FRANKLINIZATION.
    (_a_) in Facial Neuralgia.
    (_b_) in Sciatica.
    (_c_) in Facial Spasm.
    (_d_) in Emotional Aphonia.
    (_e_) in Hysterical Hyperæsthesia.
    (_f_) in Tremor.

  NOTE UPON RECENT ADDITIONS TO OUR KNOWLEDGE OF THE
      BENEFIT OF FRANKLINIZATION IN DISEASES OF DEBILITY.

  VOLTAIZATION.
    The “Constant Current.”
    Possesses an Influence “_sui generis_.”

  ELECTRIZATION in Neuralgia.
    in Fatigue Diseases.
    in Electrotonus.
    its Resolvent Effects.
    in Electrolysis.
    in Impotence.
    in Gout.
    in Rheumatic Arthritis.
    in Muscular Rheumatism.
    in General Debility.
    in Atrophic Paralysis.
    in Infantile Paralysis.
    in Traumatic Paralysis.
    in Lead Palsy.
    in Facial Paralysis.
    in Wasting Palsy.
    in Hemiplegia.

  ELECTRIZATION as a Direct Application to the Brain.
    in Spinal Paraplegia.
    in Paraplegic Constipation.
    in Incontinence of Urine.
    in Hysterical Paralysis.
    in Locomotor Ataxy.
    in Insanity.
    in Diseases of Women.
    as an Emmenagogue.
    in Inertia Uteri.
    in Post-partum Hæmorrhage.
    in Uterine Neuralgia.
    in Sterility.
    in Paralysis of Nerves of Special Sense.

  RÉSUMÉ OF THE GENERAL PRINCIPLES OF ELECTRO-THERAPEUTICS.

  CONCLUDING REMARKS.

       *       *       *       *       *

HOW TO USE A GALVANIC BATTERY IN MEDICINE AND SURGERY.




LECTURE I. ELECTRICAL INSTRUMENTS.


MR. PRESIDENT AND GENTLEMEN,

[SN: Preliminary Remarks.]

When your Council did me the honour to ask me to bring before you
the subject of Electro-therapeutics, I felt that the invitation
was addressed rather to the Hospital to which I am attached than
to myself, seeing that to it belongs the merit of having been for
some years the pioneer and outpost, so to say, in this metropolis
of the scientific and methodical application of electricity to the
alleviation and removal of disease; and that we are indebted to one
of its distinguished physicians for a remarkable investigation into
animal electricity, and the demonstration that much of what we have
been accustomed to attribute to a “vital principle” may, in reality,
be the effect only of electrical charge and discharge[1] (a valuable
contribution to the correlation of the Physical Forces); and to my
predecessor for the discovery of the special influence of voltaic
currents in certain forms of paralysis.[2]

As it is one of our objects in our practice here to study the scope
and the limits of electricity as a remedy in disease, it seemed to me
not inappropriate to devote my first Lectures to electro-therapeutics;
and the more so, as few medical men have a practical knowledge of the
subject; and I fear that the profession generally, through lacking
this practical knowledge, are to some extent responsible for the utter
and astounding recklessness with which the laity--ever ready to rush
in where physicians fear to tread--are prone to apply painful and
dangerous electrization, not to themselves, but to their suffering
friends; while it is still too common for the medical practitioner (as
quoted by Golding Bird upwards of forty years ago) to consider that
when his fiat has gone forth “let the patient be electrified,” he has
done all that is necessary, while the patient usually carries out this
mandate by the purchase of a rotary magneto-electric machine, and by
using it according to the directions of its maker, who is generally
about as well fitted to teach its application in disease as is the
maker of an amputating knife to operate with it!

The almost complete absence in the medical schools of the
great hospitals of opportunities for an adequate study of
electro-therapeutics, the importance of the subject, and the widespread
attention that it is awakening throughout the profession, have also
determined me to sketch as briefly as is consistent with clearness the
present position of the science and practice of medical electricity,
and especially of its practice.[3]

Electricity, Gentlemen, is by no means one of those remedies that,
failing to do good, is little likely to do harm. On the contrary, in
injudicious hands, it is potent for evil, while the benefit to be
derived from it is in exact proportion to the judgment and care with
which it is administered. Moreover, the results of its employment
are dependent, more than with any other therapeutic agency, upon the
methods by which it is applied--methods that should be familiar, not
alone to a few specialists, but to every practitioner.

Addressing you who are engaged in active practice, with little
time to devote to medical electricity, it will, I think, be more
acceptable for me not to weary you with a tedious discourse upon the
elementary principles of electricity, for the practical application of
these matters concerns rather the instrument-maker than the medical
practitioner, and I shall discuss none of them, except incidentally,
and _with precise reference to their application to medicine_. Besides,
we know little of them, and I cannot forget that Faraday said that
“he once thought he knew something about electricity, but the more
he investigated it the less he found he understood it.” Let us then
be content with its definition as a “FORCE,” “pervading all nature,
latent in every substance, and liable at any moment to be excited by
mechanical or chemical means.”

Nor do I propose to make these Lectures in any sense exhaustive,
but, on the contrary, to include in them only such information as is
essential, and such as you may readily, and without effort, retain in
your memory. I shall direct especial attention to practical points
which are of importance to the successful use of electricity; for
from non-observance of small details of application many failures
have resulted, the treatment getting a measure of discredit, which in
_strict justice_ should have attached only to the operator.

In the present Lecture I shall consider instruments, their
construction and management, a dry subject, but an essential one,
the first requisite of a good workman being complete familiarity
with his tools, lacking which he will be the victim of constantly
recurring annoyances and difficulties; for although the present
position of electro-therapeutics is largely due to improved methods
of administration, these methods would be impossible with faulty
instruments, while, on the other hand, the most perfect instruments
require a certain amount of skill and care in their management, and
some acquaintance with at least the mechanical details of their
construction; and without this rudimentary knowledge it is also
impossible to usefully compare one instrument with another.[4]

My second Lecture will be devoted to the different methods of applying
electricity, and my third and last to its uses in the diagnosis and
treatment of disease.

[SN: Varieties of Electricity.]

We make use of three varieties of electricity in medicine.

Firstly, of static or friction electricity, the electricity of
glass and amber, appropriately called from its early investigator,
_Franklinism_.

Secondly, of the electricity of chemical action, _Galvanism_, or
better, _Voltaism_, the “_Constant Current_.”

Thirdly, of _Faradism_, the induced currents of momentary duration,
which are generated or _induced_, in a coil of wire by the action upon
it, under certain circumstances, of a magnet, or of a Voltaic current.


FRANKLINISM.

Franklinism, sometimes of the utmost value, and far surpassing, in
certain cases, any other form of electricity, has some inconveniences
in its application, and has hitherto been little used but by
specialists. Recent improvements in Franklinic instruments have,
however, largely removed these inconveniences, and have placed at the
general service of the profession a remedy of much good and still
greater promise. The fundamental requisite in all Franklinic machines,
consists in the rotation of a glass plate against a leathern or other
rubber, and the accumulation of the resulting electricity upon a
metallic receiver, insulated by a non-conducting support, usually of
glass.

[SN: Franklinism]

Discarding the primitive cylinder machine, now long since disused,
we will firstly consider the plate machine in which the electricity
arising from the friction of the rotating glass plate against
the upper and lower cushions, is collected by two brass arms and
distributed to the brass conductor, from which they branch out, and
which is insulated by a glass support.

[Illustration: FIG. 1. Plate Electrical Machine and Glass-legged Stool.]

The machine should be fixed upon a firm stand that it may be quite
steady during rotation, and be screwed to a heavy painted deal table,
as is shown in Fig. 1.

[Illustration: FIG. 2. Winter’s Machine.]

When very seldom used, _and where expense is a consideration_, very
_fair_ results may be obtained from a Winter’s machine with a plate
of only 15 inches in diameter, and which is easily carried. In this
instrument, Fig. 2, the fact that the quantity of electricity which may
be accumulated upon a conductor is dependent upon its size has been
most ingeniously applied, the surface of the conductor being enormously
increased by the insertion into a large wooden ring of a core of thick
iron wire. Electricity accumulates upon the wire, and is prevented from
escaping by the insulating wooden covering.

But in the daily or frequent use of Franklinism it is essential,
equally for the comfort of the operator, as for the benefit of the
patient, that the most efficient apparatus should be provided. The
one delineated in Fig. 3, and which I habitually use, is that known
as Carrè’s, but I have modified it by having attached to it a second
accumulator, or conductor (the first time, I am led to understand,
that such an improvement has been added to any such machine). This
arrangement admits of the patient receiving the charge of either
positive or negative electricity--a condition said by some physicians
to be of primary importance.

[Illustration: FIG. 3. Static Machine with Gas Engine and Insulating
Stool.]

There are other machines, but I do not propose to weary you with their
descriptions.

When _any_ Franklinic apparatus is in use its plate or plates should be
evenly and uniformly rotated, and it is much better to have this done
mechanically rather than by a man or maid-servant.

I use a “Bischoff’s” gas engine, shown to the right hand in Fig. 3.
It consists of a cylinder, surmounted by a hollow column serving as
a guide to the piston. From the extremity of this column there is a
very long connecting rod which acts upon the crank of the shaft of
the fly-wheel and driving-pulley. When the piston ascends it draws
in during four-tenths of its course a mixture of air and gas from the
pipes. A little before the piston has ascended half-way a gas jet
ignites the mixture. There is a slight explosion without the least
effect on the sides of the cylinder, but sufficiently strong to push
the piston and cause it to complete its course. In consequence of this
movement the piston is raised and acts on the connecting rod, forcing
it upwards and half turning the fly-wheel. On account of the speed
acquired, and of the impulse given, the fly-wheel continues its course
by means of the crank and connecting rod, and sends the piston to the
starting-point again. Then it ascends again, taking in a fresh charge
of air and gas, motion being imparted anew to the driving shaft by
every revolution of the engine.

An engine of 2-man power, with an altitude from the ground to the
top of the column of 4 feet, and with a fly-wheel measuring 2 feet 6
inches in diameter, is amply sufficient for every purpose. It works
evenly and without noise; it is absolutely free from danger, and
it is placed instantly in or out of action by merely igniting or
extinguishing a single gas jet. But it is remarkable that no one seems
to have suggested--even before the gas-engine era--that a “fly-wheel”
with a pulley would obviate the old difficulty of the unsatisfactory
rotation of the Plate machine. Going into a hair-cutter’s shop I found
the apparatus, figured to the left of Fig. 4, standing in the shop to
work the customary “hair brushing machinery” instead of its being, as
is usual, fixed upon an upper floor. I obtained one, and fitted it in
the manner shown, to a Carrè’s machine. The fly-wheel is so heavy that
it can be rotated by the operator without the aid of an assistant, by
his giving the handle an occasional “swing round.” Its momentum then
keeps it revolving a sufficient number of times before the next “swing”
is required, to enable him to leave it and attend to his patient. The
manner in which the band from it is attached to a small wheel in rear
of the Static machine is also shown in the Figure.

[Illustration: FIG. 4. Fly-Wheel and Static Machine.]

In Fig. 3 the patient is being “charged” with _positive_ electricity,
or, as the electro-therapeutists of fifty years ago would have
said, “he is taking an electro-positive bath,” by being insulated
and connected through the metallic rod held in his hand with the
accumulator upon which the positive electricity is stored, while the
negative electricity is “run off” by a brass chain leading from the
negative accumulator to the ground. If the process were reversed, the
positive accumulator, being connected with the ground, and the patient
with the negative one seen at the top of the machine, he would be
taking “an electro-negative bath;” for we make him, as it were, a part
of each accumulator as the case may be; its accumulated electricity
passes to him and he becomes _charged_. If the air were perfectly dry
he would continue (as he is insulated) in this charged condition, but
owing to its contained moisture the electricity rapidly leaves him, and
to maintain the charge it is necessary that the plate of the machine
should be kept in constant rotation. Indeed, the escape of electricity
is so rapid that to get the best action we must have a fire in the
room, and before use well rub the plate, the insulating supports, the
legs of the stool, and all the glass parts of the apparatus with a warm
and dry piece of flannel. This is of importance, and however dry the
day, should as a rule never be neglected.

