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diff --git a/26366.txt b/26366.txt new file mode 100644 index 0000000..e464bb6 --- /dev/null +++ b/26366.txt @@ -0,0 +1,3663 @@ +The Project Gutenberg EBook of The Electric Bath, by George M. Schweig + +This eBook is for the use of anyone anywhere at no cost and with +almost no restrictions whatsoever. You may copy it, give it away or +re-use it under the terms of the Project Gutenberg License included +with this eBook or online at www.gutenberg.org + + +Title: The Electric Bath + +Author: George M. Schweig + +Release Date: August 20, 2008 [EBook #26366] + +Language: English + +Character set encoding: ASCII + +*** START OF THIS PROJECT GUTENBERG EBOOK THE ELECTRIC BATH *** + + + + +Produced by Bryan Ness, Markus Brenner and the Online +Distributed Proofreading Team at https://www.pgdp.net (This +book was produced from scanned images of public domain +material from the Google Print project.) + + + + + + + THE + ELECTRIC BATH + + ITS MEDICAL USES, EFFECTS + AND APPLIANCE + + + BY + + GEORGE M. SCHWEIG, M.D. + + MEMBER OF THE NEW YORK COUNTY MEDICAL SOCIETY AND OF THE MEDICAL + JOURNAL ASSOCIATION OF THE CITY OF NEW YORK; ONE OF THE + PHYSICIANS TO THE NEW YORK LYING-IN ASYLUM, ETC. + + + NEW YORK + G. P. PUTNAM'S SONS + 182 FIFTH AVENUE + 1877 + + + + + COPYRIGHT, + G. P. PUTNAM'S SONS, + 1876. + + + + + PREFACE. + + +In No 216 of "The Medical Record" (Dec. 15th, 1874) was published an +article written by me, entitled "On some of the Uses of Galvanic and +Faradic Baths." + +The interest manifested in the subject, as evidenced by numerous letters +of inquiry since received from physicians in almost all parts of the +United States, and some in Europe, has induced me to write the present +treatise, in which I have endeavored to present to the profession, as +far as lies in my power, all that is necessary to a full comprehension +of the electro-balneological treatment. + +When it is considered that in the employment of electric baths I have +been to a great extent groping in the dark, that I have been deprived of +the advantage of having the experience of others to guide me, it will +not appear surprising that I should have met with many disappointments. +My failures have been illustrative of the fact that the electric bath is +no more a panacea for all ills than any other remedial agent. +Applicable as it is to a great variety of pathological conditions, it +meets with many where it is destined to have negative or at best +imperfect results. Far from discouraging me, however, failures have +served to inspire me with fresh ardor to seek for light, and to +persevere in my efforts to establish on the basis of statistical truth, +the therapeutic merits of the agent which I employed. + +In view of the imperfectness of the results thus far obtained, I should +consider the present work premature, did I not find a justification for +it in my desire to induce other and abler observers to investigate the +subject, and place it on whatever footing it may merit. + +To say that I am fully conscious of the shortcomings of my work, would +be but feebly to express my convictions in this respect. I beg the +reader however to consider that the subject is not a hackneyed one, that +mine has not been the work of the compiler who remodels the brain-work +of others. It may be crude and rough, it may lack the gloss and polish +that is the result of much handling, but I have at least the +consciousness that it has the merits of originality and candor. + + NEW YORK. + 160 Second Avenue. November, 1876. + + + + + CONTENTS. + + + CHAPTER I. + + THE APPARATUS. + + PAGE + +_a_)--The tub. _b_)--The electrodes and connections. +_c_)--The water. _d_)--Chemicals. _e_)--The batteries. 7 + + + CHAPTER II. + +MODE OF ADMINISTRATION 19 + + + CHAPTER III. + + PHYSIOLOGICAL EFFECTS. + +Characteristic differences between the electric bath and +other methods of electrization--Effects on sleep; on general +sensation; on the change of matter; on the pulse and +temperature; as a stimulant and tonic; on general nutrition; +on the digestive apparatus; on the sexual apparatus--Sedative +influence--Affects cranial nerves--Cutaneous sensation--Its +freedom from pain--Muscular contractions--Effects on the mind 31 + + + CHAPTER IV. + + GENERAL THERAPEUTIC EFFECTS AND USES. + +The electric bath as a diagnostic; as an equalizer of the +circulation; as a general counter-irritant; as a general +invigorant and tonic--Its hypnotic and sedative influence--Its +improvement of nutrition--As a prophylactic 52 + + + CHAPTER V. + + SPECIAL THERAPEUTICS AND CLINICAL RECORD. + +General directions--Special diseases--Acute rheumatism--Subacute +rheumatism--Chronic rheumatism--Cases of rheumatism--Chorea, +with cases--Hysterical affections, with cases--Neurasthenia, +with cases--Agrypnia, with cases--Anaemia, with case--Paralyses +and Pareses, with cases--Neuralgiae, with cases--Articular +effusions, with case--Impotency, with cases--Constipation, with +cases--Hydrargyrosis, with case--Locomotor ataxia, with +case--Cachexia, with case--Dyspepsia--Melancholia, with +case--Inequalities of the circulation--Affections of the +Sympathetic, with case--Miscellaneous conditions--Concluding +remarks 61 + + + + + THE ELECTRIC BATH. + + + + + CHAPTER I. + + THE APPARATUS. + + +To a proper comprehension of the succeeding chapters, it is necessary +first of all to be familiar with the apparatus employed in carrying out +electro-balneological treatment, and I therefore proceed to give a +description of this.[1] It may conveniently be divided as follows, viz. + + _a._ The tub; + + _b._ The electrodes and connections; + + _c._ The water; + + _d._ Chemicals; + + _e._ The batteries. + +(_a_) _The Tub._ This must be made of a non-conducting material. Of +substances that will answer, I will mention: wood, porcelain, soapstone, +vulcanized rubber, or glass. In choosing one of these materials, regard +should be had to the facility of attaching the electrodes. In this +respect wood deserves the preference over all the others mentioned. +Where economy is to be studied, it has a further item in its favor. + +The tubs, which I have now in use for nearly three years are made of +wood, and I find them to answer very well. It must not be forgotten, +however, that a wooden tub requires to be well painted on the inside, in +order to prevent its becoming water-soaked, because in that event it +would become a conductor of electricity, and interfere to some extent, +with the administration of the electric current in the bath. + +The shape and size of the tub may be the same as those of an ordinary +bath tub. To suit individual cases however, its length may be made to +vary. The only peculiarity in its construction is at the head. Here, +instead of slanting, it is made square, and the slightly concave (from +side to side) board against which the back of the bather is to rest, is +fitted in afterwards. This is necessary, because it is very difficult to +make a wooden tub with a slanting back water-tight. If the length of +the tub from outside to outside is made to measure about five feet ten +inches, the back-rest fitted in at a proper slant will bring the inside +of the tub to about the right length for an average male adult. All +around the upper edge of the tub runs a wooden coping, which must not be +fastened down however until all the attachments for conducting the +current are _in situ_. Along that portion of the top of the tub where +required--and this will depend on the situation of the binding posts +presently to be mentioned--and underneath the coping, runs a groove for +the reception of the wires that are to connect the carbon electrodes on +the inside of the tub with the binding posts on the outside. This groove +is continued vertically along the inside of the back-rest and foot of +the tub respectively, to communicate at either end with the bed for the +reception of the carbon plates. These vertical grooves should at their +lower end be a little over 1/4 inch deep, in order to admit of the wires +being introduced beneath the carbons. + +The face of the foot of the tub and that of the back-rest, should have +in their centres (from side to side) and commencing at about five inches +from the bottom of the tub, a bed for the reception of the carbons. The +dimensions of these receptacles must of course correspond to those of +the carbon plates to be employed as electrodes. Those which I use +measure 12x8" at the head, 8x6" at the foot of the tub. They are 1/4" +thick. They are placed so as to have their long diameter correspond to +the height of the tub. The bed which is to receive the carbon at the +head of the tub must be deeper than 1/4" on account of the concavity of +the back-rest. + +In order to adapt a tub to individuals of different lengths, it will be +found advantageous to have two small vertical cleats on each side of the +tub, near the foot and bottom, for the reception of a foot-board, which +will practically shorten the tub and adapt it to persons of different +lengths. This board may conveniently be six inches wide, and should have +a number of perforations about an inch in diameter, for the transmission +of the current to the feet. 1 1/4" pine plank is the most suitable wood +to use in the construction of the tub. This is preferable to any of the +hard woods, because of the greater facility of fitting in the electrodes +etc. It is also the most economical. + +(_b_) _The electrodes and connections._ These consist of two carbon +plates, two brass binding posts, and insulated wires to connect the +carbons with the binding posts, and these with the battery. The carbons +are such as are ordinarily employed in the construction of galvanic +batteries, and can, as well as the wire and binding posts, be procured +from any house that deals in telegraph material. Their size is to some +extent optional; the dimensions I have given above however answer very +well. + +The inside of the tub having received one or preferably two coats of +paint, the carbons are now fitted in the receptacles provided for them. +The next step is the attaching of the binding posts. These should be of +the kind known as "single" binding posts with "wood screws." The most +convenient location for them will be found on the coping covering the +horizontal portion at the head of the tub. Here the coping, as it has to +cover not only the upper edge of the head of the tub, but that of the +back-rest also, is of necessity much wider than at any other portion, +and thus affords most room for the binding posts. + +Having marked out then a site for the binding posts, say in the centre +of the coping at the head of the tub--which should now be placed in +position--and about two inches apart, the posts are laid aside to be put +in place when the wires are all _in situ_, and the coping fastened down. + +In order to facilitate the description of the placing of the wires by +means of which communication is to be established between the electrodes +and the binding posts, I shall term the end of the wire that is to be +attached to the electrodes the distal, that which is attached to the +binding posts the proximal end. A gimlet hole sufficiently large to +admit of the passage of one wire should be made half an inch outwards +from the centre of the site of each binding post. The best wire to use +is about No. 16 copper wire, coated with gutta percha or rubber. The +site of the posts being as above suggested, it will be found that the +wire which is to connect the head electrode with one post requires to be +about 18 inches long, that which runs from the other post to the +foot-electrode, between eight and nine feet. The distal ends of the +wires should be stripped of their coating for a length of about three +inches, the proximal ends for about two inches. The denuded portion of +the distal ends should be rolled up in the form of a spiral coil; this +will insure their constant impinging on the carbons more certainly than +could be expected from a simple straight end of wire. + +The carbons having now been fitted in their beds, the distal end (coil) +of the head wire is placed beneath the carbon, and the wire itself +continued up along the vertical groove to either one of the gimlet +holes. Through this, from within outward, the proximal end of the wire +is now drawn and left for the present. The distal end of the second wire +having now been placed beneath the carbon at the foot of the tub, this +wire is continued up through the vertical groove, along the upper edge +of the foot of the tub to the side nearest the binding post to which the +wire is to be attached, along the groove on the upper edge of this side +to the head of the tub, and thence to the respective gimlet hole, and +through this, from within outward. The wires being now all in position, +all the coping is next screwed or nailed down firmly, care being taken +that the screws or nails used for this purpose do not injure any of the +wires. The coping fastened down, the binding posts are now screwed down +in the sites previously marked out for them. Before they are screwed +_entirely_ down, the denuded portion of the proximal end of each wire is +securely wound around the screw of the respective binding post, and the +posts are then _firmly_ screwed down, holding the proximal ends of the +wires in place. Connection is now established between the binding posts +and the head and foot electrodes respectively. The vertical grooves are +now to be filled in with putty and painted over, care being taken to +keep the carbon free from paint. The last step towards completing the +apparatus is to fasten the carbons in their beds. The simplest way of +doing this is by stretching over each carbon a piece of muslin, folded +double, and tacking this down around the edges. Zinc or galvanized iron +tacks are best. Copper tacks should be avoided on account of their +superior conductivity. + +In order to be able when required to localize the current in special +portions of the body, it is well to be provided with what I have termed +a "surface board." This is a piece of black walnut, say 14 in. long by 5 +in. wide, 3/4 thick, having in the centre a bed to accommodate a carbon +plate, say 5 in. long by 2 in. wide, 1/4 thick. From the centre of this +bed a gimlet hole pierces the board. The denuded end of an insulated +wire is drawn through this gimlet hole from without inward (toward the +bed) and twisted in the form of a spiral to prevent its slipping back, +as well as to insure its more certain connection with the carbon. The +carbon is now placed in the bed, and kept there by a piece of muslin +drawn over it and tacked down. The wire should be of sufficient length +to reach the battery. I shall speak further on of the use to be made of +the surface board. + + +_c_) _The Water._ The quantity of water may be the same as that in an +ordinary bath. In those cases alone where it is intended to localize the +current by means of the surface board, and to concentrate it _very +strongly_ in one spot, the water in the tub should be left low enough to +leave the particular spot to be treated uncovered by this; the surface +board can then be applied to this spot without the loss to the current +of strength, through derived currents, inevitable in its application +under water. + +The temperature of the water may range from 85 deg. to 105 deg. +Fahrenheit. As a rule the comfort of the patient may be consulted in +this respect. There are certain cases, however, where an especially high +or low temperature is indicated, and where the extremes mentioned have +to be touched. + + +_d_) _Chemicals._ Where these are added to the water of the bath, it is +for one of three purposes: viz. 1)--To exercise a direct therapeutic +influence on the patient, either internally by being absorbed, or +externally by their action on the skin; 2)--Through chemical affinity to +aid in eliminating certain metallic substances from the body; or 3)--To +further the absorption of morbid deposits. The various indications in +these respects will be treated of in their proper places. + + +_e_) _The Batteries._ In the choice of this, the most important part of +the electro-balneological apparatus, the greatest circumspection is +necessary. Inferior instruments and such as are liable to get out of +order frequently, have time and again been the means of discouraging the +beginner in electro-therapeutics, and causing him to abandon the study +of an art, the pursuit of which would have well repaid him for all his +labor. Fortunately our manufacturers here in New York turn out very good +instruments, and if a physician purchases an inferior one, the fault is +his own. + +Two different currents are required for the baths, viz. 1)--The +galvanic, which may be employed either in the constant or interrupted +(by means of a rheotome) form; and 2)--the faradic or induced current. +Several manufacturers of this city turn out good and serviceable faradic +instruments. Those which I have been in the habit of using for some +years past are manufactured by the Galvano-Faradic Manufacturing +Company, and they have given me unvarying satisfaction. By means of a +recently introduced attachment to their batteries, termed the "fine +adjustment," a current of exquisite "fineness" (rapidity of +interruption) is obtained, thus removing the only inferiority that has +heretofore distinguished American from the best imported instruments. +The instrument is very easy of management, and its liability to get out +of order very small. + +As however the galvanic current is of vastly greater importance in a +therapeutic respect, than the faradic, so also much greater care is +required in the choice of a galvanic than a faradic battery. In making +choice of a galvanic battery, we have to consider its relative quantity, +intensity, constancy, permanency, economy of running expenses, and +facility of management. We cannot be guided here by the same +considerations that guide us in the choice of a battery for office use, +where the _seances_ are usually brief and the elements taxed not nearly +so much as in the administration of baths. It is not within the scope of +this work to enter into a description of the various galvanic batteries +that are in use. Neither do I believe that, in a therapeutic sense, +there is much difference between the various batteries ordinarily found +described in text-books on electro-therapeutics. + +Where the battery is to be stationary, a zinc-copper battery, such as +the Hill battery for example, is preferable both on account of its +constancy and the economy of running it. Of this there should be fully +sixty cells, communicating with the bath through a current selector, by +means of which the current from any desired number of cells can be +obtained. The electro-susceptibility of different individuals varies to +such an extent that this is absolutely necessary. Where a portable +battery is desired, the Stoehrer zinc-carbon battery will be found the +most useful. + +I have mentioned these two batteries simply because I have them in use, +and they give me satisfaction. There are many others, however, that will +answer equally well. On the whole, any battery possessing quantity and +intensity in a medium degree will answer. + + + Footnotes: + + [Footnote 1: A written description can never convey so true an + idea of anything, as an ocular inspection. I will therefore say + that it will afford me much pleasure to show any member of the + profession the apparatus I am about to describe, at my + residence.] + + + + + CHAPTER II. + + MODE OF ADMINISTRATION. + + +I shall describe under this head the _modus operandi_ of administering a +routine galvanic or faradic bath. As it will become necessary to +describe special modes of administration when speaking of the +electro-balneological treatment of special diseases, the describing them +now would only lead to tautologies that I am desirous of avoiding. + +Taking our cue from the indications to be met in each case, it becomes +necessary, according to circumstances, to use either the galvanic +current, the faradic, or both successively. As modifications of the +application of the currents we have to consider 1) their intensity; 2) +their direction, and 3) the duration of the application. + +The intensity of the galvanic current corresponds directly to the number +of cells from which it is derived. It were vain however to attempt to +express this in figures, because the electro-motive force of different +batteries varies to so great an extent, that a number of cells of some +batteries of low intensity yield a current so feeble as to be barely +appreciable in the bath, while the same number of cells of a battery of +high intensity, furnish a current that few persons can bear without +pain. In thus comparing the Hill cell with the Stoehrer cell, I have +found the ratio to be about as 1 to 2 1/2, i.e., as intense a current can +be derived from twenty-four Stoehrer as from sixty Hill cells--and this +is rather below than above the mark. Were all batteries alike in this +respect, however, still no particular number of cells could be given as +furnishing a current of suitable average intensity for the galvanic +bath, because of the excessively great variations in the degree of +electro-sensibility of different persons. This is so marked that I have +seen persons in the bath tub who could bear no more than six Hill cells, +diffused as was the current from these through the water and over the +entire body; while on the other hand I have met with male patients on +whom a current from thirty-two Stoehrer cells made not the slightest +impression, and where I was compelled to supplement the current by that +from a ten-cell quantity battery (zinc carbon elements 6 in. long by 4 1/2 +wide) in order to make them realize the presence of a current. These +gentlemen had no cutaneous anaesthesia. + +In view of the facts just stated, I have found it impracticable, when +giving directions for the administration of a galvanic bath, to