2012-08-09 23:14:32 UTC

501eee346df6d 142.179.254.158 Canada

MODERN

METHODS

OF

TREATMENT

ELECTRICAL

TREATMENT

ELECTRICAL
TREATMENT
BY

WILFRED
Senior Physician
; Hospital

HARRIS,
and Physician
Lecturer
to
on

M.D.,
Neurology,

F.R.C.P.
St. Mary's

the

Hospital for Epilepsy and

Vale.

Paralysis,

Maida

ILLUSTRATED

MAOBTNU;

5; A'

We.
our

must

take

the current

when

it

serves,

Or

lose

ventures."

"Julius

C^sar,

Act iv., Sc. iii.

1707^3
THIRD EDITION

New

York

WILLIAM

WOOD
1920

AND

COMPANY

PREFACE

TO EDITION

THE

THIRD

The

advantages

widely

having been more of electrical treatment recognized through its greatly increased employment
and
a

during the War, having has for been

some

several

new

or

modified methods which

devised,

new

edition of this book, of print, has become from

a

time been out

necessary.

As Radium
on

account

was omitted -therapy of its having become

the second

edition,

speciality in itself,so
it well to exclude the
not
same

from
the

the present details of

edition I have X-ray

treatment,

thought for
has

reason.

While
many

the structure minor though,

for the
are

of the

book
some

been

changed,
have

alterations
as
use

and

additions

been
a

made,

before, its chief aim

is to provide

manual

of the practitioner whose

only electrical

instruments

likely to be faradic and

galvanic batteries.
Harris.

Wilfred
WiMPOLE

Street,
October,
1919.

PREFACE

TO EDITION

THE

FIRST

This, book presenting

has been
a

written with

the main

purpose

of

comprehensive view of the various forms of* ElectricalTreatment as practised to-day, giving particular attention to the vvork that may be done in medical

practice with a good faradic and galvanic battery. For instance, the great reliefthat may be afforded in acute sciatica,brachial neuritis,and other forms of perineuritis
by the proper application of the galvanic current

is, perhaps,

scarcely sufficientlyppreciated. a

Explanations have

been given as far as possible of the theory of the various forms of current, so that terms such as " high frequency,"
" " X-rays less shall not be meaningalternatingcurrent," and interest counters, in the hope that an added scientific
"

increase the zeal of the student and practitioner of trate electro-therapeutics. Only the figures necessary to illusmay

the text instruments

bearing

on

the

more

important have been

sought in the illustrated catalogues of Schall, Gaiffe,Watson, Miller, Cox, etc. My thanks are due to those who have kindly lent blocks for

and

and current further details must

diagrams
be

electrical y included, \

while, lastly, the addition of a full index will,I hope, increase the usefulness of the work.
the

illustrations ;

AViLFRED

Harris.

CONTENTS

CHAPTER METHODS
AND

APPARATUS

page

General

Indications

Faradism, Methods of using and Sinusoidal Unidirectional Pulsating and Static High-Frequency Electricity, and
"

vanism, Gal-

rents, Currents Cur"

"

Diathermy
"

Faradic
Reverse
"

Electrodes
Batteries
"

Current

rs

Galvanic and Galvanometer

"

Batteries
"

Commutator

Shunt
"

Rheostat

"

^Combined former TransMotor

Multostat
"

for

Sinusoidal
"

Currents

Earth-free
"

Magneto-therapy Aj^paratus
.........

Static

Macliines

High-Frequency 1

CHAPTER THE
Primary them and
"

II

FARADIC
Faradic Current

CURRENT Currents
"

Secondary
The Faradic

The
"

Choice between
Motor Points
43

in Diagnosis

CHAPTER

III

FARADIC 3Ialnutrition
" "

TREATMENT
"

Neurasthenia
''

Traumatic

Neurasthenia
etc.
" "

"

somnia In"

Shell-shock,"
Tic
"

War
"

Neurosis,
Neuritis

Hysteria

Convulsive
"

"

Neuralgias

Blepharospasm Tabes
"

Hemiplegia
"

Disseminated
"

Sclerosis
"

Dorsalis

"

Headache
"

Dilated Stomach
"

Visceroptosis Convulsions

Constipation
"

Prolapse

Coma

"

Hysterical

Catalepsy

55

CHAPTER

IV
OR

THE

GALVANIC,

CONTINUOUS,
CURRENT

DIRECT

"Leclanche Cells
"

Electrical Units
"

"

Ohm's
"

Law

Accumulators

Secondary

Batteries

and Tests for Polarity

" "

Batteries

viii

CONTENTS

CHAPTER

IV"

{continued)
PAGB
"

Effects of Galvanism Electroon the 8kin and Muscles tonus Combined Faiadism Reaction Galvanism and Degeneration Tetany Cyanotic Reaction thenic Myasof
" "
"

"

"

Reaction

106

CHAPTER GALVANISM

(continued)
Paralysis
" "

Muscular

Wasting
Atrophy

"

Infantile
"

Poliomjelitis
"

"

thritic Ar-

Hemiplegia

Neuritis
"

Facial Plexus

Paralysis

"

Sciatica

"

Brachial

Neuritis
"

Brachial
nerve
"

Injuries
"
"

Musculo-spiral of

Paralysis
"

Ulnar-

Paralysis

Forms sitis Myo-

Sensation
"

Median-nerve

Paralysis

Ischa?mic
"

Nerve

Injuriesof
"

the

Lower

Extremity
. .

cular ^Tuber.

Neuritis

Ascending

Neuritis

.140

CHAPTER GALVANISM

VI

{contimie^)
"

Optic Nerve
Nerve
"

"

Hysterical Trigeminal

Amblyopia

Ocular

Paralysis
"

"

^Third

Nerve
"

"

Auditory

Nerve

Vagus
"

Spinal Accessory
Mutism
"

Nerves

Laryngeal
"

Paralysis

and Hysterical
and

Laryngeal
"

Epilepsy

Sterno-mastoid
Nerve
....

pezius Tra205

Muscles

Hypoglossal

CHAPTER
GALVANISM

VII

icontinved)
Neuroses
"

Multiple
"

Neuritis

"

Occupation

"

Spasmodic
"

collis Torti-

Raynaud's and

Disease

Chilblains

Graves's
.
.

Disease
.

"

Leukiemia

Splenic

Anaemia

.221

CHAPTER GALVANISM

VIII

(concluded)
"

Electrolysis
Hairs
"

"

Theory Moles
"

of Ions

Ionization
"

"

Nsevi
"

"

Superfluous
"

and

Strictures
........

Fibrositis-

Scars

Fibroids 230-

Aneurysm

CONTENTS

ix

Chapter
ELECTRIC
The

ix BATHS
page

Galvanic
Current

Hydro-electric for Bath

" "

Bath

"

Method

The

Schnee Current
.......
"

Bath

"

of Using Local Armfrom

Main

Leg-baths

The

Leduc

Dangers

and Electric252

lighting Currents

CHAPTER THE SINUSOIDAL

"

CURRENT
and

The

Dynamo

Current

Armatures Motor

Commutators
"

"

Motor

Transformers

and Alternating-current

Generators
"

Direct-current

Motors

High-tension
"

and Alternating formers Trans275

Current

"

High-voltage
.........

Direct-current

Rotary

CHAPTER MEDICAL APPLICATIONS CURRENTS Sledge Transformers

"

XI

OF

SINUSOIDAL

and

Shunt
Current
"

Rheostats Three-phase
"

"

Single-phase
Current
Paraplegia
"

Current
Bath

Two-phase
"

Treatment

Hemiplegia
"

Spastic
"

"

Muscular

Dystrophies

Neuralgia

Electro-magnetism

"

Ozone

291

CHAPTER

XII BATHS
AND

ELECTRIC-LIGHT
Radiant
Heat
"

X-RAYS
"

Finsen
"

Light

"

Mercury-

Rays

Various
Rays
"

Forms The

Light

"

Rontgen

Lamp violet Ultravapour Coloured of Electric Light Phenomena of a Focus Tube

"

310

CONTENTS

CHAPTER STATIC

XIII

ELECTRICITY

AND
CURRENTS

HIGH-FREQUENCY
PAGE

Influence

Machines

Sparks,
quency
"

and Friction,
:

Apparatus Breeze, Mode

"

Methods

Static

of Treatment Charging. High-Fre"

"

Currents

Medical

of Generation Applications
.

Apparatus
.

quired Re.

.323

Index

..........

345

LIST

OF

ILLUSTRATIONS

1. Faradic
2. Faradic

battery
battery battery
reverser

(Spamcr)

.....

