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Electricity In Diseases Of The Nervous System -  Galvanism, Faradism, Static Electricity
Excerpt from Medical Electricity, Röntgen Rays, and Radium by Dr. Sinclair Tousey

Electricity In Diseases Of The Nervous System

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llia"us.
II. LUMBAR. IV. LUMBAR. v. LUMBAR. III. LUMBAR.
Psoas.
Iliacus.
Sartorius.
Quad. ext. cruris. Quad. ext. cruris.
Obturator.
Adductors.
Obturator.
Abductors.
Glutei. Glutei.
Biceps femoris.
Semltend.
Popliteus.
II. SACRAL. III. SACRAL. IV. and V. SACRAL. I. SACRAL.
Biceps femor.
3emlmemb.
Ext. long. dig.
Gastroc.
fibialis post.
Gastroc.
Tibialis post.
Peronei.
Intrinsic muscles of
foot.
Peronei.
Intrinsic muscles of
foot.
Sphincter ani
vesic~.
Perineal muscles.
et
Reaction of Sensory Nerves.-Just as the reaction of the neuromuscular
apparatus to electric stimulation is evidenced by muscular
contraction, so the reaction of the sensory neurons is made known by
sensations. In practical work, since mixed nerves are usually involved,
the two sets of phenomena are constantly present. As is
the case with muscular phenomena, so with the sensory sympto~,
certain variations in health and disease are known. These sensations
are thought to be largely dependent upon chemic changes, and hence
they are usually more apparent at the more definitely chemic terminal of
the electric apparatus-the cathode. They vary according to the
character of the electrode used, being more distinct with the smaller
electrode, by reason of the condensation of current, also with the
nature of the electric force employed. Thus the sensation accompanying
the use of the mild galvanic current is usually described as
that of burning, w~ile t.hat of creeping or pricklin~ more nearly describes
the normal sensations Induced by the mild faradic current. A further
29
450 MEDICAL ELECTRICITY AND RONTGEN RAYS
variation exists if different solutions for contact are applied, due to
the dissociation of different ions.1
Thus, if ordinary salt solution be employed, the sensations are
more active at the anode, since the dissocIated sodium ions enter at
that pole j while if sodium carbonate be used, the CO2 ions entering at
the cathode cause a greater amount of sensation at that pole. The
contact, whether complete or partial, also alters the sensation somewhat,
perfect contacts being usually much less painful than imperfect
ones. Alterations in the rapidity of interruption make a great difference
in the sensations produced on the skin. Single shocks are often
extremely painful, even apart from the muscular effects 'produced.
When the mterruptions commence to be more rapid than fifty to the
second, the sensations cease to be individualized, fusion takes place,
and with still more rapid interruptions a pleasant, smooth glow may be
alone experienced, or with more rapid interruptions numbness or
anesthesia may be produced. Leduc's currents for local anesthesia
are particularly pleasant in application.
Protopathic and Epicritic Sensibility.-An extremely important,
if not epoch-making, research of Head2 has opened up an entirely new
and wide field for investigation with reference to the electric excitability
of the sensory nerves, and has enriched clinical neurology with anew
classification of sensory nerves heretofore unrecognized. Thus he has
described two sets which he has termed the epicritic and the protopathic
sensory systems. These show marked differences in their response to
electric stimulation, and our present accounts of sensory nerve physiology
witq reference to electric stimulation will receive an entirely
new series of interpretations.
Head's views concerning these two sets of sensory nerves may
be briefly summarized as follows: Ordinary sensations of touch are
not simple and primary, but consist of at least two forms of sensibility,
which have been termed by him protopathic and epicritic, and which
sensations are dependent upon two distinct systems of fibers. He
was led to this differentiation by a large series of studies on peripheral
nerve injuries, and subjected his findings to an exceedingly critical
control bf operating upon a cutaneous nerve of his own arm. The
processes of degeneration and regeneration were carefully studied, and
the modifications in sensibility and electric reaction made the basis of an
elaborate monograph. As protopathic sensibility he describes that form
of sensibility which can produce changes in consciousness, but which
is incapable of causing a quantitative change apart from the area studied.
The position of a point stImulated can be appreciated, and each stimulus
causes a widespread radiating sensation, not infrequently referred to
parts at a distance. The return of protopathic sensibility to apart,
after its loss, brings a cessation of all those destructive changes in
nutrition that occur in parts where the skin is insensitive. Ulcers
cease to form, and sores heal as readily as on the healthy skin, although
the parts remain insensitive to all higher forms of stimulation, such as
light touch.
After an affected part has remained for a variable period in this
condition, it begins to become sensitive to light touch, and degrees of
1 See Sanchez, La theorie des ions.en electricite medicale, Nantes, 1902; Leduc,
Ionization Medicales, Monographies Medicales, 1907. 2 Brain, 1905. See also his previous and subsequent papers.
451 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
amperature which produce the sensations called warm and cool on the
ormal skin are again distinguished correctly one from another. With
lle gradual return of sensation it again becomes possible to discriminate
wo points touching the skin at distances more nearly normal, and the
ridespread radiation, so characteristic of the first stage of recovery
fter the severance of a peripheral sensory nerve, ceases, and is replaced
yan increasing accuracy of localization. It is for this form of sensation
llat Head has proposed the term epicritic.
Head comes to the general conclusion that the sensory mechanism
onsists of three systems: (I) Deep sensibility, capable of answering
CJ pressure and to the movements of parts, and even capable of producing
ain under the influence of excessive pressure, or when a joint is injured.
'he fibers subserving this form of sensation run mainly with the motor
erves, and are not destroyed by division of all the sensory ne~ves of the
kin.
(II) Protopathic sensibility, capable of responding to painful cutan-
OUB stimuli and to the extremes of heat and cold. This is the great
eflex system, producing a rapid, widely diffused response, unaccom-
,anied by any definite appreciation of the locality of the spot stimu-
~ted.
(III) Epicritic sensibility-by which we gain the power of cutaneous
CJcalization, of the discrimination of two points, and of the finer grades
f temperature called cool and warm.
With reference to their distribution, the entire body, without and
\Tithin, is supplied by the protopathic system. The fibers of this sYsem
in the skin may be spoken of as somatic, those of the internal
Irgans as visceral, protopathic fibers. Thus one should speak no
CJnger of the afferent sympathetic system, but of the protopathic supply
f the internal organs.
Another set of fibers peculiarly associated with impulses of move-
Ilent and of pressure exist in connection with the Paccinian organs.
n the body and limbs an analogous system is found, peculiarly liable
o pressure, to the localization of movement, and to the appreciation
If position. The fibers in this system run in conjunction with the motor
lerves.
In addition to these two systems, which are distributed to all parts
If the body within and without, the surface of the body only is supplied
)y a third-the epicritic system. This endows the skin with sensibility
o light touch: .To the irop~ses conducted by. this. syste1!l is 4ue the
)ower of localIzmg the position of cutaneous stimulI, of discernmg the
toubleness of two points, and of discriminating between minor degrees
.f heat and cold, and other special attributes of sensation. The fibers
If this system are more easily injured, and regenerate more slowly
,han those of the protopathic system. They are evidently more highly
leveloped, and approach more nearly to the motor fibers which supply
roluntary muscles in the time required for their regeneration.
There is a distinct difference in these two systems to electric stimula-
;ion, especially to interrupted currents. Protopathic sensibility does not
leem to be affected by such currents whose duration is less than 0.002
)f a second, and consequently current waves having that duration or less
)roduce a stimulation which is more or less devoid of painful iropres-
;ions as the duration of the impulse decreases, though they are still felt
luite distinctly as a sensation through the agency of the epicritic fibers.
452 MEDICAL ELECTRICITY AND RONTGEN RAYS
Sensory Nerve Reactions.-These may be determined for the galvanic "I'
current by means of a wire brush attached to the cathode. The anode, j
usually a wet sponge, being placed in the hand or on the sternum. 1!
The quantity of current which is regulated by a rheostat in series or by
a shunt gives the figures for minimal pain reaction. The varying degrees
of skin resistance render this method irregular as to results.
Testing by the faradic current is done by the examining electrode,
and the strength determined by the movement of the secondary coil
on the primary. The amount of separation of the coils affords a
measure of the strength of the current necessary to produce minimal
sensations.
Erb's table of normal faradic excitability is given as follows:
FIRST SENSATIONSEPARATION
OF COILS.
200-220mm.
180-220 "
200 mm.
190 "
175 "
125 "
190 "
170 "
175 "
110 "
MARKED P AINSEPARATION
OF COILS.
120 mm.
120 II
120 II
115 II
110 I,
90 II
120 "
110 "
110 "
80 "
PLACE OF EXAMINATION.
Cheek. Neck. ., Arm. Forearm Dorsum of hand. Tipof finger Abdomen Leg Dorsum foot. Soleoffoot
Modifications in the Effect qf Faradic Currents.-Muscular contraction
is chiefly produced by the use of a faradic coil with coarse wire or
one with a small length of secondary wire, perhaps 1500 feet. It is not
produced at all, or not to the same extent, if a coil with fine wire or
one with a great length of secondary wire, say 8000 feet, is used. Slow
vibrations favor muscular contraction and the most rapid interruptions
aid in preventing it. Faradic currents from a coil with fine wire and
extremely rapid interruptions have an effect upon the nerve which is
very beneficial in neuralgia and neuritis.
A faradic current of a quality to produce muscular contraction may
have its strength regulated by moti~n .of the secondary coil uJ?on a sor.t
of sledge. When the secondary coil IS very far from the prImary coil
the current may be so weak as not to 9ause contraction. ~
Sensory perception follows a law comparable to the law of muscular I
irritability so far as the epicritic sensations are concerned. To galvanic ~
currents the first sensation is noted, according to Bordier's researches, it
as follows: aals, AnaS, AnOS, aos. 1
Segmental Distribution of Sensory Nerves.-The researches of 11
Starr, Kocher, Thoburn, and, more recently, of Head and Sherrington j'1 have served to bring out a series of facts concerning the relationship ~
of the segmental distribution of the sensory nervous system. Each, !
segment of the spinal cord has a more or less regular segmental representation
in the periphery .Electric testing for distribution of sensation
has not advanced, so far as practical clinical purposes are concerned,
to the same degree as motor tests, but a careful study of these segmental
Itreas in the skin affords a very important means of diagnosis of both
peripheral and central lesions. The spinal segmental distribution of the
sensory nerve areas do not at all coincide with the peripheral distribution
of the aensory nerves. (See Figs. 298, 299, 300. and Plate 9. )
PLATE 9
4.53 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
'ves of Special Sense.-The reaction of nerves of special sense
i'idual and specific. Electric stimulation of the olfactory nerve
ttle known practical value. The sensation of the smell of phosis
often given as an approximate description of this reaction
on.
tiCal stimulation results in a sensation of a flash of light. Ac-
~ to the direction of the current, certain differences have been
ed. but marked individual variation undoubtedly exists. Cath-
AQrlculot,mpo"\ 3 V.
a..., ooelpltal
Lacrimal. v.
Tomporomalu .V. .
emal. ooelpltal c. P.
a..., aurl,"lar c. P.
Supn-o,bltall V.
.Supn,rocbl.., 1 V.
lulntrocbl.., I V.
-Nua1lV.
.In(,...,bltal'V.
-Bnooo13V.
-M.utal3V.
~8UPe 01_i""(lP.
Sle,Dal b..DCb
BuP""'Ti'""' - /- C.P.
A'_lal b.."'b -
Middle b"n,b --_/
~
AD..nOr b..DOb.. Dr ID..' a\
DO"~
r...ral b..DOh" or IDt,rcO.tal
D"'.
Ctrou..flex B. I'.
l.t""","hom,..1
Non,.rW...ho'I
B.P. ~ .
E%t"",1 ",t,...u. I .r..u...loopl",
B.I'. 1
Inte'.oI oul, -1- ,
B.I'. {
Ka_loouta -
B.P. ~ IIloh1 trlc L. Po
i ~'(t-Donal..PenI.OfPUdIOa P.
, ~ _IUologuluall. P.
-.~Oaoltoo,"nlI.P.
MlddlaoutaD~u.I.P.
IDt 1cutao aI. P.
Hedl.. -{A:; ,I, I
B.P. w1fI
UIDUB. P.
EI...D81 ..taD- 1. P. I
Pl..uo DOte'..
Interoal..phenoo. I. p,
B...,b.. lrom ..t,,"al
popU 8. P.
Mu...locutaneou.8. p.
Extemal..ph.uou.8. P. -p~ ..I \
ADterlDrUbIal8P. ~
Fig. 298.-Cutaneous distribution of nerves (after Flower).
closure is thought to give a reddish flash, and anodal closure a bluish
~. Bremer has constructed special formulas for the reactions of
}-nerve stimulation. CC and AO over the closed eye, he states,
e perception of a light central disk, surrounded by a narrow fainter
i. CO and AC cause a weaker perception in an inverse order .
:tric stimulation of the eye with strong currents is not without its
ial dangers, blindness, presumably from retinal hemorrhage, having
1 reDorted by a number of observers from Duchenne's time to the
454 MEDICAL ELECTRICITY AND RONTGEN RAYS
present. From a diagnostic standpoint optical electric testing has
given few definite results.
A uditory stimulation requires strong currents and results in perception
of sounds, as of whistling, blowing or buzzing, being most
pronounced to 00, less so to AO; ACl and CO give no results in health.
Many individuals give no reactions whatever. In pathologic states,
particularly in perforation, the reaction is usually more pronounced,
Fig. 299.-Cutaneous distribution of nerves (after Flower)
constituting a distinct hyperesthesia of the auditory nerve. In somE
instances of hyperesthesia AGl and GO, which normally give no response,
may do so.
Loss of auditory excitability may be encountered, and an inversion
of the formula has been noted in rare cases of inexact significance, and
what is known as a paradoxic reaction is known in which the oppositE
ear reacts, while that to which the electrode is applied does not respond,
Or only feebly. Voltaic vertigo is described on page 387.
455 ELECTRICITY IN' DISEASES OF THE NERVOUS SYSTEM
1ustatory perception may be aroused by electric stimulation, both
:n the tongue is stimulated and when the electrodes are applied to the
k of the neck. One of the author's patients always noted a metaliaste
when electrodes were applied to the forehead and epigastrium.
Fig. 3OO.-Cutaneous areas related to the spinal-cord segments (Starr).
Itimulation by the anode causes an acid metallic taste; by: the cath-
Ide, an alkaline bitter taste. Such gustatory sensations may be
Ifoused by minimal currents and may be subject to loss.
DISEASE OF THE PERIPHERAL SENSORY NERVES
Anesthesia is best treated by a faradic brush electrode.
~IAGNOSIS AND TREATMENT OF DISEASES OF PERIPHERAL MOTOR NERVES
AND MOTOR CENTERS
For purposes of convenience central and peripheral lesions will be
discussed together in the following pages.
Palsies of Cranial Nerves
The important motor cranial nerves affected peripherally are the
facial, hypoglossal, and spinal accessory .The ocular muscles are more
456 MEDICAL ELECTRICITY AND RONTGEN RAYS
often involved centrally, although following many toxemias the peripheral
distributions of the third, fourth, or sixth may be affected.
Ocular Muscles.-There are x:nany difficulties surrounding the
investigation of the eye muscles. The sensitiveness of the conjunctiva
and cornea, t~e delicacy of the retina, and the deep seat of the eyeball
itself all make the study of the ocular palsies difficult and exasperating.
The intricacy of the innervation plays an important part as well. It
is convenient to cbnsider the third, fourth, and sixth nerves together,
since they are so closely allied in their functions. The third nerve has
the widest distribution, supplying all the external muscles of the eye
save the superior oblique, which is supplied by the fourth, and the
external rectus, which is supplied by the sixth nerve. The voluntary
part of the levator palpebrre superior is also supplied by the third;
the involuntary part, by the cervical sympathetic nerves. The third
nerve also goes to the interior of the eye, supplying, through the ciliary
ganglion, the ciliary muscle and the sphincter pupillre. The ciliary
ganglion is at present considered by a number of scholars to be the
peripheral motor nucleus for the sphincter pupillre.
Complete paralysis of the third nerve gives ptosis, external strabismus,
inability of the globe to move upward, straight down, or decidedly
inward. The pupil is dilated and does not contract on exposure to light.
Complete paralysis is rare. Hysteric paralysis is not unusual, but so far
as the ptosis is concerned, is usually differentiated from organic paralysis
by the absen~e of an overacting levator of the other side.
Electric tests are unavailing in determining the peripheral or central
character of a third-nerve paralysis, although the longitudinal reaction
has been obtained in levator palpebrre paralysis.
In nuclear lesions it is important to bear in mind that the orbicularis
oculi is also involved. Transient ocular palsies, such as occur in ophthalmic
migraine, should not be confounded with true ocular palsies.
Fourth-nerve paralysis. causes a characteristic diplopia, which is not
capable of electric analysis.
Sixth-nerve paralysis-paralysis of the external rectus-causes a
characteristic and isolated internal squint. .
Therapy.-These ocular palsies may be treated by electric stimulation,
but it cannot be said that the treatment is always satisfactory.
Only after thorough antisyphilitic and antirheumatic treatments
have been persistently carried out is one warranted in trying electricity.
Evf!,n in hysteric ptosis one is not warranted in abusing the
electric treatment for fear of excess of suggestion. Electric stimulation
of the levator palpebrre is at times useful. Such electric stimulation
as recommended by Everthain and Salomonson should be done
by a button electrode appli~d about i inch under the highest part of the
supra-orbital arch.
The method followed for treatment of the ocular palsies by electri~
ity is by direct application of the cathode to the eyelid, the anode
bemg placed at the nape of the neck. The finger may be used as a
cathode, or small fine sponges may be employed.
Rhythmic faradization with one electrode applied to the eyelid
at the insertion of the tendon of the paralyzed muscle and the other
electrode at the nape of the neck gives successful results}
1 Chabry , Bulletin officiel de la Societe Fran9aise d'electrotherapie, p. 135,
1 Q(}.~
457 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
Facial Nerve.-This nerve is more frequently subject to disease
n any other cranial nerve.
The lesion itself may be treated by bilateral stimulation with
ranic currents. An electrode about 2 cm. (~ inch) in diameter
Ilaced in each auriculomastoid fossa, the negative electrode being
Ghe affected side. A current of 6 or 8 ma. is allowed to flow for five lutes. ,
Electricity may b~ used to maintain the nutritio~ of the paralyzed
al muscles and hasten the return of power.
In cases in which faradic excitability is present the paralyzed
,cles may be exercised by faradic currents and a. trophic effect
in them may be secured by galvanic currents. One of the best apations
is the de Watteville, or galvanofaradic current, rhythmic-
.varied in intensity and direction by the rhythmic rheostat and
~-changer or some similar apparatus. The galvanic current has a
~imum intensity of 5 or 6 ma. and the faradic coil has coarse wire
.slow interruptions and a strength of current sufficient to cause
traction of the facial muscles. One electrode is held in the hand,
.the other is applied for about a minute to the motor point of each
the paralyzed muscles. In the absence of special apparatus the
ranic and faradic currents may be" applied separately. Stimulation
isolated induction shocks or by condenser discharges are more valu-
~ in treating the muscles of the face than those elsewhere.. These
,cles are short, and do not have the inertia of a considerable weight
overcome. The abrupt contraction produced by the applications
ot, therefore, so undesirable as it is elsewhere.
Isolated induction shocks cause contractions which are much more
d8n in onset and subsidence and much briefer in duration than
rsiologic contractions. They are not generally desirable in electro-
Jhanotherapy, but perhaps are all right for exercising the small
9cles of the face which normally do not have much resistance to be
rcome by their contraction. ,
Paralysis of the entire innervation of the seventh nerve is not com-
[1, save in central lesions; paralyses of separate branches are very
luent. It is a highly complex nerve, and is probably not a pure motor
ve, but has a sensory root as well, probably, as Huntl has shown,
jhe geniculate ganglion. The typic involvements of the facial nerve
e pla;ce-(I) Outside of the stylomastoid foramen, leading to Bell's
alysis; (2) within the Fallopian canal; (3) between its emergence
n the pons and the geniculate ganglion, and (4) within the pons.
(1) In Bell's palsy, due to refrigeration, to injuries, or to tumors,
re is complete palsy of the muscles of the corresponding side of the
~ to both voluntary and emotional impulses. On looking down,
n attempt is made to shut the eye, there is even a slight raising of
eyelid on the .paralyzed side, owing to th~ unopposed levator. palirre.
The face IS flattened out and loses all Its wrmkles, the conJUnct
becomes reddened, and the eye brims with tears. The eyelids
be closed practically only during sleep, when the levator is relaxed.
) food cannot be forced out of the paralyzed side of the cheek bed
the teeth, and the vasolabial folds are obliterated.
Electric testing is advantageous in determining the extent of the
1 Hunt, J. R., Herpetic Inflammation of Geniculate Ganglion, Journal of Ners
and Mental Diseases, February, 1907. .