indicate +any certain number of cells to be used. I am in the habit of ordering +the administration of a "mild," a "medium" or a "strong" current, as may +be required in the respective cases; and in every instance it is the +electro-sensibility of the patient that determines the number of cells +requisite to obtain the desired result as represented by one of these +terms. The same applies also to the faradic current. + +To determine the direction of the current is sufficiently simple. Where +a descending current is desired, the binding post which represents the +electrode at the head of the tub must be connected to the positive pole +of the battery, the other binding post to the negative pole; where an +ascending current is desired, the reverse of this is done. + +The duration of the bath varies with different cases. The average is +about twenty minutes, though the time may range from ten minutes to an +hour and a half. + +Where it is desired to give the patient a galvanic shock, it is only +necessary rapidly to reverse the current by means of the commutator. The +simultaneous contraction of almost the ENTIRE muscular system that +accompanies the reversal of a current of sufficient intensity in the +bath, affords a striking illustration of the _general_ effects of the +galvanic bath. In cases where paralyzed muscles have lost their faradic +irritability, galvanic interruptions are almost indispensable to +successful treatment. + +I have before (page 14) described a "surface board," which I have +devised for the purpose of localizing the current from one of the poles +in any portion of the body where required. This proceeding should by no +means be looked upon as a "local" method of electrization; on the +contrary, it is just as much "general" as the ordinary electric bath. +Whereas in local applications the current runs from one point of the +body to another, in this case, supposing the spot where the surface +board is applied to be the centre, and the rest of the body the +periphery, a current runs between _every point_ of the periphery and the +centre, its direction being centripetal when the surface board +communicates with the negative, centrifugal when with the positive pole +of the battery. + +The current is felt more or less intensely in proportion to the +proximity to the body of the surface board. With the galvanic this is +less noticeable than with the faradic current. When, for example, a +faradic current of medium strength being employed, the surface board is +held about six inches from the abdominal surface, little or no current +is felt. Let the surface board be now gradually approximated to the +abdomen, and the current will be felt more and more sensibly, until, +when about an inch away from the skin, or touching this, its influence +becomes so strong as to cause more or less energetic contractions of the +abdominal muscles. Where the galvanic current is employed, the skin +beneath the surface board will be found more or less reddened after a +few minutes' application; the burning sensation ordinarily accompanying +galvanic applications will also be experienced more or less intensely, +in proportion to the strength of the current employed. + +Where the current is to be concentrated in a manner still more energetic +than that described, this can be effected by raising the objective part +above the surface of the water, and then applying the surface board. In +this way the _entire_ strength of the current is concentrated in one +spot, whereas, when the surface board is applied under water, a large +portion of current is absorbed by this. + +This appears to me the fittest place to say a few words in regard to the +relative conductivity of the human body and water--the latter at the +temperature ordinarily employed in baths, say from 90 deg. to 95 deg. +Fahrenheit. BEARD and ROCKWELL, in their work on Medical and Surgical +Electricity,[2] state that "the human body is a better conductor of +electricity than water at the same temperature." Certain phenomena +connected with the administration of electric baths having forced upon +me some doubts in this respect, I made very careful experiments, both +with and without the aid of the galvanometer (Bradley's Tangent), to +satisfy these. Without wearying the reader with details, I will state +that the result of my experiments leaves no room for doubt that water at +the temperatures stated--and still more so at 98 1/2 deg.--is superior +to the human body as a conductor of electricity. I do not mean to be +understood that water is a better conductor than _every constituent_ of +the human body; blood, for example, is a better conductor. But when I +speak of the body in this connection, I take it as we find it +practically, i.e., with the resistance of the skin, and especially the +epidermis, superadded to internal resistances. I have no doubt that +with a flayed individual it would be otherwise. I will add, that it will +give me great pleasure to repeat these experiments, which are +sufficiently simple, in the presence of any of my _confreres_ who feel +an interest in the subject. + +Having thus cursorily considered the manner of using the electric +current in the administration of a "routine" bath, and there being no +remarks required concerning the water employed, in addition to what has +been said in the previous chapter, a few words are in place on the +subject of chemicals. As has been previously stated (page 13) these are +added: _a_) to be absorbed, and thus act medicinally on the patient; +_b_) to act on the skin; _c_) through chemical affinity to facilitate +the elimination from the body of certain metallic substances, and _d_) +to further the absorption of morbid deposits. Of the many drugs and +medicines that no doubt may be made to answer these various purposes, I +have had personal experience with but few, and of these I will mention +the leading ones only. A requisite of all chemicals to be employed is +their ready solubility in water. Of substances intended for +absorption[3] I have used but three, viz: iron, iodine, and extract of +malt. The first of these I have employed in anaemic and enfeebled +conditions generally, but especially in chlorosis and chlorotic +hysteria, with marked success. It has the advantage, when administered +in this manner, not only of sparing the alimentary canal the frequently +injurious task of becoming the medium of its assimilation, but, in +addition to this, I believe that it can in this way be introduced into +the blood much more rapidly and in larger quantities than when given by +the mouth. The preparation which I have found, all things considered, +the most eligible for this purpose, is the "tartrate of iron and +ammonia." This is very readily soluble, leaving no deposit, is +assimilable, and not too expensive for the purpose. As, in my experience +at least, it leaves nothing to wish for, I would consider it superfluous +to discuss in this connection any of the other ferruginous preparations. + +Iodine I have employed with a view to its absorption in rheumatism and +gout. I cannot speak favorably of it in this connection. I have not in a +single instance found a bath charged with iodine, either in the form of +the tincture or of iodide of potassium, followed by results in any way +differing from those of the simple galvanic bath employed in the same +cases. + +Extract of malt I have employed as a roborant, either alone or in +conjunction with iron, in cases of debility and malnutrition, and found +it of service. + +Where the absorption of substances is aimed at, the _galvanic_ current +must be employed. + +Where we add substances to an electric bath with a view of producing +some special action on the skin, we may be guided by the same principles +that govern ordinary balneology. Thus to obtain counter-irritant +effects, we may add mustard or common salt; to render the bath alkaline, +bicarbonate of potassa or soda, etc., etc. + +An important object to be furthered by the addition to the galvanic bath +of chemicals, is the elimination from the system of certain metallic +substances. It will be found here that in practice we have to deal +chiefly with two substances, viz: mercury and lead. That the elimination +of these bodies by means of the galvanic bath is feasible, I shall +endeavor to demonstrate further on. At present I have simply to consider +the chemicals adapted for the purpose, and the manner of using them. + +To facilitate the extraction from the system of mercury, nitric-acid has +been recommended by those who have heretofore instituted this treatment. +While I cannot positively deny that this substance may aid in the +elimination of the metal, I am compelled to state, after its trial in +several cases, that I have obtained equally good results from the simple +galvanic bath. In the light of my own limited experience, therefore, I +cannot insist on the necessity of adding any chemical to a galvanic bath +which is administered for the purpose of extracting mercury from the +body. + +Where the elimination of lead is the object aimed at, I am, on the other +hand, satisfied of the utility of adding certain chemicals to the water +of the bath. Sulphuric acid has been suggested and used for this +purpose. I can say nothing respecting its usefulness, as I have never +tried it. Indeed, the results with iodide of potassium added to the bath +have been so satisfactory, that I have had no occasion to try any other +chemical, although almost any other of the preparations of iodine would +probably answer equally well. The chemical affinity of iodine for lead +affords a ready explanation of its usefulness in this respect. One ounce +of iodide of potassium to each bath appears to me a suitable quantity. + +I have had no personal experience with any other cases of chronic +metallic intoxication than those with lead and mercury. + +The absorption of morbid deposits (plastic exudations, etc.) can be +materially furthered by adding to a galvanic bath some resolvent--above +all, iodine. + +I have said above (page 26) that I had found no perceptible benefit from +the addition of this substance to the galvanic bath in cases of +rheumatism or gout. The contrary holds good however with respect to the +frequent sequence of these diseases--articular deposits. When the acute, +and to a great extent the subacute symptoms have subsided--and in +chronic cases especially, and the disease has left effusions in various +joints, iodine, which when employed in this manner, appears to have +little or no influence on the pain accompanying these complaints, is a +powerful adjuvant in promoting the absorption of the deposits. In +chronic synovitis and all other articular affections accompanied by +exudation, the same holds good. + +I have no doubt that future advances in this branch of science will +develop the utility of numerous other drugs and chemicals as additions +to the galvanic bath.--Before leaving this subject I must call attention +to the influence which the addition to the bath of certain substances +has on the conductivity of the water, resp. thus: the action of the +current on the patient. I have found that when I caused salt or +bicarbonate of soda to be added to the bath, the conductivity of the +water became so much increased, so disproportionately greater than that +of the body, as to render necessary the employment of very powerful +currents in order to cause the patient to feel them. + + + Footnotes: + + [Footnote 2: "Medical and Surgical Electricity." New York. 1875. + Wm. Wood & Co. pp. 431 and 432.] + + [Footnote 3: For some experiments concerning the cataphoric + effects of the galvanic current, see an article by MUNK, + entitled "Ueber die galvanische Einfuehrung differenter + Fluessigkeiten in den unversehrten lebenden Organismus," in the + Allgemeine Medicinsche Central-Zeitung, No. 16, 1875.] + + + + + CHAPTER III. + + PHYSIOLOGICAL EFFECTS. + + +In accordance with the plan of the present work, the remarks I shall +offer under this head are by no means intended to comprise all that is +known at the present day of the physiological effects of electricity in +general. It was my purpose when I undertook to write these pages, to +offer to the profession a book confined to one subject; not a +compilation, but a volume made up almost if not wholly of original +matter, chiefly, if not entirely the result of my own observations and +experience. For the general physiological effects then of electricity as +well as for the theories of its action, I refer those interested to the +many excellent works on the subject that have appeared within the last +few years. I will treat here only of the physiological effects peculiar +to the electric bath. + +The daily observations that I have had the opportunity of making in this +respect, extending as they do over a period of upwards of two years, +have not been as fruitful of results as might be expected. This is due +mainly to the circumstance that but a small percentage--and these took +the baths merely as a refreshing tonic--of those whom I have had the +opportunity of observing, were in a condition that might be called +normal. By far the greater majority were suffering from some complaint, +in most instances of a neurotic or rheumatic nature, the presence of +which, while it afforded admirable opportunity for observing therapeutic +results, modified more or less the physiological effects of the baths, +and served to deprive them of a uniformity which might to a great extent +justly be looked for in healthy organisms. If, therefore, what I now +contribute to the physiology of the subject is but little, it will I +trust be at least found of practical utility in its applicability to the +therapeutics of the subject. + +Before entering into details, it is necessary in the first place to +inquire in what respects electric baths differ from other methods of +electrization--especially those recently introduced as "general"--that +their physiological effects should merit individual consideration. They +differ in two ways. One of these is self-evident. To the effects of +electricity are superadded those of the warm bath. The effects of the +warm bath _per se_ are too familiar to every physician to require +comment. Its effects in combination with electricity, however, may not +be so generally known; and I therefore feel justified in quoting here a +passage that bears directly on the subject, from a recent German work by +Dr. Hartmann[4] of Wiesbaden. + + "The last question, whether mineral water acts also by contact + with the skin, leads us to one of its most important + effects--that through electricity. + + "Although this question has not as yet been finally disposed of, + we have still advanced far toward its solution, through the + admirable researches of HEYMANN and KREBS. Both observers have + furnished proof that the contact of the water of the bath[5] + with the human body gives rise to electric currents, which + currents must be looked upon as being the excitors of the + nerve-currents, the body acting merely as a conductor. From + these experiments we conclude that no particular difference + obtains between artificial and transported waters on the one, + and natural waters on the other hand, the assertions of + SCOUTETTENS notwithstanding, who in regard to electricity + claimed to have found a difference between the artificial and + transported waters and the natural ones. + + "We gather moreover from the experiments, that the electric + current generated through the contact of the body with the water + of the bath is modified chiefly by the gases, next by the + temperature of the water, and lastly only by its salts. + + "The effects of the bath depend on the strength of the electric + current generated and on the condition of the peripheral endings + of the nerves; the effect may be stimulating or soothing. The + strength of the current is governed, as we have seen, by the + quantity of gases present, the temperature and the salts. + Ordinary lukewarm baths, indifferent baths containing a small + amount of gases, are less stimulating than mineral baths + containing a larger proportion of gases. + + "With regard to the relative condition of the peripheral + nerve-ends, experiments on the motor nerves go to show that + swelling of the terminal ends of these nerves may diminish their + excitability to the point of its complete extinction, while it + becomes increased by their exsiccation. This fact as to the + motor nerves is adopted by HEYMANN likewise as applying to the + nerves of sensation. If, now, we presuppose absorption or even + imbibition on the part of the skin, a swelling of the nerve-ends + is comprehensible, as the imbibed fluid reaches them. But, + according to HEYMANN, the peripheral nerve-ends, i.e., the + terminal bulbs of KRAUSE, of the sensory nerves, and the tactile + corpuscles of MEISSNER, become even without this presupposition + sufficiently impregnated with water while in the bath, because + here all insensible perspiration must cease, and in a bath of a + temperature lower than blood-heat transpiration cannot take + place, so that all transudation to the skin being retained + during the bath, those termini are surrounded by moisture and + therefore swell up. + + "From this the writer concludes with regard to the effects of + the baths, that all baths in which the electric current produced + by contact of the water with the body preponderates over the + swelling of the nerve-ends, have a stimulant effect, while + those baths where the swelling preponderates over the electric + current, act as a sedative. + + "Taking a brief and comprehensive review therefore of the + effects of mineral water baths, we have those resulting from the + temperature, from the contents of carbonic acid and salts, and + lastly from the electric current generated in the bath water; + each effect however resolving itself into an excitation of the + peripheral nerve-ends, which leads in a reflex manner to an + enhancement of the change of matter." + +From the foregoing quotation may be realized the importance which is +attached to the electric current in the warm bath. And here let me ask +the question: May not the remedial superiority, in many cases, of the +mineral water bath over the ordinary warm bath be due mainly, if not +solely, to the more abundant generation in the former of electricity? Or +rather, is it not very likely that this is so? And if such is the case, +it would appear evident that the mineral water bath, the electric +properties of which, depending on the chemical changes going on between +the gases and salts of the water on the one, and the cutaneous +secretions and other constituents of the body on the other hand, are to +a great extent beyond our control, must in turn be vastly inferior to a +bath where the electric current is under our perfect control, and can be +modified in intensity, direction and quantity to meet the individual +requirements of every case. And such is the electric bath I am now +describing. + +The second difference between the electric bath and all other methods of +applying electricity is, that _the bath is the only method by means of +which general electrization can be realized_. In making a distinction in +this respect, it becomes necessary for me to advert more especially to a +method first introduced to the profession in a systematized and +scientific manner by Drs. BEARD and ROCKWELL,[6] and termed by them +"General Faradization." The undoubted good results that have been +obtained from this method--for the details of which I refer the reader +to the latest work of the authors[7]--have caused it to be extensively +adopted by the medical profession, both here and in Europe. It is, +however, not with its results that I have to do at present, but with its +appellation and true nature. General faradization, so-called, consists +of a series of local faradizations, administered during one and the same +seance, until the current has alternately been made to impinge upon and +traverse the entire or at least a large portion of the body. This +cumulative procedure, it is true, approaches general electrization, as +represented by the electric bath, more closely than any of the other +local methods; yet it is not that which its name would imply, and I do +not think it requires argument to make it apparent, that even this +procedure differs vastly from the electric (whether galvanic or faradic) +bath, where the current at one and the same time impinges directly on +every peripheral nerve-end (excepting those of the head and face) and +traverses every part of the body, obtaining--both as to reflex and +direct effects--as a whole that which the method known as general +faradization seeks to obtain by the cumulation of fractional portions. + +Having thus, I trust, established the individuality of the bath as an +electric method, I will without further digression proceed to the +consideration of its physiological effects. + +The physiological effects of the electric bath may be qualified on the +one hand as either "immediate," or "remote," on the other as either +"transient" or "permanent." Strictly to classify these is impracticable, +and I will therefore be influenced in the order of their enumeration +principally by their importance in a therapeutic respect. + +One of the most pronounced as well as uniform, and at the same time +most important, effects of the electric bath, is its property as an + + + HYPNOTIC. + +This somniferous influence, which is to some extent exercised by local +electrization, is here distinguished by its far greater constancy as +well as by its greater degree of perfection. That this difference should +exist, appears quite natural, when it is considered that the same +topical influences which produce it in local electrizations, and which I +shall presently endeavor to analyze, are here brought to bear on the +entire system. The hypnotic effect is both immediate and remote, and +more or less permanent. When there is an immediate inclination to sleep, +which may make itself