By smearing the inside of the cushions of the machine with a little
paste, composed of an alloy of mercury and tin (technically known as
“amalgam”), mixed with a little tallow, the amount of electricity is
much increased, but care should be taken not to smear the cushions
with too much, which had better be bought ready prepared. A piece
about the size of a small grape for each of the cushions will be
enough, and no more need be added for two or three weeks. Always scrape
off old amalgam before adding new. The cushions should be screwed
sufficiently tight to slightly “grip” the plate, and if it is found
that notwithstanding having rubbed the glass of the apparatus as
above directed, the instrument is not supplying a sufficient quantity
of electricity, remove the cushions and warm them thoroughly. _It
is impossible to be too careful that everything is warm, clean, and
dry_, for the great obstacle that exists against the extended use of
Franklinism is found in this difficulty sometimes present, from neglect
of the above precautions, in getting efficient action. But even on a
foggy day the instrument, _with proper care_, may be made to act well.
The operator should also remember that dust must be sedulously guarded
against. A few drops of petroleum may be sprinkled upon the table, and
their vapour condensing upon the machine will aid in protecting it
against moisture.[5]

There will also be needed two or three lengths of brass chain, or of
copper wire, and a stool about 4 feet by 2 feet, with four glass balls
or legs. A stool of this size admits of a chair being placed upon it,
as in Fig. 3, and it will be also useful for certain applications of
voltaism, which will be mentioned later on. Four glass jars are also
needed with which to insulate an ordinary couch.

[Illustration: FIG. 5. Improved Dischargers and Connecting Rod. FIG.
5_a_.]

A chair, insulated by being screwed to a glass platform, as in Fig.
5_a_, _running on castors_, is an improvement upon the old-fashioned
glass-legged stool.

[SN: Franklinization by Sparks.]

In Fig. 3, the electricity is escaping from all points of the skin,
but if it is desired to localize somewhat this escape along the course
of certain nerve branches, or otherwise, but to avoid shock, a brush
may be slowly passed by the operator almost, but not quite, in contact
with the skin. A series of rapid and successive reunions of the
electricity with each bristle of the brush takes place, generating a
current of cold air perceptible to the patient. I habitually use for
this application an ordinary clothes-brush. If while in connection with
the conductor any object (the knuckles will do) is brought sufficiently
near to the patient for his contained electricity to overcome the
resistance of the intervening stratum of air, he is “_discharged_” with
a spark. This is _Franklinization by sparks_, and is accompanied by a
certain slight amount of “shock.”

In Fig. 5, improved “dischargers,” and a convenient metallic connecting
rod are shown.

The ball terminations of the dischargers should vary in size, for
within certain limits, the larger the ball the more intense the spark;
with the pointed end the spark is very small; with the discharger
terminating in many small metallic points still smaller, and with a
similar discharger made of wood, a luminous glow alone results, and no
spark.[6]

I shall discuss, in my third Lecture, the therapeutic values of
Franklinism.


VOLTAISM OR GALVANISM.

[SN: Voltaism.]

The Voltaic current is a _continuous_ current. Unless artificially
interrupted, the electricity flows in an unbroken stream until the
battery is exhausted. The current will gradually lessen in power until
it ceases, but there will be no break in it, and no change in its
direction, which is uniformly from the positive to the negative pole.
[SN: Points of distinction between the Voltaic and Faradaic Currents.]
It is important to recollect these points, for they constitute the
chief physical distinction between the Voltaic and the Faradaic--or,
as it is sometimes called, the Induced current. This latter is not,
strictly speaking, a “_current_,” but a rapid discharge or succession
of momentary shocks, each perfectly distinct in itself, and separated
by an appreciable interval of time from its fellows.

[SN: Voltaic Cells.]

In electrization, a source of electricity is of course necessary, and
this is furnished by a cell or cells, with contained elements and
chemicals; and, until a few years ago, it was impossible to get a
_portable_ cell that remained always in order and ready for use.[7]

[SN: Requisites of a Portable Battery.]

The requisites of a portable battery are that it should be really
portable, always ready for use, and little liable to get out of
order. Such batteries may be divided into two classes: firstly,
those in which the elements are either lowered into the exciting
fluid or the fluid is lifted to them, as in the instruments of
Stöhrer, Weiss, and almost all other makers; and, secondly, those in
which the elements remain immovable in their cells, and of these the
Leclanché, the Gaiffe-Clamond, and the chloride of silver, are to be
generally preferred to any of the first-named construction, for they
admit of the cells being so nearly sealed up that no fluid can be
spilt by any movement except turning the battery quite upside down;
while the somewhat common accident with batteries of the first-named
construction--viz., destruction of the plates by leaving them in the
acid, with its anything but agreeable result of a considerable expense
to replace them, is obviously impossible. The only disadvantage they
possess is that when exhausted it is necessary to send them to the
maker to be recharged, _while the owner can keep the first-named
variety in order himself_.

Efficient cells are, however, but a first step to the perfection of
electrical apparatus, and the mechanism by which the current is brought
into use and graduated, and the general accessories of the instrument,
are of at least equal importance. The instruments which I am about to
describe, have been designed by myself, and may be obtained from Mr.
Hawksley, Surgical Instrument Maker, Oxford Street. It is claimed for
them that they place at the service of the busy practitioner a battery
that with ordinary care (and no instrument will remain in order
without this) may be kept upon his consulting-room table, always as
available to his service as his stethoscope or ophthalmoscope.

Three kinds of batteries are constructed:--A Voltaic battery, with any
required number of cells, from 15 to 100; a Faradaic battery; and a
Combined battery, uniting both Voltaic and Faradaic currents.

[Illustration: FIG. 6. 40-Cell Voltaic Battery.

A. Guard preventing the lid being shut, unless the needle of the dial
points to “0”, and the instrument is out of action.

B. Cells shown by the removal of the compartment, H, for sponges and
accessories.

C. Bolt to secure the element board, which moves upon the hinges, D.

D, D. Hinges of element board.

E. Dial plate regulating the strength of the current. The needle, when
the battery is not in use, should cover the stud, “0,” seen to its left.

F. Commutator of the poles. The poles, N and P, are seen through holes
cut in the element board.

G. Key by which the current can be shut “off” or “on,” without change
of position of the conductors. It can also be used by vibrating it
backwards and forwards as an “interrupter.”

I, I. Binding screws, to which are attached the conducting wires and
sponge-holders, &c.]

[SN: The Voltaic Battery.]

_The Voltaic Battery_ (see Fig. 6, p. 20) has its cells arranged in the
interior of a mahogany case, and in use they are hidden from view and
from danger, but I now partially expose them by removal of the tray
for holding the sponges and accessories. Their connecting wires are
brought across the under surface of the element board, which is made
to move upon hinges that, when necessary, the cells may be examined,
but at other times this element board is held in position by a bolt,
and it should never be needlessly disturbed. These wires conduct the
current through the graduating dial, and the position of the needle of
this dial determines from how many of the cells the electricity shall
be allowed to reach the binding screws, and from them, by way of the
conductors, sponge-holders, or electrodes, the body of the patient,[8]
or whether it shall be entirely shut off, as is the case when the
battery is not in use, and when the needle stands at “0” (Fig. 7).
When the needle points to any stud numbered on the dial, the number
of cells marked on that stud are brought into action, and the needle
is made just wide enough to touch one of the studs before it breaks
contact with the preceding one, and thus the current may be increased
or decreased in power without shock, and while the electrodes are
held applied to the patient; but if it were not so made a series of
painful shocks would be communicated whenever the current was increased
or decreased. Should the needle, from forgetfulness, be left when
out of use in any other position than at “0,” a guard upon the lid
of the instrument prevents its being shut, and the operator has his
attention called to his inadvertence. A Voltaic alternative, or change
of direction of the current, is sometimes required in treatment, and
the commutator of the poles enables this to be accomplished without
alteration in the position of the conductors. By pushing forwards or
backwards the handle which moves a lever working below the element
board the current is instantly reversed, and the alternation of the
letters “P” and “N” seen through holes cut in the element board
indicates at once not only that there has been a change of poles,
but which pole is at the moment negative or positive; whereas in all
previous instruments, when the poles have been changed, there has
either been no letter marking them, or this letter has really been
wrong, and one has had to remember this; and under such circumstances,
and examining patients in rapid succession, momentary confusion of
the poles was very liable to occur, even to a practised operator. A
key enables the current to be shut off or on without removal of the
conductors. Dirt is a non-conductor of electricity, and the studs
of the dial must be kept clean with emery paper or plate-powder, as
also the under surface of the needle, key, and binding screws, which
unscrew to admit of removal. In the daily use of a battery the chief
work is usually thrown upon the first half (say in a battery of forty
cells, upon the first twenty-five), and various arrangements have
been added to batteries by ingenious instrument-makers to enable the
operator to vary his selection of the cells to be brought into use, and
thus to relieve the first half of his battery, or, in other words, to
equalize its work. But this unequal work question is more a theoretical
than a practical evil; for if the initial cells grow weaker a greater
number can be placed in use. I have carefully studied all the proposed
modifications, and have found in all of them the remedy worse than the
disease, unless the graduating dial be doubled (an original suggestion
of my own), so that the initial cells of one week may be made the
terminal cells of the next.

[Illustration: FIG. 7. Graduating dial with needle at “0”.]

When desired batteries can be constructed with this double dial (Fig.
8), but it adds to the complexity of the instrument, and I do not
myself use it.

[Illustration: FIG. 8. New form of Graduating Dial.]

In Fig. 9 a similar battery is shown to that just described; but the
elements consist of carbon and zinc, and are lifted into and out of
a bichromate solution. As it can be recharged by the owner without
the necessity of sending it to the maker, it is especially suited for
country and colonial practitioners.

[Illustration: FIG. 9. 40-Cell Voltaic Battery with zinc and carbon
elements, and lifting apparatus.]

[SN: Essentials of a Medical Voltaic Battery.]

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

_a._ A constant supply of electricity of sufficient quantity and
quality.

_b._ A means by which this electricity may be administered in measured
doses.

_c._ A means by which the direction of its current may be changed.

_d._ A means by which it may be instantly discontinued.


FARADISM.

[SN: The Faradaic Current.]

The Faradaic, induced, interrupted, or electro-magnetic current, is
the third form of electricity employed in medicine. Faraday, as you
will recollect, discovered, that if two metallic wires were so fixed
as to be parallel and close to each other, but not to touch; and that
if then a current of Voltaic electricity were sent along the first
wire, another current appeared in the second. This _secondary_ or
_induced_ current, as it is called in contradistinction to the current,
the _primary_ or _inducing_ current sent along the first wire is only
momentary, but it appears again for a moment when the first current
ceases, but in a reverse direction. It is most convenient to wind
these two wires round two reels, so as to form separate coils, and to
place the primary within the secondary coil. Each single turn of the
primary then acts not only on the parallel turn of the secondary wire,
but on all the turns near it, and the power of such an apparatus is
much greater than that which would be obtained by the same lengths of
wire running side by side in a straight line. Our two coils being thus
arranged, we pass through our primary wire a succession of electrical
currents, and in practice this is accomplished by connecting its
extremities with a battery supplying a continuous current, which by an
ingenious mechanism we frequently break or interrupt.

[Illustration: FIG. 10. Faradaic Battery.

A. Cells shown by the removal of the compartment.

B. For conductors and accessories.

D. Screw regulating the pressure of a spring which modifies the
vibration of the hammer, E.

E. Hammer vibrating between the electro-magnet, F, and the point of a
platinized needle regulated by the screw, G.

F. Bundle of iron wires rendered an electro-magnet by the passage of
the Voltaic current from the cells, A, through the primary coil, K,
within which this bundle of wires is inserted.

G. Screw regulating position of a platinized needle.

H. The graduator, a stem to which is attached the movable secondary
coil, L. The front part of the case has been cut away in the engraving,
to show the construction of the induction apparatus.

I, I. Binding screws for attachment of the conducting wires, &c.

K. The primary coil, fixed upon a pedestal. In the figure, the
secondary coil, L, is wholly withdrawn from the action of the primary,
and its strength of current depending entirely upon the extent to
which it covers the primary, it is evident that the height which the
graduator, H, stands above the element board will exactly indicate this
strength.

L. Movable secondary coil.

M, M. Binding screws for attachment of the pedal rheotome, N, for
slow interruption. These interruptions are made by the pressure of
the operator’s foot upon the spring, P, but in practice they are very
seldom wanted, and the fittings are only added to the instrument when
specially ordered.

O. A spring retaining the secondary coil, L, in any desired position.]

[SN: The Faradaic Battery.]