458 MEDICAL ELECTRICITY AND RONTGEN RAYS
paralysis. The trunk of the facial may be tested in two positions-
(a) In the angle between the descending ramus and the mastoid process.
Here stimulation produces a contraction of all the muscles supplied
by the facial, although contractions of the muscles of the upper branches
-frontal and corrugator supercilii-are less powerful than the others.
This is a normal phenomenon, and should not lead to a misinterpretation
as to the contractibility of these muscles.
(b) A second point is at the tragus of the ear. Here only the second
and third branches are stimulated, and at times the reaction is wanting
entirely.
The three branches of the facial may each be tested separately. The
stimulation of the upper branch causes wrinkling of the forehead and
eyebrow: that of the middle branch, at a point just beneath, over
the tuber ossis zygomatici, causes closing of the eye, smiling movement,
turning up of the angle of nose, and a pout-like wrinkling of the upper
lip; stimulation of the lower branch causes turning over of the under
lid, lifting of the chin, and drawing of the mouth downward and outward.
In making these tests it is desirable to bear in mind that of the
three branches, the upper branch is the most excitable, the middle
branch the least, and, further, that tests with the faradic current are
apt to be painful, and that with the galvanic current dizziness, light
flashes, etc., are usual unpleasant by-effects. Minimal currents should
be employed in all tests of the facial innervation.
Reaction of degeneration is often found very early, and is usually
very complete. In ~ild cases reaction of degeneration may be absent.
Reaction of degeneration comes on slowly; reaction to the inductioncoil
current may persist for a, week or ten days, and no prognostic data
are obtainable within that period. Reaction of degeneration of irregular
distribution, i. e., involving one or two branches only, is of better
prognostic import, as a rule, than when the three branches are involved.
Electric treatment is highly beneficial in m9st cases of Bell's palsy,
electrically treated cases nearly always recovering more rapidly than
untreated cases. Persisting reaction of degeneration should lead one
to investigate thoroughly as to the cause, especially if it has been hastily
inferred that the paralysis is due to refrigeration.
The cases due to refrigeration (cold) have a good prognosis in the
main. The treatment should be carried out daily, direct applications
being made to both the nerve-trunk and to the muscles. Both faradic
and galvanic currents are advisable in those cases with definite reaction
of degeneration. It is desirable to place the positive electrode on the
nape of the neck, and the negative electrode should traverse the innervation
of the affected branches from the center to the periphery .Treatment
of the skin and muscles by the induction-coil is also advisable.
The latter alone is needed if reaction of degeneration has not set in.
Seances should not last over five minutes on the average. Mild
cases usually recover in from two to three weeks-two to eight months
is not too long for a severe case to persist and recover.
In long-standing intractable cases anastomosis is useful, eIther
through the hypoglossal or the spinal accessory .Following such
anastomosis further electric stimulation is advantageous.
(2) In lesions of the facial within the aqueduct, one may find additional
symptoms due to involvement of other structures, notably the
geniculate ganglion and the chorda tympani nerve. Thus various
459 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
oegular herpetic eruptions, associated with involvement of taste in the
lterior two-thirds of the tongue of the affected side, and irregular
:oustic symptoms may be found. If the symptoms of herpes, facial
Llsy, loss of taste, and acoustic symptoms are present, there is un-
)ubtedly true inflammation of the geniculate ganglion, with direct
ctension of the inflammation to the sheath and connective tissues
, the nerve. In the mild palsies inflammatory edema and pressure
re responsible, while in the severe types inflammation brings about
jructural alterations. J. R. Hunt1 was the first to show the generic
~Iation of the facial palsies with an herpetic inflammation of the genicu-
Lte ganglion. He has described a number of types which are purely
f neurologic interest.
Many of these cases run precisely the same course as the more
istinctly peripheral ones. Save for the richer symptomatology,
hey vary but little from the preceding group.
It is advisable, in treating these cases, to wait until all symptoms
f geniculate ganglion inflammation have subsided, and electric treataent
is best deferred for from two to three weeks.
(3) In facial palsies without taste involvement, but with loss of hearng,
the nerve is mvolved between the geniculate ganglion and the pons.
rhese cases are not infrequent in cases of fracture of the skull, in basal
lisease, and as a result of the herpetic inflammation of the geniculate.
They are to be treated in much the same manner as the preceding
~roup.
(4) When the lesion is within the pons, there is no involvement
» taste or hearing, but an involvement of the sixth nerve. is usually
)resent by reason of the anatomic contiguity of the nucleus of that
lerve.
Electricity is of service in these cases as well, but does not, as a rule,
give as hopeful results. These nuclear lesions are usually syphilitic
Jr metasyphilitic, in the latter case often appearing very early in tabes
~nd in general paresis. In these latter affections, naturally, electric
~reatment of the facial nerve is useless.
Bilateral Facial Palsy.-This is a rare affection, being due most
often to syphilitic basilar meningitis, or to alcohol, diphtheria, or
double otitis media. Double geniculate affections have not yet been
described, but are possible. In certain myopathies a pseudo~double
facial palsy is encountered.
In .facial palsy of alcoholic, diphtheric, or otitic origin, the general
procedures advocated for unilateral palsy are applicable.
Vagus Nerve.-Paralysis of the soft palate and the larynx result
from lesions of the vagus. In paralysis of the soft palate the reaction of
degeneration is sometimes encountered, especially in diphtheric neuritis.
.In such a condition electric treatment is of certain avail, particularly
in shortening the period of regurgitation of food through the nose.
In paralysis of the vocal cords from recurrent laryngeal involvement
electric stimulation is beneficial.
Adductor palsy is bilateral; the patient suddenly' loses the voice,
yet can ialk in a whisper; there is no stridor, and laryngoscopic examination
shows the cords to move outward normally.
Strong faradic shocks often make an immediate cure of hysteric
aphonia. (See Hysteria.)
1 Journa.! of Nervous and Menta.! Disease, vol, xxxiv, p, 73, February, 1907.
MEDICAL ELECTRICITY AND RONTGEN RAYS 460
In laryngeal paralysis due to tabes electric therapy is practically
unavailing, nor is it palliative even in laryngeal crises.
Spinal Accessory Nerve.-Involvement of this nerve produces
changes in the sternomastoid and trapezius, causing the head to be held
toward the opposite shoulder, with downward and outward displace.
ment of the scapula. The scapular displacement is modified greatly if
an atteI).dant lesion of the cervical roots be present. Surgical lesions
are mostly responsible for involvement of this nerve.
Treatment is to be carried out according to the procedures already
outlined for paralysis of the facial nerve.
Hypoglossal Nerve.-Paralysis of the hypoglossal results in
hemilingual atrophy. This is a comparatively rare disorder. It may
be of central or peripheral origin, in the former case depending on
syphilis, tabes, or paresis. Tumors, stab wounds, basilar meningitis,
trauma with marked sudden rotation of the neck, may all bring on
peripheral palsy.
There are no particular features attending the electric treatment
of hypoglossal palsy. It is rarely isolated, as syphilis is the most frequent
cause, in which case it is accompa.nied by associated palsies of the
contiguous nuclei.
The peripheral cases frequently recover without any treatment,
although electric stimulation hastens such a result.
Bulbar Palsies
As a result of acute or subacute poliomyelitis, several of the medullary
nuclei may be involved. This is particularly true in what is known
as glossolabial paralysis, which is a mixed paralysis, involving, for the
most part, portions of. the nuclei of the seventh and twelfth nerves.
The electric phenomena observed in examinations in this disorder,
whether in the acute or the chronic stages, are usually of a mixed
character. There are healthy fibers interspersed with unhealthy
fibers, the result being that an indefinite reaction of degeneration is
obtained, some of the fibers retaining the normal reaction, while ad.
jacent fibers present typic reaction of degeneration. These mixed
reactions are found in practically all the atrophies, especially of the
central type; that is, when the motor cells in the medulla or spinal
cord are involved. They are less often present in the paralyses of a
peripheral type, and, therefore, are of a certain amount of diagnostic
significance.
The electric treatment of bulbar palsy offers a considerable field
of operation. The best results are usually obtained in the distribution
of the seventh nerve, although it is not impossible to obtain some
beneficial results in other nerve regions.
It should be borne in mind that bulbar palsy may be found in a
number of conditions. It may be hysteric or infantile, or it may be
due to unknown and unappreciated pathologic conditions, but its
most frequent occurrence is, as has already been stated, in poliomyel.
itis, in chronic progressive muscular atrophy, and as a complication of
amyotrophic lateral sclerosis. .
Attention has already been called to the differentiation of true
bulbar palsy from so-called pseudobulbar palsy, or myasthenia gravis.
Here the myasthenic reaction is usually sufficient to mark it.
It should be borne in mind that electric treatment of bulbar palsv
461 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
ot without very distinct danger. The ordinary faradic or galvanic
cation, such as is practised in the treatment of ordinary paralyses,
at times led to disastrous results, and even to death. Oppenheim
called particular attention to this danger. Central galvanization,
v ever, is of value.
The exact indications for the electric treatment of bulbar palsy
not yet defined suitably, and up to the present time we have no
lly reliable information bearing on the therapeutic usage of other
:ns of electric energy in this affection.
Paralyses in the Cervical Region
As is well known, the spinal muscular types of paralysis have a
ture which is ~haracteristic. If the motor neuron is involved at
center, namely, in the ga~glion-'cell within the anterior horns of the
nal cord, the muscles involved are usually affected from the outset.
ey acquire the full and maximum.amount of paralysis very rapidly,
i recovery is gradual and slow. In the peripheral paralyses, i. e.,
en the motor neuron is af:fected through its distal distribution-
~rt from severance or acute pressure-the onset of paralysis is
lally slow and gradual, and atrophy becomes apparent only after
ne time. In both types the limb, if the whole member is involved,
ngs helpless-never stiff. The joints are relaxed and the articular
faces are usually separated by the weight of the member. The
Iscles are flabby and relaxed and show little or no myotatic irritaity.
The tendon reflexes are partially or wholly gone. Their pertence
in the face of a flaccid paralysis usually means the implication
the adjacent pyramidal tracts.
Such forms of paralysis are common in poliomyelitis, acute and
ronic, in amyotrophic lateral sclerosis, in tumors and hemorrhages
thin the cord, in embolism or thrombosis leading to softening, in
e earl! stages of myelitis, in syringomyelia, and in the various forms
neuritis, whether due to lead, alcohol, mercury , arsenic, diabetes,
~. The muscle arrangements in the cells,of the cord have already been
[erred to, and the localization of the cell groups in the various segents
given in tabular form. (See p. 449).
Functional or Organic Paralyses.-It remains first, in making
iiagnosis in paralysis, either of the upper cervical type or of the lower
mbar type, or when hemiplegia or paraplegia is present, to determine
ilether the paralysis is organic or functional. The differentiation
~tween these is in roost cases comparatively simple, yet in a large
Imber of others it is by no means an easy matter. This is particularly
ue, for instance, in the early palsies of disseminated sclerosis, where
le tremor and the weakness very frequently simulate alike contion
in hysteria. As a rule, muscular atrophy is not an accom-
I.niment of functional disease, at least not in the early stages, and the
ectric reaction of degeneration never occurs in functional disorders
1less muscular atrophy is found as a result of many years of disuse of
muscle group. In some of these cases a reaction of degeneration suffient
to raise a query may be found. As a rule, the functional paralyses
lvolve whole groups of muscles, or even whole muscle functions.
Ivolvement of single muscles is usually diagnostic of organic disturb-
462 MEDICAL ELECTRICITY AND RONTGEN RAYS
The differentiation of organic paralysis in the lower neuron type,
that is, in the spinal muscular neuron, is a comparatively easy affair,
since the features already outlined are usually sufficient to develop
a definite diagnosis, but in 'the corticospinal neuron types, where no
atrophy is to be expected, and where the reaction of degeneration does
not take place, differentiation becomes ofttimes fraught with difficulty.
There are cases of hysteric hemiplegia and hysteric paraplegia
which defy the ordinary positive tests of electric or neurologic examination.
In the hysteric hemiplegias and paraplegias, the study of some of the
more complicated tendon reflexes offers a clue to diagnosis. The reflexes
most often studied and upon which most reliance maybe placed
are those of Babinski and Oppenheim. The Babinski reflex is almost
invariably present in the organic hemiplegias and paraplegias. The
Oppenheim reflex has much the same significance as the Babinski
reflex.
Grasset's sign, which is less well known, consists in the inability
of an organic hemiplegic while lying flat upon the back to lift both
the limbs from a table or bed, but being able to lift each one separately.
The reason for this is that the organic hemiplegic, by reason of
defects about the pelvis, is unable to fix the bones about the pelvic
girdle; and is thus unable to lift both legs at one time. The legs should
be separated so that the one cannot mutually help the other. The
hysteric has no difficulty in raising both legs-i. e., of course, speaking
of the milder types of the disease in both instances.
Certain of the more prominent paralyses of the cervical region
will be here considered. The most important of these are the paralyses
of the trapezius, sternomastoid, serratus magnus, scapular muscles, and
deltoid. Certain combined paralyses of the shoulder-girdle, such as
Erb's palsy, are of great importance.
Sternomastoid and Trapezius.-These muscles ate usually involved
more or less in unison, their cell groups lying close to one another
in the cord. When both are involved, a central lesion is predicated,
although operations about the neck sometimes result in injury to their
peripheral nerve-supply. The bringing of tension on the sternomastoid
by forced rotation of the head is. usually sufficient to demonstrate a
change in this muscle.
Paralysis of the trapezius results in a marked drooping of the
shoulder, since this muscle is of so much importance in supporting it.
The scapula is tilted with its upper end away from the median line
and depressed, the lower end approaching the vertebral column and
elevated somewhat. On raising the arms above the head the outer
end of the clavicle becomes visible from behind. , Electric treatment by means of both galvanic and faradic shocks
should be energetic and prolonged. In surgical cases associated with
complete reaction of degeneration in all the fibers of the muscle after
ten days or two weeks, prompt surgical splicing should be instituted.
Even after months or years the results of surgical severance may be
obviated by surgical intervention combined with electric treatment.
Serratus Magnus.-Paralysis of this 'as an isolated muscle is
rare, though by reason of the fact that its nerve-supply runs in the
substance of the scalenu8lliedius muscle it may be subjected to traumas,
particularlv in neck oDerations. The deformitv is characteristic.
464 MEDICAL ELECTRICITY AND RONTGEN RAYS
of the brachial plexus, due to a severance or tearing of the root-fibers
as they emerge from the spinal cord. As a rule, the chief damage is
done to the fifth and sixth cervical nerves, although only the fifth,
or only the sixth, or even the seventh, may be disturbed; and the muscles
most widely implicated are the deltoid, biceps, supinator brevis,
brachial is anticus, and the spinati. At times only the deltoid is involved.
There may be associ9.ted anesthesia on the outer aspect of
the arm, due to the implication of the external cutaneous.
The position of the arm in Erb's obstetric palsy, called obstetric
because so frequently induced as an obstetric accident-pulling of the
arm in delivery with stretching and tearing of nerve-roots-is very
characteristic, especially if more than a mere paralysis of a few fibers
of the deltoid is present. The arm usually hangs helpless by the side,
the forearm being turned inward and backward, so that the palm of the
hand is turned backward and even outward.
The electric reactions are of interest in showing the distribution of
the implicated fibers, since the biceps, coracobrachialis, and brachialis
anticus are supplied by the musculocutaneous, the deltoid is supplied
by the circumflex, the supinator longus is supplied by the musculospiral!
and the spinati bJ:' the su{>rascapular. !1erve. 1!1 traumatic
affectIons of the musculospIral, and ill the neurItIdes, partIcularly that
of lead, the supinator longus escapes, since the spinal-cord cell-group
fibers enter the plexus above the point of fusion that makes up the
musculospiral nerve.
Electric testing at Erb's point-i. e., in the neck, about one inch
above the clavicle, and a trifle external to the outer border of the sternocleidomastoid,
is capable of throwing this entire group of muscles into
activity, and when obstetric palsy is present, stimulation at this point
is unav11iling. In Erb's palsy, also called nuchenne-Erb palsy, other
muscles may be involved, and a great degree of complexity is known to
occur .
The electric treatment of Erb's palsy by means of both galvanic
and faradic currents should be continued for a long time; many mild
cases recover spontaneously without treatment, but in the severer cases
electric stimulation is of immense service.
Musculospiral Paralysis.-This nerve is most frequently involved
outside of the plexus, and causes a loss of power in the extensors of
the forearm and wrist and the supinators. The wrist drops, the fingers
are flexed but can be extended, if the proximal joint is flexed, by the
interossei and the lumbricales. Extension of the elbow is impossible;
atrophy of the extensors causes the fQrearm to shrink very materially,
while the bones of the wrist become very apparent. Involvement of the
biceps points to injury above the middle of the arm, and supination
is then moderately well performed. If supination is entirely gone, the
nerve is usually implicated below the middle of the arm. Sensory disturbances
are frequent.
The commonest cause of musculospiral paralysis is pressure due
to sleeping on the arm, or with the arms hanging over the back of a
chair, or poor adjustment of a crutch.
Reaction of degeneration in the various muscles innervated by
the musculospiral is sufficient to make a diagnosis of this palsy, and
to distinguish it from the wider implications of the brachial plexus
in Erb's palsy.
465 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
reatment of musculospiral paralysis by the faradic and galvanic
fitS is of great service, save in those cases where actual section
Ile nerve has taken place. The electric currents are of service
.the nerve has been united by suture.
ledian Nerve.-The median supplies the pronators, the flexor
i radialis, the flexors of the fingers, and the abductors and flexors
le thumb, and the two radial lumbricales, which flex the first phalanx-
,rises from all the roots of the brachial plexus. This nerve may
nvolved above its muscular branches from wounds in the forearm,
ture of the ulna and radius, injury at the back of the elbow, from
jsure of a crutch, or from injury to parts of the plexus. Plexus
Lries will not give isolated median-nerve involvement.
The chief symptoms of involvement of the median nerve consist
,he loss of ability to flex and to pronate the forearm; this latter is a
Ltive rather than an absolute loss. Flexion to the ulnar side of
wrist is possible. The hand cannot grasp anything well, and the
1mb cannot be prought into apposition with the tips of the fingers.
cannot be abducted either. Pain is a frequent symptom, and there
1, characteristic anesthesia pictured in works on neurology.
Injuries to the nerve in the wrist causes a paralysis, limited to
3 movements of the fingers. Atrophy of the thenar eminences is.
llal.
The median nerve is frequently affected by toxic agents, with result-
9 neuritis, although this is rarely isolated. .
Treatment of paralysis from median-nerve neuritis, or of that
le to injury of the nerve-trunk, by means of electric currents differs
no essential respect from the methods to be pursued for other neurides
or paralyses. If electric testing shows the reaction of degeneraon
to be limited to the distribution of the median, it is highly probable
lat the injury is due to some mechanic cause.
Ulnar Nerve.-This is derived from the brachial plexus, and is
lpplied to the flexor profundus digitorum, flexor carpi ulnaris, all
!le muscles of the little finger, the interossei, two ulnar lumbricales,
bductor pollicis, and the flexor brevis pollicis. Many of the muscles
f the hand are supplied in part by other nerves, hence there is not a
omplete loss. A characteristic deformity, the claw hand, is a usual
esult of ulnar paralysis. The deformity is general, but the third and
ourth fingers are most affected.
The ulnar nerve is particularly exposed to damage by reason of
.ts exposed position. Wounds in the forearm, at the wrist, fracture of
~,he ulnar or radius, dislocation, fractures or contusions at the elbow,
III may lead to injury of this nerve. Isolated neuritis is known.
Head, Rivers, and Sherrington have shown that the ulnar nerve
carries epicritic fibers of touch to one and a half fingers, and the ulnar
portion of the palm and dorsum of the hand. It carries sensation of
pricking from the little and ring fingers and the palm, save from the
thenar eminence, and all the dorsum to the ulnar side of the middle of
the middle finger. If the nerve be divided, there is loss of sensibility to
cotton-wool over the entire little finger and half of the ring finger, with
the same limited area in the palm of the hand. There is also an area
which is insensitive to pin-prick over the entire little finger, and a portion
of the palm at times very limited, at other times coextensive with
the area lost to light touch.
')n
466 MEDICAL ELECTRICITY AND RONTGEN RAYS
Spinal Motor Centers and Motor Nerves of the Lower Extremity
These are less often involved in injuries than are those of the upper
limbs, whereas the gray matter in the cord is more apt to be the seat of
disease than in the cervical region. In acute poliomyelitis the muscles
of the lower limbs are usually affected more than those of the upper
extremity, this being particularly true Qf the peronei. A short consideration
will be given to the chief paralyses of the thigh and leg. Their
treatment may be considered in one paragraph.