manifest during the bath or immediately after +this, it is generally accompanied by a + + + PLEASANT SENSE OF FATIGUE, + +which cannot be likened to weariness, but rather to what we feel after +moderate exercise; it is only in some instances, where an individual +takes his first bath, or where, for therapeutic reasons, a strong +faradic current--accompanied by responsive muscular contractions--is +employed, that this feeling is intensified sufficiently to become +unpleasant, calling for rest and recuperation, and must here be looked +upon as analogous to the effects of _severe_ exercise. It invariably +disappears after a brief rest. + +Experience and good judgment will enable us moreover in almost all cases +to avoid effects of this kind. The immediate inclination to sleep is +much more decided as well as constant when the bath is taken late in the +day, than when taken in the forenoon. When the latter is the case +however, the individual will as a rule become sleepy during the +afternoon, or else at an earlier hour than usual in the evening, and +sleep more soundly during the night. This is the effect of one bath. A +series of baths will however produce more or less marked and permanent +improvement in the sleep of individuals, where this has been below the +normal standard. And this is among the most invariable of the effects of +the electric bath, whether galvanic or faradic. + +I have formed a theory as to the _rationale_ of this influence, which I +will offer as its probable explanation. We all know that sleep is a +process designed by nature for the recuperation of the system after a +certain period of activity. In other words, when the various functions +have been more or less exercised for their daily allotted time--say +seventeen hours--the respective organs need that profound rest which we +know as sleep. Now, it is pretty well conceded by physiologists, that +electricity stimulates the secretory as well as excretory organs; that +it furthers endosmosis and exosmosis--by its electrolytic influence in a +physical, by its influence on the nervous system in a catalytic manner, +in short, and by virtue of these properties, that it greatly + + + ENHANCES THE CHANGE OF MATTER + +and incites the various organs to so great an activity as to cause them +to perform in a comparatively brief space of time--say an hour, the work +of several hours. The natural sequence is obvious: _The want of rest--of +sleep, is felt at a correspondingly earlier period._ I offer this as a +probable explanation of the immediate or almost immediate disposition to +sleep. As to the permanent improvement in sleep, where this has been +below the normal standard, it must always be due to the removal of some +morbid condition, and thus belongs among therapeutic results, rather +than physiological effects. It is true that in many instances of +_agrypnia_ we are unable to discover any pathological condition that +would account for this symptom; but the probability is that here there +is a sluggishness of some one or more of the functions, mental or +physical, too obscurely manifested to be discovered by our present means +of diagnosis, yet reached and rectified by a mode of electrization that +traverses and permeates _every_ portion of the body. + +If this explanation of the hypnotic effect of the electric bath be not +the true one, it is at least--so far as I know--the first attempt at +accounting for a phenomenon that has been noticed as a result of even +local applications of electricity by many observers, and about the +pretty uniform occurrence of which there can be no doubt. + +With respect to the effect on the + + + TEMPERATURE AND PULSE, + +I have made a number of observations, of which I have recorded +twenty-two, made on persons where both were at or nearly at the normal +standard. With regard to the frequency of the pulse, the results were +conflicting and by no means reliable. In the majority of cases there was +an increase, immediately after the bath, ranging from four to eighteen +beats per minute. In others there was no change whatever, and in a few +there was an absolute diminution in frequency; this last I believe +however to be a therapeutic rather than physiological effect, +manifesting itself only where there is pneumogastric asthenia, and +attributable directly to electric stimulation of this nerve. Thus in one +instance, which occurred in the person of a physician of this city, who +had an intermittent pulse, the result was as follows: Immediately before +bath: pulse 70, two intermissions; at the expiration of 15 minutes, +during which he was under the influence of a descending galvanic +current: pulse 65, two intermissions; at the end of ten more minutes, +during which he received the faradic current: pulse 65, no +intermissions; ten minutes after leaving the bath: pulse 66, no +intermissions. As a rule then, we may look for an immediate and more or +less transient moderate increase in frequency of the pulse. As for any +permanent increase or reduction of the pulse, there is none as a +physiological effect. Where such an one does take place, it is by the +removal of some morbid influence on the heart, and must be looked upon +as a therapeutic result. + +With respect to the temperature, the results were somewhat more uniform. +I have found that where this is either normal or slightly below, the +immediate but transient effect is to raise it from 2 to 6 tenths of a +degree (Fahrenheit)--in most instances 4 tenths. In a very few cases it +remained unchanged, and in one case, where before the bath the +temperature was 100, at the close of the bath it was 99-3/5. Of +permanent modifications of the temperature, the same holds good that I +have said of permanent changes in the pulse. It must not be forgotten +that the temperature of the water is undoubtedly an important factor in +modifying the temperature of the body. In almost all instances where my +observations were made, the temperature of the water was below that of +the body, being 95 deg. or a little less. This, which has a tendency to +lower the bodily temperature, is to some extent counterbalanced by the +suppression of the insensible perspiration, so that modifications of +temperature resulting from electric baths, the water of which is but few +degrees below 98 1/2 deg., may justly be attributed to the influence of +the electric current. The importance of the electric bath as a + + + PHYSIOLOGICAL STIMULANT AND TONIC + +cannot be overrated. I deem it superior in this respect to any other +known agent. This effect manifests itself _immediately_ by a feeling of +exhilaration and unwonted vigor, _remotely_ by an improvement--where +there is a margin for such--in the performance of some or all of the +physiological functions, as well as by a gradual but nevertheless marked +_increase in weight_. + +Most striking among the tonic influences of the baths, are those that +occur within the sphere of the digestive and sexual apparatuses. I will +first consider the effects on + + + THE DIGESTIVE APPARATUS, + +which may be subdivided into those on _a_) the appetite, _b_) digestion, +absorption and assimilation, and _c_) alvine excretion. The improvement +of the appetite under electro-balneological treatment is one of the most +constant effects of this. While a series of baths will produce permanent +results in this respect, an increase of the appetite, in some instances +amounting to positive hunger, is a tolerably uniform and more or less +immediate result of each separate bath. The permanent improvement of the +appetite is relative. Not very appreciable where this is normal, it +becomes most marked where the appetite has from some cause been +impaired. The effect on the appetite is _definite_. The effects on +absorption and assimilation are _presumptive_; but when we couple the +absence of any corresponding difficulty in digesting the increased +supply of food, with the increase before alluded to in the weight of the +body, their assumption becomes fully justifiable. It is these combined +influences that make the electric bath so valuable a remedy in almost +all forms of dyspepsia. + +The influence on the alvine process is if anything even more marked than +that on the assimilative process. Where the action of the bowels is +normal, it is not modified permanently by the electric bath, although we +often have, as an immediate consequence, a cathartic effect that +manifests itself as a more or less watery evacuation, either a few hours +after the bath or on the succeeding day. Where the fecal process however +is sluggish, the improvement resulting from the baths is very striking. +I shall recur more fully to this subject under the head of constipation. + +The effects on the various functions connected with digestion are due +doubtless to the combined influences of stimulation of the secretions of +the alimentary canal and stimulation of the muscular coats of the +stomach and intestines, as well as permanent tonization of the +_muscularis_. While the enhancement of the secretions is undoubtedly due +chiefly to the electric stimulus to the secreto-motor nerves, and the +increased activity of the muscular coats to a like influence transmitted +to their motor nerves, I believe the permanent tonization and +invigoration of the muscular fibres to be mainly attributable to the +direct trophic influence of the current traversing the parts +themselves; and I have no doubt that this direct influence has much to +do with the stimulation of the secretions and _peristalsis_ also. At any +rate, I have never obtained from galvanization of the nervous centres, +which I have practiced in a great number of cases, the striking effects +on the alimentary processes which are so uniform a result of the baths. + +The influence on the + + + SEXUAL APPARATUS + +of the electric bath does not manifest itself in so striking a manner as +in the case of the organs of digestion. It is true I have seen +individuals whose sexual functions were normal, have _stysis_ in the +bath, but the mere cutaneous irritation of the electric current is here +sufficient to account for a phenomenon which, where sexual irritability +is intact, will follow any other local irritations. + +If not as immediately perceptible, the stimulant and permanent tonic and +invigorating influences on the sexual organs are not much less constant +than the corresponding influences on digestion. Careful observation, +however, of a considerable number of cases where the sexual function was +more or less impaired, has convinced me that while there can be no +doubt that _direct_ influence on the innervation, tone and nutrition of +the respective parts as well as the stimulus which the electric current +furnishes to the seminal secretion, bear a share in the improvement that +takes place, permanent beneficial results must be looked upon as chiefly +the expression of improved nutrition and tonization of the system at +large. I do not mean to be understood as wishing to put in negation the +beneficial results that the local influence of electricity is capable of +sometimes accomplishing in the sexual sphere. These results, however, +are not of a physiological, but rather of a purely therapeutic nature, +and are obtained there only where local morbid conditions exist. Now, in +the great majority of the cases that have come under my observation, the +causes of deterioration of the sexual capacity, though frequently +obscure and indefinable, were certainly not local, but to be sought for +in the general--most probably the nervous--system. In none but perhaps +the very mildest and recent cases have I ever seen _rapid_ results +follow electrical treatment of any kind whatsoever. In support of my +assertion however that in the majority of cases the sexual sphere can be +influenced only through the system at large, I will state _first_, that +I have seen cases where local electrical treatment had utterly failed +to do the slightest good, respond favorably to the baths, and _second_, +that where success was met with, it was only after persistent treatment, +continued long enough to modify favorably the condition of the entire +organism, and through this the objective sphere. + +The stimulant and tonic effects under consideration, although shared to +some extent by other methods of electrization, are here far more +comprehensive and pronounced, a fact which is not surprising, when we +reflect that in the electric bath not only are all the organs +_indirectly_ influenced through stimulation of the nervous centres, but +each separate organ is at the same time _directly_ acted upon by the +current. + +A direct sequence of the stimulant and tonic effects of the electric +bath is its + + + SEDATIVE INFLUENCE. + +This sedative effect, whereof the hypnotic effect already spoken of is +the supreme manifestation, must not be associated for a moment with any +idea of depression, for here we have none such. In addition to what I +have already said in endeavoring to account for the hypnotic influence +of the baths, I refer the reader for further information to the +admirable and lucid remarks on this subject by BEARD and ROCKWELL.[8] + +The _galvanic_ bath shares with other galvanic applications made in the +cranial and upper spinal region, the effect of producing the galvanic +_taste_, as also the _flashes_ when the current is interrupted, showing +that the + + + CRANIAL NERVES + +come within the sphere of its influence. + +A further effect peculiar to the galvanic bath is a sense of + + + ITCHING, + +felt chiefly in the lower extremities and about the neck, and +proportioned to the intensity of the current. Rather pleasant when mild +or medium currents are used, under the influence of strong currents it +may become so intense as to create an irresistible desire on the part of +the bather to scratch especially the legs. + +A negative effect of the galvanic bath, even where very intense currents +are used, is the + + + ABSOLUTE FREEDOM FROM PAIN + +throughout the entire process. I wish this to be understood of course +as holding good only when currents within the ordinary limits of +intensity are employed. The strongest that I have used, and on which I +base my statement, was that from 48 Stoehrer or 60 Hill cells. As +stronger currents are not required for therapeutic purposes, what I have +asserted remains practically true as applied within these limits. + +This absence of pain, which cannot be claimed for correspondingly +intense local applications, is to be attributed to the _diffusion_ of +the current throughout the body and its surface, as well as through the +water of the bath. The redness of the _entire_ back after a galvanic +bath, is among the proofs of this diffusion. + +Freedom from pain is a characteristic likewise of the faradic bath, +_properly administered_. When too strong a faradic current however is +incautiously administered, the resulting muscular contractions are +accompanied by an amount of local pain proportioned to the violence of +the contractions. By keeping the faradic current within proper limits, +all pain can be avoided. + +With respect to + + + MUSCULAR CONTRACTIONS, + +the effects of the electric bath may be distinguished from those +obtained by other modes of faradization by their comprehensiveness. +Many groups of muscles may be made simultaneously to contract by this +means. The practical bearing of this on the therapeutics of _pareses_ +and _paralyses_, renders it an important characteristic of the bath. + +The physiological effects on + + + THE MIND + +of electric baths, is a natural result of the enhanced tone and vigor of +the physical system, and keeps pace with this. Mental buoyancy and even +exhilaration are among the most common sequences of electric baths. +Although indirect, these results are none the less decided. + +It has been my aim in the foregoing remarks to give the reader, as +concisely as possible and within the limits which I set for myself in +the beginning of the present chapter, a summary of the more important +physiological effects of electric baths. As the isolated results of +observations made in a limited field by one unaided individual, I trust +the shortcomings of this chapter will be viewed indulgently. If what I +have said of the physiological effects of electric baths proves the +means of stimulating to further investigation more competent observers +than myself, my labor, whatever its imperfections, will not have been in +vain. + + + Footnotes: + + [Footnote 4: Dr. Franz Hartmann; "Der acute and chronische + Gelenkrheumatismus," Erlangen, 1874; pp. 194 et seq.] + + [Footnote 5: The Author here refers to mineral-water. Dr. S.] + + [Footnote 6: The Medical Use of Electricity, with special + reference to general electrization as a tonic, etc. New York, + 1867.] + + [Footnote 7: Beard and Rockwell; Medical and Surgical + Electricity. N. Y. 1875.] + + [Footnote 8: Op. cit. pp. 253. et seq.] + + + + + CHAPTER IV. + + GENERAL THERAPEUTIC EFFECTS AND USES. + + +The therapeutic uses of a remedy are based on what we know of its +physiological effects. Many--or rather most--of the therapeutic effects +of this as well as of most other remedies, correspond to certain +physiological effects. Those therapeutic effects whereto we find none +analogous among the physiological effects, are yet the results of the +physiological tendencies of the remedy, and where these tendencies do +not manifest themselves as results, it is because they find no field for +action in the healthy organism. When they meet with the requisite +pathological conditions, these tendencies make themselves manifest in +the shape of definite results, commonly known as therapeutic effects. + +NOTHNAGEL, in his classical work,[9] recognizes this theory by excluding +from his book the term "therapeutic effects" altogether. Where he finds +it necessary to say anything of the physiological effects of a remedy, +in addition to those "on man in health," he speaks--still under the head +of "physiological effects"--of those "on man when sick." When, setting +aside its empirical employment, we come then to inquire what it is that +furnishes us with the true indications for the use of a remedy, analysis +of the question leads us invariably back to its physiological effects. +If I have failed nevertheless to include the few effects which I am +about to touch on, under the head of "physiological effects," I have +done so simply in compliance with universal usage, and as a matter of +convenience for reference. + +I will now, without further digression, proceed to the consideration of +those effects of electric baths not yet enumerated. + +As a fitting precursor to the enumeration of the therapeutic properties +of the remedy under consideration, it may be well to dwell for a moment +on what is among its most prominent characteristics; I have reference to +its great value as a + + + DIAGNOSTIC. + +In explanation of this, I will state that in a very large number of +cases of disease of an obscure nature, and where, to be candid, the +electric bath was employed empirically, or, if you please, tentatively, +it has served to point out the _locus morbi_. The number of cases in +which I have made this observation, has been sufficiently large to +establish beyond a doubt the fact, that as a rule the electric current +makes itself more decidedly and often even painfully felt in any part +where a morbid condition exists; whether this be of an inflammatory, +neuralgic, rheumatic, traumatic, congestive or other nature, the result +is the same. It appears to be somewhat analogous to the "tenderness on +pressure" that we find present in many of these conditions. In +_anaesthesiae_ even the current makes itself conspicuous by the _absence_ +of its normal effects. The value of this will at once be recognized in +connection with a method of electric application which at one and the +same time acts on every portion of the body. Local electrization is +accompanied by like phenomena, _when we happen to strike the right +spot_. The superiority of the bath as a means of diagnosis is found in +the circumstance that here we _must_ touch it. + +The great importance of this feature of the electric bath will at once +be realized by every physician of much experience, for there can be none +such who has not frequently met with subacute or chronic conditions the +etiology of which was more or less obscure. + +One of the most important effects in its therapeutic application of the +electric bath, is its superior excellency as an + + + EQUALIZER OF THE CIRCULATION; + +so far as I know, it is more potent, constant and comprehensive in this +respect than any other agent. Where an imperfect circulation of the +blood is due to irremovable organic causes, the results obtained will of +course be transient only. In all other cases, however, favorable +results, more or less perfect according to the nature of the case, may +be reliably looked for. Both currents act very well in this respect, +though on the whole I look upon the galvanic as superior to the faradic +current. + +As a theory of this effect of the currents I would offer the following, +viz: That the galvanic current acts by stimulating the vasomotor centres +and peripheral nerves, by giving tone to the mucular coats of blood +vessels, and by counter-irritation. That the _faradic_ current +stimulates the vasomotor centres little, if at all, does not influence +the coats of vessels, except such as are close to the skin, but +tonicizes these latter more effectually than the galvanic current; that +it stimulates the peripheral nerves to some extent, though far inferior +in this respect to the galvanic current; but that when employed of +sufficient intensity it superadds to those mentioned a strictly +mechanical action, which consists in forcing static blood from the +capillary into the general circulation through the medium of muscular +contractions. + +As a + + + GENERAL COUNTER-IRRITANT + +the _galvanic_ bath has few if any superiors. The degree of +counter-irritation can be very nicely