II
....

(Lewis Jones)
.......

12 18
19

3. Galvanic
4. Curi-ent

5. D'Arsonval 6. Switchboard

galvanometer
for utilizing

.....

21

direct

main
. .

current
.

for

gal

vanization

and

faradization
rheostat,
motor
or

26 27 sinusoidal
29

7. Diagram

of shunt

volt selector

8. Direct main-current
current
........

transformer,

producing

Static transformer
static

for alternating

current
....

34
36

10. Wimshunst 1 1. D'Arsonval's 12. D'Arsonval's

resonator

machine

high-frequency high frequency

.......

transformer transformer
and

37

Oudin
41

13. Metronome
14. Simple 15. The

current

reverser
or

.....

143

form

of four-cell
motor
......

Schnee

bath

259
204

Leduc

16. Clarke's

magneto-electric
construction

machine
" "

....

277 280
commutator

17. Simple
18. Diagram

for

sine

curve

of

direct

-current currents,

dynamo
or

and

281

19. Connected
current

alternate
........

pulsating

unidirection
282

20. Diagram
21. Diagram 22

of EMFs

of four

pairs of coils in scries three-phase

currents

283

of single-phase

and

297 298 298 299

in quadrature, or two-phase current currents .Alternate 23. Diagram of three-phase alternating-current djmamo 24.

Three-phase

sinusoidal -current

motor

transformer

ELECTRICAL
CHAPTER
METHODS
AND

TREATMENT
I
APPARATUS

the best results witb tbe modern of methods it is of the utmost importance that electrical treatment, in the greatest possible care the practitioner should use his diagnosis of the case presented to him, and making
To obtain

should

of consider carefully the best form and method applying electricity as a therapeutic agent if he decides

For more than a hundred years static or upon its use. frictional electricity has been employed, rude plate-glass of small power, or a resin electrophorus, being machines
at firstused
as

the

source

of the electrical sparks ; while

during the last half of the nineteenth century treatment into use, the latter mainly by galvanism and faradism came
through

ardent
almost
an

the results obtained by the pioneer work and of Duchenne, whose exploration in the advocacy untrodden field of neurology at that time led to
enormous

such

increase in the interest taken in neurological

science. is These are still the three main forms in which electricity used in medicine, though the instruments now employed are
of far greater precision and power than formerly. Various modifications of these forms of electricity are also used^ being applied either as sparks in different static electricity

lated positive charging of the patient on an insuHigh-frequency stool, or as the negative breeze. are currents, like static electricity, of extremely high poten-

ways,

or

as

ELECTRICAL

TREATMENT

in tial, yet the discharge differs consistingof a number of the rapid oscillations, current having there extraordinarily
-

fore no

is

an

current electrolytic ffect. The faradio e alternating current, yet unequal in its alternations

chemical

or

.^

both in rhythm and in force,giving a very jagged, unequal if the electromotive force be planned out on a diacurve smoother alternating current is that gram. A much known as the sinusoidalcurrent, in which the rate and
amount

of variation of the electromotive force are perfectly regular, an approximate example of which is the

**^

lighting of the electric alternatingcurrent supplied by some companies. This sinusoidal current may, again, be alteredin form and changed into a pulsatingunidirectional

N^

simple deviceknown as a commutator attached to the motor -transformer,or by passing the alternating current through an apparatus which will allow one phase of the alternatingcurrent to pass but not the other. This
current, by
a
""

"

is known

valve, consistingof a group of two or four cells with aluminium and lead poles,in which the property of aluminium is taken advantage of in allowing
as

the Nodon

i current to pass fereelyn

.^.^^

one

directionbut not in the

re-

verse.

the constant voltaic current, may be used in several ways, eitherby the labileor the stabile interrupted method, or the current may be periodically or reversed, or, again, it may be employed through a
or

Galvanism,

condenser. The precise methods of employment of these forms of at current and their modifications will be treated more length in the various chapters devoted to that purpose. stalla Enough has been said to indicate that for a complete ininstruments to cover allthe possible of electrical

ments instruof varieties treatment, a large number of different and a considerableoutlay of money would be required One aim of this book is to show in detailwhat self the general practitioner willbe able to accomplish for him-

with the aid of

good faradicand galvanic battery,

FARADIC which
are

TREATMENT

the only instruments that the average busy Cases practitioner will have the time or opportunity to use. by the electric bath, or by static or requiring treatment high-frequency currents, will generally have to be sent for
treatment

to those possessing

larger electrical installation,

and whose
in

time is more

Treatment
cases

by the

given up to this class of work. faradic current is especiallyuseful

as

where general sensory stimulation is required, in hysteria and neurasthenia, especially in those cases
cutaneous

where

anaesthesia is a prominent symptom. General stimulation of the surface by faradism is also useful flabbiness and anaemia, in rickets, in cases of general

and in cases of suspended animation, as in syncope during or the administration of an anaesthetic, the coma of opiumdrugs. Faradism is also of poisoning or other narcotic where muscular stimulation is great service in those cases
in all cases of paralysis where the faradic reactions of the muscles are preserved. It is often taught that faradism is indicated for treatment of striped voluntary

required,

as

muscle, and galvanism for unstriped muscle such as the intestines. This is a dangerous error : the galvanic current be applied to the mucous membrane should never of for treatment the stomach or rectum of muscular atony

except by

an

expert,

on

account

producing electrolysis and ment the faradic current is of the greatest service in the treatof chronic atony with dilatation of the stomach, when of a special electrode introduced into the applied by means of chronic constipation, stomach, and also in cases pole being introduced into the rectum.
one

of the serious danger of ulceration. On the contrary,

Another valuable example of the class of case in which faradism is often of the greatest benefit is certain cases of
may persist after muscular rheuneuralgic pain which matism, lumbago, sciatica, or pleurisy. For the chronic

pain in the side, often most severe, long after all other signs of

which
an

sometimes

remains

attack of pleurisy

ELECTRICAL

TREATMENT

have

by the faradic current may passed away, treatment often prove of the greatest service. In rectal and uterine prolapse also, and in certain cases of enuresis, this form of
treatment

be used with great success. The best suited for these different various methods of treatment at length in the conditions will be treated more chapter specially devoted to faradic treatment.
may

sometimes

Galvanism,
those
set up
cases

or

simple faradic

where by electrolytic action is required, rather than stimulation or shaking of the tissues which
or

the constant current, is indica'tedin definite chemical change in the tissues the

the

trolytic produces. Thus, the eleccurrent is taken advantage of in the treatment of nsevi, in the epilation of hair with destruction of the hair-follicles, electrolysisof uterine the fibroidsand of strictures, though for these two latter conditions

alternating current action of the constant

surgical
more

measures

are

probably

much

safer arid

pronounced chemical efficacious. Owing to its more action the constant current has the power of provoking of neuritis or contraction of degenerated muscle in cases
other
nerve
or

the muscles only at the make

make,
means

spinal lesions in which the trophic centres of damaged. Such contraction is produced are

and

and break of the current, especially at the current applied by consequently the constant

over the degenerated of electrodes immediately muscles, with frequent interruptions of the current, is of use in the treatment of such conditions, by keeping up the

nutrition of the paralysed muscles This method, in which one wasting. negative
or

and

retarding their

stroked over labile method.

electrode-^either the is positive pole, according to the kind of case the degenerated muscles, is known as the
"

Stabilegalvanism, in which the electrodes are kept applied to the parts that are being treated, and in which direction the current ia allowed to run smoothly in the same for several minutes without interruption, is often useful

STABILE
in the treatment

GALVANISM

disorders,such as Raynaud's of vasomotor disease, "dead fingers," chilblains, exophthalmic goitre, feature, as in and in other cases where pain is a prominent

the pain of
and
current

ritis, subsiding neuritis, in sciatica,brachial neurheumatoid arthritis. Sometimes this form of

a

may also help in relieving spasm, as in spasmodic As an anodyne, torticollis, and the occupation neuroses. the positive pole or anode has the greater sedative effect,

and this may

neuralgia. introduced through the skin into the circulation, by the ionization or cataphoresis. Thus, using as process known
the anode
as

be applied over painful spots, as in trigeminal By means of this current, also, drugs may be

the active electrode, cocaine may be appHed to render the skin anaesthetic, by wetting the termina "witha strong solution of cocaine, and pressing the electrode
on

the skin, passing

steady current

of 10

ma.

for five

minutes. The sinusoidal

current

for treatment

is generally

obtained from the alternating-currentelectric -lightingmains, but it may be produced by means former of a small motor-transin places where the direct current is supplied, or by using a battery of accumulators. Single-phase and three-phase currents are used, though there is no particular
cases advantage in using the latter, except in some where limbs require treatment three time, which may at the same be done by using the arrangement known as Dr. Schnee's

bath. much

sinusoidal current is an alternating current smoother in character than faradism, though somewhat
in similar its effects. It tetanizes muscle, though it is
same

The

less painful for the

degree of contraction.

used

of atrophied and for this purpose I consider it far inferior to reversals of galvanism, or to faradism. Dr. Reginald Morton advocates the use of a sinusoidal current of very
muscles, though

for the

treatment

It is often degenerated

low periodicity,and claims that it produces contraction in degenerated muscle, as in cases of infantileparalysis, much

6
as

ELECTRICAL

TREATMENT

reversed galvanism does. I use the sinusoidal current chiefly in the treatment of spastic conditions, using arm and leg baths, as in Dr. Schnee's bath, in cases of transverse
myelitis, disseminated sclerosis, and
cases

hemiplegia.