Obturator Nerve.-This is derived from the third and fourth
lumbar nerves, and supplies the adductors of the thigh. It is a rare
form of palsy, chiefly causing difficulty in crossing one leg over the other
and in spreading the legs apart. The disorder is known to follow
difficult child-birth, but is usually a transitory affection.
Anterior Crural.-DiseaBe or injury to this nerve in different
parts of its course, if within the pelvis, may give rise to loss of power
to flex the knee and loss of hip flexion. If outside of the pelvis, flexion
of the knee alone is involved. An anesthesia of the entire thigh, save a
long V-shaped area in the back of the thigh, is present as well.
Sciatic Nerve.-lf this nerve is involved above the middle third
of the thigh, the flexors of the knee, the extensors of the hip, and
all the muscles below the knee are implicated. If below the upper third,
only the muscles below the knee are involved. .Paralysis of the sciatic
is a comparatively rare affection. Sensory disturbances are, however,
very common, and primary neuritis or sciatica is one of the commonest
of neuralgic or neuritic affections.
Peroneal Paralysis.-Involvement of the external and internal
popliteal nerves causes great loss of the ability to get about. The
tibialis anticus, long and short extensors of the toes, and the peronei
are all involved in external popliteal injuries. The resulting deformity
is foot-drop, with after-developing talipes equinus, due to the unopposed
action of the gastrocnemius. As the external popliteal 'is superficially
located it is injured b~ pressure, by fractures of the fibula, and is
occasionally diseased primarily.
The internal popliteal supplies the tibialis posticus and popliteus,
as well as the chief muscles of the back of the leg, the long flexors of
the toes, and the muscles of the sole of the foot. In injury or disease of
this nerve the foot cannot be extended, and the leg cannot be inwardly
rotated when flexed if the popliteus is affected. Injury of the internal
popliteal takes place in extensive fractures of both bones of the leg.
Plantar Paralysis.-Involvement of the external plantar nerve
causes a loss of power in the interossei, the adductor of the big toe,
the two outer lumbricales, and the accessory flexor of the foot. Walking
is interfered with, the spring having departed from the foot. The toe
is apt to strike, and stumbling is usual. The special sensory area is
sharply limited.
Injury to the internal planta,r nerve brings about a paralysis of
the short flexors of the toes, the muscles of the big toe, save the adductor,
and the inner lumbricales. It causes a somewhat similar, although
much less marked, difficulty in walking.
Treatment.-The electric treatment of these palsies differs in no
essential respects from that already outlined in previous paragraphs.
In general, one can derive considerable assistance. so far as Drornosis
467 ~LECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
concerned, from the electric reactions. The degree of degeneration
[}ich has occurred can be determined, and also the probable length
time necessary for recovery .In all these paralyses, of the lower as
ell as the upper extremities, the same general rule must be followed
I that already outlined. It is necessary in all cases to wait ten days
) two weeks for the sake of a diagnosIS, as well as a prognosis. In
le case of patients where neuritis is foUnd, or in whom painful nerve-
.unks may be present apart from neuritis, such as may be due to the
Titation of the meninges, too early electric treatment, or even the use
f electricity for diagnostic purposes, should be deprecated by reason
f the extreme pain which may be induced. If pain be not a prominent
~ature, the electric reactions should be tested as early as the second
reek; any earlier is valueless, so far as diagnosis is concerned. In
;eneral it may be said that if, at the end of from two to three weeks,
ve obtain a typic reaction of degeneration, it is probable that the
)aralysis will persist for at least three months, and may even be found
.t a much later date-a year or so. If, after three months, no distinct
mprovement has been observed, it has been generally held that no
lopeful outlook can be maintained. This, however, is not the case,
or continued and unremitting attention paid to the chronic paralysis
J/ill almost invariably result in the restoration of considerable power ,
Lt least, and the general rule that if reaction of degeneration is present
n a muscle at the end of three months such muscle is doomed, is in
:leed of distinct revision. This may even be said of those reactions of
fegeneration which are found in paralyzed groups, even after a year,
tlthough in such cases the outlook is more gloomy.
If a partial reaction of degeneration is foUnd, or mixed reaction,
~he chances are much better, and if in the milder cases of neuritis or
peripheral palsy due to injury other than actual division of the nerve,
a partial reaction of degeneration occurs, the patient will probably
recover power in from eight to ten weeks.
If the reaction is simply one of a lessened contractility to faradism
and galvanism, the chances of recovery are good, the patient usually
recovering full motion, although somewhat diminished in strength,
at the end of from four to five weeks.
The methods of application for the electric treatment of paralysis in
the lower limbs have already been outlined and are further discussed in
the paragraphs on Electromechanotherapy.
All electric treatment should, if possible, be associated with massage
and exercises.
Hysteric Paralysis
Faradic currents are used to cause contraction, while at the same
time the patient makes a voluntary effort. This forms a sort of reeducation.
Sensory hysteric paralysis always yields to faradism, with
rapid interruptions and a brush electrode. Hysteric amaurosis or more
or less contraction of the field of vision are treated by faradization
with one of the electrodes applied to the eyelids. Hysteric aphonia
is treated by faradism, and usually is quickly cUl"ed, though one case
of the author's resisted all kinds of treatment, including hypnotic suggestion.
Hysteric vomiting is treated by galvanic currents.
Hvsteric Contractures.-Faradization with a brush-electrode ap-
468 MEDICAL ELECTRICITY AND RONTGEN RAYS
plied either to the contracted muscle or to its antagonist, and galvanic
current with the negative electrode applied to the contracted muscle,
bring about a cure.
ELECTROMECHANOTHERAPY
This means the application of electricity to produce muscular
contraction. It is useful when, for any reason, it is impossible or
undesirable for the patient to exercise his muscles, any particular
muscle, or any part of a muscle.
It has, to a greater or less extent, the same beneficial effect upon
the nutrition of the muscle and upon the general system that natural
exercise produces. Muscular contraction is accompanied by oxidation,
generation of heat, and complex processes of tissue activity.
It must be borne in mind that electricity has a specific tonic effect
upon muscular as well as other tissues, which it exerts whether muscular
contraction is produced or not. This direct effect is more dependent
upon the quantity of electricity passed through the muscle
than upon abruptness in the change in the strength of the current. The
direct effect upon the nutrition of the muscles is produced chiefly
by galvanic and sinusoidal currents, and is obtained by forms of application
which do not necessarily produce muscular contraction, and
also in cases of degeneration in which no contraction can be produced
by any form of current.
Confining attention strictly to eletromechanotherapy (the therapeutic
production of muscular contraction by electric stimulation), we find
it indicated in most muscular pa,ralyses without marked reaction of
degeneration. It is sometimes important to avoid stimulation of the
antagonistic muscles which respond more readily than the paralyzed
ones, and would lead to increased deformity. If this occurs from unipolar
stimulation with the indifferent electrode upon the back, it may
often be prevented by placing both electrodes on the paralyzed muscle.
The lImb should be placed in such a position that contraction of
the muscle stimulated will produce a normal movement.
.Very often some powe~ of ,:oluntl;try movem.ent.is pr.esent, and it is
desIrable to apply electrIc stImulatIon to assISt IndIVIdual attempts
at voluntary movement.
As improvement takes place the factor of movement against resistance
is to be introduced, making the effect still more like the physiologic
effect.
Too long treatments will produce fatigue in the same way as too
prolonged natural exercise. This is to be avoided.
Method for exercising paralyzed muscles by the static induced current
ii3 described on page 494. .
Stimulation by galvanic currents is excellent ill its trophic or
tonic and nutritional effect, and with moderately strong uninterrupted
currents, 15 ma., has an excellent effect without causing muscular
contraction. To produce the latter the galvanic current must be made
and broken and should be mQch weaker, to prevent discomfort. This
involves the loss of some of the benefit obtained from the trophic action
of the current.
Galvanic currents are usually applied so as to flow with the physiologic
direction of the nerve force. For the treatment of the motor
nerves or of the muscles the positive electrode should be near the nerve-
469 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
o v
~
0.
2. /),j.qcffio,",,"O- I I"'.odlc
center, and the negative electrode should be applied to the motor nerve
or to the muscle.
Stimulation by isolated induction shocks produces abrupt muscular
contractions, which are better than none, but which are less desirable
than if they approached the physiologic type. It gives none of the
direct tonic effect of electricity, because the quantity of electricity
which passes through the muscle is very small.
Stimulation by condenser discharges is open to the same objection
from a therapeutic standpoint, though the certainty with which each
discharge may be measured makes it a valuable diagnostic method.
FaradizatIon is the method chiefly employed for electromechanotherapy,
but it has the same drawbacks as isolated induction discharges
and condenser discharges. The contractions produced by it are not as
desirable as physiologic contractions, and the quantity of electricity
is too small to produce the direct tonic effect of the current. If the
faradic current is employed, it had better be applied with one electrode
on the motor nerve or the motor
point of the muscle, while the . other electrode is on the back 1.l'"o'.oa',o
or chest or some other indifferent
place, and the application
be made simply to cause mus- ..-,
cular contractions, beIng supple- A ~
mented by the galvanic current
for its trophic effect.
The combined effects of
faradic and galvanic currents may be obtained by either their -
simultaneous or their successive 0
application. The first method
will be considered a little later,
und~r the head of Faradogal- .J./f.../i'.jfJ..lsft.. Go/wJ""lq,.,df.:.
vamc Currents. The second
method is one by which galvanic
currents of any desirable strength
are applied for ten minutes from 0-
electrodes covering the whole
affected muscle, either before or v
after a series of muscular con- Fig. 301.-Faradic and faradogalvanic curtractions
have been excited by rents.
the faradic current.
Lewis Jones' experiments show that a faradic coil without an iron
core gives currents without such abrupt increase and decrease in strength
and produces less abr~pt and disagreeable muscular contractions than
when the coil has an iron core. Even so modified, however, the faradic
coil produces quite an abrupt beginning and end of muscular contraction,
with a period of tetanus lasting from the time the cutreht is turned
on until it is turned off. This is not at all like the physiologic contraction,
and is, therefore, less desirable than the contraction produced
by the author's method of rhythmic variation by rheost~t and polechanger,
or by the other method of sinusoidal currents with rhythmic
variation. "
Faradogalvanic or deW atteville currents are applied from an
aDD:1ratus in which the secondary coil of a faradic coil forms part of
~
I
470 MEDICAL ELECTRICITY AND RONTGEN RAYS
the circuit of a galvanic battery .While it has been stated elsewhere
that the polarity of a faradic coil makes practically no difference in the
physiologic effects, and that either pole may be used as the active
electrode, this ceases to be true when the faradic and galvanic currents
are combined.
Fig. 301, 1, shows the form of the interrupted currents produced by
a faradic coil alone. The make or closure current is of much less
strength and is in the opposite direction from the current induced
at the break or opening of the primary circuit. The best results are
obtained with a galvanofaradic current, when the connections are
made so that the opening currents of the faradic coif flow in the same
direction as, and add to the strength of, the galvanic current. The
Fig. 3O2.-Author's galvanic, faradic, and sinusoidal apparatus; giving also galvanofaradic
currents, rhythmically interrupted currents, and currents with rhythmic variations
in strength and reversals of direction (A).
proper effect is shown in Fig. 301,2, and the incorrect effect is shown
in Fig. 301,3.
The sensation produced by galvanofaradization is different from
that of either of the component currents separately. Its effect is to
cause muscular contraction and trophic stimulation, but applied in
the ordinary way by means of a key that makes and breaks the current
abruptly the muscular contractions have the same unnatural character
as with the simple faradic current.
The author's method of applying faradogalvanic currents produces
muscular contractions which closely resemble physiologic ones, and
makes the application agreeable, and causes it to be followed by a sense
of muscular power which is most exhilarating and beneficial. It con.
471 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
sists in the use of a rhythmic rheostat and pole-changer (Fig. 302, A),
by which the direction of the current is reversed at regular intervals of
from one-half second to two seconds. There are sliding contacts,
which are pushed up and down the rheostat by a small electric motor.
At a certain stage the galvanometer will show that no current is passing
through the patient. Then, as the rheostat resistance is automa~ically
reduced, the current gradually begins to flow in one direction, and increases
to the maximum, 15 ma., perhaps, permitted by the adjustment
of another unvarying rheostat and the unvarying volt controller. The
latter adjustment had better be made at the commencement of the treatment.
In this case it is best to begin with the weakest possible current.
After the rhythmically varying rheostat has permitted the maximum
desired current to flow, the current is gradually reduced to zero, and is
reversed and gradually attains an equal maximum strength in the opposite
direction. From here it again gradually returns to zero.
Holding two electrodes in the hands, one feels his grip gradually
tighten and relax, first in one hand, and then in the other, as the maxlmum
current is attained in each direction. All the muscles of each
upper extremity are affected by the. trophic influence of th.e galvanic
current, and the muscular contractlon may be caused to Involve as
many of these muscles as desired by regulating the strength of the faradic
current. The a{>plication is entirely free from shock and other disagreeable
sensations. Its alternating character prevents irritation of
the skin by the accumulation of ions, and enables one to secure the beneficial
effects of strong currents without having to use enormous electrodes.
A good contact is the chief essential. The contractions closely simulate
physiologic ones.
These currents are of great value in peripheral paralyses and in
constipation, where the electrodes are applied at either side of the abdomen.
The same picture (Fig. 302) shows also the arrangement for utilizing
the 110-volt direct current in galvanic, faradic, and deWatteville applications,
continuous or interrupted.
In the author's apparatus there are three different secondary windirigs
of the same faradic coil, made instantly available by turning a
switch indicating 1500, 3000, or 8000 feet of wire. The ribbon vibrating
interrupters regulate the rapidity of the interruptionS from the
fastest to the slowest, and the two separate primary coils may have
the same or different rates of vibration. There is a sledge upon which
the single secondary coil may be moved toward or away from the primary
coils. The farther away the weaker the current and the physiologic
effect.
Gaiffe's Portable Apparatus for Exciting Physiologic Contractions
of Muscles.-The apparatus is useful in cases where paralyzed
or atrophic muscles are to be exercised in order to maintain their nutrition,
but not in cases with the reaction of degeneration. Faradic currents
cause muscular contractions which are unnatural in the abruptness
with which they begin and end. Voluntary muscular contractions
commence gradually, and after attaining their maximum, grad~ally
relax. The apparatus described by Delherml produces contractions of
this type by the application of a sinusoidal current, which increases from
zero to a maximum strength, and then gradually diminishes to zero.
1 R"II..t.in officiel de la Societe d'Electrotherapie, August, 1907.
472 MEDICAL ELECTRICITY AND RONTGEN RAYS
The apparatus consists essentially of an electromagnet which oscillates
in front of a dynamo, and causes increasing or diminishing currents in
the latter. It is portable. Fig. 303, from Delherm, shows the current
curve and the wave of muscular contractions obtained with this apparatus.
Fig. 304 shows the current curve with isolated induction shocks
from a faradic coil and the waves of muscular contraction produced by
them. Fig. 305 shows the current wave from the usual faradic current
and the tetanic muscular contraction produced by it.
Leduc currents are currents which are uniform and unidirectional,
but which are made and broken with a rapid rhythm similar to that of
the faradic current. They produce a contraction similar to that from
faradic curren~s.. and are open to the same objections as to abruptness
of. be~inning and ending and as to a tetanic cQn?i~ion d~ring the application,
and as to the small amount of electricity which traverses
the muscle. Leduc currents or any other similarly rapidly interrupted
currents of more than 15 ma. would produce intolerable convulsions.
~
These currents have a slight advantage over faradic currents for electro~
mechanotherapy in the fact that the periods of current and the strength
of the current can be exactly regulated, and are subject to none of the
irregularity present in even the best induction-coil.
Gaiffe's Large Apparatus for Electromechanotherapy.-The
apparatus (Fig. 306) has a primary coil through which passes an alternating
current which may be taken from the alternating electric-light
circuit and the strength of which is regulated by a volt-controller. No
interrupter is required; the alternating current in the primarY &!enerat.p.R.
Fig. 304.-lsolated induction sh"ocks.
Abrupt muscular contractions.
473 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
a sinusoidal current in the secondary coil. The latter is pushed back
and forth by an electric motor, and when it is immediately around the
primary coil, generates a stronger secondary current than when it is
removed from it. The adjustment may be such that during any
desired fraction of each period the secondary coil is entirely removed from
Fig. 306.-Gaiffe's large apparatus for electromechanotherapy.
around the primary coil, and the secondary current is so weak as to
produce no muscular contraction. The intervals of rest between the
muscular contractions may, therefore, be as long as desired. The
muscular contractions are excited at regular intervals, commence and
Fig. 307 ,-Enallaxotone current apparatus.
end gradually, and are very much like physiologic contractions. The
amount of electricity which flows through the muscle may be measured
by a milliamperemeter. It is sufficient to produce the trophic effect
of electricity.
The En"allaxotone Current.-This is the name given to a modi-
474 MEDICAt ELECTRICITY AND RONTGEN RAYS
fication of the faradic current suggested by Nicoletis.l It depends upon
the transmission of the induced current from a regular faradic battery
through a liquid rheostat, with a variable distance between the electrodes.
At certain periods in the motion of these electrodes there is
practically no current, while at other periods almost the full intensity
of the current reaches the patient. There is consequently an undulatory
contraction in muscles to which sponge electrodes are applied.
An Automatic Rhythmic Rheotome for Galvanic, Faradic, and
deWatteville Currents.-One terminal is fixed in position, while
the other can swing around horizontally in almost a complete circle, and
is normally pressed against the other by the action of a spring resembling
the hair-spring of a watch. An electromagnet is placed in a vertical
position near an iron bar on the revolving contact, but at a lower level, so
that the revolving contact can swing back and forth over it. When the
current is turned on, the electromagnet attracts the iron bar and breaks
the contact. The current ceasing, the electromagnet ceases to attract,
and the spring swings the iron bar back into contact again. The rapidity
of interruption may be varied from 80 to 2000 times a minute. This
is done by the adjustment of a stop which regulates the distance to
which the iron bar may swing away from the point of contact. This
apparatus forms part of the author's table for utilizing the 110-voltdirect
electric current for galvanic and faradic currents and for diagnostic illumination
(Fig. 302, p. 470).
Unidirectional Undulatory Currents of Low Potential.-
Bordier's observations 2 lead him to the conclusion that these currents
represented by the curve in Fig. 288 are even better in their effect upon
muscular atrophy than the rhythmic, gradually alternating currents
~_-1 ,-, 1--- -
Fig. 308.-Unidirectional undulatory current.
given by the apparatus (p. 470) employed by the author. The apparatus
for producing these currents differs very little in appearance from the one
alluded to. It consists of a rheostat with a sliding contact, which is
moved back and forth from the zero-point by an electric motor.
The physiologic effects of the application of these currents to muscles
and motor nerves are quite different from those of ordinary galvanic
currents made and broken by a key, or by the metronome interrupter.
The indifferent electrode should be a large plate, measuring 5by
8 inches, and covere~ with several layers of damp cloth and placed
under the patient's back. The active electrode usually connected
with the negative pole is a sponge electrode,. 2! inches in diameter.
The speed of the motor is varied so that it takes from one to t\YO
seconds for the change from zero to a maximum current, and an equal
length of time for a return to zero. The contrac-tion which occurs is of
a gradual character, like a physiologic contraction. The strength of
the current required to produce muscular contraction in healthy muscles
is greater than with sudden makes and breaks of the galvanic current,
and in atrophic muscles as much as 10 to 50 ma. may be required. These
lJournal Physiotherapie, November 15, 1907.
2 Arch. d'elect. med., June 25. 1905.
475 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
leavy currents have been used by Bordet,t who found "that "they cause a
;light burning sensation which the patient can stand, instead of the
severe burning feeling from the ordinary galvanic applications. The
more atrophic the muscle is, the stronger the current required. As to the
speed of the undulations in the current, the more natural the muscle,
the more rapid speed is required to produce contraction. The muscle
contracts gradually in its entire mass, and the contraction is limited to
that particular muscle. Bordet produced an increaBe of size and strength
in the biceps of healthy men by applying these currents to that muscle.
The strength of current was 10 ma. ; 100 waves of current were applied
every day for fifty or sixty days, with an increase of 2 or 3 cm. (0.8
inch or 1.2 inches) in circumference. This was a slightly greater increase
than was produced on the other arms of the same subjects by a
rhythmic undulatory galvanic current with a change of polarity.
These currents are valuable in the treatment of muscular atrophy.
Leduc Currents.-Leduc's Apparatus for Low-tension Interrupted
Currents.2-The constant current from a galvanic battery, a storagebattery
I or a dynamo is interrupted by a wheel interrupter, which is
kept in revolutIon by an electric motor. The interrupter is placed in
series, so that one wire from the battery leads to the interrupter, and a
wire leads from the interrupter to one of the electrodes applied to the
"-
I
-'" ' ~ '---'
B A C D
Fig. 309.-Leduc interrupter.
patient. The wire from the other electrode applied to the patient leads
to the other pole of the battery.