determined by regulating the +intensity of the current. The characteristic tingling sensation of the +galvanic current is felt over the entire surface, corresponding in +degree of course to the intensity of the current; while the redness of +the skin, bearing a like relation to the intensity of the current, is +observable more especially near the electrodes, being particularly +conspicuous over the entire back. Concentrated local counter-irritation +can be obtained by the use of the surface board. + +The counter-irritant effects of the galvanic bath, differ from those of +ordinary counter-irritants in their freedom from pain, even the slight +burning sensation accompanying strong currents ceasing with the +application. The redness remains quite a while and the stimulus to the +peripheral circulation causes the persistence for some time of a +"glowing" sensation all over the body. + +In the chapter on physiological effects enough has been stated to make +it apparent that as a + + + GENERAL INVIGORANT AND TONIC + +the electric bath can have few if any superiors. In the healthy +organism, however, the stimulant and tonic effects of the baths are much +less marked than they are where the general condition is "below par." In +health there is little or no margin for improvement. The results +obtained are _temporary_ stimulation, and a permanent invigoration which +partakes more of artificial development than anything else. It is +analogous to the development by gymnastic or other exercise of a +previously healthy set of muscles. Where we meet with atonic conditions +however, with debility, malnutrition, want of energy or general asthenia +of an obscure nature, and amenable to electric influence, the tonic +effects of the baths become striking and brilliant. I have observed +cases where patients fairly bloomed up under their influence and +acquired actually more physical strength and weighed more than before +they became sick. When we consider how in such conditions as those +mentioned, patients are made to swallow pills and mixtures for months or +years, or, more appropriately, and if they can afford it, are sent +abroad, we can realize the importance of an agent by means of which the +desired end can be obtained more conveniently, certainly, economically +and in a shorter time than by any other means. There is no rule without +its exceptions, and I freely admit that in many instances where persons +are, as the saying is, "run down," a sojourn in some mountainous region +or a course of sea-bathing, etc., would do them more good than anything +else, electric baths included. The results obtained from these last are +however sufficiently uniform to justify us in looking for very favorable +results in every case. + +In the preceding chapter I have already dwelt on the + + + HYPNOTIC AND SEDATIVE INFLUENCE + +of the baths. It is only necessary to state here that this influence +manifests itself still more decidedly in corresponding morbid conditions +than in health. The greater the degree of restlessness, irritability or +wakefulness, the more strikingly does the soothing and hypnotic +influence of the baths--appropriately administered, of course--become +apparent. + + + IMPROVEMENT OF NUTRITION, + +as manifested by rapid increase of weight, and which I have likewise +touched upon in the preceding chapter, is a reliable, constant effect of +electric baths. Where previous loss of weight is due to an incurable +organic disease, it is, if at all obtained, of course much less in +degree, as well as transient. When due, however, as is frequently the +case, to causes that are amenable to electrical influence, the increase +in weight is marked, and has a tendency to be permanent. + +It will be seen that the few therapeutic effects which I have here +enumerated, are in reality nothing more than intensified physiological +effects, there being about them nothing that might be termed specific. +It may be asked in reply: why then did I devote any space to them at +all? I will answer that I thought best to point out some general +therapeutic USES for which electric baths may be made available, and the +indications for which are furnished by so great a number of pathological +conditions, that omitting special reference to them would have led to a +great deal of tautology in the chapter on "special therapeutics." + +Before leaving the subject of "general uses" of the baths, I will dwell +for a moment on their admirable adaptability as a + + + PROPHYLACTIC. + +Every physician is fully aware of the fact that disturbances of the +circulation constitute one of the most frequent causes of disease. There +are, indeed, comparatively few pathological conditions that do not bring +with them congestion of some more or less important organ. A remedy then +which more than any other has a tendency to equalize the circulation, +and thus counteract a condition which as cause or effect, or both, is an +almost universal concomitant of disease, and which in addition to this +is so admirable and physiological a stimulant and tonic, can hardly be +surpassed as a prophylactic by any other uncombined remedy. + + + Footnotes: + + [Footnote 9: Dr. Hermann Nothnagel: Handbuch der + Arzneimittellehre. Berlin, 1870.] + + + + + CHAPTER V. + + SPECIAL THERAPEUTICS AND CLINICAL RECORD. + + +I have thought it best for practical purposes, to accompany the +consideration of the treatment of special diseases by the histories of +illustrative cases, where I had such at command. + +Before entering on the subject proper, I wish to offer some general +considerations that may influence and guide us in determining when, +where and why to employ electric baths as a remedy. + +To realize thoroughly the indications in given cases for the employment +of electric baths, we must first of all be more or less familiar with +the effects and uses of the electric current as well as those of the +ordinary warm bath. We must realize the fact that here we not only have +these two forces united, but that the more important of the two, the +electric current, here acts directly (locally) as well as indirectly +(through the nervous centres) on every portion of the body--a +circumstance of great importance in differentiating indications on the +one hand for the baths, on the other for local electrization. In view +of these circumstances we are fully justified in looking for results far +more comprehensive than any that might be obtained singly from either of +the two remedies that are here combined. There can be no doubt that in +many cases the resisting power of a disease is sufficient to withstand +two remedies brought singly and alternately to combat it, whereas the +simultaneous combined action of these remedies may be fully adequate to +overcome this resisting power. + +Approaching in its effects more closely to the electric bath than any +other remedy, is the process known as "general faradization," to which I +have already alluded (p. 36). In choosing between this and the bath, I +state it as my conviction that, while there may be a small proportion of +cases in which general faradization, so-called, is preferable, in almost +all the cases where both these remedies are applicable, the faradic bath +deserves the preference--it is a _more complete_ faradization. + +We need never be afraid of ordering electric baths on the score of any +imagined exertion or discomfort attaching to them. The most delicate, +the aged and children alike, bear them with far more ease, comfort and +impunity than any ordinary warm bath, or any but the mildest local +electrization. The entire absence of shock or pain of any kind +whatsoever, is always an agreeable surprise to those who, urged by their +physicians, have with fear and trembling submitted themselves to a +treatment, the mere name of which filled their minds with +extravagant--and, it is useless to say, groundless--visions of painful +shocks. Thanks to the tonic effects of the current, they are by the +feeble and infirm borne much better than the ordinary warm bath. There +is likewise much less liability to get cold after the electric bath. The +stimulus which the current furnishes to the peripheral circulation is a +powerful protection against cold, so that even in midwinter I see people +daily take electric baths at an average temperature of 95 deg., and enjoy +apparent immunity from colds. + +Having once determined on the use of the baths in a given case, we have +to observe certain points in their application. + +In the first place, guided by what we know of the relative effects of +galvanism and induced electricity, we must decide which of these two +currents to use, and if both, in which order. We must determine on the +direction and intensity of the currents, as well as on the duration of +the baths. + +Next we must use our judgment as physicians, in deciding whether a +given case promises to get well under electro-balneological treatment +alone, or whether auxiliary treatment may not be required to bring it to +a favorable issue. + +With respect to the frequency of the applications, I will say that while +there are some cases where a bath twice a week is sufficient, and others +where a bath every day is imperatively necessary, in far the greater +majority of cases suitable for electro-balneological treatment, a bath +every alternate day is _sufficient_, but a bath every day is +_better_--it leads to more rapid as well as certain results. + +In most of the cases, a daily bath for a few days or a week, followed by +one every other day for a time, and, when the cure is about completed, a +bath twice a week, to _consolidate_ and _confirm_ the good results +obtained, has done me the best service. + +I would dwell particularly on the necessity of _perseverance_ in this +treatment. The majority of cases that have come under my observation in +this connection, have been of a more or less chronic nature. In many of +these, where medicinal and other treatment had been unavailingly gone +through with for weeks, months and even years, I have found existing the +most absurd expectations with regard to the effects of the baths. People +who had made the tour of almost all the watering-places of Europe +without obtaining the slightest benefit, have come to me imbued with the +idea--whence derived I know not--that one or two baths should greatly +improve, and two or three more cure them; and when these expectations +were not realized, they would promptly discontinue treatment, fully +satisfied that electric baths were no more capable of benefiting them +than "all the other things." I do not mean to be understood for a moment +as intending to imply that ideas of this nature are shared by the +profession; I mention them simply in order to show the necessity on the +part of physicians to disabuse in this respect the minds of those +patients whom they may send for electro-balneological treatment. + +In appropriate cases, the use of the bath should not be too long +deferred. I have had frequent occasion to become cognizant of the fact, +that cases have been sent by physicians to take the baths only after +prolonged ineffectual treatment of another nature had been gone through +with, and where negative or at best tardy results took the place of the +brilliant results that might have been obtained, had the cases been sent +earlier. I do not mention this in a fault-finding spirit; to do so would +be unjust. The remedy under consideration has up to the present time +been too little known, the indications for its employment--in the +absence of statistics--on too uncertain a basis, to expect from any but +specialists the early realization in any case of its appropriateness. I +trust however that in the future, from being a "dernier ressort," it +will come to take its proper place among other remedies, to be +administered "when it will do the most good." When this comes to pass, +the results obtained, satisfactory as they are even now, will become as +brilliant and well-authenticated as those of every other remedy from +which experience has taught us how to reap the greatest advantage. + +In the following "clinical record" I shall not omit to cite cases where +the baths were unsuccessful, wherever it shall appear to me that the +citation of such cases may be of assistance in arriving at a true +estimation of the therapeutic value of the remedy. + +In giving the histories of cases, it will scarcely be necessary to enter +very minutely into details; the demands of the present work will be +fully met if sufficient is said of a case to illustrate the effects of +the baths in the class of cases that it represents. + +Finally, I wish it understood that in a few of the conditions in which +I shall advise the employment of the baths, I have had no personal +experience in their use, but base my opinions on what I know of their +effects, together with what is known of the results obtained in +analogous conditions by local electrical methods. + + + SPECIAL DISEASES. + + RHEUMATISM. + +Its great frequency, the pain and discomfort which it occasions, and its +many, often dangerous _sequelae_, added to its frequent obstinacy under +the most varied treatment, render rheumatism one of the most formidable +diseases that we have to encounter. The long list of remedies that have +from time to time been employed in its treatment, bear witness by their +very number to the little reliance that can be placed in any one of +them. A remedy then which can be _relied on_ to exercise a favorable +influence in all the forms of rheumatism--acute, subacute and +chronic--as well as on most of its sequelae, should of right become a +welcome addition to our armamentarium in the treatment of this disease; +and such is the electric bath. The treatment of the sequelae I shall +speak of under separate heads. The disease itself I will divide into +three classes, viz: _a_) acute, _b_) subacute and _c_) chronic +rheumatism. + +_a_) ACUTE RHEUMATISM.--A few years ago the use of electricity in acute +inflammatory conditions was scouted by most of the profession, and had +it not been for the quiet and patient labors of a few progressive +spirits, we would at the present day be still deprived of the benefits +which we reap from it in these conditions. Even to-day, the number of +those who are satisfied of the utility of electricity in this respect is +comparatively small. Only two years ago, I attended a gentleman who was +suffering from a very severe attack of rheumatic gout. I had both a +galvanic and a faradic battery at his house, which, in addition to +appropriate medicinal treatment, I applied daily to the affected +joints,--using mainly the faradic current. Being compelled at the time +to go to the country, the case during my absence drifted into the hands +of a gentleman, a professor at one of the medical colleges, of high +standing in the profession and considered one of our leading medical +men, who ridiculed and promptly discontinued the use of electricity in +the case. He gave it as his opinion that it did more harm than good, and +I have no doubt he did so conscientiously--however unprofessional his +conduct may have been, in this as well as other respects. The +contributions of others have since then vindicated my views in this +respect. Among others, Dr. Drosdoff[10] of St. Petersburg has given a +number of cases of acute articular rheumatism from the clinique of +Professor Botkin, in which the faradic current was employed either alone +or in conjunction with other treatment. From among the deductions which +he makes from a series of careful experiments in this respect, I quote a +few--such as bear directly on our subject, and to which I affix my own +numbers. + + 1) "The sense of pain as the result of electric irritation is + considerably diminished, and sometimes entirely lost, in joints + attacked by acute articular rheumatism, so that the patient + experiences no pain, even when the distance between the coils + equals naught[11], and both closure and opening are accompanied + by the evolution of numerous sparks. At the same time the + slightest pressure of the affected parts gives rise to the most + intense pain." + + "The diminution of the electro-sensibility appears in the + majority of cases to be in inverse proportion to the severity of + the disease and the intensity of the pain produced by mechanical + irritation." + + 2) "The enhanced tactile and thermic sensibility of the diseased + joints is diminished by a faradization lasting from 5 to 10 + minutes." + + 3) "From 5 to 10 minutes faradization causes a reduction of the + previously heightened temperature of the diseased joints to the + normal standard, or even below this." + + 4) "The subjective rheumatic pains which are augmented by + pressure and motion, are diminished by faradization. This + diminution is sometimes so considerable, that the joint, which + prior to the faradization admitted of no movement, is able to + execute passive and active movements with tolerable facility." + + 5) "The rheumatic pains as well as the temperature of the + affected joints remain diminished after the faradization for 3, + 4 and even 5 hours; they then gradually return to the previous + height. At the same time the duration of the paroxysms of pain + becomes shortened, and the intensity of this diminished." + + 6) "Although the rheumatic process takes a more rapid course + under the influence of faradization, and incommodes the patient + less, we have nevertheless made the observation in one case, + that the tendency to recurrence is not diminished. The attacks + however become more brief and milder." + + 7) "From what has here been said it follows, that daily + faradizations, lasting 5-10 minutes, diminish the severity of + acute articular rheumatism, restore the perverted cutaneous + sensibility, and cause a reduction of the temperature of the + affected joints." + + 8) "Several of those suffering from the pathological processes + mentioned, received no medication in addition to the + faradization, and yet made a tolerably rapid recovery." + +I might adduce further testimony of the value of electricity in recent +cases of rheumatism, were it necessary to do so. The results in my own +cases however have long since satisfied me of the utility in this +respect of faradic not only, but also of mild constant currents. +Accepting this as matter of fact, let us next inquire where and why we +are to give _general_ electrization--in other words, the electric +bath--the preference over local applications. + +Where the manifestations of the disease are limited to a single joint, +or at best a very few joints, or where we have to do with a case of +muscular rheumatism--to one group of muscles, local electrization, as +_symptomatic_ treatment, will answer. Where on the one hand however many +joints, on the other the muscles of entire limbs, or even more, are +involved, the advantages of a method by means of which we reach all the +affected parts at once, thus effecting in, say ten minutes, that which +where, for example, six joints are involved, would by the ordinary +method require sixty minutes, are readily realized. There is, however, +another reason why the baths are preferable in rheumatism to local +applications. Rheumatism is a constitutional disease with local +manifestations. The metastatic character of muscular rheumatism +especially appears to indicate the greater importance of general as +compared to local treatment. Pre-supposing, then, that electricity +exercises the favorable influence on rheumatism which clinical results +would appear to demonstrate, it follows that the electric bath, while it +furnishes symptomatic (local) treatment equally well with local +applications, does something more; it meets the _indicatio morbi_ +likewise. The warm bath no doubt contributes its due share in bringing +about the favorable results obtained.