_The Faradaic Battery._--In Fig. 10 (see p. 29), a Faradaic battery,
worked by two Leclanché cells, is shown; but I find it better to employ
either one or two ordinary bichromate cells instead of the Leclanché,
as the former can be kept in order by the operator himself without
much trouble. The primary coil is fixed upon a pedestal, the secondary
is movable, and can be lifted over or thrust away from the primary.
The degree of action in the secondary coil being proportionate to the
extent to which it is brought under the influence of the primary, this
arrangement admits of the most perfect graduation of the current; and
it has been for some time in use in all well-constructed instruments.
The innovation I have made consists in limiting the primary coil to
its legitimate purpose of induction, and rendering the secondary alone
available for application to a patient. I have been long satisfied
that therapeutically the distinction between the primary and secondary
coil entirely consists in the greater tension of the current of the
secondary coil enabling it to penetrate easily several thicknesses
of muscle, but there is no therapeutic indication that cannot be
fulfilled by this secondary coil; and at its lowest power I have
frequently applied it to the conjunctiva. The rapidity of vibration
of the interrupting hammer is varied by increasing or decreasing the
distance between the point of the needle and the electro-magnet by
the protrusion or retraction of the screw, of which the needle forms
the end--that is, by increasing or decreasing the space through which
the hammer passes in its vibration, and also by altering the pressure
of its spring, but there is seldom therapeutic need for change of
vibration; and unless this exists it is better _not to alter the
adjustment so long as the instrument acts well_.[9] After considerable
use the point of the needle, and the exact spot of the platinum disk of
the hammer against which this needle impinges, become oxidized, causing
weakening or stoppage of the current. This platinum disk has been
constructed to rotate, and a hole has been drilled in its circumference
(Fig. 11). By inserting a little lever furnished with the instrument
into this hole, the slightest twist given to the disk is sufficient to
bring a new surface of platinum into contact with the needle point.
This will usually be all that is required, but, if not, the needle can
be unscrewed, and its point cleaned with emery paper. When in course of
time the disk becomes dotted over with spots of oxidation, the screw
fixing the hammer in position must be unscrewed, the hammer lifted out,
and its surface similarly cleaned.

[Illustration: FIG. 11. The Platinum Disk and Lever.]

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

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

[SN: The Hospital Combined Battery.]

In the _Hospital Combined Battery_ (see Fig. 12), constructed from
my designs, the two currents are thus united, and its details are
precisely similar to those of the separate batteries, with the
exception of the Dial being furnished with an additional stud lettered
_Coil_. When the needle points to this stud the current from the
Faradaic coil is brought into action; when it points to the numbered
studs, the cells numbered thereon as in my Voltaic instrument, and
when it points to “0,” both currents are shut off.

[Illustration: FIG. 12. Hospital Combined Battery.

  A. Guard block.
  K. Tray for holding accessories.
  E. Dial plate.
  C. Bolt securing element board.
  G. Key for interrupting current.
  M. Hammer.
  F. Commutator of the poles.
  I, I. Binding screws for conducting wires.
  L, L. Hinges of element board.
  H. Graduator of coil.
  N. Electro-magnet.
  R. Screw regulating position of needle.
  D. Screw regulating spring of hammer.

]

Other instruments, such as those of Stöhrer and Weiss, are excellent,
and were unsurpassed until the invention and improvement of the
Leclanché and other cells. But I might talk upon instruments for hours
without exhausting the list; and I have felt obliged to limit myself
to a description of those I believe best fitted to our requirements;
but it, of course, must be understood that my further _observations
will apply equally to currents of electricity furnished by any properly
constructed and reliable apparatus_.

[SN: Accessories of the Battery.]

We have now brought the electricity to the terminals of our battery,
and we must next consider the best means of conveying it to the
sponges, conductors, or, as they are generally termed, rheophores or
current carriers, by which it is finally applied to our patient. [SN:
Conducting Cords.] Our first necessary accessory is a conducting cord
or wire, and it is of the first importance that this should really
be what it is called--“_a conductor_”--for any fault or break of
connection in it will, of course, nullify the best and most perfect
battery. It must also be sufficiently pliable, and be insulated by
being coated with some non-conducting material that the electricity
may not escape from it to any conducting substance with which it
may accidentally come into contact. The conducting cords sold by
instrument-makers are sometimes not insulated at all, and then they are
quite useless, but they are more commonly composed of several strands
of metallic wire of about the diameter of sewing thread, the whole
enclosed in some silken or woollen material, and nothing can be better
than these latter when quite new. Their disadvantages are that they
become frayed after a little use, and are liable to be constantly out
of order, causing interruptions in the current, while they will only
fit one kind of machine. I have had endless trouble with them; and
for some years I have used nothing but thin copper wire, coated with
gutta percha in the same way as that known as “telegraph wire.” This is
perfectly insulated, sufficiently pliable for all practical purposes;
it is cheap, and can be made to fit any sort of connection. Its one
disadvantage is, that it is liable to break at the point where it is
received into the terminals of the battery, or the screw socket of
the rheophore. Should this happen, all that is necessary is to scrape
off the gutta percha coating with a pocket knife for an inch from the
broken end, by which we get practically a new conducting cord.

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

FOOTNOTES:

[1] See “Vital Motion as a Mode of Physical Motion.” By C. B.
Radcliffe, M.D. Macmillan.

[2] See Mr. Netten Radcliffe upon the differential reaction of voltaic
and induced currents of electricity. Note to page 331, vol. i., of
Bazire’s translation of Trousseau’s “Clinical Medicine.” Hardwicke.

[3] This observation, made in 1873, requires some qualification now
(1886). At several of the great medical schools, though not at all,
electrical treatment has been transferred from the hospital porter to
some member of the hospital staff; and at more than one a systematic
course of lectures upon electro-therapeutics has been delivered.

[4] I speak feelingly upon this matter, for from an early period of
my electrical experience I have suffered much from batteries--from
instruments “striking work” at the most inconvenient moment--from
spilling of corrosive acid upon fingers and clothing, to the detriment
of both, and of temper too, I fear.

[5] So long ago as 1870, I was in the habit (at the suggestion of Dr.
Radcliffe) of employing at an Institution for Resident Patients, a
method of “charging” a patient which I believe to be unique.

[SN: _Unique method of charging a patient._]

During dry summer weather the patient reclined upon a couch in the
gardens insulated by glass supports, and a sort of lightning conductor
was improvised by attaching a 30-feet salmon-rod to the foot of the
couch, a piece of ordinary “telegraph wire” being carried up the rod,
its insulation being removed from about a foot which projected above
the top of the rod.

Upon a fairly warm and dry day the patient became “charged” and sparks
could be drawn from him as from a patient in ordinary connection with a
Franklinic machine in rotation.

Upon more than one occasion in those ancient Static days, an attempt
was made to insulate a patient for a whole night, and to maintain
the charge by a relay of “rotating nurses;” but the _human machines
failed_, and suitable gas engines were not then available; hence the
procedure related above was, if conducted for three or four hours on a
dry summer afternoon, a by no means bad substitute for a close room and
a rotating Static machine. In New York, in winter, when the rooms are
covered with thick carpets, and when the atmosphere is dry, it has been
known that on shaking hands with a visitor, not only has the “shock,”
which under similar circumstances occasionally occurs in England, been
felt, but that a spark has passed; and children have been known to
slide over the carpet towards each other and exchange sparks by way
of sport. _The influence of atmospheric and other ordinary electrical
conditions has been far too little studied by electro-therapeutists._

[6] The Carré Machine can be obtained from Mr. Groves, 89 Bolsover
Street; the Fly Wheel from Messrs. Hovenden and Co., Great Marlborough
Street; and the Gas Engine from Messrs. Andrew and Co., Engineers,
Stockport.

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

[8] _The Galvanometer as an aid to the Dosage of Electricity._--The
dose of voltaic electricity is made up of two factors, (_a_) the
strength of the current and (_b_), the time during which it is applied
to the patient. [SN: The Galvanometer as an aid to the Dosage of
Electricity.] The strength of the current is directly dependent upon
the number of cells employed, but, unfortunately, cells of dissimilar
construction evolve currents of very unequal strength; while cells
that have been freshly charged are more powerful than similar ones
that have been partly exhausted by use; and, therefore, to speak of
a current from “so many cells,” though, practically, a convenient
method of dosage, fails to convey any _exact_ idea of a measured and
unvarying quantity. It is a comforting theory to electro-therapeutists
that a galvanometer will enable them to administer their doses of
electricity with as much exactitude as we daily prescribe so many
grains, or so many minims of ordinary medicines; but, like some other
theories which save us much trouble, when adopted as theories _only_,
it fails us in practice (at least according to my experience), and
chiefly so, because a galvanometer can be usefully employed only when
it is included in the circuit of a continuous current, as, _e.g._,
in aneurismal electro-puncture; and, I believe, I am within the
mark in saying that electrizations, which even admit of its useful
employment, are indicated in barely 5 per cent. of ordinary cases in
electro-therapeutics; and that it is of no practical utility, where
we most want aid, in measuring, not the current which leaves the
battery terminals, but that which, after overcoming the very variable
resistance of the human skin, really reaches the underlying muscular
and nervous tissues, which, in 95 per cent. of our cases, we desire to
influence, not by a constant, but by an interrupted Voltaic current;
and the amount which really reaches these tissues depends largely upon
the condition of the patient’s skin, and, I may also add, upon the
kind and shape of the conductor, and its degree of moisture, &c.; and
the operator will do well to graduate his dose of electricity by a
consideration only of the three factors, number of cells, effect upon
himself, and effect upon his patient, discarding entirely the use of
any merely mechanical aids to graduation.

I am induced to speak thus strongly because men of scientific
reputation have advocated the habitual use of the galvanometer, not
alone by medical men trained to precision of observation, but by
private patients as “_enabling them to carry on the treatment at home
with all the accuracy desirable!_” The prospect of the ordinary patient
provided with a battery, the use of which he is complicating by a
galvanometer, is anything but reassuring to those physicians who not
only prescribe electricity, but are themselves habituated in applying
it--which, by the way, is a very different thing--and who have had
frequent experience of the manner in which patients misunderstand,
or fail in correctly carrying out, the most explicit directions.
Electricity will be left in the hands of specialists, and necessarily
do but a tithe of the good it is capable of affecting, until the
mass of the profession can be induced to master the few preliminary
details essential to its successful application, and I fear that the
suggestions that have been made--suggestions which I believe to be
entirely without foundation--that there exist practical difficulties to
its dosage, will tend to postpone rather than to accelerate its more
extended use.

Should any of you desire to use a galvanometer, that patented by
Sprague, of Birmingham, is the one most adapted for use in medicine.
Electricity is a force, and as with other forces it has its standard
of measurement. In mechanics we know that the power sufficient to
raise one pound to the height of one foot is the basis of measurement.
Similarly in electricity the unit of measurement is the force which
will raise one gramme to the height of one metre, and the standard
multiple of this was called a “British Association Unit,” or shortly, a
“B.A.” unit, and it is now called an “_Ohm_” when used to measure the
resistance offered to the current, and a “_Veber_” when used to measure
the strength of the current itself. The ordinary galvanometer is
founded on the principle that a magnetic compass needle has a tendency
to place itself at right angles to a current of electricity, and the
degree to which the needle is deflected is a measure of the quantity
of electricity, but the angle of deflection is not proportionate to
the current strength, and it differs in different galvanometers; but
in “Sprague’s Galvanometer” the dial is divided, not into degrees,
but into divisions of thousandths of _Vebers_--divisions which were
obtained by noting the deflections given by the needle with currents
of known strength. I am indebted to Mr. Sprague for his courtesy in
endeavouring to so modify his galvanometer as to render it available as
a graduator of doses of interrupted Voltaic electricity, but although
he has not succeeded in doing this, he has constructed for me an
instrument which, supposing that a battery be partially exhausted,
will indicate with precision the absolute strength of, say, twelve
of its cells as compared with twelve newly-charged cells, and also
the condition of each individual cell, points often of much practical
convenience in an Hospital Electrical Room.

[9] A little care is needed to regulate the vibrating needle. The
spring should but _barely touch_ the hammer, the adjustment being
almost entirely regulated by the protrusion or retraction of the needle
by the action of its screw; and the _slightest twist_ of this screw
will be sufficient. When the vibration is uneven or stops, and careful
manipulation of the needle fails to re-establish it, remove the needle
and clean its point as directed in the text.




LECTURE II. METHODS OF APPLYING ELECTRICITY.