It is in

of comparatively recent onset that I have seen the plegia best effectsproduced by this treatment, the rigidityin hemicertainly seeming to benefit considerably, and cases myeHtis, of spastic paraplegia due to disseminated sclerosis, tion etc., often gaining in strength, with a corresponding diminuof the rigidity. On the other hand, I have found no
benefit from of long-standing standing longspastic paralysis where there is great rigidity,as in cases of hemiplegia, especially if there are

this treatment

in

cases

marked athetoid movements. The pulsating unidirectional current, which may produced by modifying the sinusoidal current by means
a

be of

the motor-transformer, or by means of the Nodon valve, will have practically the same effect as be a rapidly interrupted galvanic current, such as may as the Leduc of an apparatus known produced by means
commutator
on

It will have electrolyticeffects,though somewhat inferior to the smooth constant current, and will be more
motor.

painful.

Static
America,

electricity has

for long been

and to a less degree on paratively valuable therapeutic agent. It has, however, until comrecently been looked at somewhat askance in as playthis country, the machines being regarded more things than of real practical benefit in the treatment of disease.
This has been due chiefly to the small size of the in use. To get anything like really valuable machines results,large machines must be used, consisting of eight or
more

recognized in the Continent, as a most

These machines plates of 24 to 36 inches diameter. with their necessary accessoriesare costly and take up a considerable amount of space. They require an electricmotor

to drive them,

and

consequently

are

not

easily available.

STATIC

ELECTRICITY

Of late years there has been what might be described as a boom in the use of high-frequency currents, and a corresponding diminution in the attention given to static though electricity,
observers

biased amongst unthat the latter has superior therapeutic

can

there

be littledoubt

with this form of electricity are of neurasthenia, functional symptoms headache, insomnia, depression, and functional paralysis
general indications for treatment

value. The

ing, and anaesthesia. Its effects are stimulating and invigoratraising the blood -pressure and increasing the action of the skin. It is said to exert a stimulant action on metabolism ; and since the current is unidirectional,resembling well be that this form of current may exert a chemical action of that nature on the exchange processes in the tissues. It is especially in cases by static charging of low blood -pressure that treatment is indicated, and persons whose blood-pressure is already high may be made uncomfortable by it.
galvanism

in this respect, it may

to supposed by many have effect on the metabolism, and to be beneficialin cases The general diabetes, and anaemia. of gout, rheumatism,

High-frequency

currents

are

effect of this current is to lower blood -pressure and to act It is often as a sedative in states of mental excitement. useful in cases of neurasthenic headache, especially when The claims that combined with light massage to the head. have been made for its curing cases of gout, rheumatism, diabetes, and pulmonary tuberculosis are unsubstantial,

and

are

to be ascribed

more

to the enthusiasm

of atony dilatation of the stomach, for chronic uterine diseases, and venereal diseases, and piles,similar claims have also been

than to any reporting the cases benefit accruing from its use. For local treatment

of the observer real and lasting

For with an equal degree of justification. certain chronic diseases of the skin high-frequency currents have as undoubtedly a beneficialeffect, in lupus, port- wine marks,
made,

8
acne,

ELECTRICAL

TREATMENT

and pruritus, and in indolent ulcers requiring local ness, baldstimulation. Lastly, for alopecia and commencing high-frequency currents administered to the scalp by
of the vacuum the loss of hair and
means
even

electrode have been found to arrest to cure the alopecia.

For practical purposes there are two methods of administering high-frequency currents : (1) by auto-condensation, and (2)by local treatment by metallic points, vacuum

electrode, or by the effluve or brush discharge. There is a third method, auto-conduction, in which the patient is placed entirely within a large solenoid, but it is a cumbersome method
and
has
not

been

found

to

present

any

special advantages. Diathermy. A

"

known
waves

as

rents, method of using high-frequency curdiathermy, transforms the oscillatory

into heat, which penetrates the tissues in a direct line between the two applied electrodes. Diathermy, by

heating the deeper parts equally with the surface, differs from radiant heat. It is especially useful in some forms
lumbago of sciatica, and rheumatic fibrositis, and chronic jointinflammations. By using one large electrode and be focused on the the other very small, the heat may
surface at the point of contact with the small electrode, which should be metallic, and then acts as a cautery, neous and is used for the destruction of nsevi and other cuta-

heavy The stream of and blemishes. white sparks that issues from such a pointed electrode " fulguration to the method. gives the name of growths
"

APPARATUS

AND

OUTFIT

REQUIRED
:
"

This will be described in the following order 1. Faradism.

2. Galvanism.
3. Sinusoidal current

and

its modifications;

4. Static electricity. 5. High-frequency currents.

F ARABIC 1.

BATTERIES

here to give in It is not proposed any way an historical review or exhaustive index of all the different kinds of faradic batteries that are being or
"

Faradism.

have been used. I shall give the essentials for an efficient battery, with a short description of two or three forms now on The best type of battery for the the market. practitioner will depend on the conditions of his practice whether the battery will have to be carried about from patient to patient, or whether it is intended for consultingroom use the battery will only. In the of cases
"

majority

be taken

to the patient's house

for the treatment,

will therefore be clearly an advantage to have a moderately small dimensions and as light as possible. The cell that is now universally used to drive medical

and it battery of

coils is of the Leclanche type, and anyone purchasing a battery for medical purposes, whether for faradism or for galvanism, should have it fittedwith dry cellsand not wet
ones. are

dry cells can be carried in any position, and much lighter, an important point with a battery containing forty cells, is often required for galvanism. such as

The

Moreover, they give no trouble in the creeping of the salts, with erosion of the wires and binding screws, such as wet excells so constantly give. On the other hand, when hausted,

be be renewed, but must cells cannot be fitted, process which must discarded, and new a ones to two repeated from every six months years, according to the amount of use to which the battery is put. For the
a

cells only are required, but a much larger cell is necessary than is used in most galvanic batteries, as volume quired of current in the primary coil is re-

h faradicattery one

or

two

in the production of a in the secondary coil is that the intercurrent smooth ruptor hammer should vibrate directly against the iron core hi the primary coil. This hammer of the interrupter may be either a rigid rod working against
a

rather than high voltage. importance point of some

small coiled spring,

10
.

ELECTRICAL

TREATMENT

the interruptor itselfmay be made of a piece of steel convespring, the latter form being usually the most nient, and a high rate of interruption may be maintained
or

with it, giving a fairly smooth current in the secondary coil. With this form of interruptor,the iron core must be a fixture and cannot be withdrawn, weakening of the primary induced current being arranged for by slipping a brass

thus cutting off the magnetic field from the primary coil. As the brass tube is slowly withdrawn, so the primary coil is excited by the magnetic field,
tube
over

the iron

core,

the primary induced stronger, until the maximum

and

withdrawal of the tube. be prolonged rigid bar, the other end of the bar must beyond the pivot and attached to a coiled spring, the In tension of which can be varied by means of a screw.
some

stronger and is reached with the complete is a If the interruptor hammer

current

becomes

German is made

types

of faradic battery
a

the interruptor

hammer

magnet separate small electroincluded in the circuit. This is done in order that the iron core of the primary may be made movable, be withdrawn to diminish the strength of so as and can from this type of The the primary current. current
is, however, machine not so smooth and steady as in is attached to a stiffspring those in which the hammer and vibrates directly against the iron core of the primary. for the One advantage of having a separate magnet

to vibrate against

interruptor, and a movable iron core for the primary coil, it has no is that by complete withdrawal of the iron core longer any magnetic effect on the primary coil. The -field induced current in the coil is now very much weaker, and is produced only by inductive action of the neighbouring
turns

of the primary coil on each other. It is therefore of much shorter duration, and consequently less painful, be obtained by though good muscular contractions may

this method.
comparable

To obtain

current
a

from

the secondary coil

current

in strength with

medium-strength

FARADISM is in iron core obtained when the farther over to push the coil much iron core is taken out. The
use,

11

it will be necessary the primary when the

from the strength of the faradic current obtained secondary coil, usually called the secondary current, may be done This may be varied in several difierent ways.