--Where the disease then does not +confine the patient to bed, the electric bath will be found a most +valuable remedy. + +The following directions will be found to answer best in the great +majority of cases: The temperature of the water should range from 90 deg. +to 98 deg. F; a mild constant current, descending, should be applied for +ten minutes; this to be followed by a faradic current of as great an +intensity as the patient can bear _without the slightest degree of +discomfort_. In the application of the faradic current, the surface +board (see p. 12) may advantageously be had recourse to for the purpose +of more concentrated influence on affected parts, to each of which it +may be applied for a few minutes; the entire faradization may last from +ten to fifteen minutes. When coming from the bath, the patient should be +received in a warm blanket, anything like a chill being carefully +guarded against. In cases where the cutaneous secretion is of an +abnormally acid character (which is often so marked as to become +apparent through the sense of smell), bicarbonate of soda or potassa may +be added to the bath. As appears from the foregoing, the entire duration +of the bath is from twenty to twenty-five minutes. The baths should be +taken daily until all urgent symptoms have disappeared; after this, +every two or three days as required, until an entire cure is wrought. + +As the results of this or similar treatment, conjoined with the +requisite medicinal or other measures, I may state: + +_a_) Considerable abridgment of the period of the disease; + +_b_) Sequelae are less constant; + +_c_) The tendency to recurrence is very much diminished; + +_d_) A relapse, if it does occur, is comparatively mild. + +With regard to _b_ and _c_, let it be understood that I speak within the +restrictions of a period of observation extending over two and a half +years only. + + + _b_) SUBACUTE RHEUMATISM. + +In the subacute variety, the electro-balneological treatment is similar +to that in acute cases, with the difference however, that here not so +much care is necessary with regard to the intensity of the currents. +Muscular contractions, as induced by strong faradic currents, are to be +dreaded in direct proportion to the acuteness of the inflammation, +_resp._ the sensitiveness of the inflamed tissues. + +It will be understood, I hope, that the electro-balneological treatment +as laid down above, though it applies to the majority, does not apply to +all cases. Special complications may make it expedient in individual +cases to modify the treatment more or less. The course to be pursued in +these instances may however be safely left to the judgment of the +attending physician. + +_c_) CHRONIC RHEUMATISM. In this affection the course to be pursued +varies from that indicated in the acute and subacute varieties. We have +here little or no constitutional disturbance, and need have no fear of +doing any harm by strong currents. On the contrary, I have found that +mild currents rarely do any good. By far the greater majority of the +cases that have come under my observation were of the muscular type, the +algic portion of the symptoms approaching those of neuralgia rather than +subacute rheumatism. Of chronic articular rheumatism I have treated but +very few cases. Although in some of the cases the treatment under +consideration was attended with brilliant results, I freely admit that +in some instances the results were imperfect, in others again entirely +negative. This I found true more especially of cases that involved +tendons. I must add, however, that in perhaps the greater majority of +the unsuccessful cases the fault lay with the patients themselves, who, +finding they were not benefited as rapidly as they had expected, +discontinued treatment before this had had time to effect any thing. + +In accordance with a theory which I have formed in regard to the +pathology of chronic rheumatism, and which I am not yet prepared to +promulgate (nor is it necessary here), I have of late been in the habit +of administering in this disease, baths calculated to stimulate as much +as possible the circulation of the blood. The best manner of applying +the baths to this end will be found further on, under "Inequalities of +the Circulation." In addition to this I cause the galvanic (anode) as +well as strong faradic currents to be applied to the affected parts by +means of the surface board. Where there is any thickening, effusion or +other similar concomitant of the disease, iodine may be added, as +hereinbefore directed. + +In chronic rheumatism it is not necessary to use the baths daily. Two +or three times a week is quite sufficient. Indeed, the daily use of +strong currents, as employed here, might in some instances be productive +of evil rather than good. Although transient benefit may be experienced +from a few baths--sometimes even from one bath, permanent progressive +improvement need never be looked for from less than about a month's +treatment--more or less, according to the nature etc. of the case. + +I regret that I have no cases of acute rheumatism to offer. As a rule, a +person suffering from this disease is not in a condition to leave the +house; and in the cases that have occurred to me in private practice, +the difficulty of introducing an electric bath at the patient's +residence has been in every instance sufficiently great to induce me to +forego this plan of treatment. While I have thus had frequent occasion +here to employ local electrization, I have had but one case of acute +rheumatism where I had the opportunity to employ the baths. The local +symptoms in this case being limited to one arm and shoulder, the patient +was enabled to locomote, and thus became an office-patient. At present +the case is still under treatment; and although the results thus far +have been eminently satisfactory, it would yet be premature to cite it +before I shall be able to state the final result.[12] + + CASE I.*[13]--SUBACUTE RHEUMATISM. Mr. F., from the _clientele_ + of Dr. Alexander Murray, about 32 years of age, of robust + appearance, large, vigorous frame, had an attack of acute + inflammatory rheumatism in the spring of 1873, from which he + recovered in a short time. In the winter of 1874 he experienced + a second attack, for which he had had treatment for about two + months prior to coming under Dr. M.'s care. After treating him + by other methods, including local galvanic applications to the + affected parts (joints as well as muscles were involved) for two + weeks, Dr. M. sent patient to take electric baths. On May 25th + Mr. F. was brought in a carriage. He was unable to walk; had to + be assisted up the steps by two attendants. His arms were in a + scarcely better condition, the wrist joints especially being + exceedingly tender and painful. The first and second baths, + administered respectively on May 25th and 29th, did not effect + much change in his condition. The third bath was taken May 30th, + with the happiest results. On June 1st patient was able to come + for his fourth bath alone and on foot, and thenceforth his + recovery was very rapid. The seventh bath, taken June 7th, left + him perfectly cured, not a trace of the disease remaining. He + has been free from rheumatism since. In the first three baths + the galvanic current was employed exclusively, the muscles and + tendons being in too tender a condition to bear the + contractions induced by the faradic current. In the subsequent + baths both currents were used, according to indications. + + CASE II.*--SUBACUTE RHEUMATISM. Mr. B--y, aet. 22, came for + treatment on August 27th, 1874. Had subacute rheumatism, with + considerable swelling of ankle-joints. The acute attack dated + back six weeks. Locomotion was very painful, and could be + accomplished only with the aid of a cane. A galvanic bath on the + 27th and one on the 28th of August were sufficient to remove + both swelling and pain, enabling the patient to resume his + avocation. + + CASE III.--SUBACUTE RHEUMATISM. J. H. K., aet. 29. In the summer + of 1873 had a very severe attack of cephalalgia, which, judging + from his subsequent history, was probably of rheumatic origin. + The attack confined him to bed four days, after which it + troubled him continuously for three months. It then abruptly + left him, to make way, apparently metastatically, for enteralgia + coupled with diarrhoea. This clung to him for five months--until + May, 1874. He was then well for a time. Late in the summer of + 1874 he began to experience pain in the soles of the feet, which + shortly culminated in a more pronounced rheumatic attack than + any to which he had previously been subject. It affected chiefly + the lower extremities. When he first came under my observation + (7th October, 1874) he had been confined to the house five + weeks. The left knee and both feet and ankle joints were much + swollen. The affected joints were exquisitely sensitive. Both + legs were very feeble, and coupled with this was great general + debility. Locomotion was rendered difficult to such an extent + that even the aid of two stout canes did not enable him to + dispense with additional help in mounting my doorsteps. The + first bath (Oct. 7th) was followed by no favorable results. + Indeed, the patient thought he felt worse, if anything. He + followed my directions, however, to take a bath every other day. + From the first three baths he received little or no benefit. The + fourth bath however had a very marked beneficial effect. + Immediately after it he was able to dispense with one of his + canes, and thenceforth improved steadily and rapidly. He took + his last bath Nov. 10th 1874, having taken in all fourteen + baths. He made a perfect recovery. At present (December 1875) he + has had no return of the disease, nor any other illness; says he + never felt better in his life. + + CASE IV.--CHRONIC RHEUMATISM. Mr. K., from the _clientele_ of + Dr. Lusk, had been a sufferer from chronic rheumatism for a long + time. As far as I could gather, the disease originated in an + acute attack some two years ago. He came for his first bath on + June 21st, 1875. Between that date and July 16th following he + took twelve baths, which resulted in a complete cure. + + CASE V.--CHRONIC RHEUMATISM. Mr. L., aet. 60, had been subject + to chronic rheumatism for many years. When he presented himself + for treatment (19th June, 1874) his health in other respects was + fair. The flexor tendons of the fingers of both hands were more + or less contracted, the result of previous rheumatic attacks. I + ordered him the baths, without any adjuvant treatment + whatsoever. His improvement was rapid. Between June 19th and + July 15th he took fifteen baths, a perfect and (thus far) + permanent cure resulting. Mr. L. has frequently taken baths + since then, solely however for the sake of their general tonic + effects. + + + CHOREA. + +The utility in this disease of electricity has been for some time past +almost universally conceded. While some vaunt the faradic, others prefer +the galvanic current in its treatment. It appears that thus far the best +results have been obtained on the one hand by galvanization of the +spine, on the other by general faradization. It occurred to me, when I +began to devote myself to electro-balneological treatment, that a method +which combines the electrical procedures alluded to, must needs also +combine their virtues. Accordingly, I discontinued my previous practice +of spinal galvanization in this disease, and had recourse to the baths +in almost every case that applied to me for treatment. I am happy to +state that in no instance where the baths were employed was anything +short of a perfect result obtained. I will state on the other hand, that +in every case medicinal treatment was had recourse to at the same time. +It is equally true however, that in all the cases medicinal treatment +_without_ the baths had proved of no avail. The best method of employing +the bath is as follows: For the first ten minutes a constant current of +medium intensity should be passed, one pole communicating with the +head-electrode, the other connected with the surface board, applied for +five minutes to the epigastrium, five minutes to the sacral region. In +anaemic persons the current should be descending, in all others, +ascending. This concluded, a strong general[14] faradic current should +be employed for five minutes. By this means all the muscles of the lower +extremities will be very thoroughly contracted. The pole of the battery +attached to the foot-electrode should now be transferred to the surface +board, and the hands of the patient made to hold this, under water, an +additional five minutes. In routine cases this method of administering +the baths will be found very efficient. In special cases it may be +modified as expedient in the judgment of the practitioner. + + CASE VI.* Hugh O--l, aet. 12 years, from the _clientele_ of Dr. + J. O. FARRINGTON, came for treatment February 5th, 1874. This + was one of the most severe and obstinate cases of chorea that I + have ever met with. Internal medication, ether spray, change of + air etc. had been of no avail. Between the date above mentioned + and March 23d the boy had seventeen baths, steadily improving. + He made a complete and (thus far) permanent recovery. His + intellect, which had been somewhat impaired, was considerably + improved. + + CASE VII. J. G., aet. 9 years, was sent for electrical treatment + on September 22d, 1874, by Dr. KREHBIEL. He had been under + medicinal treatment for a long time, the choreic manifestations + dating back upwards of a year. When I first saw him, the choreic + movements were so continuous and violent as to preclude the + possibility of administering electric baths. The attempt was + indeed made; but no sooner had we managed to place the boy in + the tub, than he splashed the water freely about, and by the + violence of his movements bid fair to injure himself. I + therefore deferred for a time the electro-balneological + treatment, and had course to ordinary spinal galvanizations. + These, together with internal medication--which Dr. K. attended + to--had by the 8th of October diminished sufficiently the + violence of the movements to admit of the administration of the + baths. Accordingly the local applications were discontinued, and + from Oct. 8th to Nov. 27th the boy had seventeen baths, when, + all traces of the disease having disappeared, treatment was + discontinued. + + + HYSTERICAL AFFECTIONS. + +If there is any one disease that more frequently than any other tempts +the physician to have recourse to empirical treatment, it surely is +hysteria. The obscurity, in many cases, of its etiology, as well as its +frequent obstinacy under the most diverse methods of treatment, +successively employed, are alone sufficient to warrant us in having +recourse to electricity, where this has not already been employed. +Where we can establish the etiology of a given case, we cannot of course +be in doubt as to the remedy; and in many instances of this kind we find +in electricity our most potent curative agent. But even where we are in +doubt or positively ignorant as to the origin of the symptoms, we are +justified in giving preference empirically to electricity, not only +because, the disease being essentially of a nervous character, we find +in electricity the most powerful of neurotics, but also because _recent_ +statistics, those that embrace a period when electricity has been +permitted to participate, if not duly, at least more largely than +heretofore, in the treatment of disease, go to show that by means of +this remedy better average results have been obtained than with any +other. Again, where there are no positive indications to employ any +special method of electrization, either central or local, it appears +rational to give the preference to a method that is at the same time +central and peripheral, that admits of the application of either current +with the utmost facility, and is susceptible of so many modifications +that, with at best two or three tentative applications, it can be +suitably adapted to almost any given case. The results I have thus far +obtained justify me in asserting that, of the cases that are merely +functional in their nature, by far the greater majority will yield +completely to judicious electro-balneological treatment. + +As to the mode of administration in this affection, I can suggest +nothing. There is so little uniformity in the manifestations of +hysteria, that it were idle to even attempt to establish anything like a +routine electro-balneological treatment. Each case must make its own +laws. + + CASE VIII.* Mrs. A., aet. 28, married, sterile, from the + _clientele_ of Dr. KREMER, was referred to me on June 12th, + 1874. She had been a sufferer from hysteria for a number of + years. Among the more prominent symptoms were intense + _pruritus_, transient flushing and heat of the entire surface, + with pricking sensations and headache. Six baths, in each of + which both currents were employed, sufficed to effect a complete + and permanent cure. + + CASE IX.* Mrs. E., from the _clientele_ of Dr. KREHBIEL, aet. + 28, married, of an exceedingly nervous temperament, had suffered + from excessive nervous irritability and prostration since her + last confinement (about a year previous to my seeing her). There + was no organic trouble, the symptoms pointing to pure functional + hysteria. She was sent for electro-balneological treatment April + 21st, 1874. Six baths, in which both currents were employed, + restored her to perfect health. + + + NEURASTHENIA. + + (NERVOUS EXHAUSTION.) + +Those who are familiar with the pre-eminent qualities as a neurotic of +electricity, will not be surprised to be told of the beneficial effects +in the condition under consideration of electric baths. It is not only +in _general_ nervous exhaustion, however, that electric baths exercise +this salutary influence, but in the condition known as _cerebral +exhaustion_ likewise. Judging from my own experience, their efficacy in +this latter condition is far greater than that of local applications, +whilst they are unattended with any of the irritant and other +disagreeable effects that even with the greatest care and caution we +cannot always disassociate from galvanization of the brain. They no +doubt act here in two ways, i.e., first and chiefly, through reflex +influence from the entire periphery; second, by derived currents on the +brain directly. Whatever their mode of action, the results obtained are +of the most gratifying kind. The pitiable condition in which some +patients of this class present themselves, is familiar enough to every +physician; but it appears that the greater the degree of exhaustion and +the more prostrate the various functions, the more striking are the +effects of the baths. The patients seem to live up anew under their +influence. While in many if not most other complaints that come under +electro-balneological treatment, a certain number of baths are requisite +in order to get discernible effects, in the disease under consideration +each bath, except perhaps the first, is followed by more or less +immediate improvement, which, if the treatment is persevered in, remains +permanent. + +It is almost unnecessary to say, that in the more advanced cases great +care is requisite in the administration of the baths. By +over-stimulation at first, much harm may be done, and the patient, +instead of getting better, get worse. In such cases very mild currents +should be employed in the beginning. As recuperation advances, stronger +currents may be gradually introduced. The intensity of the currents +should be carefully regulated to keep pace with the gradually increasing +capacity of the various organs to respond to the electric stimulus +without detriment. Both currents may be used from the first. The +galvanic current should precede the faradic, and be employed for not +more than ten minutes. Where irritability is a feature of the case, the +current should be descending; otherwise ascending. This may be followed +by the faradic current, not of sufficient intensity for the first few +baths, however, to cause any but _slight_ muscular contractions. In most +of these cases iron may be advantageously added to the bath. The +duration of the baths should at first not exceed fifteen minutes; in +some cases this even is too long, the patient complaining of being +fatigued perhaps after the lapse of ten minutes. When this is the case, +the bath should be at once terminated. It is in these instances not the +electric current, but the warm water bath, that gives rise to the sense +of fatigue. Later on in the treatment, the duration of the baths may be +from twenty to twenty five minutes, according to indications. + + CASE X. _Cerebral Exhaustion._--K. S., aet. 42, lawyer. First + consulted me on June 2d, 1874. The salient points in the history + of this most interesting case are as follows: Ten years prior to + his calling on me he was engaged in some very heavy law cases + and other duties requiring intense mental application. At that + time he began to manifest occasional symptoms of cerebral + exhaustion; was unable to endure mental exertion with same force + as theretofore. These attacks, commencing in 1864, supervened at + various times until 1868, sometimes incapacitating him for + business for a few days at a time, and accompanied by intestinal + catarrh, flatulence and gastric disturbances--probably the + results of loss of nerve-power. In 1868, having been subject for + a time to extra heavy mental strain, he was completely + prostrated, and compelled to retire from the pursuit of his + profession. By the advice of his physician he went to the + country. There, without any premonitory symptom whatsoever, he + suffered an attack of (left) hemiplegia. I quote from his + recital as follows: "While standing in the office of the hotel + registering my name in the book, I suddenly dropped down, + retaining full consciousness. I lost the power of speech for + some hours. After twenty-four hours the paralysis began to + recede, and in a few days I had made a spontaneous recovery. I + then went further into the interior. Two weeks subsequently I + had a similar, but milder attack; retained full consciousness + and mental control. Returned to city (New York) two weeks after + this, in a very debilitated condition. On the third day after my + return, I had a more violent attack than either of the + preceding--again on the left side. I felt as if a line were + drawn perpendicularly through my body, dividing it in halves. My + stools were clay-colored. With this attack for the first time I + became unconscious, and passed into a delirious state. So far as + I know, no diagnosis of my condition was made. I was confined to + bed for a month, at the end of which I was in a very feeble + state. I then went to Europe, where I spent some years. While + there I consulted the first physicians of London and Paris, with + but little benefit, however. Both mind and body remained feeble. + My normal weight is upwards of 120 pounds, but has for a long + time past been in the neighborhood of 90 pounds." + + When Mr. S. came to consult me, he had but lately returned from + Europe, whence, he stated, his physicians had sent him home to + die. His complexion was sallow, sickly; skin of face plentifully + wrinkled; features wearing the air of suffering and anxiety that + so frequently accompanies painful chronic conditions. He had for + some time past suffered from excessive cerebro-spinal + irritability, for the relief of which cantharidal collodion had + been employed in the cervico-spinal region (the same had also + been used in the hepatic region, to meet the diagnostic views of + some one of his medical attendants). He had a remittent chronic + intestinal catarrh, with--noticeably during the periods of + exacerbation--abundant discharge of a glairy mucus. The appetite + was very capricious--not to say poor, and he was obliged to be + exceedingly careful in his diet. He was not capable of any + continued mental application. The muscular system was weak and + flabby. All the vegetative