GENTLEMEN,

[SN: Résumé of First Lecture.]

In our first Lecture we studied the different kinds of electricity
employed in medicine, and the construction and management of batteries.
I reminded you that we made use of three kinds of electricity;
firstly, of friction or static electricity, _Franklinism_; secondly,
of the electricity of chemical action, _Voltaism_, or _Galvanism_;
and, thirdly, of induced electricity, _Faradism_:--that there had
been certain difficulties in the employment of Franklinism, but
that these difficulties no longer existed; that Voltaic electricity
was electricity in motion, or current electricity, but that
while its current (unless artificially interrupted) was always
_continuous_--flowing, that is, in an unbroken stream--and from the
positive to the negative pole, until the battery was exhausted--it by
no means followed that it was _constant_, that is, that it did not vary
appreciably in power during application; that only batteries supplying
a fairly constant current were fitted for medical use, and that all
others should be rejected. We then considered different batteries,
both fixed and portable; that while large fixed low tension batteries
were unquestionably superior in their therapeutic effects, patients
unfortunately were not always movable, and that a portable battery
became, therefore, a _sine quâ non_; that portable batteries might
be conveniently divided into two classes, one in which electricity
was generated by the elements being immersed in an exciting fluid
only during actual use, and being taken out of the fluid immediately
after use; and the second that in which no removal of the elements was
necessary; that the Voltaic current was graduated into doses by some
arrangement determining the number of cells to be employed in each
case, but that this method, while practically useful and sufficient,
failed to convey an exact idea of a measured and unvarying quantity
of electricity; and that it had been contended that by the use of a
galvanometer, doses of electricity might be as accurately administered
as so many grains or minims of ordinary medicines, but that, perfect
as the theory might be, I had personally failed to obtain help in
practice from a galvanometer; that next in importance to a method of
dosage, was it to be able to instantly change the direction of the
current, or to at once turn it “off” or “on,” in addition, of course,
to the fundamental requisite of a continuous supply of electricity of
sufficient quality and quantity.

We next considered the induced or _Faradaic_ current, so-called,
which I reminded you is not a current at all, but a rapid discharge
or succession of those momentary shocks, each perfectly distinct in
itself, and separated by an appreciable interval of time from its
fellows, which Faraday discovered to be generated or induced by a
Voltaic current flowing along a wire in other wires parallel to, but
separated from, the first wire; that by winding the two wires upon two
movable reels and introducing one within the other, not only might
these _secondary_ currents be multiplied indefinitely in proportion to
the number of spirals of wire, but by introducing or withdrawing the
one from within the other an exact method of graduation was afforded
us. I pointed out to you that there was no therapeutic distinction
between the so-called primary and secondary currents, and I recommended
you therefore to use only the currents of the secondary coil. I then
showed you the construction of Faradaic instruments, and of instruments
combining both Voltaic and Faradaic currents, and our survey was
completed by a consideration of the different varieties of conducting
wires or cords, and my recommendation of thin gutta-percha covered
copper wire as generally superior to any other form. We have to-day
to study methods of applying electricity, and to learn how to use the
instruments, with the construction and properties, of which I trust you
are now familiar; and, Gentlemen, it is well worth your while to have
obtained this knowledge, for its possession will not only enable you to
readily rectify any faults in the working of your batteries, but the
necessity of sending them to the instrument-maker may be often avoided.

We have already studied methods of applying Franklinism.[10]

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

[SN: The Application of Electricity.]

A convenient method of applying electricity, when very strict
localization is not required, is to insert the feet and hands of the
patient, or one foot and one hand, as the case may be, in separate
vessels containing tepid salt and water with which the conducting wires
of the battery are in contact, the current being allowed to circulate
during the time required. Ordinary foot-pails, basins, or jugs, will
fulfil every requirement; while thick telegraph wire answers well to
connect the battery with the vessels of water, as it is little liable
to break and wears well. A variety of the constant current (originated
by Dr. Radcliffe) is very readily applied in the way just described,
with the addition only of some means of insulating the patient and the
accessories, and of a length of ordinary uninsulated copper wire.
[SN: Radcliffe’s Positive Charge.] Dr. Radcliffe believes that an
administration of _positive_ Voltaic electricity, somewhat analogous
to the charge of Franklinic electricity, is frequently beneficial. He
insulates the patient and the accessories, and having connected the
negative pole with the earth by a wire which he calls a “ground-wire,”
he allows the current to pass. With careful insulation the negative
electricity passes away by the wire, and while the current circulates
the patient continues “charged” with positive electricity. There must
be two wires from the negative pole, one to be applied, as well as
the positive, to the patient, and the other taken “to earth.” This
latter may be conveniently attached to a chandelier or gas-pipe,
which always gives a direct metallic conduction to the ground. A
perforated vulcanized indiarubber mat, or a sheet of gutta percha, or
a glass-legged stool can be employed to insulate the patient and the
accessories.

[SN: The Electric Bath.]

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

[SN: General Faradization.]

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

[SN: Centralized Galvanization.]

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

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

[SN: Localized Electrization.]

But the great majority of cases require--not a generalized, but a
strictly localized application, and for the fundamental principles of
all methods of localized electrization we are indebted to the late Dr.
Duchenne (the “father of electro-therapeutics”), for before him no one
had attempted any local application of electricity that could properly
be so called. Indeed, to Duchenne may be fairly ascribed the very
birth of medical electricity as a branch of therapeutics, and in the
true and kindly words of the _Lancet_, when announcing his death:--“No
field of work was ever seized upon with more eagerness; ever cultivated
with more earnestness; or perhaps ever made to yield a better harvest
than that which the discovery of induced electricity placed at the
disposal of the man whose genius was the first to recognize, and
his talents to secure, the opportunity it afforded. Taking his work
at its lowest estimate, he was a man to whom medical science owes a
large debt of gratitude, and whose memory deserves a warm tribute of
regard.” Duchenne’s two test experiments, demonstrating the fundamental
principles of his method, I will now repeat upon the posterior surface
of my left forearm. I propose to arrest Faradism in the skin, without
allowing it to stimulate the subjacent muscles. To do this it is
necessary for the skin to be quite dry--moisture, as you know, being
a conductor of electricity--and to make sure of sufficient dryness, I
sprinkle the skin with a little starch powder. I now apply to the dry
skin the dry metallic conductors of an induction instrument in action.
I am afraid you cannot see, Gentlemen, the small sparks produced as
the two electricities combine upon the cutaneous surface, or hear
the slight crackling sound produced, but you observe no muscular
contraction, and what I feel is a superficial and evidently cutaneous
sensation. I now replace the dry conductors by well-moistened sponges.
You observe that I have not altered the power of the current, but that
there is energetic contraction of the extensor muscles. This is quite
involuntary, and is due to the electric irritation of the branches of
the motor nerves.

It follows from these experiments that we may, at pleasure, arrest
electricity in the skin, and that without puncture or incision we may
make the current traverse the skin, and concentrate its action upon
subcutaneous organs. It was at one time objected that the muscular
contraction was the result--not of irritation limited to the muscle or
its motor nerves--but of reflex action; but Duchenne demolished this
objection by a vivisection. Having removed the skin from the face of a
living rabbit--to whom chloroform had been administered--he divided the
facial nerve of one side only, in order that the muscles supplied by
it might be cut off from all connection with the cord. He then applied
electric excitation to each muscle of the face, alternately, on the two
sides. The muscles contracted separately and equally on both sides.
He then destroyed the brain of the same animal, in order to place the
cord in a condition favourable to the production of reflex action, and
again excited the muscles as before. The results were absolutely the
same.[11]

Muscular electrization may be produced either--as I have just shown
you--by placing the conductors upon the muscle itself, a procedure
termed _direct_ or _intra-muscular_ electrization, or by exciting only
the motor nerve trunk, which is termed _indirect_, or _extra-muscular_
electrization, and which we shall consider presently.

[Illustration: FIG. 13. Cylindrical Sponge-holder.]

[SN: Different kinds of Rheophores.]

For direct excitation of the larger muscles it is convenient to use
well-moistened sponges, contained in cylinders of different sizes,
or metallic disks, covered with wet leather and having conveniently
shaped handles. A useful size of cylinder is one such as this (see
Fig. 13), having a depth of about 1-1/2 by 1-1/8 inches, which allows
the sponge to fairly fill it, while in such forms as this--6 inches
by 1--when the sponge is inserted the lower three-fourths of the
cylinder is empty, and the conduction of the current liable to become
imperfect. Such a cylinder as this, without any insulating handle at
all, is worse than useless, and is a still persisting relic of the
barbarous time when the patient was invariably electrized by causing
him to hold the conductors one in each hand, a proceeding extremely
dangerous in certain pathological conditions, and in other cases not
likely to be of benefit to him. The insulating handles should be well
hollowed out, that they may be used, lying comfortably between the
fingers, when holding two in the same hand. The disk rheophore (see
Fig. 14), a metallic button covered with wash-leather, is extremely
useful; it has the advantage over the sponge of allowing firm pressure
to be made without the inconvenience of water being squeezed out, while
by using its edge it may be made to answer in the majority of cases
for a pointed conductor, which is fitted chiefly for application to
very small muscles, such as the interossei and some of those of the
face. The wire is attached to the conductor by being screwed into the
socket (see a′, Fig. 14). A conducting cord is very apt to get frayed
at the point of juncture, and that the wire which I recommend is
not open to this objection is not the least of its advantages. [SN:
Direct Electrization.] In direct electrization the rheophores should
be firmly pressed down upon all points of the surface of the muscle,
that all of its fasciculi may be equally electrized. With the Faradaic
current it is convenient to apply the rheophores, held in the same
hand (see Fig. 15), for from twenty to thirty seconds, to every part
of the surface of the muscle, or group of muscles, promenading them
as nearly as may be in lines from the origin to the insertion of the
muscles. If the rheophores are not held in the same hand care should be
taken to keep them near to one another, for the tension or penetrating
power of Faradism is so great, that without this precaution there will
be liability to excite reflex action. With the interrupted Voltaic
current this liability does not exist, and a better plan when using it
is to hold the sponge from the positive pole stationary, near to the
origin of the muscles, and to stroke or paint as it were the entire
muscular surface with the sponge from the negative pole, gliding it in
lines from the position of the positive. In using the constant Voltaic
current both sponges must be held quite immovable, and so applied
it differs altogether in its effects from the very same strength of
current interrupted by moving the conductors. I will demonstrate
these different applications upon the extensors of my left wrist and
fingers--Faradism--Voltaism--Constant Current.

[Illustration: FIG. 14. Metallic Disk, covered with Wash-leather.]

[Illustration: FIG. 15. Method of holding Sponge-holders with Sponges
inserted.]

[SN: Indirect Electrization.]

Indirect, or extra-muscular electrization, next claims our attention.
You will recollect that it is produced by acting upon the special
nerve trunk and its branches, instead of by placing the rheophores
upon the muscle itself. We may thus call a motor nerve into action
without affecting the cutaneous nerves, and with a minimum of power
of current, and necessarily a minimum of sensation which hardly ever
need amount to actual pain. This method is preferable, therefore, in
cases where we desire to produce muscular contraction and as little
sensation as may be, and again when the sedative influence of the
constant Voltaic current is required to be localized in any special
nerve. In its application it is convenient to place a good-sized
sponge connected with one pole upon an indifferent part of the body,
such as the sternum, and to apply a pointed conductor from the
second pole directly over the course of the nerve it is desired to
act upon. Speaking generally, these motor points as they are called
may be selected by reference to a good anatomical plate, but only
approximately, for we know that it is common to find variations
in the course of the nerves and in the mode of their distribution
among the muscles, and this being so, it is well when we propose to
act upon a motor or mixed nerve (which is not paralyzed), to make
sure that we are localizing the current in it by producing for a
moment the contraction of its muscles and then marking the spot by
touching it with a pencil of nitrate of silver. This, of course, is
only necessary where in our subsequent electrization we do not wish
muscular contraction, as in the treatment of neuralgia.[12] I will
demonstrate indirect electrization by Faradizing the median nerve in my
left forearm above the wrist, and before it passes beneath the annular
ligament of the carpus. It lies a little below the surface, between
the tendons of the flexor carpi radialis and palmaris longus. You
observe that its muscles powerfully contract and oppose the thumb to
the other fingers, at the same time abducting it. There occurs also a
slight flexure of the first phalanges of the index and middle fingers.
Professor Ziemssen in his work on Medical Electricity has published
some extremely accurate plates of the motor points of the body, and I
have grouped together the more important of them in a chart or map for
convenient reference.[13] Ziemssen’s method of procedure was to find
out experimentally the points where the application of electricity most
readily produced muscular contraction. He then marked these points with
coloured chalk, and after a sufficient number of trials with nitrate of
silver. Photographs of the parts thus marked were taken and afterwards
transferred to the wood blocks. These figures may therefore claim to be
true to Nature, although they may not be absolutely correct for every
individual. Ziemssen verified their approximate exactitude by following
the course of the nerves very accurately in the dissecting-room and
observing their points of entrance into, and their course within, their
muscles, with constant reference to the surface of the body; but he
was not completely satisfied until he had determined the motor points
upon the skin immediately after death, and before the reaction to
electricity had disappeared, and submitted these points to the scalpel.
The results of the three methods coincided perfectly.