The wire leading from the battery to the interrupter is connected
with a stationary brush which has a broad surface for contact with the
rim of a revolving disk. The latter consists of metal, but has two
insulated sections at opposite sides. The wire leading away from the
interrupter is connected with another brush contact, the position of
which is adjustable. When the movable brush is directly opposite the
fixed one, as in Fig. 309, A, both brushes are in contact with the conducting
part of the disk at the same time and for the same length of
time. As the disk revolves at a uniform speed, the current flows for a
certain length of time and then ceases to flow for a certain length of
time. These periods of current and absence of current are exactly proportional
in duration to the length of the conducting and the insulated
portions of the circumference of the wheel.
Displacing the mo"vable brush (as in B, Fig. 309) so that when every
part of the fixed brush is in contact with one end of the conducting
section, while only half of the movable brush is in contact with
the other end, produces a change in the relative duration of the
periods of current and no current. With the same speed of rotation the
lArch. d'elect. med", June 25, 1907.
2 Ibid., September 15, 1903.
-
476 MEDICAL ELECTRICITY AND RONTGEN RAYS
periods of current are only half as long as before, and the periods of no
current are increased by a certain fraction. Reference to diagrams C
and D (Fig. 309) shows that while the current begins to flow as soon as
the contact is made with the stationary brush, it is arrested before contact
with the stationary brush has ceased.
Different positions of the movable brush give periods of current
flow which are equal to, or are only !, t, To, :z'lr, or T~"O" the duration of
the periods of current arrest.
The number of periods per minute is varied by a rheo~tat controlling
the motor which turns the wheel of the interrupter .
The strength of current flowing during the periods of contact is
regulated by the ordinary means. In the case of a galvanic battery,
one can use a cell selector, regulating the number of cells in series or in
laMA. II r
~ b
Fig. 310."-Character of Leduc currents.
parallel or a rheostat regulating the outside resistance. A rheostat will
generally be required with a storage-battery. Both a rheostat and a
volt-controller or shunt are generally required when the 110-volt direct
electric-light current is used.
The strength of current ordinarily required is less than with the
galvanic current-usually from 1iI-to 15 ma., The maxim~m strengt.h
of 50 to 80 or more ma. sometImes used wIth the galvamc current IS
never to be used with the Leduc currents. The effect of the latter is
that of a series of abrupt makes and breaks, and this would be exceedingly
disagreeable, and perhaps dangerous, with strong currents.
The current strength may be measured by an aperiodic galvanometer.
This will indicate fairly well the average or effective strength of the
current, and from this and the relation between the periods of flow and
arrest one may, if desired, calculate the absolute strength of the current
when actually flowing.
The difference in potential at the two electrodes where they are applied
to the patient, and also the resistance of the patient's body, may
be determined by making a very brief observation with a voltmeter
connected in shunt with the two electrodes.
Character of Leduc Currents.- Each successive period gives the same
known strength of current flowing for the same length of time and in the
same direction.
Difference Between Leduc and Faradic Currents (Figs. 310 and 311).-
The faradic currents, on the other hand, show periods of current in alternate
directions, and the strength and duration of the successive impulses,
477 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
Dd even their periodicity, vary in consequence of imperfect action of
le vibrating interrupter. The latter may not make perfect contacts
very time. Advantages and Disadvantages of Leduc Currents as Compared with
'aradic Currents.-The advantages are chiefly due to the fact that the
llccessive currents are of the same known strength and occur at a known
ate per minute. The muscular response, a tetanic contraction lasting
s long as the interrupted current is turned on, is similar to that pro-
.uced by faradic currents, but electrodiagnosis is much more exact with
he Leduc currents. It is also easier to make accurate comparisons
letween reported cases and the one under observation.
The disadvantage is that the successive currents are all in the same
lirection, and the same polarization occurs which has such a tendency
;0 vitiate measurements and cause irritation when the galvanic current
a used. The faradic current is alternating, and is not open to this
)bjection. This objection to the Leduc current may be overcome by the
)ccasional use of the pole-changer, without which no electric apparatus
~an be considered complete, or by the use of an apparatus giving alter-
Dating Leduc currents, or, best of all, by transmitting the Leduc currents
through the author's rhythmic rheostat and pole-changer.
The Leduc apparatus may, therefore, be considered a most valuable
improvement over the faradic coil for diagnostic purposes. Its advantages
for treatment are not so well established, although Leduc's
"electric sleep" is thought to be a condition produced by the interrupted
unidirectional current which the alternating discharge from a faradic coil
will not produce. There is no doubt at all that the utmost regularity
in the successive currents is desirable in every case, but unidirectional
currents may not always be preferable to alternating ones. The fact
that the induced currents from a faradic coil have a higher voltage than
that of the direct primary current in the same coil does not enter into
the problem.. The Leduc apparatus allows of the application of currents
of equally high tension. Both the Leduc and the faradic currents
are, however, known as low-tension currents. High tension is a term
that applies more properly ~o the discharge from a static machine, an
Oudin resonator, or a Ruhmkorff coil. It means a sparking distance
measured in inches, not in thousandths of an inch, as in the Leduc and
the faradic currents. Leduc has found that the most effective stimulation of muscular
contraction is obtained when the duration of the passage of the current
is Tifl!lf second each time. Adjusting the appar3;tus for this le~gt?
of current waves and for a frequency of 100 perIods a second, It IS
simply necessary to determine the voltage necessary to excite muscular
contraction; or, what is sometimes more convenient, the milliamperage
required with electrodes of a certain area of contact.
The contractions ordinarily elicited by electricity are due to the
closing and opening of the circuit, and not to a uniform flow or absence
of current. They seem to be due to the variable period of the current;
a very short, but still a measurable length of time during which the current
is increasing from zero to its maximum strength or diminishing to
zero. The variable period of the current at the closure of a galvanic
circuit has been found by Blaserna to be 0.00048 second, and at the
oDening of the circuit it is 0.00027 second.
MEDICAL ELECTRICITY AND RONTGEN RAYS 480
jar already charged. The patient is not insulated, and the external
armature of the Leyden jar is connected with the ground, while the other
pole, the brass knob connected with the inner armature of the Leyden
jar, is brought near the patient (Fig. 313). A spark passes to the
patient, and produces physiologic effects which are of diagnostic and
therapeutic value, and especially so from the fact that the spark can be
applied exactly to the desired spot, and can be perfectly regulated as to
volume and consequently as to voltage. The author's technic is to have
the patient seated or standing or lying about 3 feet from the static
machine, but not upon an insulated platform. The operator holds a
Leyden jar, his fingers grasping the outer metal coating. A wire or
chain which need not be insulated is fastened to the outer coating, and
at its other extremity to a water or gas-pipe, which effectually grounds
it. The static machine is to be in operation, and its discharging rods
are to be fixed at a certain distance apart, and this regulates the voltage
of the charge. The latter cannot exceed the amount required to spark
across the air-space between the discharging rods. The Leyden jar
is held so that the inner electrode, that is, the brass rod connected with
the inner metal coating or armature, touches one of the discharging
rods of the static machine. It takes only a short time completely to
=:...<:tJJ
Pa/"'~nl-
<1. " '("
,-, , <, , " " ',1',
,) '> ~ ".' /
'c to3"0.."d
Fig. 313.-Isolated Leyden jar spark applied to patient.
charge the Leyden jar, and it remains charged until the inner electrode
is applied to the patient. A spark is then produced, the patient and the
earth completing the connection between the internal and external
armatures. From the standpoint of convenience in handling, as well
as with regard to the physiologic effect, the appropriate size of Leyden
jar is one consisting of a glass bottle 1.0 inches long and about 2, inches
in diameter, with external and internal armatures covering the bOttom,
and extending 3, inches up on the sides of the jar. The operator experiences
no sensation either when charging the jar or when applying
the spark to the patient. The capacity of the same Leyden jar is, of
course, always the same, but the quantity of electricity which it takes
to charge this capacity, as well as its tension, is increased when the
distance between the discharging rods of the static machine is increased.
This distance should be, inch at the commencement of the examination
or treatment, and may be gradually increased to 1., or possibly
2 inches, depending upon the nature of the case, the sensitiveness of
the region to which the spark is applied, and the individuality of the
patient. The spark may be applied through the clothes or directly
to the skin. Isolated condenser discharges may be applied in rapid succession.
and everyone be perfectly regulated. Almost any type of
00 8==
~
481 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
static machine will charge a Leyden jar amply for this purpose. It
does not require one of the large glass-encased machines with eight to
sixteen or twenty glass plates used for the generation of the x-ray.
Condensers for stimulating muscles or nerves have a capacity of
m"D", 1!-0-, or, at the most, 1\ microfarad.
The Leyden jar cannot be successfully charged for use in exactly
this way, either from an induction-coil or a transformer. The alternating
character of the impulses prevents the armature which is applied to
one pole of the coil from receiving a permanent charge of either positive
or negative electricity.
Leyden Jars or Other Condensers as an Essential Part of Highfrequency
Apparatus.-A single example will suffice to illustrate this
use of the condenser principle. Fig. 314 shows a form of resonator
employed by the author. P and P' are the poles of an x-ray coil or an
x-ray transformer, whose discharging rods or spintremeter are wide
apart. A conducting cord passes from each pole of the coil to the in-
-
Fig. 314.-Leyden jars as part of apparatus for generating high-frequency currents.
ternal armature of a Leyden jar, and between the internal armatures of
the two jars there is an adjustable spark-gap, S. G., surrounded by a glass
cylinder to muffle its noise. The external armatures of the two jars are
connected one to the beginning of a flat spiral of insulated wire, and the
other to the second, third, or fourth turn of the spiral, according to the
effect desired. The internal armatures of the jars act as large capacities
because each forms part of a condenser. A sufficient output is required
from the coil or transformer to overcharge the Leyden jars at each impulse
from the coil. Taking the right-hand jar, for instance, its internal
armature receives at a certain instant a positive charge which drives
the positive electricity from its external armature through the desired
number of turns in the spiral resonator to the outer armature of the other
jar. At the same instant the internal armature of the other jar has
received a negative charge, and the negative electricity is repelled
from its outer armature through the resonator to the outer armature of
the other jar. The result is that the outer armature of one Leyden jar
is charged with positiye and that of the other jar with negative elec-
Q1
MEDIcAL ELECTRICITY AND RONTGEN RAYS 482
tricity. Though there is a complete metallic connection between these
two opposite charges through the wire of the resonator, they are held
bound upon the surface of the glass by the charges upon the inner armatures.
When the latter are discharged by a disruptive discharge across
the spark-gap, and the charges on the external armatures are liberated,
a discharge at once takes place through the resonator turns, and this is
of the same high-frequency character always found in a discharge of
static electricity, and especially the discharge of a Leyden jar .Thousands
of oscillations occur in the conductor through which the discharge
takes pJace in the small fraction of a second required completely to
neutralize the two opposite charges. The term high frequency refers
to these millions of oscillations each second, not to the few score, or
possibly a few thousand, disruptive discharges a minute which are
directly visible and audible at the spark-gap. The condenser stores up
the energy of each current induced in the secondary of the induction-coil
or transformer, and ~ives.itwhat may be called a static quality, resulting
in inconceivably rapId oscillations each time that a discharge occurs.
The resonator or spirafwire acts as a self-inductance, and increases
~he voltage of the electri~ity supplied to it, so that an efHuve from 1 to 4
mches long may be obtamed at the electrode.
The condensers act in the same way in all thehigh-frequency apparatus,
in connection with resonators. and solenoids of different types.
These act eit}ler to increase the electromotive force, or as choke coils to
reduce it, or again, in auto conduction cages, to induce high-frequency
currents in the patient. .
Condenser Electrodes.-These are especially useful in the application
of high-frequency currents. Fig. 315 shows one type with a leadingin
wire and a metallic rod extending down through the middle of a glass
Fig. 315.-A condenser electrode.
tube, which is closed at the extremity. The tube contains air or other
gas which mayor may not be partially exhausted. When this electrode
is applied to the skin or to a mucous membrane, the patient's
body becomes t~e external armature of the condenser. The glass and
Fig. 316.-A condeneer electrode.
air of the tube form the dielectric and the metal rod the inner armature.
Another condenser electrode (Fig. 316) consists of a metal rod with a
hard-rubber covering.
The ordinary vacuum electrodes (Fig. 317) for high-frequency currents
have a similar principle. If they have a leading-in wire the communication
of the high-frequency charge to the contents of the tube is
Derfectlv direct. If there is no wire. the metal Ro~kpt of thp hll.nrJ]f!
483 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
Jrms one armature of a condenser in which the dielectric is formed by
le glass wall of the tube where it is in contact with the metal socket.
'he handle is charged with positive and negative electricity in exceed-
19ly rapid succession, and with each positive charge of the handle the
,ositive charge of the inner armature, the contained partially rarefied
;as, is repelled. With each negative charge of the handle the positive
harge of the gaseous contents surges back to a point within the glass
,ube where it is separated from the charged handle by only the thickless
of the glass. At the other extremity of the vacuum tube a similar
nductive action is produced; the positive charge repelled from the
.-egion of the handle forms the posltive charge of a condenser whose
inner armature is the rarefied gas, whose dielectric is the glass wall of the
tube, and whose external armature is the surface of the patient. -The
latter receives by induction a negative charge, negative electricity in
the patient's body being attracted to the surface of the glass dielectric,
and positive electricity being repelled to the most distant possible part
of the patient's body. With the exceedingly rapid alternations in
polarity which characterize the high-frequency current, electrostatic
charges surge back and forth through the patient's body. These originate
in and are concentrated at the surface of contact with the vacuum
electrode, where the local effect is, therefore, greatest. They extend to
every portion of the body, as can be easily demonstrated by touching
any part of the patient lightly with the tip of the finger-nail. The
Fi~. 317.-A vacuum electrode.
characteristic violet light is seen between the finger and the patient,
and there is a slight smarting sensation from the passage of innumerable
microscopic sparks. The experiment produces no shock or muscular
contraction, and none of the sensation which has so long been associated
with the name of el~ctricity. Chemic changes produced by the current
in the deepest tissues show that the charge is not limited, as ill the case of
static electricity, to the surface of the body, but that it also penetrates
every portion of the body.
Another type 01 condenser electrode is made by filling a glass tube
with a liquid which is a good conductor, or by coating its interior
with metal. Condenser electrodes filled with salt solution have a greater
electric capacity than vacuum electrodes of the same size and shape.
They give a somewhat stronger current with the same adjustment of
the high-frequency apparatus, but do not themselves become hot, as do
the vacuum electrodes. This is a noteworthy advantage over the latter.
They are not liable to be ruined by breaking down of the vacuum,
leakage that is, which is practically impossible to repair in the case of a
vacuum electrode, and which is usually the result of overheating at the
handle or of an excessive current puncturing the dielectric, or of mechanic
violence, screwing the handle on too tight,. or knocking the tube against
some hard object. This type of condenser electrode does not get hot j
it does not contain a vacuum, and is, therefore, not affected by a minute
fissure which would terminate the usefulness of a vacuum electrode.
484 MEDICAL ELECTRICITY AND RONTGEN RAYS
It does not contain a space filled with violet light and ultraviolet rays,
but, like the vacuum electrode, it generates a certain amount of ultraviolet
rays where minute sparks pass between the glass. and the surface
of the patient. In other respects its effects seem to be identical with
those of the vacuum electrode.
The Reason Why a Glass Tube which Has Lost its Vacuum Does Not
Act as a Condenser Electrode.-In the first place, a glass tube which has
not been exhausted, but which has only a small fraction of an inch of
air between the glass in contact with the patient and the charged wire
or other conductor, really does act as a good condenser electrode for
Fig. 318.-Principle of the vacuum electrode in contact with the patient.
high-frequency currents. Such an electrode may consist of a glass
tube sealed at the end applied to the patient, and having a wire extending
practically its whole length. A small thickness of air acts as
part of the dielectric, the other part being the glass wall, and the two
armatures being the wire and the patient.
The ordinary vacuum electrode presents quite different conditions.
There is along space of perhaps as much as 6 inches between the glass
in contact with the patient and the charged metal handle or leading-in
wire. Electric induction cannot take place to a sufficient extent in a
condenser having a dielectric 6 inches thick, and air at the ordinary
.&Ii'enf
-
Fig. 319.-Principle of the vacuum electrode held at sparking distance from the p8.tient.
.
pressure will not act as a conductor of electricity unless ionized. And
even then it is not a sufficiently good conductor for this purpose. The
vacuum electrQde contains air or other gas at a pressure of ri1-0--o- atmosphere,
the Geissler degree of vacuum, which is an excellent conductor of
the high-frequency current.
The operation of the condenser electrode may be diagrammatically
shown as in Fig. 318. At a certain instant the metallic handle from the
high-frequency apparatus may have a positive charge. It induces,
through the glass at that point, a negative charge in the conducting
medium, e. g., rarefied air or saline solution, contained in the tube, and
conseauentlv a positive charge in the distal portion of the conducting
485 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
medium. There again a condenser action occurs inducing a negative
charge in the portion of the patient in contact with the glass. At the
next instant the.polarity is reversed at every point in the series.
The Operation of the Condenser Electrode When at Some Distance from
the Patient.-Fig. 319 shows this in a diagrammatic way. At the instant
that the distal portion of the conducting medium is charged with positive
electricity, a condenser action takes place, producing through the glass
and open-air dielectric a strong negative charge in the nearest portion
of the patient. If the air-space is only a fraction of an inch, this negative
charge will break through the layer of air as an efHuve or as a
shower of sparks, as the case may be. In the diagram a negative charge
is shown to have accumulated in this way upon the surface of the glass,
held there just as in the "dissected Leyden jar."
THE USE OF CONDENSERS IN CONNECTION WITH INDUCTION-COILS
This is of the greatest importance, and has been considered on p. 139.
NEURALGIA AND NEURITIS
Satisfactory distinctions between the neuralgias and neuritides are
not easy to draw. The severe neuralgias pass over into mild or severe
neuritides, whereas, the mild neuritides may be considered as neuralgias.
It is largely a question of degree. So far as the severe neuritides are
concerned, however, certain grave alterations are found in the nervetrunks
which are not known to exist in neuralgias. Such are cell infiltrations
in and about the nerve-fibers, proliferation of new connective
tissue causing pressure, and various degenerations which are usually
peripheral, but which also may be interpreted as central in origin.
The chief neuralgias which are amenable to electric treatment and
which the electric therapeutist is oftenest called upon to treat are those
of the trigeminal, brachial, the musculocutaneous, and the sciatic nerves.
There are other neuralgias, such as ovarian, coccygeal, the neuralgias of
herpes, etc., which occasionally call for electric treatment, but in general
those of the facial region, brachial, and of the sciatic distribution are the
most obstinate.
In the consideration of the treatment of the neuralgias one should
bear in mind always the question of referred pains. These referred pains
have been so exhaustively studied by Head, Dana, McKenzie, and others
that we are now in a position to refer the vast majority of the so-called
neuralgias to certain disturbances in the viscera. These visceral disturbances,
as is well known, send or cause nerve impulses to travel to the
spinal cord, which, coming ill some sort of contact with certain sensory
nerves in the spinal segment, are referred to the skin area of these segmental
nerves.
These skin areas have been very accurately mapped out by the
researches of the authors mentioned, and it is well known, through
these researches, that the whole surface of the body may be divided
into areas which correspond to or represent the cutaneous surface in
contact with the nerves of the visceral organs. .This leads to the development
of cutaneous tenderness in practically all referred pains, and this is
a very essential factor in the diagnosis of this type of so-calledneuralgias.
These cutaneous tendernesses have a marked feature in contrast with
the pains, which are perceptible over the area of a nerve-trunk, such as
are frequently seen in the neuritides.
486 00
MEDICAL ELECTRICITY AND RONTGEN RAYS
Thus in the investigation of the neuralgias special care must be
taken, first, to outline the importance of visceral diseases; secondly,
to determine if such neuralgias may be due to growths on or pressing
upon the nerve-trunks; and, finally, to consider the specific type of herpes
neuralgias which are due to the involvement in the posterior ganglion.
It should be borne in mind that such involvement in the posterior ganglion
may set up very severe neuralgias without a corresponding herpetic
eruption, although, as a rule, a skin eruption is apt to follow the inflammation
of the posterior root ganglion. These herpetic areas are clearly
outlined in works on neuralgia, and the relation of visceral disease to
herpetic inflammation is one of the most interesting chapters connected
with sensory localization.
The electric treatment, therefore, of the different neuralgias must
take into consideration the manifold origin of these affections. The
treatment of neuralgias due to visceral diseases-in otper words, the
referred pain neuralgias-consists essentially in the use of electricity
as a counterirritant, the counterirritant being applied, if possible, in the
area corresponding to the viscus affected. Medical treatment of the
viscus should not be overlooked, being often of more value than the
electric treatment of its reflection only, so to speak.