functions were more or less impaired. + + On June 3d, 1874, Mr. S., by my directions, took an electric + bath. He continued the baths daily for some weeks; then every + two or three days, all the time steadily improving. He had some + adjuvant medicinal treatment, probably similar to what he had + already had in Europe. He states, however, that his improvement + commenced with the first bath he took; and the baths certainly + constituted the main treatment throughout. He gained daily in + every respect. Mind and body were invigorated; his muscles + increased in size and hardness; color gradually returned to his + cheeks, etc. He continued the baths with more or less regularity + until the close of the year, taking in all sixty-one baths. He + was then in a better condition than he had been for many years. + Thinking a trip to Europe would benefit him, I advised him to go + there and remain a few months. He left early in January and + returned in the beginning of April, 1875. He had been very well + during his absence, until within a few weeks prior to his + departure from Europe, when he experienced a severe attack of + cerebro-spinal congestion, which caused him much suffering. On + his return he resumed the baths, and continued them throughout + the spring, continually gaining in strength and weight. At the + beginning of last summer he was practically well. He has + regained his normal weight (120 pounds). As a criterion of his + bodily vigor, I will simply state that I have seen him lift, + with ease, 350 pounds, which, for a person of his weight, is not + bad. His mental force is as good as it has ever been. The + digestive disturbances have disappeared; he can eat things which + for years he had been compelled to eschew. To use his own words: + "I am well." In view of the fact that he had already received, + at the hands of competent men, all sorts of internal as well as + external treatment, I believe I am justified in attributing his + cure almost entirely if not solely to the baths. + + CASE XI. Mr. * * *, aet. about 50, lawyer, of large, vigorous + frame, came to consult me January 4th, 1875. He complained of + symptoms that are the frequent results of prolonged mental + over-taxation. His intellect was as good as ever, but he lacked + his wonted mental endurance and power of application. His mind + was perfectly clear, but unable to work. It was a case of + "_limited_ cerebral exhaustion." Physical nutrition was pretty + good; yet his color was not normal, being rather paler than it + had been and has since become again. His flesh was flabby. There + were vague neurotic disturbances, etc., etc. He had until + recently occupied a leading public position, and the onerous + duties that devolved on him in connection with this, evidently + stood in direct etiological relation to his trouble. I ordered + an electric bath every other day. This was complied with until + the end of February, when the patient had apparently entirely + recovered his health, mentally as well as physically. I saw him + not very long ago; he looked the picture of health, and told me + that he was and had been since I saw him, perfectly well in + every respect. + + CASE XII. Mr. L., aet. 23, presented himself for treatment in + October, 1874. He had at various times made the attempt to study + some profession, but had never been able to concentrate his mind + sufficiently on any object to enable him to persevere in its + pursuit. He was fretful, irritable and vacillating; would desire + one thing to-day, another to-morrow; never long of the same + mind. Melancholia, digestive disturbances and hypochondriacal + phenomena accompanied this condition. No organic disease was + discoverable. On October 1st he took his first bath. Very + shortly after this he commenced the study of medicine. He + improved rapidly in every respect. During the month of October + he had six baths, which resulted in complete and permanent + relief of all the symptoms. He progressed satisfactorily in his + studies, and is at the present time taking his second course in + one of our city medical colleges. + + + AGRYPNIA. + + (INSOMNIA; SLEEPLESSNESS). + +Although, as a rule, but the symptom of some definite pathological +condition, agrypnia is of such frequent occurrence, and so detrimental +to the general health, that it appears to me to merit special +consideration. This holds good especially in this connection, because, +even where electric baths fail to influence the disease giving rise to +the insomnia, they almost invariably remove this, irrespective of its +cause. Even where, the disease itself remaining uncured, the insomnia +must return sooner or later, the sleep is very much improved while the +baths are being had recourse to. We must of course endeavor in all cases +to relieve the original disease, and, where the baths are not adapted to +this purpose, resort to other and appropriate means. It will be found of +no small service to us in the therapeutical management of every case, to +be enabled to procure for the patient, without the aid of medicinal +hypnotics, sufficient of sleep during treatment. + + CASE XIII. Mr. A., from the _clientele_ of Dr. LEONARD WEBER, + was sent by Dr. W. to take electric baths. He suffered from + chronic spinal congestion. Among the most prominent and annoying + symptoms was _agrypnia_. It was for the relief of this symptom + chiefly that Dr. W. ordered him the baths. He began to improve + in this respect from the time he took his first bath, and + although the disease itself remained uncured, he enjoyed good + sound sleep while he was under treatment, his general health + improved, and he frequently spoke of the notable benefits that + he received from the baths. He continued them until his + departure for Europe, where, by direction of his physician, he + went last spring. I have not seen him since, but Dr. W. tells me + that he is doing well. + + CASE XIV. Mr. D. was brought on Sept. 30th, 1874, by his + physician, Dr. HOGAN. He was in the incipient stage of _delirium + tremens_. Had not slept for some nights. Dr. H. had administered + successively opiates, chloral and bromides in full doses, + without effect. On the evening of above date the patient had a + bath, in which the descending galvanic current was used. As a + result, he slept well that night. The baths were repeated on the + two succeeding days, with like effect. As the disease developed + however it became necessary to send the patient to an asylum, + whence he returned cured in a short time. The effect of the + baths in this case, where full doses of the most powerful + hypnotics of the materia medica had failed, was remarkably + illustrative of their hypnotic power. + + + ANAEMIA. + +As is well known to the profession, anaemia forms the basis of a great +number of morbid conditions. Hysteria, general debility, emaciation, +sterility, various nervous affections, phthisis, in short, a perversion +of almost any of the various physiological functions may be the direct +result of anaemia. On the other hand, anaemia may be only a symptom or +sequel of some other morbid condition--but of such cases I do not now +speak. I have to do here only with those cases where anaemia is the +primary and etiological of a group of symptoms, and where therefore it +is to this that the treatment must be mainly directed. Now let us see +what this treatment is. Dr. FLINT[15] suggests the following therapeutic +measures: "_first_, a nutritious alimentation, into which meat should +enter largely; _second_, the use of tonics and stimulants to render the +digestive functions more active; _third_, iron as a special remedy--the +effect of which is often remarkable; and, _fourth_, a regimen calculated +to increase the energy of the assimilative functions, consisting of +exercise in the open air, recreation, etc." This agrees mainly with the +views of other writers. It may conveniently be condensed under two +heads, instead of four, namely: _first_, to secure for the patient +appropriate food and adopt the best means to insure its assimilation; +_second_, the administration of iron. As to the ingestion of appropriate +food, open air exercise, etc., patients are of course to receive the +necessary directions. The remainder of the therapeutic indications, as +given above, are admirably met by electric baths. As we have seen in a +preceding chapter (p. 43 et seq.), they are a tonic and stimulant of the +first order, and as nearly as possible a specific for the furtherance of +the digestive and assimilative processes. When impregnated with iron, +they constitute a treatment for anaemia which, in conjunction with the +requisite diet and other hygienic measures, is inferior to no other. It +will moreover be found very efficacious in counteracting secondary +anaemia, and thus, by maintaining the general strength of the patient, +often enable nature and appropriate treatment to cope successfully with +the original disease. + + CASE XV. Mrs. S., aet. 22, four years married. I was called to + see her on October 2d, 1874. She then had a spontaneous + miscarriage, the fifth since her marriage. She asked me whether + nothing could be done to enable her to carry a child to full + term, as both she and her husband were very desirous to have + offspring. In pursuance of my directions, she presented herself + at my office about ten days after I first saw her. On + examination I found no organic trouble, no uterine displacement, + nor any other local trouble to account for her premature + confinements. Involution had progressed normally. The only + deviation from the normal that I could discover about the uterus + was undue paleness of the cervical portion. Her appearance was + very decidedly anaemic; features pale, flabby; lips whitish blue; + physical energy much depressed. She had had but very slight loss + of blood on the occasion of her recent miscarriage; certainly + not enough to account for her anaemic appearance. Viewing her + case as one of idiopathic anaemia, I ordered her electric baths + strongly impregnated with iron. In addition to this, the regimen + usual in such cases, and also strychnia and phosphorus + internally. She took her first bath on Oct. 14th; then one bath + weekly until she had taken six baths, the last of which was + administered on the 24th of November. During all this time she + kept steadily improving. The anaemic appearance and symptoms + gradually receded, and, soon after she had taken her last bath, + I discharged her, as far as the anaemia was concerned--cured. + While she was under treatment she had, by my advice, refrained + entirely from sexual intercourse. Early in the spring of 1875 + she called to tell that she was again pregnant, and in November, + 1875, I delivered her of a healthy male child, at full term. + + + PARALYSES AND PARESES. + +I include these under one head, because not only is their origin +frequently identical, but, chiefly, because the therapeutic indications +are almost always the same in both. Whatever the cause in any given +case, whether cerebral, spinal or peripheral, organic or functional; +whatever the treatment that may be indicated--and this should never be +neglected--for the primary trouble, the direct electrical treatment of +the paralysis, sub-paralysis or paresis, being purely _symptomatic_ +treatment, remains in the great majority of cases essentially the same. +The objects to be aimed at are two, viz: _first_, a normal state of +nutrition of the affected muscles; _second_, their normal contractility. +In other words, we are to endeavor to prevent atrophy of the affected +muscles, or, where this has already taken place to some extent, to +restore their normal bulk; and, _second_, we must strive to restore the +more or less impaired contractility of the paralytic or paretic muscles. +Even where symptomatic treatment for these purposes is the _only_ +treatment employed in a case, we frequently meet to a great extent the +_indicatio morbi_, by favorably influencing, either in a reflex or +direct manner, the primary disease. This is true of _local_ +electrizations of the affected parts; it holds good much more strongly +however of _electric baths_, because here, in addition to the reflex +influence that we get from local applications, we have also the direct +influence of the electric current on the spinal cord and posterior +portion of the brain not only, but on the sympathetic system and all the +important organs contained in the thoracic and abdominal cavities. The +great importance of this is apparent, when we reflect that in very many +if not most cases of disease of the nervous system, central or +peripheral, electricity in an appropriate form is a useful therapeutic +agent, and that moreover the great majority of functional paralytic +disorders respond favorably to its influence. As for any harm being done +by it in those rare cases where its use may be contra-indicated, I admit +that such may accrue from the administration of electric baths without +medical supervision; it is entirely obviated however where the baths are +under the supervision of a physician, who does not, like a layman, +indiscriminately admit to their use any and everybody who is willing to +pay for their administration, but will carefully discriminate, and +conscientiously exclude those cases in which general electrization might +result injuriously. In such cases a tolerably accurate diagnosis is as +a rule readily made, and will enable the physician to separate the +suitable from the unsuitable cases. + +As to the mode of administration of the baths in cases of the class +under consideration, the use of both currents is requisite; the galvanic +as a nutrient, the faradic as an excito-motor agent. Where, as is +sometimes the case, faradic irritability is extinct, or so slight as to +be practically unavailable, the (slowly) interrupted galvanic current +must take the place of the faradic, until faradic irritability has +become re-established. As to the intensity, direction, etc., of the +currents, each individual case has its own laws, which must be +recognized by the supervising physician. + + CASE XVI.--_Infantile paralysis._ Albert Pichl, aet. 22 months, + was sent me by Dr. LILIENTHAL, October 3d, 1874. Had complete + paralysis of right leg (of four weeks standing), with + considerable atrophy of the entire leg as well as the gluteal + region of the corresponding side. The temperature of the leg was + much lower than that of the healthy limb. _Faradic irritability + was entirely extinct._ The treatment was begun by galvanizations + of the lower (lumbar and sacral) portion of the spinal cord, and + the use of the interrupted galvanic current on the affected + muscles. This was at first done daily. The contractility of the + muscles gradually but slowly improved, but neither the atrophy + nor temperature of the limb appeared visibly affected by the + treatment. With a view to favorably influencing these + conditions, I ordered him galvanic baths. He had a bath every + alternate day. The result was favorable and rapid. The leg + became sensibly and permanently warmer after each bath, and + commenced steadily to increase in bulk. Faradic irritability + soon returned. The local applications were continued several + times a week for some time, and then gradually abandoned, the + baths being meantime continued regularly. The boy very soon + began to walk, and in December active treatment was + discontinued. At that time, faradic irritability having long + since become completely re-established, I caused the child's + father to purchase a faradic battery to use at home. The limb + was eventually entirely restored in every respect, with the + exception of a slight abduction of the foot, for which I + referred the patient to Dr. GIBNEY. I saw the child recently; he + remains well. + + CASE XVII.* _Sub-hemiplegia from cerebral hemorrhage._ Mrs. S., + aet. 30, married, from the practice of Dr. KREHBIEL, was sent by + Dr. K. to take baths, July 3d, 1874. It was a routine case, + differing in no respect from what is ordinarily witnessed as a + sequence of cerebral hemorrhage. Six baths, taken at intervals + of two and three days, restored almost entirely the muscular + power of the affected side. The patient subsequently made a + complete recovery without further treatment. + + CASE XVIII. _Paralysis from insolation._ Mr. P., proof-reader + aet. about 40, had suffered for some time from sub-paraplegia, + the result of insolation. He was sent to take baths in May, + 1874, by his physician, Dr. SCHIRMER. Electro-balneological + treatment in this case met with no success. + + CASE XIX. _Lead paralysis._ Mr. M., aet. about 35, painter, was + referred to me for treatment May 15th, 1874, by Dr. MOHN. The + extensors of one (I believe it was the right) arm were + paralyzed. The characteristic blue line about the gums was + clearly defined. I ordered an electric bath daily. The + descending galvanic current was used for twenty minutes each + bath. From half to one ounce of iodide of potassium was added to + each bath. The blue line became less distinct from day to day, + until, after eleven baths, it had entirely disappeared. The + object for which I had ordered the baths having now been + accomplished, I treated the affected muscles with the faradic + current. A short course of this treatment sufficed to remove the + paralysis from all but one finger (it was either the middle or + ring finger), the extensors of which had probably undergone + fatty degeneration. + + + NEURALGIAE. + +The great variety of causes that may give rise to neuralgia, precludes +the possibility of any specific for this symptom. In discussing its +electro-balneological treatment, I would observe _a primo_ that I +cannot, in the light of my personal experience, agree with those who +claim for electrical treatment good results in a _majority_ of +cases.[16] On the other hand it cannot be denied that, either as a +palliative or curative measure, electricity, employed in an appropriate +form and manner, is of inestimable value in many cases, and frequently +succeeds where all other remedies are of no avail. Where we know the +cause of a neuralgia, it is of course comparatively easy for us to +determine whether or not electricity promises to avail anything. But +even where the nature of the cases appeared to indicate its use, the +failures, in my hands at least, have outnumbered the successes. The +brilliant results--sometimes almost instantaneous--that we obtain now +and then, should not lead us into overlooking our failures. Undoubtedly +the circumstance that most of the cases that have come under my +observation were of a very obstinate nature, referred to me by other +physicians after varied unsuccessful treatment, has much to do with the +formation of my views as expressed above, and future experience may +perhaps lead me to modify them. + +Speaking still from my own experience, I will state that the cases that +have proven the most amenable to treatment were, _first_, those of +rheumatic origin; _second_, hysterical neuralgiae, and, _third_, cases +where no assignable cause could be elicited. The most obstinate +varieties were those of a malarial type (even when quinine in large +doses or arsenic were employed in conjunction with galvanism) and those +that depended on some form of chronic inflammation--_neuritis_, +_periostitis_, etc. Of central neuralgiae, I have had excellent results +in the sympathetic variety and in the pains of posterior spinal +sclerosis, while in the neuralgiae of cerebral origin (diffuse cerebral +sclerosis, tumors, etc.) I have never met with any appreciable success. + +Where, then, we are able accurately to diagnose a case, there cannot be +much doubt as to the appropriateness or not of electrical treatment, and +in cases whose origin is obscure, which may be considered practically +functional and therefore treated more or less empirically, electricity +holds out as much or more hope than any other remedy. Whether +electricity should be employed locally or in the form of baths, must +depend on the features presented by each individual case. In neuralgia +of the fifth pair--excepting those reflex cases where the _point +d'origine_ is to be sought for somewhere in the trunk or extremities, +and those that depend on cerebral hyperaemia or anaemia, where the +equalizing effects of the baths on the circulation are frequently of +great benefit--these are generally useless. Of other neuralgiae, I have +found the baths less successful in those of the superior than in those +of the inferior spinal nerves. Lumbo-abdominal neuralgia and sciatica +have yielded much more readily than brachial or dorso-intercostal +neuralgia, etc., etc. + +The mode of administering the baths in neuralgiae does not possess enough +of uniformity to render suggestion in this respect of any value. I will +state however that, as a rule, the best results have been obtained from +the descending galvanic current. + +In chronic cases the baths should be administered daily, and should not +be discarded as unavailing until at least a dozen have been successively +taken. + + CASE XX. _Sciatica._ Mr. R., a middle aged man, mechanic, was + sent by Dr. ARCULARIUS Nov. 9th, 1874. Had post-rheumatic + sciatica of some six weeks' standing. There were no remarkable + features about the case, which however was sufficiently severe + to disable him from pursuing his avocation. He took his first + bath on the date above-mentioned. Another bath was administered + next day, and three more every alternate day. He was then almost + well. On Nov. 25th he returned, there remaining still some + traces of the affection. Four more baths, the last of which was + administered on Dec. 4th, sufficed to complete the cure. + + CASE XXI. _Sciatica._ Mr. G., aet. about 35, saddler, was sent + by Dr. WAECHTER, March 6th, 1875. Had suffered from sciatica + without discoverable cause for several years. For one year prior + to his visit had been unable to work, and was confined to bed a + great portion of the time. There was slight atrophy of the + affected limb. He had had considerable medical (including local + electrical) treatment, without avail. The baths were faithfully + and persistently tried in this case, effecting however but + slight improvement. Subsequent hypodermic injections, first of + strychnia, then of atropia and finally of chloroform, the latter + in doses ranging from 30 to 60 minims, gave him only temporary + relief. The patient was finally discharged uncured. + + CASE XXII. _Lumbo-abdominal neuralgia._ Mr. W., aet. about 40, + was brought by Dr. MARVIN S. BUTTLES in June, 1875. He had been + in poor health for a number of years, and was then in a very + cachectic condition. There was considerable gluteal atrophy on + the affected side. At Dr. B.'s suggestion he took a course of + electric baths, with the happiest result. He improved steadily, + and on the occasion of a late inquiry after I had not seen him + for some months, Dr. B. told me that the patient had entirely + recovered. His general condition as well as the neuralgia had + been very favorably modified by the baths, and he is now in far + better health than he has been for many years. + + CASE XXIII.