[SN: Cutaneous Electrization.]

We will next consider cutaneous electrization. I have already shown you
that when the skin and the conductors are both quite dry, a Faradaic
current of moderate power (and practically this form of electricity
is always employed in cutaneous electrization) does not penetrate the
skin, but is localized upon its surface. There are three methods of
applying cutaneous Faradization--the method that we employed--that
of “_Metallic Conductors_;” the “_Electric Hand_,” as it is called,
in which the operator having applied one conductor to some little
sensitive part of the patient’s body, holds the second in his left, and
passes the back of his right hand over the points he wishes to excite,
these points of the patient’s skin and the back of his hand being dry,
and sprinkled with absorbent powder; and the “_Wire Brush_,” a brush
of metallic wire, which replaces one of the conductors, and which is
moved over the skin. With a strong Faradaic current this wire brush
becomes the most powerful of all the excitants of the skin which do not
disorganize its structure; in fact it was proposed by some scientific
parliamentary philanthropist as a substitute for flogging in the navy,
and I have no doubt that more intense pain may be produced by it than
by any application of the cat, however well laid on!

[SN: Electrization of Internal Organs.]

The methods of electrizing internal organs need not detain us long.
The rectum and muscles of the anus may be electrized by introducing
into the rectum the rectal rheophore, a metallic stem insulated by gum
elastic, and moving it over the internal surface, bringing it also into
contact with the levator and sphincter ani. A well-moistened sponge
connected with the other pole may be applied to the abdominal muscles
or to the neighbourhood of the anus. The rectum must be first freed
from fæcal matter.

The bladder is most readily electrized by the introduction into the
rectum of the rectal rheophore, and into the bladder--previously
emptied--of a curved metallic sound insulated by an elastic catheter
to within an inch of its vesical extremity. This sound must be brought
into contact successively with all points of the neck of the bladder.
The uterus by the introduction of the rectal rheophore, connected
with one pole, to the os uteri, and by the application of two sponges
from the other pole, one to the abdominal parietes, the other to the
lumbar region. The larynx, externally by one sponge to the nape of the
neck, and the second to the exterior of the larynx; or, internally, a
sponge to the neck as before, and the introduction by the aid of the
laryngoscope of a small bit of sponge at the end of a curved metallic
stem, insulated by a gum-elastic catheter, the current not being
allowed to pass until it is seen by the laryngeal mirror that the
sponge is in the desired position. The male genital organs by moist
rheophores to the scrotum over the testicle; but if it be desired to
excite the vesiculæ seminales, the bowel is first emptied, the rectal
rheophore is then introduced and so directed that its olive-shaped
termination may be brought into relation with the vesiculæ. For this
purpose it is sufficient to move the rheophore from right to left and
_vice versá_. A powerful current will penetrate the intestine and reach
the vesiculæ, exciting them energetically. The circuit is completed by
a second rheophore placed on an unsensitive part of the body.

[SN: Electrization of the Central Organs.]

In electrization of the central organs of the nervous system, the
Voltaic current is alone used, and in its application to the brain,
the sympathetic nerves, or the organs of the senses, especial
circumspection must be employed. As a general rule it should not be
had recourse to when central excitement is contra-indicated, and
in _all cases_ the minimum dose should be commenced with, and the
application discontinued upon the occurrence of giddiness, nausea, or
cerebral symptoms. With these precautions the brain may be electrized
by well-moistened sponges applied to each mastoid process, to each
temple, or to the frontal and occipital protuberances. The sponges
must be held immovable. To galvanize the superior cervical ganglion of
the sympathetic, one electrode of small size must be deeply pressed
into the auriculo-maxillary fossa, and the other with a good-sized
sponge applied over the sixth or seventh cervical vertebra, or to the
manubrium sterni, close to the border of the sterno-mastoid. The spinal
cord may be electrized by keeping one sponge, usually the positive,
stationary, and moving the other up and down by the sides of the
vertebræ, or one pole may be applied to the spine, and the other held
to a nerve or muscle. The retina by a moistened conductor to the closed
eye, and the second to the temple or to the mastoid process of the
same side. The auditory nerve by one conductor tipped with sponge and
inserted to the bottom of the meatus, the second being held in the hand
of the opposite side; or the meatus may be filled with tepid water, and
a metallic wire traversing the axis of a vulcanite tube may be immersed
in the water, the second conductor being a well-moistened sponge to
the nape of the neck. Direct application to the ocular muscles or to
the conjunctiva is usually inadmissible, but one pole may be placed
over the facial nerve below the ear, and the other applied to the
closed eyelid, or the operator may use the forefinger of his right
hand, covered by a finger-stall of wet linen as an electrode, passing
the current through his own body by holding a moistened sponge from
one pole in his left hand, the conductor from the second pole being
similarly held in one of the hands of the patient. This application
is not only convenient, but it is calculated to allay the fears of a
sensitive patient: or a pointed conductor, covered with wet leather,
may be connected with one pole, and its point held immovable and
firmly pressed down upon the orbital margin, as near as possible to
the position of the muscle it is desired to excite, while the patient
touches at intervals the sponge from the second pole held by its
insulating handle in the operator’s disengaged hand.

[SN: Electrolysis Needles.]

The chemical action of a continuous Voltaic current is sometimes useful
in the removal or dispersal of tumours, and in the consolidation of
aneurisms, one or more needles being introduced into the tumour, and
connected with a Voltaic battery. I shall discuss this subject in our
next Lecture, but I have here some of the most generally useful needles
(Fig. 16), and I have had made for them holders with eyelet-holes
for the attachment of conducting wires which render the operator
independent of special conducting cords, for with a coil of insulated
wire and a pocket knife he can fit up his needles in a few minutes in
any way best adapted to his proposed operation.

[Illustration: FIG. 16. Electrolysis Needles and Needle-holders. By
pressing the spring side B, the holder opens as shown in C, to grasp
the needle D. The wire is twisted into the eyelet hole-A.]

[SN: Precautions in mode of Application.]

Having now considered the more generally useful methods of application,
it may perhaps not be out of place to remind you in concluding this
part of our subject that certain precautions are necessary to be
observed. We must keep constantly before our attention that we are
prescribing or administering an exceedingly powerful remedy, and
with all new patients we should commence with a minimum dose, watch
its effect, and if we need to increase it, do so gradually--_e.g._,
muscular contraction being sought we must use the power just sufficient
to produce it and _no more_--and so on with other applications; and it
is especially necessary to use care in applying the Voltaic current to
the face, neck, or any part of the head. Duchenne blinded a patient by
suddenly applying a current from 40 cells to the facial muscles, and
he had the candour to publish his misfortune. Sudden applications and
sudden cessations should especially be guarded against. The cessation
shock can, of course, only occur in cases where the conductors having
been held immovable, and the current gradually increased, one or both
of them has been abruptly, and it may be inadvertently, removed; and
I have known a patient so frightened by such a cessation shock as to
decline further treatment. The negative pole of a Voltaic battery
will, if frequently applied to the same spot, soon cause a sore,
and to avoid this the point of application should be slightly varied
occasionally; and let me impress upon you, Gentlemen, the importance
of always testing electricity upon yourselves before applying it to
a patient. Use as many galvanometers, or so-called “instruments of
precision,” as you like, but use in addition the back of your left
hand as a convenient approximate test for the Voltaic, and your
thumb muscles for the Faradaic current, except when about to apply
electricity to your patient’s head or face, and make it then an
invariable rule to first apply to your own face the same strength
of current you are about to administer to your patient’s. If you
authorize your patient to have treatment carried out at home impress
this rule upon whosoever electrizes him. Under such circumstances
it is especially imperative, for there is great belief, even with
educated persons who ought to know better, that the benefit derived
from electrization is in exact proportion to the pain given by it, and
a little personal experience is a very wholesome corrective to such
a notion. Graduate your dose, then, by the number of cells employed
checked by testing its effect, and do this upon each application, for
there is no certain means of securing that the strength of either a
Voltaic or a Faradaic current shall not have varied from day to day.

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

FOOTNOTES:

[10] See pages 6-17.

[11] See Duchenne (de Boulogne) “On Localized Electrization and its
Applications to Pathology and Therapeutics” (English Edition). Part I.,
pp. 38-40. London: Churchill.

[12] It is often of imperative importance in the administration of
the “constant” current that we should really localize it--not in name
only, but in fact--in some special nerve; and this is not always quite
so easy in practice as in theory. [SN: Importance of exactitude in
administering a constant current.] To secure the result we desire, we
must see that the cord or wire from the terminals of the battery to
the electrodes is without flaw; that the electrodes are well moistened
and placed firmly in the position determined upon; and especially
that they are held quite immovable during the entire application, for
if not maintained immovable, we shall be using not a “constant” but
an “interrupted” current with totally dissimiliar physiological and
therapeutical effects! We must satisfy ourselves that the current from
our battery is also constant, and that we so apply it to our patients
that the affected nerve shall be--as it is called--included in the
circuit--that is, between the poles, and that the current circulates
through this nerve as perfectly and continuously as it would through a
piece of wire connecting the terminals of the battery.

[13] Published by Churchill.




LECTURE III. ELECTRICITY IN DIAGNOSIS AND TREATMENT.


A.--_Electricity in Diagnosis._

GENTLEMEN,

[SN: Electro-Diagnosis.]

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

[SN: Test of Electro-Irritability.]