Referred pains in the head, neck, and face are frequently the result
of disease of the nose, the eye, the ear, the tongue, the teeth, the tonsils,
the larynx, or of the brain itself. Finally, a number of the internal
viscera, such as those of the thorax and abdomen, which receive their
nerve-supply from the vagus or the glossopharyngeal nerves, are capable
of inducing referred pains in and about the head and neck, and some very
persistent neuralgias of the face are often due to disease of viscera below
the diaphragm.
Electric Treatment of Neuritis.-In cases of neuritis the nerve is
usually to be treated by galvanic currents; the paralyzed muscles, by
faradization or galvanofaradization.
Sinusoidal currents may be applied in the same way as faradic or
galvanofaradic currents, and often succeed in cases of neuritis wher~
these currents have failed:
Static Induced Sparks for Neuralgia.-These are applied by a metal
electrode through the intermediary of a static regulator. Direct static
sparks are also useful.
Trigeminal N euralgia.- The most persistent of all the neuralgias
of the face is that known so widely as tic douloureux. This
belongs to the group of neuralgias due to disease of the sensory ganglion.
It differs, somewhat, although not always, from the ordinary
herpes neuralgias in that it is more persistent, more severe, is usually not
associated with paralysis, and does not cause an herpetic eruption. This
is not an absolute rule, but is the general course of the disease. Any
one of the chief branches of the fifth nerve may be involved, and in the
more protracted cases it is usual to find that all the distribution of the
fifth nerve is implicated, and in the chronic cases certain tr9phic changes
usually accompany the onward progress of the disease.
Ordinary faradic or galvanic electricity, more particularly faradic,
is practically of no value in the treatment of trigeminal neuralgia, save
perhaps in the very early stages. The principle of a counterirritant
does not apply to these cases, as it does to the treatment of referred
pains. Certain modifications of electric treatment, however, have
487 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
Dved of service in this persistent form of neuralgia. Thus high-
~quency currents and high-voltage currents have shown themselves to
of value, and the treatments advised by Bergonie and Leduc have
en reported as efficacious. Leduc 1 has reported an inter{;sting case
which he has been able to apply, by the method of cataphoresis, the
ns of quinin with permanent relief. The case was that of a woman
xty-eight years of age, who developed a tic douloureux after refrigera-
:>n. The inferior branch alone was involved. The area was exlisitely
tender, and the slightest variation in temperature caused
paroxysm. She was unable to swallow anything cold, and even the
'owing of cool air upon her face was unbearable. She was unable to
eep, her teeth were sacrificed to no advantage, and the submaxillary
erve was divided and the lower jaw resected without results. Bichlorid
~ quinin in 1 per cent. solution was applied electrically for half an houri
,ith a current which was gradually raised to 20 ma. This gave rise to
~dness in the skin and edema, but there was a marked diminution in the
ain, and the patient was able to sleep. A second application was
lade three days later, since which time (one month after the application)
here had been no return of the pain. Leduc has never given the
ubsequent history of this case, and it is certain that to report such a case
ne month after does not prove the permanent efficacy of cataphoresis
tl the treatment of this affection.
Bergonie has advised a method of applying very heavy currents
.y means of electrodes which cover the entire side of the face. The curent
is applied in as large doses as from 60 to 80 ma., the active electrode
'aluminum electrode covered with damp wadding or clay) being the
)ositive pole, and being very accurately fitted to the surface and modelng
of the face. The duration of the application should be at least half
~n hour.
Bergonie' 8 M ethod for Trigeminal N euralgia.-Correct technic is
~xtremely important 'when applying currents of this strength, in order to
Lvoid dangerous shocks or burns. The electrodes must be large, and of
luch a nature that the current will be uniformly distributed over all
points of contact. An ordinary sponge electrode often has one or more
?laces where the metal is almost directly in contact with the skin, and
::onsequently practically the entire current would pass to the skin at a
small spot and produce a burn. The active positive electrode is made
)f sheet metal fitted to the shape of the side of the face, and with three
prolongations extending over the forehead, the upper jaw, and the
lower jaw. Felt, clay, or kaolin ~et with solution of sodium bicarbonate
prevents any metallic contact with the skin. The indifferent, negative
electrode is of the same nature, and is applied at the nape of the neck
or between the shoulder-blades. A rheostat should be used to turn the
current on and off extremely gradually.
A continuous current of as much as 60 ma. will sometimes succeed in
greatly relieving a case of trigeminal neuralgia after extraction of teeth,
nerve resection, and removal of the Gasserian ganglion have failed-and
the improvement may be permanent.
The Method of Mild G(llvanization.-Three to twelve milliamperes
may be applied for an hour at a time from similar electrodes.
Di8tribution of the Current in Applications to the Face.-The heavy
galvanic currents which are sometimes applied for facial neuralgia,
1 Archive de Electricite Medicale, 1904.
488 MEDICAL ELECTRICITY AND RONTGEN RAYS
either for the effect of the currents themselves or that of the medicinal
ions carried by the current, do not pass in a straight line from the active
electrode to the nape of the neck, where the indifferent electrode is
placed. The current is diffused through every part of the head and neck,
but is of greatest density along paths of least resistance. It passes with a
practically uniform density through all parts of the skin in contact with
the electrode, and also through muscles and fascia. When it comes to
bone, it encounters resistance which is very much greater than at the
different foramina and the vessels and nerves passing through them.
The greater part of the current, therefore, follows these important structures
and passes through the Gasserian and other ganglia and the brain,
cerebellum, and medulla.
The symptoms observed by Gautrelet (p. 392) from the application
of similar currents in rabbits are due to a primary stimulation and an
ultimate paralysis of the nervous system along these conducting paths.
The method of heavy currents for long applications is to be applied
with great caution, and only by an expert physician. The following
physiologic effects are introduced at this point to enforce this admonition.
Although the electric treatment of trigeminal neuralgia is of great
service, particularly in the milder cases, it cannot be said that at the
present time any sure electric method is known for the very severe
cases, and one must sometimes have recourse to surgical procedures
which have been advised. Alcohol injections into the substance of
the Gasserian ganglion or the affected branch of the nerve have proved
to be the simplest and most efficacious method of treating these affections.
Such injections are easy of application, are not attended by
any disastrous by-effects, and the experience of Schlosser, Levy, and
others shows that relief may be given for yeats at least, even if such
injections do not make a permanent cure.
Treatment of Trigeminal N euralgia by x-Ray and by High-frequency
Currents.-These important and often successful methods are described
onpp.573 and 1084.
Radium.-This has also been used, but without lasting success, in
the cases which the author has seen. ,
Cervicobrachial Neuralgia.-Neuralgia in one or more of the
branches of the brachial plexus is not infrequent. The pain is usually
felt in the neck, and shoots down the nerve-trunks to the arm and forearm.
Movements of the arm are usually very painful, and the hunched-up
shoulder and half-carried arm are characteristic of the attitude of these
patients. The most frequent causes of brachial neuralgias are exposure
to cold or i~jury, tumors, and poisoning from gout, alcohol, lead, or
syphilis.
Brachial neuritis may be an expression of a greater degree of injury
in the nerves at their origin in the plexus., or somewhere in their course.
Here the pain is apt to be more severe, the nerve-trunks themselves
become tender, and trophic changes take place in the muscles, the skin,
and the nails.
The deltoid muscle, for reasons as yet little appreciated, is apt to
develop a deltoid neuralgia or neuritis. It is, as a rule, a mild inflammation
of the circumflex nerve. It is a not infrequently annoying
trouble among people who write considerably, and may perhaps be
classed at times as an occupation neurosis. It is a not infrequent dis-
489 EJ.ECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
order among workers with the broom, and is seen here in some of its
more severe forms.
In the diagnosjs of the site involved in cervicobrachial neuralgia and
neuritis certain additional symptoms are of value. In inflammations
low down in the cervical area, involving the first dorsal, pain over the
clavicle is very marked. Furthermore, a neuritis in this region is apt to
involve the sympathetic fibers, which have a relation here with the upper
dorsal segments of the cord. The evidences of these sympathetic signs
are a slight retraction of the eyeball; the lids come closer together on
the affected side, the outer angle droops, and there is a slight contraction
of the pupil on the affected side, with diminished light contractility.
Some cases show a dilated pupil on the affected side.
Many of the severe cases of brachial neuritis are extremely obstinate,
persisting at times for months rather than weeks, and they tax the
therapeutic resources of the attending physician.
In addition to ordinary methods of treatment by rest, salicylates,
iron, heat, and general supporting measures, counterirritation by
means of the actual cautery and the use of electricity are the two most
satisfactory measures to employ.
Electric currents are harmful in the very early stages of the affection,
and practically the only forms that are of service are the direct, highfrequency,
and sinusoidal currents. Induction currents are usually
harmful. Exercise, at least so long as pain is present, is very prejudlcial.
A mild galvanic current, not over 5 or 6 milliamperes, should be
applied. The positive pole is to be applied over the painful nervetrunks;
the negative pole, to the back of the neck. The currents should
not be interrupted, but should pass continuously over the affected nervetrunks
for at least ten minutes. The pole should be shifted from time to
time, but not removed from contact with the arm.
The sinusoidal arm bath is of value when the pain has receded
to such a degree that the pain is felt only on movement. High-frequenc':
t currents are often beneficial in the treatment of the chronic
painful stages of the disease. They relieve pain greatly, even when
they exert no marked effect upon the course of the neuritis.
Intercostal Neuralgia.-Bergonie's method of covering the painful
area with a large positive electrode and applying currents of .1)0 to 80
ma. for half an hour at a time is effective here. The same careful
technic is essential as in cases of trigeminal neuralgia. The x-ray is
very effective in these cases. Glass vacuum electrodes from the Oudin
monopolar resonator also succeed very well. A local electric-light bath
is excellent, producing its effect chiefly by dry heat, and if the skin is
slightly blistered, this does not cause pain.
Sciatica.-This is perhaps the most frequent of all the neuralgias
of the body. Lying, as it does, in an exposed position, the sci&,tic nerve
is subjected to frequent stretching, and not infrequent chilling and
trauma. It is a medley, in reality, of conditions rather than one, and
what has been written with reference to the occurrence of referred pains
must be borne in mind in all cases in which pain in the sciatic nerve
distribution is found.
As a referred pain, sciatic neuralgia is frequently found as a result
of affections of the prostate gland, of hemorrhoids, of fissure of the anus,
and in a few visceral conditions in women associated with retrodisplace-
490 MEDICAL ELECTRICITY AND RONTGEN RAYS
ments and procidentia. These are not cases of true sciatic involvement,
although the severity of the pains may lead to such a diagnosis. In much
the same way chronic hip-joint affections may give rise to sciatic pains.
Pressure on the nerve from chronic constipation, from a pregnant
uterus, and from tumors is to be borne in mind. Chronic progressively
increasing pain in the sciatic distribution points to a tumor pressing
upon the nerve-trunk within the pelvis.
Finally, one has to bear in mind that specific herpetic eruptions
occurring in sciatica point to inflammation in the sensory ganglion.
These cases are frequently severe, but are apt to recover with a fair
degree of rapidity.
The symptoms will vary much. The referred pain sciaticas are not
of very wide distribution as a rule; those due to herpes may involve
most of the branches. The true perineuritic sciaticas vary considerably,
sometimes involving only a few branches, at other times occupying most
of the entire distribution. The agonizing and paroxysmal nature of the
pain is one of its chief characteristics. It is usually increased by movement
of any kind, and more particularly so by all those movements which
call for hyperextension of the nerve. Tenderness along the nerve-trunk
is usually present. It is apt to be absent in the referred pain sciaticas.
As a rule, the pains are worse at night, and eventually the patient is
forced to limp and hold the limb stiff, frequently giving rise toa distinct
and typic posture, with a resulting deformity ..
So far as electric treatment of sciatica is involved, it should be
considered purely as an adjuvant, although high-frequency current
applications and those of Leduc's low-tension interrupted current are
often of immediate and permanent relief in a number of the most intractable
cases.
In the referred pain sciaticas counterirritation by the faradic brush
or the static breeze is of signal service, but is useless in the severe perineuritic
cases.
Heavy constant currents- are valuable for their sedative effects.
Large electrodes should be used, and long applications are necessary-
30 to 60 ma. for from ten to twenty minutes-one electrode over the
iliac fossa, the other to the sciatic nerve in some part of its course.
Both ascending and descending currents should be tried, since the determination
of the best direction of the curren.t has been, and is still, the
subject of considerable controversy. In both acute and long-standing
cases high-frequency currents are of very great service. They seem
to have most value in cases in which thickened painful nerve-trunks are
present. Just why, is not known. It is highly injurious to attempt
to treat sciaticas of the perineuritic type too early. Absolute rest is the
first requirement if one would avoid the chronic infiltration connectivetissue
changes which inevitably lead to the more protracted chronic
forms of the disease. Even the use of the constant current, which is the
only admissible form, should not be begun prematurely.
Various forms of the sinusoidal current are useful in the subacute
stages. The bipolar bath with this type of current is most satisfactory.
It should be used only when relief follows its application. If such
usage provokes pain, it is wiser to delay its application.
In the very obstinate forms it may be assumed that adhesions have
been formed. These may frequently be diminished by the use of highfrequency
currents and ultraviolet ray emanations. The results in some
of the author's cases (P. 573) have been magic.
491 ELECTRICITY IN DISEASES OF THE NJi1RVOTTS SYSTEM
Chronic Sciatic Neuralgia.-Galvanic, Faradic, and Static Applica-
~s.-Weak Galvanic Currents.-Eight or ten milliamperes may be
)lied, as already described for heavy currents; or Benedikt's method
,alvanization of the sacral plexus by a metallic electrode in the rectum
i a large electrode over the sacral or lumbar regions; an electric lavage
Ly be used instead of the metallic ~Iectrode for the rectal pole. Farad-
:tion may be applied by sponge electrodes, one over the lumbar
~ion and the other over different painful spots and the affected muscles ;
the active electrode may be a faradic brush, and, if so, the secondary
il should be of fine wire, to avoid muscular contractions. Static
sulation followed by static sparks along the spine and the sciatic nerve,
,d static induced currents are all useful.
Static Induced Currents for Sciatica.-The patient is not insuted,
and holds a large plate electrode connected with the external
mature of the positive Leyden jar upon the skin of the epigastric
gion. A small metallic ball electrode from the external armature of
le other Leyden jar has an insulated handle by means of which it is
)plied to the skin in the lumbar region over the emergence of the sciatic
~rve from the vertebral canal, and then to the different painful spots
ithout breaking contact with the skin. The discharging rods of the
atic machine should be separated far enough to produce visible conaction
of the lumbar muscles at each spark. This separation will
sually be less than half an inch. After ten minutes' use of the negative
ectrode the connections may be changed so as to make the positive
'ectrode the active one. A static bath with powerful sparks along the
Iwer part of the spine and the sciatic nerve may be given at another
'eatment, alternating with the static induced current treatment. The
est results are obtained from daily treatments, and De Bloisl reports
0 cures out of about 100 cases treated.
General M easures for Sciatic N euralgia.-A great many cases require
)me general treatment, dietetic or medicinal, and by static baths or
ydro-electric baths with sinusoidal currents, without which the local
lectric treatment may fail.
The Method of Galvanization for Acute Cases of Sciatic Neuralgia.l-
'his is applicable from the very first moment of the attack, but does not
ucceed so well after the case has become chronic. An electrode,
>referably the positive, but this is not essential, 6 by 7 inches in size,
s placed over the upper part of the sciatic nerve, a convenient way
>eing for the patient to sit upon this electrode. The other electrode is a
arge one, bent so as to fit around the calf of the leg; or the other electrode
nay be formed by a foot-bath extending up to the ankle. A certain
tmount of glycerin added to the water will prevent a burn occurring at
'jhe upper surface of the water, Wearing a stocking also acts as a preventive.
The current strength is to be from 30 to 50 ma., and is to be
~pplied for half an hour to an hour-at first, every day.
The prognosis may be judged of by the results of the first few treatments.
li this treatment has been begun a few days after the outset
of the attack, and no marked relief is obtained in seven treatments, the
case is probably dependent upon a constitutional cause, and it will take
several weeks to effect a cure. If relief is prompt, the case will be cured
sooner.
Galvanic Currents for Sciatic Neuritis.-There is the same arrange.
1 La Presse medicale, Apri119, 1905,
2 Albert Weill, Jour, de Physiotherapie, Au2Ust, 1903.
492 MEDICAL ELECTRICITY AND RONTGEN RAYS
ment of electrodes, but the application is much weaker and shorteronly
8 or 10 ma. for about ten minutes. The positive electrode may be a
roller electrode passed over the different muscles which are painful or
show trophic changes.
Of recent years it has been suggested to uSe certain remedies which
are thought to have an effect in di~inishing the proliferation of connective
tissues. Such a remedy as potassium iodid has been used for years,
and with a certain amount of success, but its range of usefulness is very
narrow. More receI}tly thiosinamin and fibrolysin have been recommended
in the treatment of conditions accompanied by proliferation
of new connective tissue. The former has a very limited range of application,
but the latter may be tried in some of the chronic cases accompanied
by thickening of the nerve-trunks when other remedies have
ceased to be of service. Massage in combination with electricity is
frequently of value, but should never be used in the acute or subacute
stages, that is, when the nerve-trunks are tender. Just what electrolytic
ionization may do for the perineuritic sciaticas is an open question.
Surgical procedures, such as stretching the nerve, are hazardous,
but dissection and actual division of definite adhesions which may be
found and longitudinal splitting of the nerve has been practised to advantage.
Treatment of Lumbago by Faradization.-Sponge electrodes 2
inches in diameter are applied, one on the vertebrre and the other shifted
from one painful spot to another. The fine wire coil with very rapid
vibrations is used, and the strength is increased as toleration is established.
Mechanic vibration of th3 affected muscles finishes the treatment,
which takes ten minutes and may be repeated once or twice a day.
Electricity in Renal Pain.-It often happens that a patient who is
sent for x-ray examination for .calculi, and in whom none is found, will
be very much benefited by the x-ray exposure.
Galvanofaradic currents as strong as the patient can bear may be
applied from two electrodes about 4 inches in diameter, placed one
in front and one behind the painful kidney. ,
Neuralgia of the Testis.-Thisis treated by positive galvanization
with as strong a current as can be borne. The testicle is wrapped in
moist cotton, outside of which is lead-foil connected with the conducting
cord. The negative electrode should measure 4 by 5 inches, and is
applied to the lumbar region.
ELECTRICITY IN TREATMENT OF ORGANIC DISEASES OF THE CENTRAL
NERVOUS SYSTEM
SPINAL CORD
The chief diseases of the spinal cord may be grouped as those due to-
(1) Disease of the motor ganglia-poliomyelitis type.
(2) Disease of the motor paths-lateral sclerosis type.
(3) Disease of the sensory paths-tabes dorsalis types..
(4) Diffuse disease-myelitis type.
(5) Intraspinal disease-syring<:>myelic type.
Diseases of Motor Ganglia.-Poliomyelitis; bulbar palsies in higher
distributions; chronic atrophies (Poliomyelitis chronica), mixed types;
amyotrophic lateral sclerosis. The chief diagnostic features of the poliomvelitis
syndrome are loss of tendon reflexes. muscular atrophy. trophic
493 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
listurbances, no sensory phenomena, reaction of degeneration. Grave
'orms of neuritis often may be confused with poliomyelitis, but the pain
31ement in the former affection usually suffices to make a differential
diagnosis.
Acute Poliomyelitis-lnfantile Spinal Palsy.-There is abundant
evidence tending to show that this, of all the affections of the nervous
system, responds with marked advantage to the use of electricity. There
is almost no time following an attack of poliomyelitis after the very
acute symptoms have passed when electric treatment may not be of
service. The ancient dictum that if reaction of degeneration has been
present for at least three months regeneration may not be looked for is
totally false, and considerable degrees of recoverability may obtain
after more than two or three years of absolute loss of electric excitability.
It is becoming more and more apparent that the involvement of the
ganglion-cells in poliomyelitis is extremely irregular, and there is abundant
evidence tending to show that rarely are all the cells in the nuclei
supplying the muscles equally affected. Thus, notwithstanding very
severe and deep implication of a muscle group, many of its fibers are
spared, and the ganglion-cells are capable of stimulation; with retardation
of further degeneration in the muscular fibers. This appreciation that
functional muscle-fibers are often retained for a long time in infantile
paralysis was first pointed out by Duchenne, of Boulogne, and it is very
easy to neglect this point of view in the study and treatment of these
cases. Special efforts should, therefore, be directed to the cultivation
of these residual sound fibers, in order that they may themselves retain
what capacity they have, which, without proper physiologic stimulus,
would inevitably be lost.
The more extensive the nucleus of origin of any group affected may
be, the more certain it is that sound fibers and unaffected cells will be
found. It is, therefore, of great importance in making the diagnosis of
any given case, so far as electric results are to be obtained, to bear this
definite fact in mind. Reference to the cell groups in the cord (see p.