--_Lumbo-abdominal neuralgia._ Mr. G., aet. 40, came + to consult me in October, 1875. He had suffered from neuralgic + pains, more particularly in the renal region of both sides, but + also in the neighboring parts, for only one week. The case being + so recent, I entertained a very favorable prognosis, which + subsequently was amply verified. A bath on the 12th of October + and one on the 16th sufficed to effect a complete cure. + + + ARTICULAR EFFUSIONS. + +It would appear at a first glance as though local galvanization of +affected joints should be more directly and powerfully instrumental than +electric baths in promoting the absorption of morbid deposits. To +suppose so would however be a mistake--even where a single joint is +concerned. Where many joints are involved, the advantages over local +galvanization of the baths is sufficiently obvious. Where but a single +joint is involved, the current can by means of the surface board be +concentrated on the affected joint, while by the general galvanization a +stimulus is furnished to the absorbents, that in itself is probably +fully as important as any local treatment could be. In this manner +absorption is made to progress much more certainly and rapidly, and this +course is therefore to be given the preference in all cases where no +special contra-indication exists. + +The ascending general galvanic current should be employed for from 5 to +10 minutes. The surface board, connected with the negative pole, should +then be applied for a few minutes successively to each of the affected +joints. Iodine in some form should be added to the baths. + + CASE XXIV.* _Specific synovitis of knee-joint, with considerable + articular and peri-articular effusion._ Mr. C., from the + practice of Dr. SHEPPARD, aet. about 35. First saw patient at + his house on Nov. 9th, 1873, in consultation with Dr. S. and Dr. + HUTCHINSON, of Providence, R. I. Had been on mercury and iodide + of potassium for a long time. When I first saw him, he had been + incapacitated from work for about a year. Had been unable to + leave the house for three months. The affected joint was very + much enlarged, with little or no mobility, the condition being + practically the same as true ankylosis. It was decided to + substitute tonics for the specific treatment, and to administer + galvanic baths. On Nov. 11th the first bath was administered, + another on the 15th, and a third on the 19th. Considerable + improvement in motility was then apparent. Two more baths, taken + respectively on the 22d and 29th, effected some reduction in the + size of the knee. The baths were continued to January 3d, 1874, + when the effusion had become almost entirely absorbed, and the + joint perfectly mobile. The patient then had been for some time + taking daily walks, unassisted. He now (Jany. 3d) walks without + any difficulty, has regained his normal vigor, and is perfectly + well. + + + IMPOTENCY. + +The frequent obstinacy of this distressing condition under every variety +of non-electrical treatment, is the cause of the frequency with which +cases present themselves to the specialist. Unfortunately however but +few of the referred cases are of recent origin. In almost all instances +they have gone through a vast amount of medication and other treatment, +and finally, either through their attending physicians or of their own +accord, they come as a _dernier ressort_ to seek relief from electrical +treatment. I have already (p. 47) spoken of the comparative merits in +this disease of local and general electrization. A few years ago I was +ignorant of the good effects of the baths in male impotency. I came to +test and employ them here from two causes. In the first place, patients +were sent me specially for electro-balneological treatment, ordered by +their physicians; and, second, I began, when I became familiarized with +the effects of the baths, to have recourse to them in cases where with +local electrical and other treatment I had been unable to accomplish +anything. My average results, without becoming uniformly successful, +became so very much better, that after a brief but abundant experience +with this treatment, I have come to consider it the most important we +possess in this affection; one that will frequently succeed when +everything else, including local electrization, has failed, and which, +in cases where no incurable organic changes underlie the affection, +will, if properly persisted in, either cure or improve to a great extent +a large majority of the cases. I have even seen instances where, the +sexual power having receded as the legitimate result of advancing age, +it returned almost or quite perfectly and with seeming permanency under +the influence of the baths. In the class of cases--and they are quite +numerous--in which impotency (loss of the power of erection) occurs as a +purely nervous symptom in comparatively young men; where its cause is +sometimes purely imaginative, at others the result of early excesses, +the baths are attended with the most gratifying average results. Where +the cause is purely psychical, a very few baths are sometimes sufficient +to dispel the morbid phenomena. Where masturbation or excessive venery +are at the bottom of the trouble, there is always a probability of more +or less organic change in the lower portion of the spinal cord, and +frequently also a secondary enfeeblement of the digestive functions, +which render requisite a long and steadily continued use of the baths. +Patients whose sexual power was intact, who took the baths for other +purposes, have time and again called my attention to their aphrodisiac +effects. + +While here the _general_ electric influence is the main remedial agency, +there is no reason why the possible--or, I should say, probable--good to +be obtained from its _local_ influence should not be realized--the less +so that it is so facile to obtain this in the bath, by means of the +surface board. While individual cases will undoubtedly call for +modifications, I have found the following plan to answer best in +certainly more than half the cases that have come under my observation: +The first five minutes of the bath may be occupied by a general galvanic +current of medium intensity, _descending_ where the patient is of an +irritable, _ascending_ where of a phlegmatic temperament. The pole +connected with the foot electrode should now be detached, and the +surface board substituted. The second five or ten minutes may be +consumed by running a galvanic current between the head electrode and +the surface board, the latter applied alternately to the penis, scrotum, +perineum and, where thought best, also to the lumbo-sacral region. +Where, as is usual, the impotency is accompanied by a certain degree of +cutaneous anaesthesia of the penis, but especially where the seminal +secretion is scanty, the board should be positive (ascending current); +where however nocturnal spermatorrhoea, premature discharges (before +coition is possible) or other irritable phenomena characterize a case, +the surface board should be negative (descending current). The head of +the patient should rest on a sponge thoroughly saturated with water, and +communicating with the water of the bath, so as to include the +cerebellum in the direct circuit. The last five or ten minutes of the +bath should be devoted to passing the faradic current between the head +electrode and the surface board, this last applied about the genitals, +but chiefly about the perineum, the current to be of sufficient +intensity to contract the perineal muscles. With anaemic patients iron +should be added to the baths. These should be taken at first daily, +later on every other day, then three times a week, and so on until it +becomes apparent that all the good that can be obtained from them has +been obtained--whether this be a perfect cure or only a certain degree +of improvement. Where it is thought requisite, internal medication and +various hygienic measures may be advantageously resorted to as +adjuvants. While these will do no good when employed alone, they may +serve to enhance the effects of the baths. + +In the following cases, I will include some where the impotency was not +perfect, where the conditions were merely those of sexual debility. As +there is here merely a difference in degree, it would be superfluous to +separate the two conditions under distinct heads. + + CASE XXV.* _Perfect impotency._--Mr. F., from the practice of + Dr. CARO, a robust gentleman, aet. thirty-six, full of muscular + vigor. Had had syphilis, the symptoms of which had disappeared + under Dr. C.'s treatment. For two years the power of erection as + well as sexual appetite had become extinct--if we except an + occasional imperfect spontaneous erection on waking up in the + morning, and even this was of rare occurrence. Ordinary + medication proving inadequate, Dr. C. sent patient to take + electric baths. From March 7th to July 16th, Mr. F. used the + baths, averaging about two weekly. He was then, and still + remains, perfectly restored. + + CASE XXVI. _Perfect impotency._ A. E. K., aet. 23, commercial + traveler, applied to me for treatment in the spring of 1873. His + general health was very good. He had masturbated but little. Had + been in full possession of his sexual power until almost + twenty-two years of age, when he found that, without assignable + cause, he had lost the power of erection. His general condition + being, as far as discoverable, perfect in every respect, I + instituted a local electrical treatment. This was continued for + some time without avail. Strychnia was then administered with no + better result, and after some months' treatment I told him that + I could do nothing for him. He remained without any treatment + whatever until the spring of 1874, when I advised him to try + electric baths. He took in all about half a dozen baths, which + resulted in his complete and thus far permanent restoration. + + CASE XXVII. _Sexual debility._ Mr. W., aet. 32, married, + manufacturer, consulted me in February 1875. Had gradually for + about a year past lost sexual power. Was able to perform the + marital act at rare intervals only, and when he did, felt + exhausted the whole of the succeeding day. I ordered him + electric baths. He took the first on February 22d, 1875. Between + this date and March 22d, he took six baths. The sexual power had + then fully returned. I must not omit to state that during the + time he was under treatment he took, by my direction, gr. 1/25 + phosphorus twice daily, which may have somewhat accelerated the + result. + + + CONSTIPATION. + +Atony of the _muscularis_ of the intestine is admittedly the direct +cause, in most instances, of constipation. It is the condition known as +"torpor of the bowels." It is ordinarily due to abnormal innervation of +the parts. The inefficient innervation may be--and in females frequently +is--reflex, or its cause may be sought for in the central nervous +system. The condition of the voluntary abdominal muscles is likewise a +factor in the alvine process. Sluggishness of the abdominal (portal) +circulation is a not infrequent etiological concomitant of constipation, +and, finally, the conditions grouped as "dyspepsia" may form the +causative feature of a case. I have mentioned these different causes +simply in order to account to some extent for the almost wonderful +effects in this condition of electric baths. When we consider that in +every one of the morbid conditions here enumerated, electricity is a +very efficient remedy, and that for the resulting muscular atony it may +be called a specific, it will not appear surprising that a mode of +application which brings the electric influence to bear on both cause +and effect--often on a combination of several of the causes enumerated, +should be attended with such brilliant results. I have thus far met with +no failure in the electro-balneological treatment of constipation. + +In the majority of cases the following method has proven the most +efficient. The first ten minutes of the bath should be devoted to the +administration of a galvanic current, as intense as can comfortably be +borne by the patient. The one pole should be connected with the +head-electrode, the other, by means of the surface board, applied +alternately, to the epigastrium, chiefly, and to the hypogastric region. +The current should a portion of the time be ascending, the rest +descending. Occasionally the current should be rapidly reversed by means +of the commutator, the intensity however having been previously reduced, +in order to avoid too severe a shock; this will cause efficient +contractions of the abdominal _parietes_, and probably also of the +intestinal _muscularis_. The second ten minutes of the bath should be +devoted to faradization, employed in the same manner as the previous +galvanization, only that here the direction of the current is +immaterial, and no reversals are requisite. The current should be of +sufficient intensity to produce energetic but not painful contractions +of the abdominal parietes. + + CASE XXVIII. Mrs. * *, aet. 55, in average health, without + however being robust, had suffered from constipation for about + thirty years. She had had every possible medicinal treatment, + with no avail. Nothing had ever ameliorated her condition. + Without the aid of a cathartic, her bowels moved but once every + week or ten days. She was of course compelled frequently to + resort to laxatives. In the fall of 1873 I ordered her electric + baths. She was not very energetic in anything, and this lack of + energy caused her to take the baths less frequently than I + desired her to. Had she taken them regularly, she would probably + have been restored in as many weeks as it took months to effect + her restoration. As it was, she took some thirty baths in the + course of about fifteen months. For nearly a year past she has + had a passage every day with the utmost regularity. No adjuvant + treatment was employed in this case. + + CASE XXIX.* Emil Miller, a bright child two years of age, was + brought for treatment July 7th, 1874. He had suffered from + obstinate constipation almost from his birth. Had been under the + care of several physicians, but had never received any benefit + from treatment. Even with the aid of powerful cathartics, given + in doses suitable for an adult rather than a child, defecation + took place only once every three or four days, and was so + exceedingly painful as to elicit cries of pain from the child. + The feces were always hard and lumpy, and of an abnormally light + color. A digital examination per rectum revealed considerable + flaccidity. My diagnosis was _paresis of the muscularis of the + intestine_. I ordered faradic baths. On July 12th the first bath + was administered, and I must confess that the result was a + perfect surprise to me. True, I had expected a cure to take + place; but I had looked for gradual improvement, and was not + prepared for a result such as was here obtained. _From the time + the first bath was taken, defecation took place regularly once a + day, without pain; the feces became perfectly normal both as to + color and consistency, and the boy continues to the present day + to defecate regularly and in every respect normally._ To insure + permanency, the baths were continued, at first twice, then once + a week. They have now been discontinued for upwards of a year, + there being no occasion for their further use. No other + therapeutic measures, internal or external, were resorted to in + this case, nor was any change made in the diet of the child. + + + HYDRARGYROSIS. + +The etiology of this condition requires no comment. I will simply relate +a case illustrative of the eliminative effects of galvanic baths. + + CASE XXX.* _Mercurial Stomatitis._ Mr. S., about 35 years of + age, came to me for treatment in the fall of 1872. He then had + indurated chancre, two buboes and syphilitic sore throat. He had + had the chancre for six weeks before applying to me, but had + been, he said, ashamed to consult a physician. Before medication + had had time to make any impression on the disease, roseola + appeared. The syphilis was very obstinate in this patient, + compelling me to keep him under the influence of mercury for a + long time. In October 1873, the patient presented himself with a + very aggravated mercurial stomatitis. The customary remedies, + internal as well as external, made little or no impression on + the affection. On November 11th, I discontinued all other + treatment, and ordered a course of galvanic baths. He took his + first bath on the same day. This was repeated every alternate + day until six baths had been taken, when all symptoms of the + disease had disappeared. He has had no mercurial trouble since + then. The descending galvanic current from a zinc-carbon battery + was used throughout. + + + LOCOMOTOR ATAXIA. + +Were it not for the remarkable results obtained in the following case, I +should not have felt justified in devoting any space to an allusion to +this formidable disease. I insert the case as it was published in No. +216 of the "Medical Record." I have to add that the patient, some six +months ago, suffered a relapse, which however is not nearly as +aggravated as his former condition, nor are the symptoms so +pathognomonic. I had a letter from him about a week previous to my +writing this, in which he states that he intends soon to come to the +city for the purpose of taking another course of treatment. Even if the +treatment however has not had the effect of curing the disease--and this +I do not claim for it, it has been of sufficient importance if it has +resulted in arresting for a time its progress, giving the patient +temporary comfort, and prolonging life. Further trial may possibly have +better results--in more recent cases--with respect to permanency. + + CASE XXXI.* Mr. W., aet. 48, came to consult me January 12th, + 1874. He had then felt the symptoms of locomotor ataxia for + about six years. Had been unable for several years to walk + without the aid of a cane. When walking he dragged his right + leg along in a semicircle, and was able to accomplish very short + distances only. There were almost complete anaesthesia and great + paresis of the bladder. The same conditions were observable in + regard to the bowels. Anaesthesia of both lower extremities + existed, complete in every respect in the right leg, almost so + in the left. Dyspepsia and general debility and emaciation + accompanied the disease. Treatment was begun on January 15th. I + prescribed phosphorus and cod-liver oil, and passed a strong + galvanic current through the spine for probably ten minutes. + January 16th, a galvanic bath was administered. Towards the + close of the bath (which occupied twenty minutes), patient + thought he felt some sensation in his legs. The baths were taken + every two or three days, alternating with strong galvanizations + of the spine. While taking his second bath, patient remarked + that "his right leg felt warm for the first time in six years." + The treatment as described was continued for about six weeks, + during the latter part of which the local applications were + gradually diminished in frequency, the baths being continued + regularly. Medication was discontinued about this time. About + the middle of March. Mr. W. was enabled to resume his occupation + (paymaster's assistant on the Erie Railway). His improvement had + been rapid and steady. All the symptoms gradually disappeared, + and in the beginning of April the patient was, with the + exception of some feebleness, consequent on his protracted + illness, as well as ever. He continues so to the present + day.[17] He still takes two or three baths a month, but has had + no other treatment since May (1874). He walks freely without a + cane, and talks jocosely of running footraces. All functions are + performed normally. + + Although in this case the baths were not employed exclusively, + yet they predominated in the treatment; and if the judgment of + the patient, a very intelligent gentleman, is to be relied on, a + large share of the success is due to the baths. + + + CACHEXIAE. + +After what has been said in a preceding chapter of the tonic effects of +electric baths, it would scarcely appear necessary to introduce the +subject of cachexiae. If I do so nevertheless, it is only to be afforded +the opportunity of relating the following case, which possesses +sufficient interest to render its introduction here desirable. The first +portion of it has already been published (Med. Record, No 216), but to +this I have to add what occurred subsequently. + + CASE XXXII.