The chief use of electricity in diagnosis is dependent upon its power
of evolving muscular contraction. We have seen--as I demonstrated
to you upon my left forearm--that both muscles and nerves, when
in a normal condition, respond to the stimulus of electricity. In
disease this response, or irritability, may remain unaltered, or it
may be increased, decreased, or abolished; and our first step in
electro-diagnosis should therefore be to ascertain the exact condition
of electro-contractility. As in practically almost all our cases we
have to do with altered reaction existing only in one nerve or muscle,
or in one of two symmetrical groups of nerves or muscles, we possess
a ready means of testing irritability by ascertaining its relative
condition upon opposite sides of the body, as, for example, in an
ordinary case of hemiplegia. [SN: Test of Farado-Irritability.] In
examining such a case electrically--and the principles of procedure are
the same in all cases--it is convenient to commence our investigation
with the Faradaic current, and to ascertain the _lowest_ power which
will call into action any one of the muscles of the healthy side,
and then to apply this same strength of current _to identical points
of the corresponding muscle on the diseased side_, noting whether
it causes contraction. If so, we decrease the power of the current,
when if contraction still occurs there is increased irritability, or
_vice versá_, as the case may be. Having ascertained the condition
of the muscle we proceed similarly to test its motor nerve, for
we shall see hereafter that in certain diseased conditions muscle
and nerve irritability are affected unequally. One conductor being
held to an indifferent part of the body we apply a fine-pointed
conductor to the most superficial point in the course of the nerve,
in the way that, as you will recollect, I electrized my left median
nerve. [SN: Test of Voltao-Irritability.] We next submit the muscle
and nerve to similar examination with the Voltaic current. Holding
both conductors immovable, we interrupt the current for a moment
by moving the “key” of our battery, or if it is not provided with
a key, while one conductor is stationary, we break the current by
lifting and reapplying the other. It is essential that on both sides
there should be exact similarity in the application, and that the
electrodes should be placed on identical points of the muscle, and
this is especially important with the Voltaic current, for healthy
muscle responds to it more readily when it flows down the limb, that
is, with the positive pole nearest to the spine, and the negative
farther from it than when it flows up, and consequently a reversal
of the poles will influence the result. [SN: Rule for strength of
Current.] In testing a case in which there is equal disease upon
both sides--as in some cases of paraplegia--we must be guided by
a knowledge of the strength of current usually required to induce
contraction. As a general rule, unless a current that causes energetic
and painful action in the muscles of the ball of the thumb produces
some contraction, irritability is impaired. If, in our examination of
the muscle, we find irritability normal to both currents, we have proof
of the integrity of the muscular tissue. If the muscle also responds
by contraction to electrization of its nerve, we have further proof
that the nerve is healthy, and also the spinal cord at the point of
origin of the nerve. [SN: Electro-Irritability diminished.] If we find
the irritability lessened, there is disease of either muscular tissue,
nerve or cord; and, as a rule, this will be in direct proportion
to the amount of diminished irritability. [SN: Electro-Irritability
increased.] Increased irritability points to increased vascularity
or irritative lesion; but in such cases we very seldom require the
aid of electricity to complete our diagnosis. [SN: Voltao-Irritability
increased.] The reactions of Faradism and Voltaism are usually
equal, but in some cases in which muscular response to Faradism is
diminished or abolished the muscular reaction to an interrupted
Voltaic current is not only preserved but increased. The diseased
muscle will respond much more readily to the Voltaic current than the
corresponding muscle of the healthy side; while at the same time it
will be found on examining the nerve that there is equal diminution
to both currents. [SN: Diagnosis of Peripheral from Central Disease.]
This increased muscle reaction is due to the special irritability of
muscular tissue, and is quite independent of any nerve influence. It
exists only in peripheral and never in central lesion, and by it we
obtain an absolute diagnosis of such cases as local paralysis of the
facial nerve from facial hemiplegia, paralysis of the extensors of the
wrist and fingers, due to lead poisoning, from commencing muscular
atrophy, or progressive muscular atrophy from paralysis from section
of a nerve--all important questions as affecting treatment. [SN: “The
Degenerative Nerve Reaction.”] It is known as the “degenerative nerve
reaction,” as it always follows when a nerve trunk is involved in the
lesion. There is then diminution of Faradaic irritability through both
nerve and muscle, diminution of reaction to the Voltaic current when
the rheophores are applied over the nerve, and increase of reaction
when they are applied over the muscle; but there is no relation between
these interesting variations in the electrical condition of nerve
and muscle, and the degree of paralysis to the will, for there may
be perfect muscular paralysis, as in hemiplegia, when the electrical
condition of both nerve and muscle is unchanged; but, on the other
hand, in muscles equally paralyzed we may find absolute electrical
changes in some, and none in others. We may often positively predict
that these latter will rapidly recover--one instance of the use of
electricity in prognosis.

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

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

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

[SN: Limitation of Electricity as a remedy.]

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

The men who estimate it fairly are quite the minority. It is
generally either much undervalued, or else believed to be a sort
of modern “_Elixir Vitæ_,” capable of curing a hopeless hemiplegia
from destruction of brain tissue, or a paralysis agitans from
senile degeneration. Although electricity will do neither of these
impossibilities, yet, considered as a remedy, it is of great value in a
wide margin of diseases. It will either stimulate or soothe both nerve
and muscle, according to its variety and mode of application; it will
frequently restore voluntary movement, it will relieve pain, heighten
temperature, recall sensation, coagulate the blood, and dissolve or
slowly cause the absorption of tumours.


B.--_Electricity in Treatment._


FRANKLINIZATION.

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

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


ELECTRIZATION.

[SN: Electro-therapeutics.]

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

[SN: The Constant Current.]

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

[SN: Electricity possesses an influence _sui generis_.]

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

[SN: Impotence.]

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

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

[SN: Rheumatic Arthritis.]

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

[SN: Muscular Rheumatism.]

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

[SN: General effects of Electrization.]

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

[SN: General Debility.]

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

[SN: Paralysis.]

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

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

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

[SN: Rigid form of Infantile Paralysis.]

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

[SN: Traumatic Paralysis.]

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

[SN: Wasting Palsy.]

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

[SN: Hemiplegia.]

In non-atrophic paralysis--of which hemiplegia may be taken as a
type--the propriety of electrization, and especially the proper
moment for its application, requires careful consideration. In both
brain and spinal cord disease muscular electrization is not advisable
until some time after the attack, or until the muscles exhibit
signs of impairment of nutrition from disuse. As long as there is
rigidity--especially with increased reflex action--any stimulant
application of electricity is not likely to do good, and may do harm;
but in older cases--both hemiplegic and paraplegic--cases of from six
to eighteen months’ duration--the immediate benefit to be derived
from localized electrization is often remarkable, especially in those
cases where, after a partial return of voluntary movement, the patient
suddenly stops short, and for weeks or months makes no progress. As
the sequel of electrization, the hemiplegic patient able to use the
arm slightly, but not to feed himself, may regain this power, to his
infinite comfort, and the paraplegic patient, able with difficulty
to drag himself along by crutches, is enabled to walk by the aid
of a stick. Some improvement is usually soon obtained, and it is
progressive for, perhaps, two or three months, after which continued
electrization fails to increase it; but at a subsequent period--six
months afterwards--a renewed electrization may give rise to a new
improvement; but be this as it may, whenever in these old-standing
cases we see signs of impaired nutrition, it is wise to occasionally
stimulate the muscles by Faradism. We should endeavour--in the words
of the late Nestor of modern medicine, Sir Thomas Watson--“to preserve
the muscular part of the locomotive apparatus in a state of health
and readiness, until peradventure that part of the brain from which
volition proceeds having recovered its functions, or the road by which
its messages travel having been repaired, the influence of the will
shall again reach and reanimate the palsied limbs.”[19] [SN: Direct
application of Voltaic Current to Brain.] In hemiplegia the propriety
of a direct application of the constant Voltaic current to the brain
must be thoughtfully considered. In selected cases, where the clot
or softening is of limited extent, its removal may be accelerated by
a carefully localized current--two or three cells--for two or three
minutes to the injured hemisphere, followed by Voltaization of the
cervical sympathetic (so-called) for four or five minutes. After such
an application there follows--according to Althaus--“greater ease in
the head, as well as in the limbs, and if there has been pain this
is relieved.” [SN: Electricity in Spinal Paraplegia.] Similarly the
absorption of the inflammatory products may be promoted in the earlier
stages of spinal disease, by localizing the Voltaic current in the
parts affected, especially where pain is present, and we have reason
to suppose that the myelitis is circumscribed. The daily application
of the positive pole for about five minutes, and with from ten to
fifteen cells, to the painful spot--the negative pole being held to
an indifferent part of the body--is likely to promote absorption. At
any rate it will sometimes relieve the pain. In the later stages of
paraplegia, as soon as there is diminution of electro-irritability in
the paralyzed muscles they should be sponged with the Voltaic current,
or Faradized; and where anæsthesia is present, a good painting with the
wire brush will often be of service. [SN: Paraplegic Constipation.]
Paraplegic constipation may frequently be relieved by Faradization
of the abdominal muscles, and the troublesome dribbling of urine, so
often present, by external Faradization of the bladder--one pole to
the pubes, and two sponges from the second pole--one to the sacrum
and the other to the perineum. Incontinence of urine in children may
be similarly treated. [SN: Emotional Paralysis.] Cases of hysterical
or emotional paralysis may frequently be benefited by the application
of the wire brush, which also sometimes acts like a charm in removing
anæsthesia, which, although originally of central origin, continues
after the removal of its cause. Anæsthesia from section of a nerve is
sometimes persistent in this way after repair of the nerve lesion. [SN:
Locomotor Ataxy.] The wire brush is also useful in sometimes removing
the anæsthesia present in locomotor ataxy, some cases of which may be
largely benefited also by the constant current to the spine--one pole
to nape of neck, and the other to the lower lumbar vertebræ.[20]

[SN: Electricity in Mental Diseases.]

Electricity is coming into use in mental diseases. Faradism, and
especially cutaneous irritation with the wire brush, would seem to
be most suitable for cases accompanied by depression or torpor, the
stimulating effects being of service in inspiriting the patient,
while the soothing influence of a direct application of the
_constant_ Voltaic current to the brain may be employed in cases of
over-excitement requiring a sedative.

[SN: Diseases of Women.]

It is remarkable that electricity should have been so little used
in this country in the diseases of women. [SN: Electricity as
an Emmenagogue.] According to Golding Bird, it is the only true
emmenagogue that we possess. Be this as it may, all of its forms
are serviceable in stimulating the secretions, and may be employed
with success in cases of suppression of the catamenia from a torpid
condition of the uterine organs. A generalized application will often
suffice. Let the patient sit with her feet in tepid salt and water,
in which is immersed a wire from one of the poles of an induction
instrument in action, while a large sponge from the other pole is held
applied to the lumbar region. Strength of current as much as she will
bear. Time, ten to fifteen minutes. The application should be made
twice daily for the three or four days preceding the usual catamenial
period. If this method fails in its object, direct electrization must
be resorted to; but Franklinization most often succeeds.

On the Continent electricity has been largely employed in the treatment
of inertia uteri in the second stage of labour, also in producing
premature labour; in the resuscitation of still-born children, and
in uterine displacements. [SN: The Advantages of Electrization over
Ergot.] We possess other remedies for these conditions, but in labour
its advantages over the administration of ergot, include the rapidity
and certainty of its action, the exactness with which its dose can be
regulated, and the strength and regularity of the contractions which
it produces. It admits also of being used in extreme cases in which the
power of swallowing has been lost, or where everything is rejected from
the stomach, while it never exerts in any way--as ergot is said to do
occasionally--any injurious effect upon the new-born child.

[SN: Faradization in Post-partum Hæmorrhage.]

Gentlemen, it is my firm belief that if a Faradaic instrument were
at hand, and properly used, there would never be another death from
_post-partum_ hæmorrhage. The Faradaic current, thoroughly localized
in the uterus, will always produce its contraction, not only while
life persists, but even for a limited time after death, but failure in
localizing electricity in an organ, withdrawn from sight and covered
with thick muscular tissue, is especially liable to occur, unless the
details of application are conducted with extreme care. Assume the case
to be an example of severe _post-partum_ hæmorrhage, that the ordinary
resources of medicine have failed the obstetrician, and that he fears
every moment may be his patient’s last, but he has an induction
instrument at hand. Let him waste no time, but at once introduce his
right hand into the cavity of the uterus and grasp in his left the
moistened sponge attached to one of the conductors of the instrument
in action. Let an attendant, holding by its insulating handle the
conductor from the other pole (which should be a well-moistened sponge)
thoroughly paint with it, as it were, the abdominal parietes, pressing
it with considerable force against the practitioner’s hand, and
afterwards apply it to the lumbar region. _Contraction of the uterus
will invariably result if the current used be of sufficient power._

[SN: Uterine Neuralgia.]

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

[SN: Paralysis of Nerves of Special Sense.]

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

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

FOOTNOTES:

[14] Since writing as above, in 1873, our knowledge of the beneficial
effects of Franklinism has been very largely added to and the improved
apparatus, described at page 10, has enabled the treatment to be
conducted with a degree of precision and success impossible with
the comparatively imperfect instruments in use at that date. [SN:
_Importance of distinguishing between the Positive and Negative Charge
of Franklinism._] Dr. Radcliffe has contended for many years that
the effect of a charge of _positive_ electricity differs altogether
therapeutically from that of a negative charge; and Giacomini (quoted
by Duchenne[15]) attributes a hyposthenic influence to the _negative_
charge. He contends that this charge is derived from the nerves of the
patient instead of from the ground as is the positive charge, and it is
ranked by the Italian School among their most valuable hyposthenisants.
According to Giacomini the “patient is _de-electrized, is consequently
deprived of a greater or less quantity of a stimulant analogous to heat
and undergoes a real hyposthenisant effect_. Erysipelatous tissues
may be seen to become blanched under its influence, and chronic
inflammations undergo an unquestionable improvement. Headaches and
neuralgic pains have been instantly relieved by this kind of electric
flux as by the application of ice, which abstracts heat, and perhaps at
the same time electricity also.”

In reference to the above it has been proved by various physicists that
the natural electrical nerve current is strengthened by the positive
charge, and weakened by the negative--and hence it would seem to be
established that Dr. Radcliffe’s contention is the right one; and that
these two charges are literally “wide as their poles asunder” not
only physically, but _therapeutically_, and this divergence is more
important when we recall to mind that when a patient is insulated, not
only does the electricity accumulate upon the surface of the skin but
that the whole body is saturated with it as a sponge may be with water.