Fig. 1.
"

Spamer's

faradic battery.

by keeping the secondary coil permanently fixed over the primary coil, and diminishing the strength of the primary induced current either by withdrawing the iron core, or by slipping a brass tube over With the the iron core. latter method, the primary and secondary induced currents will be at their strongest when the brass tube is completely

withdrawn, but with be weakest when the

movable iron core the currents will is completely withdrawn; Either core
a

12

ELECTRICAL

TREATMENT

methods may be adopted in the case of small and cheap faradic batteries, where economy of space and is desirable. of cost of these two

Such
This is
a

battery isthat known

small, compact which is said to work for forty to sixty hours. There is a with a fixed iron core and fixed spring vibrating hammer, secondary coil, the variation of the strength of both the primary and the secondary induced currents being arranged for by slipping a metal tube over the iron core. There is a

1 coil(Fig. ). battery driven by one dry cell,

as

Dr. Spame/s

Fig. 2.- Lewis

"

Jones's faradic baLtury.

switch for the starting of the.battery current, and two pairs of binding-screws for the attachment of the electrode wires for obtaining either the primary or the secondary current. A third way of regulating the strength of the secondary current is by arranging for the secondary coil to slide over the primary, the current diminishing in strength as the This is a secondary coil is withdrawn from the primary. delicate and exact way more much of graduating the strength of the secondary current, and such coils arc known as space and are more sledge coils. They take up more

decostly than the simpler form of battery previously scribed. A good example of this form of faradic battery is that designed by Dr. Lewis Jones (Fig.2). It has a

FARADISM

13

vibrating against a fixed iron core, and the primary current is not made use of. The secondary coil the primary, and the coil is divided into two slides over
spring hammer unequal binding from parts, each of which is connected to two of three By this arrangement the current screws provided. one-third, two-thirds, or the whole of the secondary

be employed, which has certain advantages, as large we shall see later. The battery is driven by one dry cell,said to supply current for eighty hours' working coil may
of the coil. Another way
of regulating the strength of the primary is by graduating the strength of and secondary currents the exciting current from the driving cell; this is done by
contact with a series starting switch making ferent of metal knobs, each connected with resistances of difsecondary coils with strengths. Lastly, in some
mi'ans

of

long windings of 10,000 turns, the winding may be tapped at differentlengths. By means of a radial switch and five metal knobs attached to the winding at 2,000, 4,000, 6,000,
j,000, and

the full 10,000

turns,

the

strength of

the

will vary accordingly. jecondary current at the binding screws The electromotive force of the induced current in these long coils is higher than in a coil of only a few

hundred

turns, and the effect of the current

nerves

on

the cutaneous

isgreater, so that for producing effects of sensory stimulation of the skin it would be better to choose a coil of long winding and to use the coil with the
sensory

iron

core

kept in. For producing good muscular contractions sensory effect, with comparatively little cutaneous
by Drs. Head

experiments

and Lewis Jones have shown that with a very high rate of interruptions, 200 to 300 per be produced second, good muscular contractions may without any painful effect at all being produced, so long as the muscle is not strongly tetanized. If the muscle is
thrown

be severe there may pain cramp, from stimulation of the sensory nerve-endings within the

into strong

14

ELECTRICAL
not

TREATMENT
-

nerve stimulation of the cutaneous as the endings. A form of faradic apparatus, known Bristow coil, makes use of condensers, and its current is considerably less painful than the ordinary form of faradic

muscle,

from

coil,and is useful for stimulating weak react to faradism.

muscles which

will
force

Tracings of the
developed
by

curve

of

the

electromotive

be the induction current of any coil may obtained by means obtained by photographing the curves the oscillograph. Dr. Head as of an instrument known

has found that with currents lasting less than one eightthousandth of a second in duration no painful effect is produced on the skin.
possess no convenient means of intensity of the faradic current, comparable measuring the to the galvanometer the which is used for measuring
more expensive -made and sledge coils have a graduated scale on the sledge, with a pointer attached to the end of the movable secondary coil, so that the distance through which the coil is moved away

Unfortunately,

we

constant

current.

The

better

from and
same,

the primary can be accurately measured ; supposing that the driving current of the coil is the and- that the interruptor is vibrating in the same
or

towards

way,

on

different occasions, then the same tensity insions of secondary current can be obtained on both occaby seeing that the secondary coil occupies exactly
any
two

the sledge. In practice, the medical the approximate man strength of the will get to know current developed by his coil with the differentpositions

the

same

position

on

brass slip-tube, and with the different positions of the secondary coil,if his coil is of the sledge type. The strength of the muscular duced contractions proby the current in normal muscle will be a good guide,

of the iron

core

or

to the skin when wet willthe degree of sensory stimulation to it. electrodes are applied A good plan will be for the medical man always to
as

GALVANISM

15

make a practice of starting with a weak current, and to hand first with properly try the current upon his own As wetted electrodes before applying it to his patient.
soon

he perceives a definite sensory effect, and slight contractions of the hand muscles, he may begin to apply the current to his patient, strengthening it very gradually
as

occasion arises. Thus the dosage of the faradic rate current is always uncertain, in the absence of any accumeans the current, but with a httle of measuring
as

practice a fair estimate of the comparative strengths be of the current required in different conditions can

easily made. The indications for using the primary or the secondary induced current, and the different methods of using the currents, will be referred to in the chapter devoted specially to the faradic current. For treatment 2. Galvanism.
"

by

galvanism

larger and more expensive battery, containing a much larger number of cells, is required than for faradism, less complicated. though its arrangement will be much battery is that The simplest form of constant current
known

patient's battery, consisting of small dry cells,from four to forty in number, arranged in series that is to say, the positive pole of the first attached
as a
"

by

wire to the negative pole of the second, and so on for all the cells, the two unoccupied poles ^thenegative being at one end of the series and the positive at the other connected by wires to metallic plugs in the front of the case,
a
"
"

to which

the wires carrying the treatment electrodes can be attached. Besides these two plugs, there will also be a of others connected by wires to intermediate number cells in the series, as the third, sixth, ninth, twelfth, and then every alternate cell up to the full number, all these plugs being arranged in a row along the outside of the front of the battery, and numbered 0, 3, 6, 9, 12, 14, 16,
etc.

In addition, there is figured the sign

"

at the

one

16

ELECTRICAL

TREATMENT

to mark tlie negative pole, and the left) end (usually the sign + at the other end to mark the positive poleWith this arrangement be locked, and the battery can

opened by the patient or nurse who is given the battery to use, and it is almost fool-proof : an important consideration in a galvanic battery which may need
never

be

be given into the charge of persons totally ignorant of electrical matters ; for if the cells or their connections are meddled with, the battery is very easily put out of

order, and will be completely spoilt if the terminals at the two ends of the series of cells be short-circuitedby a wire t joininghem, even for a few minutes, or if the wires of the treatment electrodes, when the battery is in use, be allowed to remain in contact. filled with small dry These galvanic batteries are Leclanche cells, sizeabout 4 in.by 1 J in. by 1 J in. Each cell, has a voltage or EMF of 1'5, and an internal when new,

A battery of twenty-four of resistance of about 0*3 ohm. these cellswhen new will,therefore, give a current of about for most purposes of treatment. 36 volts,which will be sufficient greater voltage will be needed, as in cases of sciatica,when it may be required to send a more through the limb from the current of 20 mg,. or even buttock to the foot. Li such a case the resistance of the patient's skin and tissues will probably be not less than Yet occasionally
a

"pi

2,000 ohms, and by using the formula C

=

"

where C

the voltage of the battery, the current in amperes, E the total resistance of the battery, electrodes, and R be seen that in order it and patient's skin and tissues, will it will be necessary to use a a current of 20 ma. to
=

obtain Leclanche cells. battery of not less than twenty-seven new they are used, so their As the cellsget older, and the more time their internal resistance and at the same voltage falls,
usually increases, and so the efficiency of the battery diminishes. It will thus be seen, from the equation above