* _Mercurio-syphilitic Cachexia._--Mr. L., aet. 27, + had primary syphilis about four years ago. Subsequently had + inveterate constitutional symptoms, for which he was under + medical treatment both here and in Europe. When he had sojourned + in the latter country some time, he was pronounced cured by his + physicians. He married, and returned to this country in the fall + of 1872. A few weeks after his return he fell into a gradual + decline, which confined him to the house--and part of the time + to bed--for eight months, during the latter portion of which he + had discontinued all medical treatment. It was with difficulty + that, assisted by his wife, he managed to reach my office. I + found him terribly enfeebled; greatly emaciated; sallow + complexion. He was much annoyed by rheumatic pains, which I + considered specific. His condition was so exceedingly low, that + I decided to postpone all medication until he should be + stronger. I ordered galvano-faradic baths, i.e. the galvanic + current in the bath as an eliminative, the faradic as a tonic. + The first bath was taken on November 20th, 1873. For one month + he took the baths, and nothing else. He was then so much + stronger, that I felt justified in instituting a mild specific + course of treatment, the baths being continued as theretofore. + At the end of two months the patient was nearly as strong as + ever, was able to resume his occupation, and had gained + twenty-seven pounds in weight. + + Thus far this case was published as above stated. For the sake + of the interest attaching to it, I will now proceed to give its + further history. Mr. L. remained to all appearances well until + July, 1874, when he commenced to suffer from headache and + constipation. On the 23d of August following, while I was absent + from the city, he presented himself to the gentleman who + attended to my practice during my absence, with paralysis of the + external rectus muscle of the left eye. He also consulted a + specialist, who pronounced the paralysis rheumatic. When I + returned from the country he presented himself for treatment. I + commenced a series of daily electric applications to the + affected muscle, which failed to respond to the faradic current, + but contracted very readily when the slowly interrupted galvanic + current was employed. As I had strong suspicions that syphilis + was at the bottom of the trouble, I also administered iodide of + potassium in gradually increasing doses--not however until + electrization and strychnia employed for some weeks had failed + to do any good. The administration of the iodide met with no + better success. The patient's general health gradually declined. + On October 22d, he complained of numbness in the left leg, which + gradually increased, the leg at the same time becoming paretic, + so that the patient required the aid of a cane for ordinary + locomotion. His condition now became rapidly worse. His + movements became ataxic. Anaesthesia of the bladder, paresis of + this and the intestine, with obstinate constipation, loss of + appetite, emaciation, etc., rapidly supervened. I suspected the + development of _gummata_ on the meninges of the brain and cord, + and advised him to use the inunction cure, and to remain at home + until he should be well. This, on account of the business losses + which it involved, he was very much averse to doing. He + consequently proposed a consultation with an eminent physician, + which was had. This gentleman pronounced the case one of spinal + (either multiple or posterior) sclerosis, and discarded the + syphilitic theory. A consultation two days subsequently with + another physician had a like result. In deference to the opinion + of these gentlemen, I treated the patient in accordance with + their diagnosis. This was in the second week of November. The + patient became rapidly worse. He soon ceased to walk--he tumbled + about. After six days' treatment, considering his life in + imminent danger, I reiterated my advice to institute the + inunction cure, and the patient then acquiesced. Nov. 24th I + ordered a drachm of Unguent Hydrarg. to be used every evening; I + could not however prevail on the patient to remain at home + during the treatment. He continued to grow worse. Nov. 26th he + had complete retention from vesical paralysis, and sent for me + at night to relieve him. Thenceforth until he got nearly well he + was obliged to use the catheter regularly. A few days after + this, fortunately for himself, he fell down as he was leaving a + horse car, and sprained his ankle. I say _fortunately_, for this + accident _compelled_ him to remain at home. From this time he + began to improve. December 2d I substituted for the ointment a + twenty per cent solution of the oleate of mercury, of which he + used a drachm morning and evening. The improvement from this day + was exceedingly rapid. On the 4th of December he had regained + control of the bladder. The constipation, which had been very + obstinate, also began to yield. From this date he used the + oleate only once daily, and discontinued it entirely on the + 14th. On the 10th he had already resumed his avocation, and the + same month absolutely danced at a ball. He took iodide of + potassium for a time after his mercurial course. He has since + been and is now in perfect health. + + + DYSPEPSIA. + +The remedies for this disease are unfortunately so numerous, there is so +much temptation to try another where one remedy has failed, that it is +seldom or never that an uncomplicated case of dyspepsia applies for +electrical treatment. As a rule, the disease that furnishes cause for +referring a case to the specialist, is some nervous trouble secondary to +the dyspepsia. + +In regard to the influence of electric baths on dyspeptic conditions, +whether complicated or not, I can however speak unqualifiedly in their +favor. I know of no one other remedy that can at all approach them in +this respect. Whatever the secondary or other troubles of patients, any +co-existing dyspepsia was in every instance either cured or greatly +ameliorated. The improvement usually begins at once--after the first or +second bath, and continues steadily. As I have not had occasion to treat +by means of electric baths any uncomplicated cases of dyspepsia, I can +adduce none. I may safely claim however for the baths a reliability and +bespeak for them a confidence that I might claim or bespeak for no other +remedy or plan of treatment whatsoever--assertions which would appear +rash and venturesome, had I not at my command abundant clinical evidence +to warrant my making them. + + + MELANCHOLIA. + +A case of melancholia, highly illustrative of the effects in this +condition of electric baths, came under my notice very recently. It may +serve as a guide in the treatment of this and kindred conditions. + + CASE XXXIII. Mr. F., aet. 22, single, butcher, consulted me Oct. + 21st, 1875, for melancholia and loss of memory, from which he + had suffered for upwards of a year. He had frequently + entertained the idea of suicide. A thorough examination revealed + no trouble of any of the viscera. All functions appeared normal. + He had never masturbated. There were no collateral symptoms to + furnish any evidence of organic cerebral trouble. I prescribed + phosphorus and strychnia, and galvanized the brain twice a week. + Two weeks of this treatment had completely negative results. I + then ordered electric baths. Four baths resulted in a complete + cure. + + + INEQUALITIES OF THE CIRCULATION. + +As a very fruitful source of morbid conditions of almost every nature, +abnormities of the circulation of the blood are well worthy our +attention. As is the case with dyspepsia, so here likewise patients +seldom present themselves for treatment unless some definite secondary +pathological condition has supervened. We find these patients +complaining of cold hands and feet, irregular and disturbed sleep, +occasional local congestions, with vague, usually slight pains here and +there, etc., etc. Where organic cardiac disease is at the bottom of the +trouble, we cannot of course expect much permanent improvement. Although +even here considerable relief is often afforded while the baths are +being used, their discontinuance will in all probability be soon +followed by a return of the former condition. Where, however, cases are +not complicated by organic disease, where we have a "sluggishness" of +the circulation, due either to vasomotor inertia or atony of the +muscular coats of vessels, the electric bath will be found reliably +efficient. I have already (p. 55) alluded to this subject, and explained +the probable "mode of action" here of the baths. I will now offer some +suggestions as to the best method of administering them with a view to +equalizing the circulation. + +We must here seek to stimulate the vasomotor system, both central and +peripheral; to give tone to the coats of vessels, both by direct and +indirect electric influence; through counter-irritation to relieve +internal congestions, by causing an afflux of blood to the skin. These +objects are best attained by means of the galvanic current, which should +be employed of sufficient intensity to produce a rubefacient effect. The +faradic current acts in the same direction, but far less energetically, +if we except the vessels near the surface, the muscular coats of which +are probably more efficiently tonicised by this than by the constant +current. The faradic current however is applicable here in another way, +and for a very important object. I refer to the _mechanical_ +counter-action of a sluggish circulation, through the agency of +prolonged muscular contraction. This mechanical effect is not of course +peculiar to the faradic current; it is shared by gymnastic and other +exercises; but obtained in any other way whatsoever (with the exception, +perhaps, of _massage_, which is however much more troublesome as well +as inferior, and moreover not always admissible) it involves, in order +to produce perfect results, a considerable amount of bodily exertion, +often beyond the physical power of persons who are in ill health, and +bringing with it the risk of positive injury, through over-exertion, +which with the _passive_ contractions obtained by means of the faradic +current, is entirely obviated. By administering the _general_ faradic +current in the bath, of sufficient intensity to _maintain_ muscular +contraction as long as the circuit remains closed, any stagnant blood in +the lower extremities will be efficiently forced into the general +circulation. After from three to five minutes of this faradization, the +surface board may be successively applied for a minute or two each to +the arms, abdomen, pectoral and dorsal muscles. I believe the _best_ +results can be obtained by first going through the faradic process, then +subjecting the patient to general galvanization, as above indicated, and +concluding by another but brief faradization. + + + AFFECTIONS OF THE SYMPATHETIC. + +Last, but not least, I have some remarks to offer on the treatment by +the electric bath of certain affections of the sympathetic nerve. While +I do not in any such cases accord to the baths the rank of an exclusive +remedy or even a specific, their importance as an adjuvant is sufficient +to entitle them to special consideration in this connection. In those +neuroses of the sympathetic where electricity (galvanism) is indicated, +the _greatest_ benefit can be obtained from local applications. On the +other hand the baths, employed in addition to local applications, will +be found a very important factor in the treatment, possessing, as they +do, two advantages, viz: _first_, by their means, the electric influence +is brought to bear--in a much less concentrated form it is true--on the +entire sympathetic system, from the _ganglion impar_ to the _ganglion +cervicale supremum_, and, by derived currents, on the cephalic ganglia +also, at one and the same time; _second_, the rest of the body +participates in the general nutrient and tonic effects of the bath +equally with the sympathetic, the latter thus receiving a reflex benefit +which local applications fail to furnish. There are, moreover, cases +where hyperaesthetic conditions of the nerve do not admit of local +applications, and where yet electricity is urgently called for. Thus I +have at present under treatment a lad sixteen years of age, in whom both +supreme cervical sympathetic ganglia as well as the ganglion impar were +until recently so susceptible that the mere adjustment of the +electrodes caused him great pain, while on the other hand he bore the +baths exceedingly well. In such cases, electric baths, suitably +administered, frequently constitute in conjunction with proper +medication, the most useful treatment. + +As to the mode of administration in sympathetic neuroses of the baths, +the most direct manner in which to influence the diseased nerve, is by +connecting one pole of a _galvanic_ battery (I consider the faradic +current next to useless here) to the head electrode, the other to the +surface board, the latter applied portion of the time to the epigastrium +(solar plexus), the balance to the coccyx (_ganglion impar_). This will +include in the direct circuit the main portion of the sympathetic, the +position in the tub of the bather bringing the cilio-spinal centre very +close to the head-electrode. The direction of the current must be +determined by the individual features presented by each case, as also +the duration of the bath. + + CASE XXXIV. Mr. S., aet. 31, merchant, was referred to me April + 3d 1874, by Dr. KREHBIEL. In January, 1874, Mr. S., until then + in the enjoyment of good health, woke up one morning to find, as + he expressed it, "everything dark before his eyes." He groped + his way to the window, in order to open the blinds. When at the + window, he felt as though about to fall out--probably vertigo. + He soon returned to an apparently normal condition, and went + about his business as usual. A week after, he had a much more + serious attack, which he describes as follows: "I had been + playing whist during the evening (several hours), when suddenly, + without premonition, I felt as though a champagne cork popped + against the top of my head, inside. Accompanying this was an + indefinable sensation about the heart as though the blood all + rushed thence down to the feet. I did not lose consciousness; + did not fall. I trembled all over, and a great fear came over + me. Felt very weak all night; my pulse was very slow." About two + months subsequently, patient was referred to me, as above + stated. He then had an uneasy look; an indefinable continual + sense of fear; was excessively nervous in the forepart of the + day; had brief attacks of tremor--usually every alternate + morning, but not typical as to time of occurrence. The history + exhibited neither syphilis, malaria nor intemperance. Had never + had headache. Sleep good; appetite likewise. The most + pathognomonic symptom, however, related to his pulse. This was + abnormally slow, ranging from 44 to 54 (the latter only when + standing or after walking) per minute. It was full and regular. + There was no organic heart trouble. In the absence of any other + symptom whatsoever pointing to irritation of the pneumogastric + or spinal accessory, I was justified in excluding this as the + possible cause of the cardiac infrequency. On the other hand, + the pathogenetic manifestations appeared all to point to + "asthenia of the sympathetic"--at any rate the portion of this + whence the cardiac nerves take their origin, and I formed my + diagnosis accordingly. In the beginning, the treatment consisted + of bilateral ascending (from cilio-spinal centre to both mastoid + fossae) galvanizations of the sympathetic, and galvanic baths + (head electrode negative, surface board positive, to + epigastrium) on alternate days. Improvement in every respect was + steady, though not rapid. At the end of three weeks, I + supplemented this treatment by the administration of ergotin and + nux vomica. At the expiration of two more weeks, the patient + being nearly recovered, I discontinued these medicaments, + substituting the valerianates of zinc and iron, and steadily + maintaining meanwhile the electrical treatment as above + indicated. After a short time recovery appeared complete, and + patient was discharged from treatment. He returned however a few + months subsequently, complaining of "faint spells" in the + mornings, accompanied with excessive nervousness, and a renewed + though moderate cardiac infrequency. Electrical treatment, + similar to that above described, soon restored him. One or two + more slight relapses occurred during the next six months. For + over a year past however Mr. S. has been in the enjoyment of + perfect and undisturbed health. His normal pulse ranges from 72 + to 80. + +Whoever is familiar with the physiological effects of electric baths, +will readily concede their great utility in a variety of conditions that +I have not thus far specially alluded to. Of such I would mention +ASTHENIAE, ATONIC AND DEBILITATED CONDITIONS GENERALLY, including the +state of CONVALESCENCE FROM ACUTE DISEASES and the DECLINE OF ADVANCING +AGE; many cases of CHRONIC HEADACHE; some INCLASSIFIABLE CONDITIONS OF +MARASMUS and MALNUTRITION, etc., etc. In all such cases, when purely +functional and uncomplicated by incurable organic disease, good results +may be confidently looked for. + + * * * * * + +With these remarks I conclude my subject. Whichever the errors that a +too limited experience may have engendered--and I doubt not there are +many, I cannot on reviewing my work accuse myself of lack of candor nor +yet of undue enthusiasm. I have cited but a small proportion of the +successful cases whereof I possess records; still I believe that I have +adduced amply sufficient clinical proof of the great value as a remedial +agent of electric baths, and of the desirability of their more general +adoption. I would more especially call attention to the +inappropriateness of deferring their employment until almost all other +remedies have been exhausted; and when I reflect that pretty much all +those cases that had been referred to me by other physicians had already +had the doubtful benefit of almost every other conceivable treatment, +while many of those who came of their own accord, had in addition made +the rounds of all the quacks, and exhausted nearly all the nostrums that +are to be found advertised in the columns of our daily papers, the +wonder seems that the results obtained were as good as they have been. I +sincerely trust that in the future physicians will avail themselves +more frequently than heretofore of a remedy that is certainly capable of +accomplishing much good; and I hope that in addition to myself there +will be found others, more competent, to devote themselves to the study +of the subject. To these, and perhaps to myself at a future time, I +relegate the task of correcting my errors and promulgating hitherto +undiscovered truths. + + + Footnotes: + + [Footnote 10: Centralblatt fuer die medicinischen Wissenschaften, + No. 17, 1875.] + + [Footnote 11: The apparatus used in these experiments was that + of Du Bois-Reymond, with a Grove's element.] + + [Footnote 12: Since writing the above, this case has had an + entirely favorable termination.] + + [Footnote 13: The cases distinguished by an asterisk were + published in No. 216 of the "Medical Record."] + + [Footnote 14: Wherever I use the word "general" as descriptive + of an electric current used in the bath, it is not as a + characteristic, but merely to distinguish it from the instances + where the surface board is employed.] + + [Footnote 15: Austin Flint, M.D. A Treatise on the Principles + and Practice of Medicine. Philadelphia, 1873. 4th ed. pp. 63 and + 64.] + + [Footnote 16: See Beard and Rockwell, op. cit., 2d ed. p. 472.] + + [Footnote 17: This was written a year ago. See remarks preceding + the case.] + + + + + INDEX. + + + A. + PAGE + Agrypnia 92 + Anaemia 93 + Apparatus for baths 7 + Articular effusions 105 + + + B. + + Bath-tub 8 + Batteries 16 + + + C. + + Cachexiae 118 + Chemicals in baths 15 + Chorea 80 + Circulation, effects on 55 + " inequalities of 123 + Clinical Record 61 + Conductivity of water, etc. 13 + Constipation 112 + Counter-irritant effects 56 + + + D. + + Debility, general 129-130 + Diagnostic uses 53 + Digestive apparatus, effects on 44 + Dyspepsia 121 + + + E. + + Electric Bath compared with other + electrical methods 32 + Electrodes 10 + + + G. + + General Therapeutics 52 + + + H. + + Hydrargyrosis 115 + Hypnotic effects 38-58 + Hysterical affections 82 + + + I. + + Impotency 106 + Insomnia 92 + Invigorant properties 57 + + + L. + + Locomotor Ataxia 116 + + + M. + + Melancholia 122 + Mind, effects on 51 + Miscellaneous disorders 129-130 + Mode of administration 19 + Muscular contractions 50 + + + N. + + Nervous Exhaustion 84 + Neuralgiae 100 + Neurasthenia 84 + Nutrition, effects on 59 + + + P. + + Paralyses 96 + Pareses 96 + Physiological effects 31 + Prophylactic influence 60 + Pulse, effects on 41 + + + R. + + Rheumatism 67 + " acute 68 + " chronic 74 + " subacute 73 + " cases of 77 + + + S. + + Sedative effects 48-58 + Sexual apparatus, effects on 46 + Sexual debility 106 + Sleep, effects on 38 + Special therapeutics 61 + Stimulant effects 43 + Surface board 14 + Sympathetic, affections of 126 + + + T. + + Temperature, effects on 41 + Tonic properties 43-57 + + + +[Transcriber's Notes: The table below lists all corrections applied to +the original text. + +p. 029: [normalized] the sub-acute symptoms -> subacute +p. 056: GENERAL COUNTER IRRITANT -> COUNTER-IRRITANT +p. 056: [normalized] the use of the surface-board -> surface board +p. 059: does ... became apparent -> become apparent +p. 067: [normalized] acute, sub-acute and chronic -> subacute +p. 073: [normalized] bi-carbonate of soda or potassa -> bicarbonate +p. 107: ordered by their physicians: -> physicians; ] + + + + + +End of the Project Gutenberg EBook of The Electric Bath, by George M. 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