[SN: _Franklinization in Conditions of Debility._]

In my own experience the positive charge has been of great good as
a most potent restorer when the organism from any cause has become
enfeebled. In the general weakness of old age it would seem to have
been beneficial upon several occasions in resuscitating vital action
and in imparting new force and energy. I have also used it with the
best results in conditions of debility following acute diseases, as for
example in convalescence from fevers; in cases of general prostration
from overwork or anxiety--and in some cases of phthisis and other
wasting diseases. In certain varieties of mental disease--notably
melancholia--it is often of service, and in cerebral anæmia, in asthma,
in inveterate insomnia, and in all functional uterine irregularities it
should be employed _before, not after_, all other therapeutic agencies
have been exhausted.

[15] See “Duchenne on Localized Electrization,” English Edition, page
4. Churchill.

[16] In the treatment of _Neuralgia_ by the constant current the
electrodes should be so applied as to include between them the part
or nerve affected--the number of cells the highest number that can
be borne without pain, _i.e._, the current to be distinctly but not
painfully felt, both electrodes being immovable. [SN: Electricity in
Neuralgia.] Time, five to ten minutes. Frequency, as often as the
attacks of pain recur. I am satisfied that in severe cases this rule
of application is essential--that the influence of the current shall
be maintained as much as may be in the irritable nerve during the
intervals of pain. In one case under my care the patient was galvanized
with benefit 27 times in the 24 hours; but in milder cases one or two
applications daily will generally suffice. A weak current from two or
three cells--the electrodes being applied to each temple for one or
two minutes--will sometimes dissipate a severe headache. This soothing
influence of the current is often useful in allaying SPASM, as, for
example, in spasmodic torticollis. The current should be localized in
the irritable muscles: and it is generally advisable to energetically
Faradize their antagonists and to conjoin with the electrical treatment
appropriate gymnastic exercises, alternating with periods of perfect
rest. I may mention that the only recorded case of improvement in that
remarkable condition of spasm first described by Hammond under the name
of _Athetosis_ resulted from the Voltaic current. The case was brought
before the Medico-Chirurgical Society by Dr. Gowers, and is published
in the 49th volume of their Transactions. The reader will find the
subject of neuralgia very exhaustively considered in Dr. Anstie’s
work.[17] He quotes some extremely severe cases in which the effect of
Electrization was to arrest the pain in a few sittings, and to procure
a remission for several days or even weeks; and I have had several
cases which I believe to have been as fairly cured as an ague fit may
be said to be cured by quinine. Dr. Russell Reynolds also quotes the
case of a patient, a lady, who for twenty years had suffered from an
extremely severe neuralgia of the ophthalmic branch of the fifth nerve,
which recurred daily and from which her health had greatly suffered. It
was not only relieved but removed by a single application.

[17] “Neuralgia and the Diseases that resemble it.” By Francis E.
Anstie, M.D., &c. London: Macmillan and Co. 1871.

[18] Electrolysis is, of course, chiefly applicable to tumours which,
from their nature or situation, are difficult or impossible to be
removed by the knife; and, perhaps, also to malignant tumours; for
whether or not the Voltaic current exerts a special destructive
influence upon diseased germs, it seems certainly proved that there is
a less frequent return of cancerous growths removed by its agency than
by ordinary operative procedures or by caustics.

[SN: Electrolysis of Tumours.]

This treatment of malignant tumours by electrolysis is yet _sub
judice_, but the evidence in its favour has recently much accumulated,
and its full and exhaustive trial by competent observers possessing the
opportunities of large hospital practice ought not to be much longer
delayed. [SN: Electrolysis of Malignant Tumours.] Neftel, of New York,
who is its chief advocate, contends that malignant tumours are at first
entirely local, and he explains their recurrence, after removal by the
knife, from the fact of the impossibility of the whole of the diseased
mass being excised, as apparently healthy parts when microscopically
examined show that they have already become infected. Electrolysis
he considers acts not only on the tumour but also on the surrounding
tissues, the current being diffused to some distance in all directions.
After electrolysis he applies a mild and not painful current for from
a quarter to half an hour daily to the _locus morbi_, and continues
this for some months. In one of his cases a mammary tumour existed of
the size of a small orange. Three needles, from the negative pole of
thirty-five cells, were inserted for half an hour under chloroform,
and the operation was repeated thrice at intervals of a week, daily
external galvanization being also used. The tumour gradually became
smaller, and at last disappeared, but external treatment was continued
for several months. At the end of a year there had been no relapse. In
another case, in which the tumour had been excised by Marion Sims, it
reappeared, and was again removed by the same surgeon, and pronounced
cancerous. It again reappeared and was then electrolyzed, upon three
occasions, by two, three, and four needles respectively, and with a
current gradually increased from ten to thirty cells. The tumour by
degrees grew less, and in three months was entirely dispersed; while,
when the patient died from another disease three years afterwards,
there had been no recurrence.

[SN: Aneurismal Electro-puncture.]

Electrolysis has been successfully employed in several cases of
aneurism. Where pressure and ligature admit of application, it is
hardly necessary to say that the preference should be given to them;
but many internal aneurisms, and especially aortic aneurisms, cannot
be thus treated, and in such cases the question of electro-puncture
should be carefully considered, and, when called for, it should not be
too long delayed. Two fine, sharp, and carefully insulated needles, one
connected with each pole, should be introduced into the aneurismal sac,
and the current allowed to pass for from half an hour to an hour, the
needles carefully withdrawn, and their punctures covered with a bit of
lint soaked in collodion or styptic colloid. Authorities are divided
as to the kinds of aneurism calculated for electro-puncture, but there
is no doubt than an aneurism pressing on the parietes, but not having
actually perforated them, is the best adapted for this treatment, and
that it is contra-indicated where the sac is of large size, or where
large trunks issue from it.

[19] The following is an illustrative case:--

A lady, forty-one years of age, had suffered from right hemiplegia for
eighteen months, and described her condition as having remained without
improvement for the past six months. She had recovered sufficiently to
walk with the aid of a stick, but the movements of the arm were very
weak, especially those of the deltoid, extensors of the fingers, and
individual muscles of the hand. Faradic contractility was somewhat
lowered, but there was no rigidity. The muscles were carefully
Faradized with a current just sufficiently strong to produce their
contraction. The entire application occupied about fifteen minutes,
and was made once daily. After a fortnight’s electrization she was
able to raise the arm to a right angle with the body, and _to use the
hand to feed herself_, neither of which had she been able to do before
treatment.

[20] The following is an extract from Dr. Sturge’s Report of the
results of treatment at the National Hospital for the Paralyzed and
Epileptic:--

“In the division of Muscular Atrophies some striking cases have
occurred, and in all of these the improvement is mainly due to the
electrical treatment prescribed.

“A patient, with atrophy of some of the muscles of both arms of six
months’ standing, which incapacitated her from dressing herself or
cutting her food, or doing much household work, was discharged at the
end of three and a half months, able to feed and dress herself, sew,
and perform almost any domestic duty.

“Another woman, with atrophy of the muscles of the forearm of several
years’ standing, and who was similarly incapacitated from almost
all use of the hands, went out, after a month’s treatment, able to
dress and feed herself, and to perform many actions that were before
impossible for her.

“A man came to the hospital with atrophy of many muscles in various
parts of the body, more especially in the left arm, which he was unable
to move from the side. He went out able to lift his arm well over his
head, and with much increased strength in the limb.

“Another man, in a very similar condition, was also greatly benefited;
and whereas on admission he could barely bend the right arm at the
elbow, after three months’ treatment he was able to use a hammer with
the arm.”




INDEX.


  Bath, Electric, 42

  Battery, Accessories of, 35
    Faradaic, 29
    Hospital Combined, 33
    Portable, 18
    Voltaic, 20
    Voltaic, Essentials of, 27


  Cautions in Electrizing Facial Muscles, 85

  Cells, Voltaic, 18

  Conducting Cords, 35

  “Constant Current,” importance of exactitude in administering, 52

  Cords, Conducting, 35

  Current, Constant, Radcliffe’s Variety of, 41


  Degenerative Nerve Reaction, 66

  Diagnosis between Real and Feigned Disease, 67
    of Central Paralysis, 66
    Electro, 62
    of Peripheral from Central Disease, 65
    of Hysterical Paralysis, 67
    of Spinal Paralysis, 66

  Dischargers, Improved, 16


  Electricity as Proof Positive of Death, 67

  Electricity in Diagnosis, 62
    Varieties of, 5
    Methods of applying, 37
    the Galvanometer as an aid to the Dosage of, 22

  Electrization, 71
    as a Constant Current, 72
    as a Stimulant, 72
    Central, 44
    Cutaneous, 53
    Direct, 49
    in Diseases of Women, 90
    Effects of upon Nutrition, 72
    in Fatigue Diseases, 74
    in General Debility, 80
    General effects of, 79
    in Hemiplegia, 85
    Indirect, 50
    in Locomotor Ataxy, 88
    Muscular Rule for, 83
    in Mental Diseases, 89
    in Neuralgia, 73
    in Paralysis, Atrophic, 81
    in Paralysis, 80
    in Paraplegic Constipation, 88
    in Paralysis, Emotional, 88
    in Paralysis, Infantile, 81
    in Paraplegia, 88
    in Paralysis of Nerves of Special Sense, 92
    in Post-partum Hæmorrhage, 91
    in Paralysis, Traumatic, 84
    Localized, 44
    in Wasting Palsy, 85
    of Auditory Nerve, 57
    of Bladder, 55
    of Brain, 56
    of Central Organs, 57
    of Internal Organs, 54
    of Larynx, 55
    of Male Genital Organs, 55
    of Ocular Muscles, 57
    possesses an influence _sui generis_, 74
    precautions in, 59
    of Rectum, 54
    Restorative Power of, 74
    of Retina, 57
    of Spinal Cord, 57
    of Sympathetic, 56
    of Uterus, 55

  Electrical Static Machine, 7, 10
    Static Machine with Fly-wheel, 12
    Winter’s Machine, 8

  Electrolysis of Tumours, 76
    in Aneurisms, 77
    Needles for, 58

  Electrotonus, 75

  Engine, Gas, Bischoff’s, 9


  Faradism, 28

  Faradization, General, 43

  Franklinism, 6

  Franklinization, 68
    by Sparks, 16
    Distinction between Positive and Negative Charge of, 70
    in Conditions of Debility, 71
    in Emotional Aphonia, 69
    in Facial Neuralgia, 68
    in Facial Spasm, 68
    in Sciatica, 68
    in Localized Excessive Sensitiveness, 70
    in Tremor, 70
    Modes of Generating, 7, 15


  Galvanism, _see_ Voltaism

  Galvanization, Central, 44

  Galvanometer as an aid to the Dosage of Electricity, 22


  Irritability, Electro, 62
    Farado, 63
    Voltao, 63
    Electro, Diminished, 64
    Electro, Increased, 65
    Voltao, Increased, 65


  Paralysis, Importance of Early Electrical Treatment in, 82
    Rigid Forms of, 84


  Rheophores, Different Kinds of, 47


  Voltaic Cells, 18
    Current, Resolvent Effects of, 76

  Voltaism, 17
    and Faradism, Points of Distinction between, 18

  PRINTED BY BALLANTYNE, HANSON AND CO.
  LONDON AND EDINBURGH

       *       *       *       *       *

BY THE SAME AUTHOR.

_PREPARING FOR PUBLICATION._

A MANUAL OF DISEASES OF THE NERVOUS SYSTEM.

Within the past few years the treatment of Diseases of the Nervous
System has grown up into a recognised speciality in the Medical
Profession. Recent investigations, physiological, clinical, and
pathological, have cast a flood of light upon its study, and it
possesses--as a separate field of practice--Special Hospitals, and a
voluminous and rapidly extending literature.

Under these circumstances the Author, although fully conscious of the
extreme difficulty of presenting, within a small compass, an adequate
view of our present knowledge, feels that a concise introduction
to neuro-pathology may not be unacceptable to students and junior
practitioners. It will be his endeavour to give the results of the best
work by the many distinguished physicians, both English and Foreign,
who have so completely made this department of medicine their own; to
impart as much practical information as possible; to give an analysis
of the principles which ought to govern our treatment of diseases of
the Nervous System; and to direct especial attention to the importance
of early diagnosis. He hopes to omit nothing really essential, and
to make the work a safe and trustworthy guide to the practice of the
speciality upon which it will treat.