GALVANIC
given, of what

BATTERIES

17

great importance

it is,in order to get the

a as

possible, this will be best done by seeing that the patient's skin and carbona with biand the electrodes are thoroughly wetted (best of soda solution) and that the electrodes are
in this kept in close apposition to the skin. With care direction,and with large electrodes, the total resistance to 750 ohms or even may sometimes be brought down
less,and

greatest possible strength of current out of battery, that the factor K shall be kept as low

galvanic

the strength of current obtainable is thus proportionat higher. For the treatment of facial paralysis,
a

is required, the small current of about .3 ma. patient's resistance may be brought as low as 2,000 ohms less, using one or electrode applied behind the ear and
where only the other stroked over the face, and for this purpose a four, cellswill be sufficient. small battery of six, or even With such batteries are usually supplied wires and electrodes for treatment, consisting of a flat flannel-covered
"

silk-covered, about four feet in length, and one will have a forked end in order that the number of cells in use may be gradually increased two
time without interrupting the current. This wire should always be used on the right-hand side of the battery.
^t
a

leaden electrode and handle. The wires

are

circular covered flexible,cotton-

pad
or

fitted to

Variation of skin electricalresistance occurs extremely rapidly under the influence of emotions of differentkinds, and this fact has been utilized by Dr. Waller to measure the reaction of individuals to certain emotional tests, by using rheostats in the circuit, a delicate string galvanometer
scale to measure spot of light. The type of battery shown

and

the movements
in Fig. 3 is

flected of the re-

more

finished-

looking

and The

more

presentable than cells are hidden from

a

scribed. that previously deview by a polished

an

switchboard, carrying

current

collector consisting of

18

ELECTRICAL

TREATMENT

of separate metallic ebonite base fitted with a number knobs placed close together in the form of a ring, each of which is connected imdemeath with the carbon of one of

Fig. 3.

"

Galvanic

reverser,

battery, 24 ceils,fitted with current collector and and space for galvanometer.

current

the cells, in regular order, while another wire

connects

A the zinc of the firstcell to the negative binding screw. crank, connected by a wire to the positive binding screw, and pivoted in the centre of the ring of knobs by means

spring contact, can be brought into connection with ^nj one of the knobs, which are placed close together so

of

CURRENT

REVERSERS

19

that the crank contact in passing from one other is in contact with two knobs at the

knob
same

to the

time, in

order to avoid interrupting the current while more cells into action. Care should be taken, however, are thrown not to leave the crank in connection with two of the knobs for more as while it is in this position the than a moment, short-circuited. In the circuit are for the attachment also placed two other binding screws of a galvanometer if desired,or, if this is not wanted, the screws together by a wire. may be joined pensable indisA reverser current (Fig. 4) is an almost second cell is being
accessory to a well-found is usually galvanic battery, and fixed on the switchboard, being connected

with the cellsor source of the galvanic current in the following

manner

^(g:";"

are

Three smooth studs, equidistant, connected by wires with the

positive and negative ends of the battery of cells: one of the wires is attached to the middle stud, and the

Fig.4.-

Current

reverser"

wire is connected with both of the outer studs. It makes the central stud is connected to
other

no

difference whether
positive
or

the

the

negative wire, as it remains constant. Two metal arms, parallel to each other, are so arranged to make as good contact, by means of springs, with the touches the central stud, and the studs, so that one arm other touches the metal arms
one

of the outer studs. pivot

on

The
to

other ends of

two

screws

which

wires

are

attached. By means
these
can

of

wooden

handle attached to the two

arms,

sideways so as to make contact with either the middle and left-hand stud, or the middle and righthand stud, the extent of movement being limited by a

be moved

20

ELECTRICAL

TREATMENT

It is then obvious that if the centre stud be attached to the positive end of the battery of cells,and the two outer studs to the negative, the current will be
metal stop.

conducted
screws
reverser.

to the two these studs along the arms and their attached wires at the pivot end of the Thus, the right-hand screw will become negative

from

and

left positive. On pushing the current reverser to the left,the right-hand arm across and screw will now become positive and the left negative. From these two
the

wire is led to the galvanometer and from there to the main binding-screw, and the other wire is led direct Thus, the galvanometer will to the other binding-screw.
screws
one

be in series with the patient when he is connected the binding-screws, and moving the current reverser
reverse

up

to

will

the direction of the current through the galvanometer the direction of and the patient, though, of course,
reverser

the current from the battery of cellsto the current remains unchanged. A galvanometer is The

best form

valuable addition to the battery. is that known D' Arson val's, the small as
a

size, graduated to read to 15 milliamperes, with a shunt it read also to 150 ma. These galvanometers to make dead-boat are that is to say, the needle indicating
"

the current

on

point, without coming

to

the graduated scale oscillatingbackwards

as

moves

at

once

to the

and

forwards

before

rest,

do
is

those

permanent galvanometer

magnet
no

galvanometers In the employed.

magnet

in which a D'Arsonval

is employed except to surround the working parts and protect them from outside dent influences, and they are therefore indepenmagnetic of the earth's magnetism, and can work in any position,
permanent

and are uninfluenced by neighbouring lighting currents or dynamos. The

magnets

or

electric-

firstsuggested principle on which they work was by Lord Kelvin, to replace the permanent magnet of the old type of galvanometer by a solenoid, a long coil of very

GALVANOMETERS fine wire wound move so that it can

is attached to two
to the
as
an on

21

frame, and suspended aluminium freely between two points. The frame hair-springs, which always bring it back
an

position, and a needle is also fixed to the frame indicator, which moves over a graduated scale. When
zero

Fig. 5.
"

Arson val galvauometer, ^D' or 500

with shunt, reading to 5,50,

ma.

circulates in a neighbouring coil of wire, another current isinduced in the solenoid, and the latteris attracted or repelled according to the polarity of the inducing current.
a

current

by which, by means of turning a screw, nine-tenths of the inducing current can be short-circuited away from the inducing coil,so that the
shunt
an

The

is

arrangement

influenced by only one-tenth of the current solenoid is now which is actually being used on the patient. The same galvanometer scale may thus read from 1 to 5 ma., or from
10 to 50.

Larger galvanometers

are

made

with two shunts,

22

ELECTRICAL
and
500

TREATMENT
the
as
same

for tens
5, 50,
or

hundreds,
ma.,

scale then
no

according

to whether

reading for shunt is being

used, or that for one-tenth, or for one-hundredth (Fig.5). The older type of galvanometer, in which a permanent magnet was suspended upon a steelpoint, should be entirely avoided,
constant
as

accurate very inowing to the great frictionat the pivot and the breakages of the needle-point on which they are
they
are

far

more

troublesome

and

susj^ended. The electrodes necessary in the equipment of the battery flat pad electrodes, about 6 inches by 3 inches, two are
and two circular pad electrodes about 1 inch and IJ inch in diameter. For treatment of facial paralysis I prefer narrow a electrode, J inch in width by 2 inches in
length.

It will be advisable to have three or four spare be screwed on to the circular pad electrodes which can handle when required. The form of covering treatment
I prefer is chamois leather, as when thoroughly wetted it retains the moisture better than webbing, and slips more
easily the skin. It will be advisable to have fresh covering fitted on to the electrode for each patient, and this can easily be done at home.
over

leads to connect the electrodes with the battery should be each about 5 feet in length. Those usually sold for this purpose are covered with cotton or silk, one
The red and
green in order to distinguish the poles, and attached at both ends to rigid metal pins for connection to the binding screws of the battery and electrodes. Leads
one

covered

alone do not insulate the current properly, especially if wetted, and when the wires touch the uncovered skin of the patient considerable pain may be caused at the point of contact.

with

cotton

Good ordinary

be made connections may of being electric-bellwire, the copper wire core

and cheap wire
an

covered with rubber, with A dozen yards of this may

outside coat of waxed cotton. be purchased for a few pence,

electhodes
and it is the matter
lengths of 4
copper wire of terminal
or core can

23

of only

and

5 feet and remove for the last inch at each end. This form ing-screw, be easily fastened securely to any bindthe end is easily renewed when broken ;

few minutes to cut two the covering from the

and when the wire becomes too short, or if it should get length may be cut from the broken in the middle, a new
reserve.