449) may be made to determine this point.
In general it may be said that the grades of injury in acute poliomyelitis
are at least threefold. Certain muscles show great weakness, but
are not completely paralyzed; reaction of degeneration varies within the
limits of the muscles, but it is not absolute all over; trophic changes are
not present to any marked degree, and there are few evidences of temperature
changes in the affected member. These are the muscle groups
for which mild exercise, passive movements, and massage result in
ultimate recovery, but there is no doubt that electric stimulation, if not
begun too soon, at least not for eight to ten weeks after the onset of the
paralysis, will hasten the recovery very distinctly. Even after years of
neglect such muscles may be helped by proper electric stimulation, particularly
in those cases in which the reaction of degeneration is not
marked or is absent. Cases are certainly on record of some ten to
fifteen years' standing in which improvement has followed the electric
treatment.
As for those patients in whom complete reaction of degeneration is
found, less can be done by electricity. They are not hopeless, however,
by any means, and a marked return of power may be found in muscles
which, for a long time, have shown very typic reaction of degeneration,
even when it has extended over a considerable period of time-even as
Tr\""h R.~ five or ten vears.
494 MEDICAL ELECTRICITY AND RONTGEN RAYS
In the treatment of these cases of poliomyelitis care should be taken
not to commence electric, and mechanic treatment as well, too early.
While the ganglion-cells are acutely inflamed it is harmful to excite them
electrically, and only after these little patients have been at rest for
a period of from eight to twelve weeks should the more active use of
electricity and forced movements be begun. In some cases where contractures
have a tendency to come on early, proper orthopedic procedures
and the stimulation of antagonistic muscles may be advisable.
The early electric treatment should not be begun so long as there
is any tenderness in the muscles or in the nerve-trunks. The presence
of pain in these patients should not be overlooked. In the early stages
it argues for a meningeal involvement.
After careful tests are made and the results recorded, each muscle
being tested systematically as to its motor point and its muscle substance
and tendon reaction, treatment should be directed toward stimulating
the unusable muscles. The galvanic and faradic battery currents
are those mostly employed. In the cases in which change of temperature
and trophic disturbances have boon observed the early signs
of repair are noted in the gradual modification of these symptoms to
conditions more nearly approaching the normal. The circulation improves,
the limbs commence to fill out, the blueness becomes less marked,
and the temperature rises.
Electric treatment may be carried out in a bath or by ordinary electrodes,
and should be aided by manipulative movements, light massage,
and passive resistance movements.
Later, electric reactions commence to appear as the few non-diseased
fibers commence to take on normal functions. The first reactions are
usually those in response to the in~uction-coil.
The static wave current has been applied for a profound local effect
in infantile paralysis. Electrode of 22-gauge soft metal, 11 by 8 inches,
to upper half and lower two-thirds of spine alternately for twenty
minutes with 8 or 10-inch spark-gap from 8-plate static machine.1
E.'l;ercising Paralyzed M uscles by Static I nduced Current.- The large
indifferent electrode, 10 by 14 inches, is moistened and applied to the
back. Smaller ones are strapped to several different affected muscles
and all connected. Connections are made with the outer coats of the
two Leyden jars. Slow speed is turned, and a spark-gap that will yield
marked but not painful contractions (140 per minute) for about ten
minutes.
Light, mechanical vibration, and massage are also used.
Jones.' summary represents the author's position so thoroughly that
we cannot refrain from quoting it in this place :
" In every case of. infantile paralysis which is not clearing up satisfactorily
it is important to apply electric treatment, continuing it for
six months to a year or more.
" I.t is th~ exception for a muscle to be so completely destroyed by
poliomyelitis as to be without any functional fibers, and these remaining
fibers can be cultivated by persevering stimulation of theIIi.
" Where the muscles show only the reaction of degeneration, or even
where reactions are entirely abolished, some improvement may be hoped
for in a good percentage of cases.
" The amount of restoration which may be possible in a muscle will
1 W. B. Snow, Jour. Advanced Therap.. October. 1912.
495 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
epend upon the number of surviving ganglion-cells. With prolonged
reatment recovery advances very much farther than one might expect,
nd is !nfinitely superior to the results obtained when treatment has not
leen given.
II Even where the electric reactions are not altered in quality, it is not
;ood practice to leave the case to take care of itself."
Chronic Poliomyelitis-Progressive Muscular Atrophy.-This is a
arge group of cases of varying causation, pathologic change, and outlook.
:t is difficult to treat them all as one disorder. Two general types are
;0 be differentiated-the neuritic and the central. Irregular reactions
jO electric currents are found in both. In the ultimate stages of com-
:Jlete atrophy absolute loss of electric response is the rule- " The results of electric treatment in these atrophies are not to be
viewed in an oversanguine light. There is no doubt that conscientious
j,nd consecutive treatment will retard the progress of the atrophy.
In the central or spinal types this effort is rewarded with more suc-
[Jess than in the neuritic or myopathic forms. Erb has recommended
the direct application of the galvanic current to the spinal cord, laying
particular stress on direct electrization of those segments of the cord in
which the major implications are to be found-usually the cervical or
lumbar enlargements. J ones recommends the use of the induction-coil
currents in mild doses in these cases.
Progressive Muscular Atrophy.-Hydro-electric baths with triplephase
currents cured a case reported by Albert- W eil..
As to the use of other forms of electric stimulation in the chronic
atrophies, experience is not yet cumulative enough to enable one to
come to definite conclusions. High-frequency currents have been used
by a number of observers, among whom Denoyes has reported good
results, but one is compelled to withhold conclusions in the cases reported
up to the present time.
Disease of Motor Paths (Lateral Sclerosis Type).-On general
principles it may be said that disorders of the pyramidal tracts are not
only not helped by electric treatment, but, on the contrary, are harmed.
Up to the present time there are no reports of help coming to these cases.
In those cases in which pressure on the lateral tracts by tumor causes
the affection, x-ray treatment" occasionally diminishes the size of the
tumor, but its use is not advisable unless surgical intervention is absolutely
impossible.
In multiple sclerosis no definite progress has been made. Certain
cures have been reported, but these were undoubtedly cases of hysteria.
It is well known that multiple sclerosis has periods during which improvement
takes place, only to have the patient slip further back at
the next advance. Psychotherapy also has a marked value in helping
patients with multiple sclerosis to make less of their ills than is their
usual wont.
Certain advances ought to be made in the electric treatment of multiple
sclerosis patients. The tissue proliferation is of a type which, by
analogy, should be affected by high-frequency currents, just as we know
that the perineuritic inflammatory exudates of chronic character are
modified. The field is not hopeless by any means.
Disease of Sensory Paths (Tabes Dorsalis Type).-The evidence
bearing upon the availability of electricity for the treatment of disorders
of this group is far from being conclusive. Much depends upon the
496 MEDICAL ELECTRICITY AND RONTGEN RAYS
attitude of the observer. It is admitted that the cure of true posterior
sclerosis has not been advanced at all by any yet devised form of electrically
induced energy. Pains may be relieved, minor palsies helped,
the tonus of weak muscles improved, and the functions of the bladder
and rectum much stimulated, but true tabes dorsalis has not yet succumbed,
nor can it yet be seen why there is any likelihood of its doing
so. Pseudotabes of neuritic nature following poisoning by alcohol, lead,
aspergillus, ergot and its allies, or other agents causing a mild ascending
degeneration may recover after the application of the electric treatment)
but it is not even certain in these cases that the neuritic process has been
hastened in its repair by the electricity. These pseudotabes cases recover
after treatment by almost anything, or nothing, and hence it is
of little profit to argue the question without a raison d' etre.
Application of Galvanic Currents to the Spine in Locomotor Ataxia
by Means of Cell-baths.-The patient may be seated in a perineal bath,
which forms the positive electrode, while both forearms rest in baths
which are connected with the negative pole. A galvanic current of 25
to 30 ma. is gradually allowed to flow for about ten minutes. The
treatments are given three times a week for four to six weeks. All the
current passes through the patient's body, and according to the rule by
which currents travel chiefly by the best conducting path, we know
that a large proportion of it traverses the spinal cord. Allard and
Cauvy,l who suggested the above technic, believe that a favorable effect
may be exerted upon the hyperemia and the sclerosis, and especially
the lightning pains and the transitory paralysis of the early stages of
the disease may be benefited. ..
Vesical Crises in Locomotor Ataxia. Treatment by Galvanic Currents.-
The bladder is filled with boric acid solution, and a negative
urethral electrode is introduced into the bladder. A large positive
electrode is applied over the l~mbar region, and a current of 40 ma. is
gradually turned on and allowed to flow for fifteen minut~s. Treatments
are given twice a week.
Can it be claimed that electric treatment will delay the progress
of a tabes case? In view of the great chronicity of the affection
and its irregular course, particularly its long periods of non-progression,
it is hazardous even to claim this for electric treatment in this
disease.
The last word, however, has not yet been spoken, and it will be premature
to negative on a priori grounds some new claimant to therapeutic
honors. It is certain that the radium treatment, x-ray treatment,
Finsen-Iight treatment have thus far disappointed their advocates.
The requisites for proving the claims are extremely severe, in view
of the many-sided character of this affection.
The x-Ray and High-frequency Currents Applied to the Spine in
Locomotor Ataxia.-The author has seen great lasting improvement,
though not a cure, in a case which was also treated by mercurial
injections.
Diffuse Spinal Disease (Myelitis Types) .-In those patients in
whom the paraplegia is sP!:t-stic we cannot look for much relief from
electric treatment, but in the ataxic types associated with lost knee-
1 Rev. Internat. de med. et de chir.. Anril10. 1906.
497 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
jerks, in which involvement of the gray matter seems evident, the indications
for electric therapy are somewhat similar to that already considered
in the Progressive Muscular Atrophies. Certain of the ataxic
paraplegias are much benefited by the judicious and persistent use of
both galvanic and faradic currents.
Intraspinal Disorders (Syringomyelia Type).-It is a curious fact
that of all the disorders of the spinal cord which would seem to offer
the least hope for benefit from electric treatment, syringomyelia should
be one in which such treatment haS been followed by definite and unmistakable
signs of betterment. Raymond has reported the good effects
of x-ray treatment in a number of cases. The pains have been stopped,
the progress of the atrophies delayed, and other signs of improvement
indicated a regression in the tissue proliferation in the syringomyelia
area. Experiences of this are, up to the present time, too fragmentary
to permit of wider generalization, but the results in the cases
reported have been striking. This, taken into consideration with the
well-known conservatism of the reporters, should be sufficient to encourage
further investigations along this line.
BRAIN
The most important organic brain affections here to be considered
are brain tumors and brain hemorrhages, resulting in the hemiplegic
and diplegic syndromes. The most striking of these are the infantile
cerebral palsies and the adult hemiplegias.
A definite decision concerning the utility of electricity in organic
affections of the brain cannot yet be reached. Although various observers
have been using all types of currents for years, and some are
extremely enthusiastic as to what electricity can do in this class of
affections, the more conservative and careful observers approach the
matter with considerable reserve. Extravagant claims would border
on charlatanism, but it were equally as false to common sense to say
that what we now know is of no service, and even to maintain that all
that may be learned is bound to be futile.
But not to deal in futures, it is sufficient to make the general confession
of faith that our present standpoint is that electricity may be
an extremely important adjunct to our therapeutic resources, if not the
entire source of reliance.
Hemiplegia.-In the organic hemiplegias it should be borne in mind
that the first motor neuron is involved. We cannot expect by electric
or other means to obtain the regeneration of the fibers in the affected
corticospinal path. The injury done here is more or less inevitable and
unmodifiable. The spinal peripheral motor path, however, is unaffected,
and the changes which take place in the muscles, bones, and blood-vessels
of the paralyzed limb are the result not of any real inherent affection
in their own proximal neurons, but of the lack of physiologic functioning
in the corticospinal part of the path.
It is, therefore, evident that persistent regard paid to the unmodified
peripheral motor tract is absolutely essential, and one finds in the use
of electric currents a very helpful therapeutic resource. Old hemiplegic
cases lacking electric treatment or treatment by massage become more
and more helpless, but by means of intelligent muscular gymnastics,
with the aid of galvanic and faradic currents, a great amount of improve-
32
498 MEDICAL ELECTRICITY AND RONTGEN RAYS
ment may be brought about. This improvement, however, will not
pass beyond a certain point, and just how far such treatment may be
effectual depends upon the individual case: general laws cannot be postulated.
For the prevention of the development of rigidity the use of both
the faradic and galvanic currents is beneficial. After rigidity has set in
and has been present for a number of years the results are less valuablein
fact, massage is then more serviceable.
Treatment of Hemiplegia.-Begin passive movements of every articulation
from the very day of the stroke. This will prevent arthritis, the
deformed attitudes, pain, and, in a great measure, the muscular contractures
which make the sequelre of an apoplectic stroke so much worse
than would be the case if the condition were simply that of paralysis of
certain muscles. Reeducation of voluntary motion is to be begun as
early as possible. Electricity may be useful in the treatment of atrophy
of certain groups of paralyzed muscles, but not for general application
to the whole hemiple~c side of the body.
The electric treatment of hemiple~c cases should be begun only after
the acute symptoms of the paralysis have fully developed-that is, in
from four to six weeks after the initial lesion. As pain is rarely an accompanying
symptom of hemiplegia, this does not have to constitute a complication.
The improvement in the hemiplegic cases usually comes on
more or less rapidly-in some cases almost immediately. The galvanic
currents are best applied, the direction being that of the course of the
motor tract, namely, from the spine outward. The anode is placed along
the spine, and the cathode at the periphery, the anode being moved slowly
up and down without being raised from the skin. The electI:ode should
be of medium size, and the duration of the application should be from
ten to twenty minutes, and should be made at least three times a weekpreferably
daily.
There are those who maintain that a certain amount of stimulation
of the brain itself may be brought about by the use of the more carefully
graded currents of Leduc. In the treatment of aphasia a certain
amount of success has been claimed by certain French investigators.
The application should be made by the alternating current of low intensity
and slow interruptions, and should not be of more than five
minutes' duration at one time, while care should be taken in ascertaining
the resistance of the brain tissues to the interrupted current; This
subject will be discussed more .fully in a separate paragraph, under the
caption of Electric Sleep.
Infantile Cerebral Palsy.-The individual lesion which may be
present in this type of affection varies so widely that we cannot in this
place attempt to outline the symptomatology of the group. Suffice it
to say that the chief damage is done to the corticospinal neuron, and
may manifest itself in monoplegia, hemiplegia, or diplegia. In the
monoplegic types nature herself does much to minimize the damage
done, and great improvement in the functional capacity of the affected
muscles may be looked for from her unaided efforts. Both massage
and electricity should be utilized early in the treatment of these paralyzed
children. The indications are precisely the same as those which
have been already spoken of in the paragraph on Hemiplegia.
It is to be borne in mind that the lesions in infantile cerebral palsy,
when not due to a generalized encephalitis, are of the hemorrhagic type,
499 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
d that functional losses are much more extensive than the primary
atomic defect. It should, therefore, be the aim of the electric therautist
to minimize, so far as possible, the tendency to the continuance
this functional defect until the time when the exercising of the hemoragic
area would of itself bring about an improvement in the condition
to movement. Both galvanic and faradic currents will prove of
rvice, these currents being useful for the maintenance of nutrition.
rle use of massage in conjunction with the electric current should not
) lost sight of, the two mutually assisting. Some students have ob-
.ined a like stimulation of muscular tone, and nutriti9n by the use
, high-frequency currents, induction discharges; and static breezes.
he latter, however, are more useful in maintaining skin nutrition than
ley are in affecting the muscular tissues beneath.
New Growths in the Brain.-Here the symptomatology is so varied
.1at we must refer the reader to works on neurology .What can be
"pected of electricity in the treatment of new growths? It must be
onfessed that it is not by any means clear that the electric treatment
f new growths is of much service, and this is not the place to consider
rhat radium emanations or ultraviolet rays may do for certain forms
f intracranial growth. In view of certain recent results obtained in
he treatment of syringomyelia by the use of x-rar and by ultraviolet
Ight, it cannot, on a priori grounds, be stated that similar types of tissue
..egeneration in the brain may not be beneficially treated with this form
f electrically produced energy .
Manifestly surgical procedures are those best adapted for the treatnent
of intracranial growths, but in view of the gloomy outlook, even
mder the best of conditions, research iIJ the matter of the treatment
If growths by different types of electric energy should not falter.
Epilepsy.-,-It seems unnecessary to repeat that epilepsy is not the
lame of one disease-there are several different epilepsies. That the
notor discharl$"e induces the familiar picture is true, but the causes
)f the motor discharge vary from slight emotional excitement to actual
I.natomic destruction. It seems incredible that electric action could
j,ffect anatomically altered brain tissue to such a degree that the epileptic
discharge could be modified, and such is the general experience of
those who have tried electric methods in the treatment of epilepsy. Good
observers, such as Althaus and Erb, have, however, reported beneficial
results in certain cases of epilepsy. Erb particularly advises the use of
the constant current in certain cases, the anode being placed ~rst on the
side of the forehead, with the cathode at the uape of the neck, and a
weak constant current being passed for one minute. He later changes
the electrode, the anode occupying the middle line of the head in front,
the cathode being placed over the occiput, and the same type of current
being passed for the same length of time.
X-ray treatments have been reported to have been of benefit in
some cases, and it is conceivable that such treatment has had an effect
upon a new growth which had been the primary cause of the irritation
in the cortex leading to the motor discharge. One cannot, however, pin
one's faith to these measures. They should be adopted as expedients
only, and we are not yet in a position to maintain that they should be
used primarily. .
500 MEDICAL ELECTRICITY AND RONTGEN RAYS
GENERAL NERVOUS DISORDERS
Of the more general nervous disorders, irregular forms of muscular
spasm may be considered. So far as habit spasms and tics of. various
types, including the tic of torticollis or wry neck, are concerned, it seems
certain that electricity is of very secondary value. In most of the habit
spasms the psychic element is very strong, and electricity, instead of
being of service, usually tends to aggravate the ills that are already
there. Those forms of spasm or tremor or irregular tonic or clonic
movements which are of an organic nature due to minute alterations in
the vascular supply of the central nervous organs, also resist electric
treatment.
So far as the cases of wry neck and of forced irregular posture, which
are due to exposure to cold and muscular or neuromuscular involvement
are concerned, electric treatment is par excellence favorable. Here
the faradic current, or more particularly the static breeze, or inductioncoil
sparks are of great service.
Chorea.-Treatment of chorea by electric energy remains a terra
incognita in neurology .Certain cases of chorea are undoubtedly much
benefited by electricity, especially by the static breeze, or application
of induction sparks to the spinal cord, or galvanic baths; but the action
is probably due entirely to the tonic effects on the body.
Cases of chorea treated at St. Bartholomew 's Clinic have been quickly
cured by the application of glass vacuum electrodes from the Oudin
resonator along the spine and over the upper and lower limbs.
If it be assumed that most choreas are, after all, the results of a postinfectious
toxemia having a special predilection for the motor area,
causing excessive irritability, or bringing about insufficient inhibition,
then it is comprehensible why general electric stimulation by the static
currents is as efficacious as it is at times. Furthermore, in the treatment
of exhaustion states following excessive choreic movements electricity
is of inestimable value and should be added as an adjunct in
the treatment of this affection by the ordinary tonic measures usually
carried out. Pharmacopeal therapy, hydrotherapy, and electric therapy
combined give better results than anyone alone. Jones has found
in the treatment of these cases that the application of the negative
breeze to the spine is a convenient and more agreeable method of
treatment than the ordinary static spark procedure.
Occupation Neuroses.~These, as has already been said, are
properly considered in the light of a complex etiology. They are
cases of neurasthenia mixed with a bad psychic habit, and experience
shows that in their treatment they are extremely obstinate. As is
well known, such forms of occupation neuroses associated with cramplike
conditions in the muscles are common accompaniments to piano
playing, violin playing, tennis playing, and tailors, shoemakers, and
writers are often afHicted with It. A vast number of neuroses belong
to this group.
Electric treatment is of service undoubtedly in the toning up of
the muscles themselves, but it is more than doubtful whether it ever
reaches the psychic factor in the disorder. Our own experience has
been very disheartening in the electric treatment of these occupation
neuroses, especially writer's cramp.
Galvanic Currents for Writer's Cramp.-A large negative electrode
is placed between the shoulder-blades and the forearm rests in a bath
501 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
()f tepid water in which the positive electrode is placed. A current of
30 ma. is applied for fifteen or twenty minutes every day.