LONDON: J. & A. CHURCHILL.

       *       *       *       *       *

PRICE 5s., 35 INCHES BY 21 INCHES.

_With 20 Illustrations, &c._

[Illustration: A MAP OF Ziemssen’s Motor Points of the Human Body

(A GUIDE TO LOCALIZED ELECTRIZATION).

BY HERBERT TIBBITS, M.D., &c.]

       *       *       *       *       *

TRANSLATED AND EDITED BY DR. TIBBITS.

_Part I. 8vo, pp. 322, price 7s. 6d., with 92 Illustrations, and Notes
and Additions by the Translator_,

A TREATISE ON LOCALIZED ELECTRIZATION,

AND ITS APPLICATIONS TO PATHOLOGY AND THERAPEUTICS.

By Dr. G. B. DUCHENNE (DE BOULOGNE).

CONTENTS.

CHAP. I.--Medical Electricity. The Physiological and Therapeutic
Properties of Static, Galvanic, and Induced Electricity.

CHAP. II.--Localized Electrization. The Principles and Methods
of Procedure in the Local Application of Electricity; (_a_) of
Galvanic Electricity (Galvanization); (_b_) of Induced Electricity
(Faradization).

CHAP. III.--Historical and Critical Observations upon the Principal
Methods of Electrization: (_a_) Electro-puncture; (_b_) Electrization
by Reflex Action; (_c_) Therapeutic Value of Localized Faradization;
and (_d_) of Galvanization.

CHAP. IV.--Electro-Medical Instruments, with regard to their
Application in Pathology, Physiology, and Therapeutics.

The First Part of Duchenne’s work is devoted to METHODOLOGY, AND IS
COMPLETE IN ITSELF.

The admirable selection by Dr. Poore from Duchenne’s Clinical Works
(published by the New Sydenham Society) renders unnecessary any further
publication _in extenso_ of Duchenne’s most voluminous treatise.

“Duchenne’s great work has for years held its place as the most
complete on the subject of which it treats, and Dr. Tibbits, by
presenting us with an English version of the forthcoming Third Edition,
has earned the gratitude of the profession in this country.

“... The reader will find himself so thoroughly instructed in the
principles underlying the medical employment of electricity, as well
as in all the methods of applying it, that the work can hardly fail
largely to increase the use of this powerful and often valuable
agent.... The translation itself is very creditable, and reads with
almost as much smoothness as original English composition, while the
experience of the translator in the Electrical Room of the National
Hospital gives great value to his notes and additions. We are happy to
congratulate him upon having so far accomplished an undertaking of much
utility.”--_The Lancet._

“We have to congratulate Dr. Tibbits upon his successful labours
thus far. This instalment promises that the results of the best
subsequent work will be incorporated into Duchenne’s own treatise with
so much judgment and adequacy as to make this Edition an independent
standard.... The tentative and accurate spirit of the master has
found its kin in the spirit of his follower, and we see little in the
work of either open to cavil or correction.”--_British and Foreign
Medico-Chirurgical Review._

       *       *       *       *       *

_Second Edition, Revised and Enlarged, with 95 Illustrations, 9s._

A HANDBOOK OF MEDICAL & SURGICAL ELECTRICITY

BY HERBERT TIBBITS, M.D., ETC.

CONTENTS.

  CHAP.
    I.--Electricity and Electro-Medical Instruments.
   II.--The Application of Electricity.
  III.--Electricity as an aid to Diagnosis.
   IV.--Electricity in Medicine.
    V.--Electricity in Surgery.
   VI.--Electricity in Midwifery and the Diseases of Women.

_Opinions of the Medical Press._

“This work fills up a hiatus in the literature of medical electricity.
It purposes to teach (to use the words of the preface) ‘the busy
practitioner not only when to use electricity, but in explicit and full
detail how;’ and in ‘moderate bulk to contain only what it is essential
to master.’ Dr. Tibbits’ object has been to give the results of the
best work, and to this end he has availed himself freely of the large
experience of the Electrical Room of the National Hospital for the
Paralysed and Epileptic.

“The work is what it professes to be, and is a handbook in the best
sense of the work. The book, indeed, answers thoroughly to the author’s
description: that he has ‘throughout endeavoured to keep constantly in
view the practitioner rather than the theorist,’ especially in points
of detail which are of importance in order to secure the successful
application of electricity, and to insure (a not insignificant matter
in this respect) the comfort of the patient.”--_The Lancet._

“There is not a word of exaggeration, or of fanciful hypothesis in the
book, and, above all, there is not the least suggestion that there
is after all a mystery behind, and that the reader would do well to
come to an expert for advice. On the contrary, everything is made so
clear that any practitioner, whether he previously knew anything of
electricity or not, may from this book at once begin the practical
use of it, and if there are any lingering doubts in the minds of some
ultra-conservative persons as to the practical value of electrical
treatment, this book should dispel them.... the busiest practitioner
can, without difficulty, learn how to effect a large amount of
good which he was previously quite unable even to attempt.”--_The
Practitioner._

“As Medical Superintendent of the National Hospital for the Paralysed
and Epileptic, as well as through private practice. Dr. Tibbits has
had ample opportunities of studying the application of electricity to
medicine, and in the volume under notice, which aims principally at
giving full and explicit details within convenient limits, _how to
use electricity_, we are bound to say this object is fairly carried
out.”--_The Dublin Journal of Medical Science._

“The exact value of electricity as a therapeutic agent is imperfectly
understood. That it is of great value in some cases as a means of
improving nutrition, relieving pain, and exercising disused muscles,
is undoubted, but still its exact value in all cases remains to be
settled, and in Dr. Tibbits’ book we find a guide which will, at all
events, help us to a solution of some of our difficulties.--_The
Medical Times and Gazette._

“Dr. Tibbits, who is known as an authority upon electricity, has
written a concise book upon this subject for the general practitioner,
embracing only the valuable part of the existing knowledge. The work is
written in a condensed style, and is well adapted for the practitioner
who does not make a specialty of electrical treatment.”--_The New York
Medical Journal._

LONDON: J. & A. CHURCHILL.

       *       *       *       *       *

_DIRECTIONS FOR USING THE_ HAMMOND Wall Cabinet

MANUFACTURED BY _THE WAITE & BARTLETT MAN’F’G CO._, 143 East 23d
Street, New York.

TO USE THE GALVANIC CURRENT.

To use the galvanic current place the ends of the conducting cords
in the two binding posts marked =13-13=. Place the socket of current
selector (=20=) on the pin marked O, and turn the lever of selector
on pin No. =1=, or on any number, according to the number of cells
desired; at the same time see that all the switch levers are on their
blank buttons, except the one at left of current selector, which should
be on its left-hand button marked Constant.

If it is desired to use cells from any other part of the series, place
the socket on the pin from which it is desired to begin, and having
previously moved the lever ahead of this pin move it along until the
desired number of cells intervenes between socket and lever. The number
of cells in circuit when the socket is not on O, but on a pin with a
number, is the difference between the number of the pin and number on
which the lever rests, for instance, if socket is on pin =12= and lever
on pin =22=, then =10= cells are being used, the starting point being
=12= cells from any part of the series may thus be brought into the
circuit. If socket be placed on pin =39= and lever on pin =40= then the
=40=th cell would be in use only.

_Always keep the socket on the lowest number and the lever on the
highest, as putting socket ahead of lever would reverse the current._

Should, through any accident, a cell become disconnected or run down,
or should it get out of order from any cause, it is only necessary to
short-circuit the cells and throw the milli-ampere-meter in circuit
by adjusting the switch =10=. By placing the socket on the pin marked
O and selecting cell after cell with the lever, the defective cell is
easily found by the milli-ampere-meter failing to deflect when the pin
corresponding to the defect is reached.

TO OBTAIN THE INTERRUPTED GALVANIC CURRENT.

To obtain the interrupted galvanic current, move the switch at left
of selector on to button marked interrupted, then turn the switch
just above the vibrator on to its button marked =11=, by adjusting
the screws at =14= and =15= the proper degree of vibration will be
obtained. It is necessary that the point of the screws at =15= should
touch the plate with every vibration as the current passes through at
this point and unless it touches, connections would not be made.

TO MEASURE THE RESISTANCE OF THE PATIENT.

To measure the resistance of the patient turn the lever at the left
of selector on to the button =8= marked milli-ampere-meter and wire
rheostat. Supposing him to have the electrodes in his hands and a
current from =30= cells registers =8= milli-amperes; without changing
any other conditions, throw the upper left-hand lever =10= on button
marked rheostat and milli-ampere-meter only. The patient will now be
thrown out and the needle will fly around as far as it can go.

Begin by throwing in resistance, which is done by manipulating the top
row of levers, until the needle which will have retraced its course
rests directly over the division marked =8= milli-amperes or whatever
may have been the previously recorded amount. The numbers on uncovered
buttons added together will be the resistance of the patient. The known
resistance having taken the place of the patient.

_The upper left-hand lever should at all times except for purposes of
measuring the resistance of a patient, be kept on its blank button, or
the battery will be short circuited and injured._

THE POLE CHANGER.

The pole changing lever above the two posts marked =13-13=, when
pressed between the two right-hand springs makes the right-hand binding
post positive, and when pressed between the two left-hand springs the
left-hand post becomes positive and the right negative.

GRAPHITE RHEOSTAT.

When the left-hand lever is placed on button =9= it throws the graphite
rheostat (=16=) into circuit. To use the rheostat first draw up the
rod (=17=). By slowly pressing the rod down through the graphite it
gradually lessens the resistance thereby increasing the current without
shock to the patient. With this rheostat you can place any number of
cells in the circuit.

THE DE WATTEVILLE SWITCH.

The de Watteville switch is placed directly above the pole changer
is used for obtaining either the galvanic or the faradic current
separately or the two combined. When the double lever rests on figure
=1= and =3= the galvanic alone can be used; can when on =3= and =5= the
faradic can be alone used and when on =2= and =4= the two currents are
combined and used without changing the conducting cords.

THE FARADIC APPARATUS.

The Faradic apparatus of this cabinet combines a fast and slow
interrupter also a single contact key. The style of coil used is the
Du Bois-Raymond. To use =Primary= coil, place the two tips on ends of
conducting cords into the two binding posts in front of the coil, the
others being connected with any desired electrodes. The strength is
increased by drawing the coil to the =Right=, first placing switch at
right end of coil on button marked P.

To use the secondary coil remove the tips of cords from primary posts;
then place the ends of cords in the two binding posts =13-13= and place
switch on right end of coil on button marked =S=. To increase the
strength of secondary, push coil to the =Left= gradually, which is just
=Opposite= to what is done in case of primary current.

THE USE OF THE INTERRUPTER.

To use the rapid interrupter which works against the end of core it
is only necessary to adjust the screw F, and any degree of vibration
may be obtained. The same may be said of the slow interrupter which is
adjusted by the screw D, but it is further controlled by the sliding
weight at E. By sliding the weight up and down the interruptions are
varied from very slow to rapid.

The higher the weight the slower the interruptions and vice-versa. At
button G, is the “single contact” used in obtaining single impulse
contractions.

The different interrupters may be placed in circuit by a switch on
the base of the Cabinet which works over a series of buttons marked
S, F and C which put in operation the slow, fast or single contact
interrupters, as desired.

DIRECTIONS FOR CONNECTING CELLS.

Fill the cells according to the directions on the cell label, and
connect the wires of the cable to the cells, as shown in the cut; No.
O being attached to zinc of the first cell, No. =1= to the carbon of
the first cell, while at the same time the carbon of the first cell
connected to the zinc of the second cell by strip from the carbon of
cell, No. =2= wire of the cable to the carbon of the second cell, and
so on, the last wire being connected to the carbon of the last cell, as
shown by No. =40=. The two wires marked faradic should be connected as
shown, the four cells being placed in two rows of two each, the zincs
and carbons being connected together as shown in diagram.

       *       *       *       *       *

Transcriber’s Notes:

Footnotes have been moved to the end of each chapter and relabeled
consecutively through the document.

Illustrations have been moved to paragraph breaks near where they are
mentioned.

References in the text to illustrations have been standardized.

Sidenotes originally appearing near the start of a paragraph are
positioned at the beginning of the paragraph; sidenotes in the middle
of long paragraphs are positioned near the relevant sentences.

Punctuation has been made consistent.

Variations in spelling and hyphenation were retained as they appear in
the original publication, except that obvious typographical errors have
been corrected.