Should the current fail after everything has been arranged for the treatment, and the switch turned on, it will be advisable to test the wires before examining the cellsinside
the battery, after firstlooking at the binding-screws if they are screwed up tight. The best way to to see test the wires is to attach one to a binding-screw of

battery, and turn on the crank five cells; then with the othet or end of the wire, after pulling the wire taut with the hand, If the momentarily to touch the other binding-screw.
the constant current of the collector four

indicates the passage of a current after testing each wire, the wires are probably intact, and the fault cannot have been in the battery or wires, but must have
galvanometer
been in the electrodes,or in their mode of application to the patient. Occasionally, however, even this mode of testing may fail at the first attempt to locate the faulty wire,

the wire may be broken and yet the broken ends may be kept in close apposition by the silk covering most interrupted of the time that it is being used, giving a jerky, current that is most objectionable to the patient.
as

thus necessary to the practitioner faradic battery, such as a that designed by Lewis Jones, and a galvanic battery, preferably of thirtytwo cells,
are
"

Two

batteries

or

even

forty, the latter being fitted with reverser, current and D'Arsonval

current

collector,

galvanometer,

pairs of wires, and several treatment electrodes. For the same total cost a cowbined batterycould be bought,

with two

containing the faradic apparatus, though

of

less eJBicient

24

ELECTRICAL

TREATMENT

design, and

thirty-two cells for galvanism,

and

the galvanomete

with, current collector and current reverser. This combined battery will, however, be necessarily much heavier than either of the other two, will be far less

and

at the patient's house, as convenient when faradism only is required, instead of the small and heavy compact faradic battery only being taken, the same to
use

for treatment

combined battery has to be carried on all occasions. A combined battery, of somewhat better design, will be Very useful for consulting-room work for those practitioners
experience of batteries and of the technique of muscle-testing. In such a combined battery the faradic apparatus, sledge coil, interrupter, and starting switch who
are

have

usually arranged
a

on

one

side, with two

separate compartment underneath in the centre of the switchboard will be placed the while single or double collector for the galvanic current, a

in

large dry cells to drive the coil,

rheostat, galvanometer,
commutator,

current

reverser,
screws

De

Watteville

and

two

binding

in front for the

convenient switch, by means of which either faradism from the induction coil be led to the same or galvanism from the collector may pair of binding screws, avoiding the necessity of changing

attachment The De

of the electrodewires. Watteville commutator is

the wires. It is usually arranged so that when the commutator is directed to the left, marked G, the galvanic turned to the current is led to the electrodes, and when

right,marked F, the faradic current is obtained. When is placed exactly in the midway the commutator time led to the position, both currents are at the same
electrodes. By an arrangement of the wire connections beneath the switchboard, the secondary coil is then placed in series with the cellssupplying the galvanism, the faradic
all the galvanic cells,and the galvanic current passing through the coil before reaching the electrodes. The resistance thus experienced by each
current

thus passing through

DIRECT-CURRENT
current

SUPPLY

25

before its exit from the battery will diminish a littlethe intensity of the available current, yet it is occasionally useful to apply in treatment combined faradism It is, however, important and galvanism in this way. that, before using his battery in this way, the practitioner

should test for himself to see that the coupling up of the faradism and galvanism has been properly done by the The negative electricianbefore sending the battery out.
pole of the one should be connected to the positive pole of the other, the electrodes being connected to the two

strated be easily demonpoles. If this is done, it can that with a given strength of faradic current its ing tetanizing effectsupon muscle are much enhanced by turnon a galvanic current of about three ma.
extreme

the interruptor of the coil current is made to vibrate quite slowly, so that the individual contractions visible. produced by each faradic shock are just The addition of a comparatively weak galvanic current by
seen

This is best

when

this process of
muscular

"

"

galvano-faradization
a

shocks much of katelectrotonus

contractions produced This is due to stronger.

set up

vidual makes the indiby the faradic

local condition

in the neighbourhood of each the interruptor electrode. It is useful to be able to make be of the coil work quite slowly sometimes, which can

done by

bent wire fittedon to the of an aluminium top of the interruptor, with a sliding weight. This can be by screwing up or unscrewing so the contact
means

adjusted,

point of the interruptor, that any desired speed between two and forty interruptions per second can be obtained. In districts where the continuous current is available
for electric lighting it will be convenient to make use of it in consulting-room practice for faradization and galvanization

by
may

means

of

suitable switchboard

(Fig.6).

This

be made either of polished wood, slate, or marble, either of the latter being preferable to wood in districts

where

the voltage of the electric supply is from

200

to

26

ELECTRICAL

TREATMENT
to tlieswitchboard from
a

250.

wallplug, two 16-candle-power carbon lamps being interposed as

The current is led on

-Switchboard

utilizing tli2 direct main galvanization and faradization.

for

current

for

Faradic sledge coil, De Watteville The figure shows, from below upwards, faradic key, reversing key, shunt rheostat or volt-selector, faradic switch, voltmeter, and three resistance and galvanic switches, galvanometer,

lumps.

VOLT
a

SELECTORS

27

resistancefor the faradic apparatus if the voltage is 100 volts.and 32-candle lamps being used with the higher voltage. The current, after passing through the two lamps, is
led to
hammer,
an

ordinary faradic apparatus

primary coil, and

with

interrupting

secondary

sledge coil, etc.

Diagram

of shuut rheostat,

or

volt selector.

For galvanism, the current from the main is led through a resistance of a lamp of 8- or 16-candle-power, according required, and thence to a volt selector,or shunt rheostat. This consists of about 500 turns of insulated platinoid wire wound tightly on a slate bed, the insulating material being sand-papered off the surface of current
insulated of the coils of wire, leaving the sides of the coils still from each other, the total resistance of the coils of wire being not less than 500 ohms. sliding on a metal bar can be slid along
to the volume

A
over

spring contact the coils, and

one

the wires carrying the main current are connected, 7). each end of the platinoid coil (Fig.
Two

to

the right-hand end of the other wires connect tact platinoid coil and the rigid bar of the sliding spring conto the two binding -screws for the attachment of the wires leading to the patient. The patient is thus placed in a shunt circuit,and the apparatus may be called a shunt

28

ELECTRICAL

TREATMENT

rheostat, or a volt selector. The galvanometer is inserted in the circuit between the sliding spring contact and the left-hand binding-screw. While the sliding spring contact is at the right-hand end of the platinoid coil, the EMF in the patient's circuit is only a small fraction of a volt,

and this is gradually and steadily increased, without any jumps or shocks, as the sliding spring is pushed along the bar towards the left, the available voltage being proportionate to the voltage of the main supply and the candlepower of the lamp used in the resistance. Thus, with a
100- volt supply and a 16-candle-power lamp, the maximum voltage available in the patient's circuit is about 65. The is of the D'Arsonval type, and should be galvanometer

fittedwith

shunt enabling it to read to 5, 50, or 500 ma. A voltmeter may also be fitted,if required, and there are a De Watte ville commutator for faradism or galvanism, and
a

for the galvanism. This apparatus is very convenient for applications of faradism and muscle testing in consulting -room practice, or for local applications
a

current

reverser

of wasted muscles. The same be obtained in a portable box apparatus may form, with an adaptor plug and cord for fixing on to a lamp socket, so that the battery can be used wherever

of galvanism,

as

for the treatment

there is a constant current main supply. If, however, larger currents of 15 or more to ma. are be used, as for the treatment of sciatica, for electrolysis, for the electric bath, then there is a certain amount or

danger in thus using or even of risk of inconvenience the main current from the direct current supply. This is due to the liabilityto sudden interruptions of the current
failure of the supply, owing to faults occurring either at the power station or in the underground cables. Such sudden interruptions in the voltage of the
or

partial temporary

current

supplied would the patient if a constant

cause

quite unpleasant 10 ma. current of even

were

shocks to being were

applied ; while if such currents

being applied in the

SINUSOIDAL

CURRENT
or

29

neighbourhood of the head

if a general electric being given, the results might even bath were be serious. Besides these accidental causes rent, of interruptions of the curneck,
or

interruptions
times

are

liable to

occur,

of the day,
to another,

owing
or

machine

accumulators.

battery of To obviate this risk of shocks, either a baton

either to to the switching

usually at stated from one changing

of
a

8.

"

Motor

trausformer,

to utilize direct main sinusoidal current.

current,

producing

The motor is provided with three slip rings, aud is wound for producing is transformer Only three-phase one sinusoidal current. sledge-coil by wires to two of the slip rings, thus providing a singlesliown, attached phase sinusoidal current at the electrodes.

tery of Leclanche cellsshould be used for the administration or more, or else a battery of constant currents of 8-10 ma. of accumulators, which may be charged in the consultingroom

itselffrom

the main,

through

suitable resistance. have

{Seepp. 112 and 270.)

3.