Exophthalmic Goiter.-Until the exact pathology of this disorder
is placed upon a more rational foundation it were futile to claim for
it that it may be cured by electric measures of treatment. There are
numbers of cases in which electric applications of the induction current
applied to the sides of the neck have proved to be of considerable
service. .These are probably th.ose cases in wh.ich the goiter ~s largely
due to disturbances ill the functions of the cervical sympathetic nerves,
and the electric treatment serves to restore in part at least a function
which has been greatly altered by the toxemia of the overacting thyroids
or parathyroids. Applications to the glands themselves have been made
with a view to diminishine;the amount of glandular substance secreted and
thrown into the circulation. Whether electrolysis can bring this about,
as has been claimed by a number of observers, is highly doubtful. At
any rate, the question must remain an open one until more is known of
this disorder. When it is recalled that Dubois, of Berne, reports the cure
of a number of cases by the use of psychotherapeutic principles, it is
necessary to realize the psychic element in producing the anxiety,
tachycardia, and irritation phenomena in the disorder .
The electrodes may be placed at the sides of the neck behind the
angles of the jaw with the negative electrode upon the side of the most
marked exophthalmos; or the negative electrode may be placed at
the nucha and the anode first over one carotid region and then over
the other.
Another successful way to use the galvanic current in this condition
is to apply an electrode to each side of the gland. The electrodes should
be thoroughly wet in a solutioll of bicarbonate of soda and the-current
should be applied for fifteen minutes at a time, using from 10 to 15 milliamperes.
The treatment can be applied twice a week. The direct application
of a spark from a static machine has also been of great service,
but, of course, it is rather a disagreeable method of treatment. When
this is used the patient is placed on the insulated platform in the US\lal
-
Fig. 320.-8park director.
manner and connected with the positive pole of the static machine.
The negative side of the machine is grounded ; the patient holds what
is known as a spark director (Fig. 320) in contact with the gland; the
brass ball electrode, which is held in the hand of the operator, is brought
502 MEDICAL ELECTRICITY AND RONTGEN RAYS
within 4 or 5 inches of the other end of the spark director, when a spark
will jump. This is rather a severe treatment, but some cases have
been greatly benefited by it.
Treatment by the x-ray and high-frequency currents has resulted
in a certain percentage of permanent cures in the author's cases.
Hysteria.-The attitude assumed on this question is a more or
less radical one. It is highly important in the first place to distinguish
between hysteria proper as a well-defined and carefully described
psychoneurosis, and hysteric or hysteriform symptoms which may be
the accompaniment of a vast number of organic affections, not only
of the central nervous system but also the entire body.
A characteristic feature in true hysteria is a certain foundation in
character which permits of the ready dissociation of the personality,
and it is, therefore, characterized by great emotional instability and a
childish development, stamping the individual at once as a being more
primitive than the education and environment would seem to show; in
other words, the true hysteric character is a primitive character, and
it is well recognized that true hysteria is much more prevalent among
primitive peoples, such, for instance, as the natives of Java, of w~om
Kraepelin has made a thorough study, the American negro, and other
types. The hysteric character is never altered by electricity. Many
manifestations of the dissociation in consciousness, such as the pains,
paralysis, anesthesias, etc., are very frequently relieved by the use of
electric currents, particularly those of a painful or shock-like nature.
Those forms of energy are useful which make sudden unexpected demands
upon the attention of the individual, and which for the time, to
use Janet's phrase, are capable of rousing the nervous tension to such
a point that the dissociated element in consciousness is brought back
into the hierarchy of the conscious personality. With the cessation of
the treatment, however, disaggregation takes place in another association,
other symptoms arise, and the fundamental features of the
personality remain untouched. In fact, the wonder-working, 9.S it
were, of the electric display only contributes to the receptivity of the
individual to certain classes of impressions, which tend to perpetuate
the primitive nature of the individual instead of affording any means
of education. If the electric treatment is used only as a means to an
end, an attempt, as it were, to first gain J(;he atteption of a very loosely
aggregated personality, which is then worked upon by proper psychotherapeutic
measures, then its use may be advisable, but as pure electricity
it works to the disadvantage of the individual. The galvanic
or faradic treatment of hysterically paralyzed limbs is, we believe,
very harmful to the individual. The element of suggestion that the
limb is paralyzed by the incessant working over it by electricity tends to perpetuate the paralysis and may make it permanent. .
On the other hand, so far as the treatment of hysteric symptoms,
which are the reflex of disorders of an entirely different nature is concerned,
electricity is often of a great deal of value, and when it is of
service the attention of the physician should immediately be awakened
to the possibility of an underlying or~anic cause for the hysteric manifestations.
Thus, the common assocIation of hysteric symptoms with
such disorders as tumors of the spine, tumors of the brain, abcesses of
different portions of the body, tumors of the kidneys, tuberculosis, floating
kidney, stone in the bladder, etc., etc., all of which conditions are
503 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
cnown to give rise to hysteric symptoms very frequently, should not be
>verlooked, and when these are alleviated by electric treatment the
physician should not be deluded into belief that they are hysteric and
~hat the patient is well, but the very fact of their being amenable to
electric treatment should point in the direction of a further search for
the cause of the hysteric manifestations. Thus, it may be seen that the
electric treatment of these conditions offers a very important diagnostic
clue.
Mental Disorders.-It is entirely too early to generalize upon
the value of electric forms of stimulation in mental diseases. If it be
of service at all, it is of some assistance in the treatment of depressed
states, usually the depressed phases of maniacal depressive insanity,
Also, perhaps, in the mild or severe depressions associated with senile or
presenile psychoses in which the element of arteriosclerosis is the
primary pathologic factor. It has already been pointed out that certain
forms of electric energy have shown themselves to be of service
in the treatment of some cerebral tumors, and mental changes due to
cerebral tumors are concomitantly helped thereby.
It is beyond question, however, that electric forms of energy have
no radical effect on any definite psychotic conditions, but as an .adjunct
in the general treatment of some of the psychoses electricity is undeniably
of a great deal of benefit. And in the large groups of cases of
the psychoneuroses, particularly in the neurasthenic group in which
the mental state closely approaches insanity, electric stimulation,
particularly by various adaptations of the static current, is of general
tonic value.
The exact limitations of electric stimulation of metabolism and
the effects that such change in metabolic activity may have upon the
development of psychoses are matters which are as yet in the realm of
pure hypothesis. It is highly desirable that careful consecutive studies
be 'made on definite forms of psychoses, so far as we believe that such
definite forms do exist, in order that clearer notions of the value of this
form of energy may be obtained.
NEURASTHENIA
The beneficial effects of electricity in this disease are of two different
physical kinds besides that due to mental impression. Practically
all forms of electricity which are suitable for use in this disease improve
the general nutrition and digestion. The urine contains more urea
and less uric acid and albumin and sugar if the latter are present. In
cases of malnutrition with phosphaturia and azoturia electricity increases
bodily weight and causes the urine to become normal. The effect, so
far described, is one of regulation of cellular activity and of a beneficial
effect upon the central nervous system.
The second kind of effect from electricity is upon the circulation,
and this may be in the direction of causing an elevation or a reduction
in blood-pressure according to the form of electricity which is employed.
Generally speaking, extremely high-tension applications, like the static
spark or breeze and the spark or efHuve from the Oudin resonator .<the
latter giving a high-frequency high-tension current) , increase the bloodpressure,
and while called for in cases with hypotension, are contraindicated
in neurasthenia with high arterial tension or with arteriosclerosis.
Comparativ~ly low-tension high-frequency currents, like
504 MEDICAL ELECTRICITY AND RONTGEN RAYS
those from the d' Arsonval apparatus, have a marked effect in lowering
arterial tension, and are especially indicated in neurasthenia with high
arterial tension or with arteriosclerosis.
Application of. Static Electricity in Neurasthenia.-It is not
necessary that the static machine should be of the largest and most
powerful type, but it must work well and give a good discharge between
balls 3 inches or more apart.
Static Insulation or Static Bath.-The patient sits on an insulated
platform with his feet resting upon a metal plate connected with the
negative prime conductor, while the positive prime conductor is grounded.
Treatments last for five minutes at first, but are increased to fifteen
minutes, and are given every day. This is an e~cellent tonic to all the.
tissues in the body.
Static Breeze.-The patient is insulated as before with the negative
pole, while an electrode from the positive terminal with one or several
points is brought near some part of the surface of the body. The effect
is a sedative one upon the central nervous system. For instance, the
sensation as of an iron band around the head is relieved by a few minutes,
application of the static breeze to the nape of the neck. A favorite
application in neurasthenia is astatic hreeze from a crown suspended
over the head and connected with the positive pole while the patient
is negatively insulated. A reversal of this polarity causes a much
greater prickling sensation in the scalp and makes it disagreeable.
The positive pole is readily distinguished by the fact that the discharge
from it to the negative pole when they are an inch apart may be
diverted by a piece of wood, sUch as a match. Moving apiece of wood
over the surface of the positive pole, one is enabled to make the discharge
start from wherever, withm certain limits, the wood touches or
even approaches the positive pole. The positive discharge follows wood.
Another way is by the fact that a brush discharge of a violet light
several inches long may be obtained from a pointed electrode connected
with the positive pole of the static machine, while no discharge is perceptible
from a point connected with the negative pole until it is close
enough to send a spark to the surface.
Insomnia from neurasthenia often yields to astatic bath with ahead
breeze, and so do all kinds of nervous apprehension and even delusions ;
but excessive or too prolonged stimulation of muscular contraction by
the static wave currents will cause insomnia.
Static Sparks.-The patient is in negative insulation, and a metal
ball electrode connected with the positive pole is brought near enough
to send a spark to the surface of the body. This may be applied through
the clothes, and the ball electrode should be approached with a sort of
quick, striking motion, permitting only one spark to pass before the
electrode is again beyond sparking distance. A stream of sparks at
one place is painful and exceedingly disagreeable.
For a general tonic effect and to raise the arterial tension a series
of sparks along the spine are excellent.
They cause localized contraction of muscular fibers and are indicated
in pronounced muscular atony, either general or local.
Static sparks applied in the left iliac region have a most beneficial
effect upon the constipation which is often a symptom of neurasthenia,
and they also restore the appetite and relieve the general sense of
deDrp~~inn-
505 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
Indirect Static Sparks.-For all the purposes for which static sparks
e applied, the effect may be obtained by grounding the positive pole of
e static machine (connecting it with the water or gas or steam pipes),
Id applying the sparks from an electrode which is also grounded. This
akes the application much easier for the operator, since the electrode
not charged and need not be insulated.
Static Friction or Massage.-Tbe patient is in negative insulation,
Id the positive pole is connected with a roller electrode, which is rubbed
ITer the surface of the body outside the clothes, or the same applicattion
may be made indirectly, grounding the positive pole and the
)ller electrode. The effect is that of a continuous shower of sparks,
.le length of which is determined by the thickness of the clothing. The
pplication is a severe one and makes the strongest man twist and
~uirm. The electrode should be moved over the surface quickly and
hould not be applied for more than a few seconds at a time. Pronl
as most admirably epitomized the indications for static, faradic, and
alvanic applications in this disease. He considers static massage as
.seful in cases with anresthesia en plaques and with spinal cord irriation,
causing seminal emissions and cramps and exaggerated reflexes.
~he applications are made to the upper part of the body.
The Static-induced Current.- The pelvic neuralgia of neurasthenia
!1 women is almost always relieved by vaginal applications of the static-
!1duced current. Albert-Weill's2method of application is by a vaginal
~Iectrode connected with his rheostat for controlling the strength of the
tatic-induced current. The operator holds the insulated handle of
,his electrode with one hand while he massages the abdomen with the
)ther.
The application should be as strong as can be borne without discom-
'ort.
The symptoms especially calling for treatment by static electricity
lore insomnia and myasthenia.
Faradic Applications.-These are not made with a view to causing
muscular contractions, and the current must, therefore, be a weak one
Iond preferably one with the most rapid possible interruptions. The
latter are easily secured if the faradic coil is made with a ribbon interrupter.
A strip of steel tape is the vibrator which interrupts the primary
current. It is permanently fastened at one end and may be
tightened by turning a screw at the other end. The tenser the steel
ribbon the more rapid are the vibrations produced by the action of the
electromagnet which is placed opposite the middle of the ribbon. The
more rapid the succession of Induced currents, the less is the effect
in causing muscular contraction and the greater is the tonic effect upon
the sensory nervous system. The faradic coil should have an adjustable
number of turns in the secondary coil and the greatest number should
be selected.
Almost every type of faradic coil gives currents which have perceptible
polarity, but this is so very slight that either electrode may
be used indifferently. .
General faradization i~ useful in cases of neurasthenia. The patient
sits upon or lets his feet rest upon a large sheet of metal covered with
wet flannel as the indifferent electrode. The other electrode is passed
lTraitement de la neurasthenie, Revue de Therapie, July 15, 1905.
2Manuel d'Electrotherapie et d'Electrodiagnostic, Paris, 1906.
506 MEDICAL ELECTRICITY AND RONTGEN RAYS
over the forehead, the nape of the neck, the spine, the precordia, and
the abdomen. This active electrode may consist of a damp sponge
electrode or it may be the operator's hand. In the latter case the
operator holds a metallic or sponge electrode connected with the active
pole and the current passes through his body to the patient. The
treatments last about ten minutes.
Beard considered general faradization as especially indicated in
neurasthenia with myasthenia and malnutrition, and that it should be
avoided in yery excitable neurasthenics, for whom static electricity
seems to be better.
Local Faradization.-Erb's treatment for cerebral or spinal neurasthenia
is by local applications alone of faradization for only two to five
minutes.
Bladder symptoms of a paralytic type in men may be treated by
faradization with the indifferent electrode on the abdomen or buttocks,
and the active electrode applied to the perineum and scrotum successively.
Rapid interruptions and a fine secondary coil are used.
The pelvic neuralgia or neurasthenia in women is best treated by
static electricity applied illtravaginally, as has been described on page
505, or by vaginal faradization. For the latter, sponge electrodes are
held in the vagina and over the abdomen. Very rapid interruptions
and the maximal strength of currellt are used for ten minutes each
day.
Galvanic Applicatjons.-General galv!lnization is applied from
a large indifferent negative electrode applied to the feet and an active
positive electrode rubbed over different parts of the surface. Two to
four milliamperes is the pr9per strength of current. Such an application
is not very often employed.
Central galvanization may be used when the patient is well nourished,
and his muscular strength has not been affected by the disease. A
large negative electrode is placed over the epigastrium, and a small
activ~ positive electrode is applied successively to the forehead and
vertex for one or two minutes, and then to the sides of the neck and
down the spine for two to five minutes. A current of 8 to 10 ma. is used,
but it must be gradually turned oIl for each position of the active electrode,
and gradually turned off before the electrode is removed from
each place. The strength of current may be a little greater at a distance
from the head.
Local Galvanization.-The uniform and uninterrupted galvanic or
constant current is used for two or three .local conditions.
Impotence from neurasthenia in men may be treated by a current
?f ~o to 20 m~l~iamperes, flowing for fifteen :minu.tes betw~en a large
mdlfferent posItIve electrode at the genItal center m the spme, and an
active negative electrode passed over the perineum, scrotum, spermatic
cord, and the root of the penis. Albert-Weil sometimes terminated
each t.reatment by rhythmic galvanization. Treatments are given daily.
Impotence is a condition in which the discovery and removal of the
cause of the trouble is extremely important. Such a condition as
hemorrhoids or rectal ulcer may interfere with.the success of any treatment
directed toward the genital organs alone, and then again every
one realizes the profound influence of the mind over this condition.
Constipation.-This is almost always a condition of spasmodic contraction
in neurasthenia and is relieved by the constant current of
507 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
508 MEDICAL ELECTRICITY AND RONTGEN RAYS
trode up and down the spine for ten minutes. In high-frequency treatment
the metal electrode applied directly to the surface of the body may
be considered the indifferent electrode. The brush electrode by which
an efHuve is applied, or the glass vacuum electrode with its shower of
tiny sparks, either electrode making a direct application of ultraviolet
radiations and of ozone, may be considered the active electrode. The
nerve centers requiring especial tonic treatment in most cases of neurasthenia
are the solar plexus and the spinal cord.
Low arterial tension is progressively improved by bipolar applications
of high-tension high-frequency currents applied through a metal electrode
at the epigastrium, and a succession of sparks of considerable size
applied along the spine. A metallic electrode may be used for the
latter purpose, but a glass vacuum electrode is much more convenient.
A greater strength of current and a less close application of the vacuum
electrode as it is passed over the surface makes the difference between
sparks of considerable size and tiny or imperceptible ones. Moutier
secures the same increase in arterial tension by sparks from a monopolar
resonator, and the present author usually employs this method, which
has the great convenience that it can be applied through the clothing.
Albert-Weil thinks that the bipolar application is a little more effective.
Dyspepsia.-The pain is often relieved and the action of the stomach
and intestines regulated by a bipolar high-tension high-frequency
current from a metal electrode in contact with the back and an efHuve
or a vacuum electrode applied over the stomach.
Impotence.-One high-frequency 3,pplication suited to this symptom
in male neurasthenics is from a bipolar resonator, with an efHuve over
the epigastrium and a spark electrode applied over the genital center in
the spinal cord.
The author has had successful results with a monopolar application
from the Oudin resonator and a glass vacuum electrode to the penis,
scrotum, and groins. A strong application is employed, regulated so
as to produce a current which makes the glass quite hot, but with very
little spark effect, powder being used to enable the electrode to slip
smoothly over the surface with<?ut breaking the contact or producing
perceptible sparks. No effect may be noted at the first treatment, but
during the subsequent treatments the erections become extremely
vigorous. Functional power is restored, but whether there is a relapse
depends upon the patient's general condition.
A further consideration of the use of high-frequency currents in this
disease is found on page 567.
ELECTRiC SLEEP AND ELECTRiC DEATH
Electric Sleep.-This is a name given to a form of anesthesia which
Stephane Leduc has been able to bring about in animals and in man
as a result of the application of a type of electric current which he himself
has devised. The current has already been spoken of in the paragraph
on local anesthesia and the treatment of neuralgias. It is an intermittent
current of low tension and of infrequent interruption, which passes
through the entire body of the animal. The interruptions in the
current, as has already been stated, run from 90 to 110'per second, and
the electromotive force rarely exceeds 30 volts. The strength of current
is 4 ma. The apparatus is described on page 475.
509 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
Leduc was able, in 1902-03, to bring about complete narcosis in
animals by the application of his current directly to the cranium, one
electrode being placed upon the head and the other either upon the
extremities or over the abdomen of the animal.
The description of what takes place can perhaps be best told in his
own words, for he made himself the subject of an experiment and his
assistants placed him under general electric anesthesia.
The results of his experiments were communicated to the French
Societe de Biologie, November 22, 1902, and in the Archives d'Electricite
medicale, July 15, 1903, he gives us a description of his own sensations
when passing into the electric anesthesia.
One large electrode formed of absorbent cotton impregnated with
1: 100 solution of chlorid of sodium, with a metallic plate behind, is
placed on the forehead and fastened to the head. This frontal electrode
IS the cathode. A larger electrode made in the same manner is placed
over the back and fastened there by means of an elastic band. The
Leduc current is then turned on, being interrupted for the first tenth
of the period of application one hundred times to the second. The
sensation produced by the stimulation of the superficial nerves, although
slightly disagreeable, can be easily endured.
After a short time the patient feels a calm similar to the sensation
produced by a continuous current, and this, after having passed its
maximum, slowly diminishes, notwithstanding a gradual increase
in the electromotive force of the current.
The face becomes red, slight contractions of the muscles of the face,
neck, and even of the forearm occur, and fibrillary tremors of the
extremities take place, then one feels a tingling of the extremities in
the fingers and in the hands, which gradually extends to the toes and
the feet.
At first an inhibition in the centers of language takes place, the patient
is unable to express his thoughts, although he has active cerebration
going on all the time. Then the motor centers are completely inhibited,
the subject cannot react even to the most painful stimulations, he is
unable to communicate with the experimenters although fully conscious.
The extremities, without being in a complete state of relaxation,
did not show any particular involvements; certain choking or tremors,
not corresponding to any painful impressions, may take place, but
seem to be caused perhaps by an excitation in the muscles of the larynx.
In his experience the appearance remains absolutely unaltered, the
respiration perhaps a little diminished.
When the current was at its height, he describes his feeling as though
he were in a dream, and although hearing things about him, he only
half appreciated what was going on. He had a feeling of consciousness
of his own impotence and inability to communicate with his colleagues.
The contacts, the .pinching and the pricking in the forearm, could be
felt, but the sensations were much diminished, as in a very large swollen
member.
The most painful impression was to notice the dissociation and the
successive disappearance of the faculties; the impression was identical
with that which one feels in a nightmare in which, in the presence of a
great danger, one feels that one is neither able to cry out nor to make
any movement.
Tn h;'! firRt. exDeriment consciousness was not entirely abolished,
510 MEDICAL ELECTRICITY AND RONTGEN RAYS
but in a second seance his colleagues- advanced to the point where.. so
far as they were able to determine; consciousness had lapsed completely,
but Leduc was able to feel that this had not really taken place because
there was not complete suppression of all sensibility.
The electromotive force had been raised as high as 35 volts, the
intensity in the interrupted circuit being 4 milliamperes. In each one
of the seances he remained twenty minutes under the influence of the
current.
Awakening was instantaneous and the after-effect was a mild state
of exhilaration.
With animals, however, as has been shown by Leduc and his pupils
and by many other observers, the electric sleep may be prolonged for
considerable periods of time-for three or four hours at least-and
operations may be performed upon them.
Certain points have been brought out with reference to this electric
sleep which, although as yet.not definite, may be outlined at this time.
In order to produce the electric sleep according to the experiences
which have thus far been reported, it would appear that the ordinary
street current is not as valuable~r as safe, it would perhaps be better
to say-as a current which is delivered more equably, as from a storagebattery.
The street current which charges a storage-battery and is
utilized from there would be the ideal current. The arrangement suggested
by a number of experimenters would be to utilize the storage
current for the electricity which is to traverse the body, and the street
current to run the motor of the interrupter.
Gradual application of the current is to be preferred to an abrupt
dosage.
The negative pole, the cathode, should always be applied to the
head, for experience has shown that if the anode be applied to the
head grave disturbances in respiration take place and the temperature
is apt to go up.
Certain conditions are observed to be more or less constantly present:
Thus the pupils are usually contracted during the state of electnc sleep.
The temperature is usually about normal or slightly above. The respiratory
rhythm is slightly hastened. There is usually an increase in the
arterial pressure which seems to depend upon vasomotor causes. Certain
of the reflexes seem to be exaggerated, while others are diminished-
.In overdosage, leading to an electric epileptic state or to electrocutlon
by the Leduc current, the blood-pressure suffers a very marked
fall and the respiratory inhibition is decided.
Whether the Leduc current can be used to advantage in electrocution
of the human being is for the future to decide, but there are
certain facts which point to its desirability in this direction.
As to its applicability in man for anesthetic purposes, the future
alone will be able to determine. At the present time of writing the
facts brought out by the application of this new type of current are of
extreme theoretic importance, but it has not been tried in a sufficient
number of cases to justify any general statements concerning its applicability
for general narcotic purposes.
Local Anesthesia from Electric Currents.- This has been obtained
by H. Giinzel,l using a direct 25 to 30 volt current of 2 to 10 ma. interrupted
230 times a second. The anode is placed on the skin over the
1 Berlin. klin. Woch.. 1908, No.45.
.~11 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
painful spot and the cathode at Some indifferent place. He has found
it effective in migraine, bronchial asthma (with the anode on the neck),
and angina pectoris.
Electric Death.-Internal lesions in death due to industrial electricity-
pathognomonic leBions for the most part-have beeri absent
in these cases. Numerous experiments have been made on animals to
determine the causes of death and the character of the lesions. The
earliest experimental investigations made on animals with the modern
industrial electric currents that' are of service in the present presentation
were those of Grange, Gariel, and Brouardel, made in 1884, and
those of Brown-Sequard and d ' Arsonva}1 in 1886 and 1887. It should
be borne in mind, however, that Priestly, as earlyas 1766, killed animals
by static electricity, and that at that time numerous experimenters
followed him, notably Fontana, the Italian physicist. The
experimentB of Nothnagel in 1880 are also worthy of record in this
relationship. - D ' Arsonval 's results will be referred to under the paragraph on
Causes of Death, since he was interested in the physiologic side of the
problem only. From the pathologic point of view the investigations
of Peterson and Doremus, conducted ill the Edison laborities in 1888,
are of interest.
Animal experiments made by Kratter2 within recent years on mice,
guinea-pigs, rabbits, cats, and dogs show certain signs regarded by him
as more or less pathognomonic of the condition. Subpericardial and
subpleural ecchymoses and, more particularly, subendocardial ecchymotic
extravasations occurred in most of his cases, combined with
bloody emphysema of the larger bronchial ramifications. These signs,
when taken in conjunction with the external burns, are believed by him
to be sufficient to make the diagnosis " death by electricity." Rigor
mortis occurred very rapidly and persisted for a distinct period of time.
Macroscopic changes in the brain and spinal cord were not prevalent,
though in some there were subdural and intermeningeal hemorrhagic
extravasations. These are of interest by way of comparison with
similar findings by Peterson, and in cases of electrocution as reported
by Van Gieson. Changes in the morphology of the blood have been
emphasized by earlier observers, but the careful work of Kratter and
other recent writers would seem to prove quite conclusively that such
do not occur save at the sites of electrode contact. Cunningham8
has shown that if the thorax be opeqed immediately following death
due to strong continuous currents, the heart on close examination will
be found to show a minute quivering throughout its entire muscular
substance. While the coordinate beats of tho ventricles, as a rule, are
absent, the numerous isolated bundles of muscle-fibers will be found
alternately to contract and relax with vigor in different parts of the
ventricle j and as the right and left auricles become gradually distended
this irregular quivering of the muscle bundles grows feebler and feebler,
until every trace of muscular contraction has disappeared. This state
of delirium cordi8 or, as Cunningham prefers to call it, " fibrillary con-
1 D'Arsonval, La morte par l'electricite danB l'induBtrie, CompteB renduB,
April 4, 1887, vol. civ ., p. 988.
2Kratter, Der Tod durch Elektricitat, Vienna, 1896, S. 61, et 8eq.
sNew York Medical Journal, Oct. 28, 1899, pp. 581,616.
512 MEDICAL ELECTRICITY AND RONTGEN RAYS
traction,' , as the cause of death was first pointed out by Cunningham,
and also independently by Prevost and Battelli.t
The nervous tissues have been carefully searched for pathologic
changes, and it has only been within recent times that distinct changes
have been found. It seems not improbable that changes of importance
would be found by the newer technical methods of investigation, but thus
far only a few workers have employed the Nissl methods, or modifications
of the same. Kratter.'s observations were made by the older methods,
and he found no special cell changes. He confirms the observations
made by Peterson, Spitzka, Van Gieson, and others that minute capillary
hemorrhages in the perivascular spaces are present, especially in
the superficial layers' of the cortex, but these he distinctly shows are
not universal, and cannot be regarded as of sufficient moment on which
to base a pathologic diagnosis of death. He concludes, however,
that he believes that minute changes, not known to our present technical
methods, are responsible for death by electric currents. More recently
Corrado2 has shown that such minute changes may be gemonstrated
by means of the more modern histochemic methods.
Corrado's conclusions may be summarized as follows :
The continuous electric current derived directly from the commutator
and applied to robust adult dogs weighing from 2.5 to 20 kilos
(5 to 50 pounds) , one electrode being placed on the head and the other
on the lower portion of the spinal cord, with a voltage of from 720 to
2175 volts, and an amperage of 20 to 30, or in two dogs, 10 to 12 amperes,
produced death in every instance. Death occurred immediately and
was not influenced by artificial respiration. On the closure of the circuit
the animal, without emitting a cry, became rigid, and all the muscles,
especially those of the back, contracted violently, producing a
pronounced opisthotonos. This rigidity persisted for from one-half
to one minute after the cessation of the flow of the current. Respiration
was arrested from the first moment of the passage of the current.
An examination of the ganglion cells of the brain and spinal cord
by the newer methods of Nissl and also by the m~thod of Golgi showed
a number of interesting lesions, the importance and interpretation of
which are only just beginning to be appreciated.
Corrado describes changes as occurring in the external shape and
configuration of the cell-body, changes of the cytoplasm and of the
processes.
A. Changes in the Cell Contour.-(I) Noteworthy and various
deformities, erosions, jagged outlines, lacerations, and even severe
destruction of the cell outline. (2) The contour of the cell became
hazy and diffuse. (3) In some cases the protoplasm became granular
on one side.
B. Internal Cell Changes.-(I) A gradc of dissolution of the chromatic
substances with powdery granulations was observed. The cell
contents were more homogeneous and showed the beginning changes
of chromatolysis. (2) Frequent and pronounced vacuolation (perhaps
artefact) .(3) The chromatic substances had a slight tendency to
become dispersed in the remainder of the cell-body, at times in distinct
collections, which in certain parts of the cerebral cortex had a special
tComptes rendus de l'Academie des sciences, March 13,27, 1899.
2G. Corrado, De alcune alterazione delle cellule nervose nella morte per ellettricita.
At ti. d. R. Assad. med. Chir. di Na.Doli. lR9R. vollyyv
513 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
Jrangement. These collections of chromatic particles were not dislosed
in the direction of the passage of the electric current. (4) The
1Ucleus is quite resistant. It may, however, be modified in shape,
)ecome diminished in size, or may entirely disappear. The contour
)f the nucleus may be irregular or even angular. The chromatic substanc«
)f the nucleus may be irregularly disposed, granular, arranged in fine,
.rregular filaments at the periphery, or it may entirely disappear, leaving
,he nucleus colorless. The position of the nucle\ls may vary .A cer-
~ain tendency is manifest for it to be located on one side, especially to
Jhat side on which the accumulation of chromatic substances occurs.
rhe nuclear membrane may be broken. (5) The nucleolus is the
1lOst resistant part of the cell. It is for the most part preserved and
leeply stained, even when the remainder of the cell is profoundly altered.
!\.t tiI.Des it may be diminished in size. It has a tendency to an eccen-
Gric position, being pushed out to the periph-
~ry of the nucleus or even to the periphery
)f the cell.
Corrado also describes a series of changes
in specimens treated by the Golgi methods.
l'hese changes of the dendrites consist
for the most part of varicose atrophy, fragmentation,
and other modifications of shape
and position. Since the Golgi method a:ld
its now known modifications SPOW precisely
such changes in normal material, it is fairly
well established, by reason of this and also
on account of the great lack of uniformity in
the Golgi pictures, that it is unwise to describe
these as degenerative lesions pathognomonic
of any diseased condition. Hence,
these observations of Corrado by means of the
Golgi method are not considered final.
In man the pathologic features have
been closely followed, though not as yet by
the newer methods. Electrocution has given
the most accurately observed cases, and the -
investigations of Spitzka, Van Gieson, and
K tt th t I b t I th Fig. 321. -Showin~ the
ra .e~ are e mos ea ora e. ~ e case character and distributIon of
of WIllIam Kemmler, the first officIally elec- the petechial spots on the floor
trocuted criminal under the modified stat- of the fourt:h yentricl? in the
.case of Schlchiok Juglgo (Van
utes of the State of New York, the followmg Gieson}.
autopsy record is taken from the notes
of Dr. George F. Shrady: {{ Capillary hemorrhages were noted on
the floor of the fourth ventricle, the third ventricle, and the anterior
part of the lateral ventricles. The circumvascular spaces appeared
to be distended with serum and blood. The brain cortex beneath the
area of contact was notably hardened. The vessels of the corpora
striata were I;lotably enlarged at differents parts of their ramificatIons.
The pons was slightly softened. The spinal cord showed rio gross
lesions." The abstracted report of the microscopic findings of Dr.
Spitzka is as follows: The brain, spinal cord, and peripheral nerves
appeared structurally healthy in every place examined except in the
anemic and hardened areas. The hemorrhagic spots showed no vessel
33
514 MEDICAL ELECTRICITY AND RONTGEN RAYS
alterations. (The cytologic changes described by him are of little
moment viewed from present day standards.) The vacuolation of
the ganglion cells described are those now recognized for the most part
as being due to manipulative artefacts, hardening etc., and cannot be
brought into correlation with the later-day pathology of the ganglion
cell (Ewing, Goldscheider, Turner, Barbacci, etc.). The histologic
examinations of those paying the electrocution death penalty, made
by Dr. Van Gieson and others, are more extended, and since newer
methods of accurate fixation and staining were in vogue, some clue may
Fig, 322.-Showing the character and distribution of the petechial spots on the floor of
the fourth ventricle in the case of Schichiok Jugigo (Van Gieson).
be gained as to the amount of cellular change. The details of the visceral
examination do not need repeating, since nothing abnormal has
as yet been found in any of the viscera related in any way to the method
of producing death. Of the cases examined by Van Gieson, that of
Schichiok Jugigo may be taken as a type. "The pia was uniformly
thin and moderately congested. The blood was fluid throughout. The
vessels at the base of the brain were normal. The floor of the fourth
ventricle at its upper half contained some dilated vessels, and on the
left side there were a number of minute radiating petechial spots from
1 to 2 mm. in diameter. These small petechial extravasations showed
small masses of extravasated red blood-cells, situated for the most part
in the perivascular spaces just beneath the ependyma." The hemorrhage
appeared as if a small vessel had given way, but whether such
rupture was due to the current, to the muscular contortions, or to the
effects of man!pulation are not determined by the observer. In his
summary of autopsy findings, after reviewing the result of a number
of autopsies, Dr. Van Gieson notes the following: " (1) The passage
of an electric current of the pressure employed in these cases (of approximately
from 1400 to 1700 volts) and in this manner does not do any
damage to any of the internal organs, tissues, or muscles. None of
these parts. are lacerated o.r changed in volume.i neither I;tre there any
gross chemIc' or morphologIc changes ?r alteratIon of theIr finer structural
features. {2) The local therml~ ~ff~~t.R nf t.h~ ~l~~t.rnn~R R.r~
515 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
limited to the scarf-skin. (3) The occurrence and distribution of the
minute hemorrhagic spots are not uniform or constant features in these
cases and, as they are found after death from a great variety of causes,
they cannot properly be regarded as positively characteristic of death
by this method." .Observations on man, which can be used to compare
with those of Corrado on dogs, are still lacking. For man it cannot
thus far be said, therefore, that the observations of Corrado on dogs
have been verified.
PHYSIOLOGIC CAUSES OF DEATH BY ELECTRICITY
From the time when the ~ods were displeased with the children of
men to the present, speculatIon has been rife upon the question as to
the cause of death by electricity. The earlier observations have been
collected by Arago,l and we are indebted to him for a large number of
interesting facts. Among the earlier observers John Hunter taught
that death was due to the II instantaneous destruction of the vital
power." Brodie believed that the action was on the head. Edwards
wrote of the disorganization of the nervous system. Robins claims
that death was due to asphyxia. Schneider, in 1833, taught that the
electric current did not traverse the body but spent itself on the surface,
thus causing the extensive burns, and death was due to the shock of
the nervous system. Stricker's observations were among the first
series of studies of the more modern period. Reports of autopsies are
more.frequent from this time, an~ experime~tal work h~s been.. greatly
amplIfied. It IS worthy of mentIon ill passillg that PrIestly, ill 1766,
and Fontana, in 1775, made a number of elaborate experiments.
The modern epoch of experimental work may be said to have been
inaugurated by No:thnagel, of Germany, in 1880, by Brouardel, Grange,
and Gariel, in 1884, in France, closely followed by Brown-Sequard and
d ' Arsonval in 1887, by Kratter in Germany, and by Biggs, Donlin,
Houston, Jackson, Knapp, Peterson, Robert, and Terry in America,
with the later studies of Tatum, Jones, Bleile, Oliver and Bolam, and
Cunningham. From the pathologic point of view the work of Nissl,
Hodge, Levi, Lugaro, Mann and Corrado2 is to be borne in mind.
From the foregoing it may be seen that the entire possible theoretic
ground was covered by the earlier observers, but their investigations
lacked the precise experimental evidences demanded at the present time.
The investigations of Nollet, Grange, d ' Arsonval, Grasset, Dubois,
Leduc, and others mark the earlier steps in the progress of the elucidation
of our knowledge concerning the phenomena of death by electricity,
while the investigators just mentioned have brought the question to
the present time with some definite conclusions. d ' Arsonval 's and
Brown-Sequard's earlier hypotheses were received more widely than
those of the other writers, and have been extensively quoted, but within
recent times many of their conclusions have been questioned. d ' Arsonval
taught that death was produced in either of two ways or, perhaps,
by the concurrent action of both: (1) By direct action, during which
the disruptive action of the current produced mechanic alterations in
1 F. Arago, Sammtliche Werke, Uber das Gewitter, Deutsch von W. G. Hankel,
Bd. Iv ., IJeipzig, 1854.
2 For bibliography of this recent work, see Barbacci, Centralblattrur allgemein
Path.ologie,. 17, .1~, 1899; Jelliffe! Archives of Neurology and Psycho-Pathology,
vnll: EWlnl!.lbld; Turner, BraID, 1899.
516 MEDICAL ELECTRICITY AND RONTGEN RAYS
the tissues and thus altered their physiologic activities. (2) By indirect
or reflex action, whereby the important nerve-centers of the medulla
were affected in their physiologic functions, which induced death.
Brown-Sequard later amplified this indirect action in the nervecenters.
d ' Arsonval again brought up the question, first promulgated
by Grange, that the electric current could bring about effects simulating
death, but the subject could be revived by artificial respiration, to
which reference will be made further in the discussion.
Cunningham's1 very able summary of the experimental data following
the epoch of d ' Arsonval is here very freely used. The researches
of later writers clearly led to the conclusions that neither the results
of experiments on animals with strong electric currents nor the numerous
reports of pathologic findings in the bodies of men killed accidentally
by the electric currents of commerce or legally electrocuted by the hightension
current employed by the authorities in New York State, are
in the least corrobative of the hypotheses of these French investigators.
Cunningham's experiments bear out the conclusions of the later writers,
who find that in the higher animals the chief lethal effect of both the
continuous and the alternating currents is due to their action on the
heart. Thus, in order to bring about fatal results very much stronger
currents are necessary when the electrodes are applied to both sides
of the head. A complication of the problem arises from the fact that
death may take place in different ways, according to the path traveled
by the electric current. Thus the work of Cunningham and others has
shown that if death results from the more or less prolonged passage
of a strong current through the exposed brain and upper spinal cord,
the lethal effect is plainly the result of asphyxil1., while in a second class,
where the course of even a moderate current traversee the heart for a
brief period only, the deadly result is due to the interference with the
coordinating power of the heart, which takes place suddenly and is
permanent, causing the central nervous system to die of anemia. A
corollary of this fact is the indication that death by electrocution could
be caused in a shorter time and with greater certaInty if the electrodes
were so placed that the greater part of the electric current were made
to traverse the heart directly. The cerebrospinal arc should be included,
however, in the path of the current in order to still the respiratory as
well as the cardiac movements. As pointed out in the section on Pathology
, the heart in animals killed by electric current is found to show
a condition of " delirium cordis " or " fibrillary contraction." This
is what leads Cunningham to assert that death by commercial electric
currents, as well as death by electrocution, is due for the most part to
the fact that the electric current induces fibrillary contractions of the
heart. The summary of conclusions by Cunningham is here given:
(1) Industrial electric currents, which traverse the whole body transversely
or longitudinally in sufficient intensity, kill because fibrillary
contraction of the heart is produced, and not, as has been hitherto
surmised, by producing a total paralysis of that organ or by killing
outright. (2) Such currents neither kill the central nervous system
outright nor paralyze it instantaneously. Death of the nervous system
fl'om such currents is due to the total anemia following a sudden arrest
of the circulation. (3) In rare cases, when an electric current traverses
only the cerebrocervical portion of the nervous system in considerable
1 Cunningham. New York Medical Jol1rnlll (Inc cit_)
517 ELECTRICITY IN DISEASES OF THE NERVOUS SYSTEM
'intensity and for a considerable length of time, it may ~ill by asphyxia,
consequent on a inore or less complete inhibition of the respiratory
movements, which occurs chiefly during the passage of the current.
N o existing facts warrant the conclusion that the medullary respiratory
center is paralyzed or killed in such conditions! (4) Industrial currents
are practically non-lethal to frogs and turtles, as the conditioI1' of
fibrillation quickly and spontaneously disappears from their hearts after
the current has ceased to pass. Such animals can, of course, be killed by
the very prolonged application of a current of moderate intensity or by
a brief one of enormous voltage and large intensity. (5) Strong electric
currents applied to the surface of the skin affect the heart in the same
manner as currents of less strength do when they are applied directly
to the exposed heart. (6) It may be possible for an electric current
of enormous intensity and electromotive force to produce instantaneous
death, either by its disruptive action or by producing an instantaneous
heat coagulation of the cellular constituents of the body. .Jndustrial
currents do not kill instantly, although as a result of their action death
rapidly occurs. The experience of individuals who have recovered
from severe electric shock indicates that such a mode of death is not a
painful one.
Since, from a pathologic point of view, the critical analysis of the
cellular changes described by Corrado does not enable one to say what
the initial cause of the cellular destruction may have been, the results
of physiologic investigation IPUst be accepted; and since independent
observers-Cunningham, Prevost, and Battelli-have come to similar
conclusions, it seems that the question of the cause of death by electricity
has an authoritative answer in the conclusions just quoted.
The experiments of Prevost and Battelli, page 367.. are of the
greatest value. They show that with the same position of the electrodes
currents measured in hundreds of volts kill by cardiac fibrillation;
and currents measured in thousands of volts kill by respiratory paralysis. \
1 Corrado's observations, while not disproving this statement, throw some important
light on the pathologic processes taking place in the medullary centers.
 

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