Sinusoidal
an

current."

By

this, as

we

said,

is meant

of electromotive alternating current whose curve force in both positive and negative phase varies as a perfectly constantly and smoothly, in what is known

For all practical purposes the current from sine curve. the electric-lighting mains, in those districts supplied by an alternating current, is a sinusoidal current, and it
may

be made
to

use

be

formers, of after passing it through various transdescribed presently. In those districts

which
where
current

are a

supplied by the direct or constant current, or battery of accumulators is available, a sinusoidal by the use of a may be obtained lor treatment

30
motor

ELECTRICAL
the transformer,
motor

TREATMENT being
current

wound

according

supply available, for accumulators, or 100-, 200-, such as a 12-volt motor for the direct electric 240- volt motor or -lighting currents. Such a machine is used to produce a single-phase alternating current, with the addition of a sledge transformer to vary

to the voltage of the continuous

the

(Fig.8).

gradually strength of the sinusoidal current A similar machine, for producing three-phase
with three sledge transformers,

sinusoidal currents, also be used.

In these
motor

may

transformers

opposite to two collectorrings, from are led on points of the armature *which a single-phase alternating current is taken ofE. If three-phase sinusoidal currents are required, a third collector
must ring must be added, and the winding of the armature be equally divided into three parts, one end of each being of the three slip rings, while the other connected to one together. Owing to the reversal of three ends are joined

into the armature of a the field of an electro-magnet.

the direct current is led direct-current motor, revolving in

Wires

from

two

the direction of the current that is induced in the iipper by the magnetic field, the and lower halves of the armature current that is obtained from the two slip rings which are is an alternating connected to the two halves of the armature The voltage of this current, sinusoidal current. will be proportionate to the voltage of the current The that is used to. drive the motor, as 1:^2. ency efficior

will be about 60 per cent., of these small motors and from a 240- volt direct current a sinusoidal current of about 150 volts will be obtained.
the risks of earth as contact through gas- or water-pipes, just when using the direct main supply current, on account of the connection

This current

will not

be safe from

of the motorwith the direct current through the armature transformer ; therefore, if this sinusoidal current is to it must be re-transformed in be used for bath treatment

MOTOR

TRANSFORMERS

31

in principle as sledge coil. This is exactly the same the primary and secondary coils of a faradic battery. The alternating current from the two slip rings is led into the

inner fixed coil,and the outer coil of wire, wound on a the inner coil,and quite separate bobbin, is slipped over be made can either be fixed thus in position, or can
to slip off the inner coil along

sledge,thus diminishing the voltage of the current induced in it. Owing to the current that is supplied to the inner coil being already
a

sary and magnet are necesalternating,no interruptor hammer as in the faradic apparatus, and an alternatingcurrent is induced in the outer coil having the same periodicity of electromotive force as the alternating and type of curve rent current that is led out of the motor transformer. This curfrom the sledge coil, being entirely out of contact with that from the main, is perfectly safe for bath treatment, and there is absolutely no risk of shocks from accidental
contact with gas
or

water

pipes.

If

commutator
are

that
armature

be added to the transformer, the currents induced in the upper and lower halves of the

may be led to the two slip rings so that their instead of reversed, as it is when a polarity is the same, in sinusoidal current is produced. With this commutator
current, or what may be called pulsating unidirectional By means a sinusoidal constant current, is produced. of a switch, either a sinusoidal or the pulsating imidirectional
use,

be led to the sledge-transformer. With this lattercurrent a galvanometer may be included in the circuit, be measured, though ifthe sinusoidal so that the current may
current may current is used the only
means

of a of the current is by means Another modification that may

of measuring the strength hot-wire milliamperemeter.

be fittedto these transformers that
means
a

is the Leduc reverser, galvanic current is obtained.

can

so

rapidly reversed

ment of an arrangeby which the collectingbrushes of the Leduc reverser be shiftedin position,the period of contact with the

By

32

ELECTRICAL

TREATMENT

galvanic current during the reversals may be either long This rapidly reversed galvanic current by means or short. of the Leduc motor produces tetanic muscular contractions

justas
is much
even

faradism

the brushes
more

the sinusoidal current does, but with the current contact arranged for maximum
or

may
are

degree of contractions, painful for the same when a low voltage of galvanism is used. The pain be considerably diminished if the collecting brushes

placed that the period of contact during the reversals is at a minimum. The curve of the electromotive force of this current will,of course, somewhat resemble that of the
so

jerky. sinusoidal current, but will be much more When a third slip ring is added to the transformer, and is equally divided into three the winding of the armature
to give

three-phase sinusoidal current, then three sledge coils must be used for the regulation of this current, and three wires and three electrodes are necessary for the
a

treatment.

This

is

very

useful and

applying
as

and both legs, Thus, with three electrodes, or other similar arrangement. A, B, and C, there is a current from A to B, another from B to C, and a third from C to A. With such a transformer

the sinusoidal current with in Dr. Schnee's bath, to one arm

pleasant way of local bath treatment,

and
may
two

group of three sledge coils, a single-phase current be employed at any time, if preferred, by using any

the corresponding bindingOn screws, wires, and electrodes connected with them. the whole, the three-phase method of application is less

of the three sledges, and

painful than the single-phase. A convenient form of threephase sinusoidal current is supplied by a small apparatus devised by Stirhng, the motoj: being driven by an accumulator,
and the whole apparatus being portable, in a box. in the be combined These motor transformers may wall apparatus, for consulting-room work, with that and

same

for the application of galvanism

faradization, so
may

that

with such

an

apparatus

variety of currents

be

EARTH-FREE

MULTOSTAT

ri3

varying speeds of interruption; galvanismy with slow interruptions by hand, or with rapid ; a pulsating reversalsby the Leduc reverser unidirectional

used

faradism, of

current (or sinusoidal constant)

and

single-phase

or

For purposes treatment, it isimportant that allthese various of electrical currents should be completely insulated from the main

three-phase sinusoidalcurrents. Earth-free multostat, or pantostat"

driving current, in order to eliminate all possibiUty of of an earth current. giving a shock to the patient by means This is arranged for by the driving motor being completely from the dynamo which it works, so insulated electrically that both the alternatingand constant currents taken from freefrom the riskof earth currents. this dynamo are entirely Some of these machines use the sinusoidalcurrent in the place of faradism ; others have a separate small faradic apparatus which is worked by constant current from the d}Tiamo, thus providing real faradism. In addition to

faradism,galvanism, and sinusoidal currents, these machines are also arranged by suitable resistancesto give cautery and light,and also mechanical power for working or a Leduc interrupter and reverser of galvanism.
a

pump

In districts which are supplied by alternating current for electric lighting, this main current may be made use of by a comparatively simple and cheap apparatus for the

application of single-phase sinusoidal current for either localor bath treatment. This current, which is circulating in the street mains at a pressure of 1,000 volts or is led into a stationary transformer, builtsomewhat
more,
on

the

as principleof a faradiccoil, soon as it enters any building. The transformer is always situated in a cellar, similar or position, and is usually enclosed in a strong wire cage, be interferedwith by unauthorized so that it shall never

persons, as the current running in the wires which lead into is the street, being at a pressure of 1,000 volts or more, highly dangerous to life. In this transformer the voltage

34

ELECTRICAL
or

TREATMENT

is reduced to 200

100, and after passing

through

fuses

and the meter, is led throughout the building. Thus, in the consulting -room the alternating current is available from a wall-plug or lamp-socket, and the only apparatus
necessary

for its

use

in application to patients for local

Fig. 9.

"

Transformer

for alternating current, for bath treatment.

with

volt

selector,

is a sledge transformer, or a volt regulator -the latter fittedwith fuse, lamp for signal and safety resistance,
treatment
"

and mounted on slate. For bath treatment

with the addition of a This coil transformer,

similar apparatus is necessary, 9). stationary coil transformer (Fig.

a

already been explained, is added in order entirely to isolate the current used for treatment from the current in the main, so that there
as

has

STATIC shall be
gas
or

MACHINES

35

no

danger from accidentalearth contact through Though

water pipes,or electric switches.

absolutely no logical physioare produced by the action of the strongest effects electro-magnets excited by the direct current, yet, if powerful alternating current magnets are used, definiteresults are the patient approaches such a obtained. When induced in his body, magnet, alternating currents are

Magneto-therapy."

and owing to the stimulation of the retinaeflashesof light is felt, seen, a sensation of warmth are and it is said that headache and other neuralgic pains may be diminished. Such treatment is said to have a great sedative effect and to promote sleep. Such magnets require to be worked
by heavy currents up to 40 amperes. 4. Static electricity." For treatment

either the Wimshurst or may be employed. The details of its mechanism need it not be gone into here ; suffice to say that large machines
are

by static electricity, Holtz type of machine

not less than necessary to produce satisfactory results, eight glass plates of 30 inches diameter being advisable, while 36-inch plates are preferable. The voltage of the current obtained depends on the diameter of the plates

their speed of rotation, while the volume of the current, or the of milliamperes, depends on number diameter of the plates and on their number. The Holtz type is said to produce much less inverse current than the and
on

Wimshurst.

Various forms of Wimshurst machines are made by different makers, those by Gaiffe and other Paris makers usually having ebonite instead of glass plates. machines are generally built without a glass case; but in this country, at any rate, an air-tight glass case is usually provided, the air inside being ke])t dry by a dish of calcium chloride. The advantage of using ebonite instead of glass is that they may safely be n at a high rate of speed without risk of fracture of the These French

36

ELECTRICAL

TREATMENT

plates ; while glass plates,especially of large diameter, may break at a high speed, owing to the great centrifugal force developed at the periphery of the ever, plate. Ebonite, howis liable to buckle and to deteriorate in course of

Fig.

10.

"

Eight- glass-plate Wimshurst

static machine

iu

case.

its insulation suffering, and therefore the output A good static machine, with of the machine diminishing. eight glass plates of 36 inches diameter, will cost 70 guineas time, will cost from "10 tD "15 ; the set of electrodes,including jointed handle, head breeze, with connecting and earth chains, another
to

(Fig. 10). In addition

this, the

case

"8

or

"10.

strongly-made

the patient's chair, mounted on 12 inches long, is also necessary, in the price of the machine. The machine is best driven by

polished platform to carry varnished glass legs at least and

a

is often included

J horse-power,
may

costing from

"8

electric motor of to "10, but the pulleys

DC

be geared to a pair of pedals worked bicycle fashion. ball The on total cost of such a machine, mounted bearings, with the necessary apparatus, will thus work
out

at not

less than "105,

as

rule, while for 12-plate

STATIC

MACHINES
larger,
a

37

fcaachines the

cost

is proportionately

|-horse-

powcr motor being usually required to drive them. A well-made large static machine, such as that described, will also be available for X-ray work, a very

Fig.

11.

"

D' Arson vaVs

transformer,

and

primary

Ley den showing solenoid.

jars, spark

gap

though the produced on the screen, output is not so great as that from a good coil, and longer The time will be necessary for exposure for photographs. steady
static machine may also be used, with the addition of Leyden jars,park gap, and copper solenoid, to produce s high-frequency currents. Such a transformer as D'Arson-

light being

11). val's costs about "5 16s. (Fig. The machine is used by one pole, usually the positive,

38

ELECTRICAL

TREATMENT

being connected to the patient, who is seated upon an insulated platform, while the other pole is connected to earth by a light chain attached to a water- or gas-pipe. electrodes, also attached by a light chain to earth, can then be handled by the operator without risk of shocks. The platform should be stoutly built, about 42 inches by
27 inches in size, supported by stout, well-varnished glass legs 12 inches high. The edge of the platform should be surrounded by a raised wooden beading to prevent a

The

chair slipping off, while no metal points or sharp wooden be permitted, all the surfaces being carefully edges must smoothed and rounded, in order to minimize the loss of leakage through the electrical charge through the air.
the floor of the platform is fixed s. brass plate about 12 inches square, for attachment of the chain to one pole This chain is attached to one of the machine. end of an brass knobs, ebonite bar, 12 inches long, ending in two

On

placed between the poles of the machine, the knob at the other end being connected by a chain to earth. The bar is reversible, so that either knob can be applied to either pole of the machine by simply turning the bar through one
to pole of the machine which the patieixtis attached can be reversed at will. The electrodesare devised for the application either of sparks or of the static electricbreeze, and at least five will

half-circle. By

this device

the

be found useful : a brass ball and a brass rollerelectrode for the application of sparks ; and a singlepoint and a multiple-

point electrode for the application of the breeze. Another multiple -point electrode isin the form of a metal cap attached to a swinging bar from the top of the case of the machine, so the patient's that the cap can be brought into position over head. The
a

hand,

first four electrodes are held in the operator's handle being also attached to them so that jointed

both hands

be used for their support. may It is important to be able to test the polarity of the become as may machine, either knob of the machine

HIGH-FREQUENCY

APPARATUS

39

the machine is in positive or negative, although, once action, there is littlechance of the polarity becoming reversed

{see 328). p.
In the old type of small static machines, Leyden jars used to be attached to the terminals of the machines in order to reinforce the strength of the sparks ; but these high-power used with the modern machines, for the application of the static induced current, except by Morton's method, or when, by the use of D'Arsonval's transformer, the static machine is to be used as a source
are
never
'

of high-frequency currents. 5. High-frequency currents.

"

These

currents

are

produced by using the oscillatory discharge of a Leyden jar. When the jaris discharged, what appears to the eye is one single spark or explosion, but in reality there is produced
an

extremely

periodicity of which may Two large Leyden jars are

oscillatory discharge, the reach many millions in a second. used, or a battery of condensers rapid

arranged as plates, the inner coatings of which are charged from the terminals of a large induction coil,while the outer coatings are connected together by a helix or solenoid of
about of thick wire. This solenoid is best J inch in diameter, as, of copper tubing of some to the enormously high potential and the rapid

twenty

turns

made
owing

oscillations the currents that are induced in the solenoid, of these currents are conveyed almost entirely along the surface of the conducting wire, and scarcely at all in the centre
as the of the wire. This is known skin effect." When the jarsare being charged from the induction the spark gap between the two coil, they discharge across
"

terminal knobs while at the

at
a same

in

stream

of brilliant crackling sparks,

time extremely rapid oscillatorycurrents are set up in the potential of 100,000 volts or more

copper solenoid connecting the outer coatings of the jars. Although the outer coatings of the jars are thus shortcircuited by means of the copper solenoid, yet, owing

40

ELECTBICAL
or

TREATMENT

to the copper wire,

a

helix, the current in the neighbouring

tubing, being wound in the form of rent circulating in one coil induces a cur-

The

coil, thus, through the electromagnetic increasing the resistance effect produced, enormously of the solenoid to the passage of the current. solenoid may, indeed, be compared with the primary
a

coil of

f^radic battery, and a derived circuit,formed by attaching wires to the two ends of the solenoid, will afford oscillatory currents justas the derived circuit from the

primary faradic coil affords the primary faradic current. These oscillatory currents are known as " high-frequency "
currents.

Another

secondary

coil may

solenoid, so producing higher voltage. In Tesla's transformer cuiTents of even the primary consists of four turns of wire wound on a

this primary

be wound around induced oscillatory

of about 12 inches diameter, while the secondary is placed inside the primary, and consists of a long coil of insulated wire wound on an ebonite cylinder.

wooden

frame

Instead of
as
a

Tesla transformer, be employed

currents.
a

an

instrument

known

resonator

may

the

high-frequency

raise the potential of is That usually employed copper

to

Oudin's, consisting of
wire wound round 8 inches diameter.
a

solenoid of medium-sized

vertical wooden cylinder of about This may be in series with the copper

solenoid of the D' Arson val transformer, or it may be connected directly to the Leyden jars, sliding contact varya ing the number of turns of wire in the circuit until a lively
upper terminal of the resonator, while the cord leading to the treatment electrode is attached to a second sliding contact on the resonator, to the upper terminal (Fig. or 12). appears
at

brush

discharge

the

Other by
vacuum

apparatus
"

necessary
"

are

couch

for treatment

the

condensation

method,

and

variously-shaped

electrodes and single- and multiple-point metal electrodes. The couch is an ordinary bentwood couch with cushions 2 or 3 inches thick, on which the patient

HIGH-FREQUENCY

APPARATUS

41

lies; behind the cushions is a large flat metal plate, which is attached to one terminal of the solenoid,the other

Fig. 12." High-frequency

D'Arsonval's apparatus, combining and Oudin's resonator.

former trans-

terminal being connected to a bare metal electrodeheld in the patient's hand, or applied by means of a vacuum

42
or

ELECTRICAL

TREATMENT

formers, metal point electrode. These higli-frequencytransdescribed, are best driven by a 10-inch or as from the 12-inchinduction coil, which may be worked either

interruptor, continuous current main through a mercury jet by a battery of accumulators and a Beclere coal-gas or ruptor mercury break. The coiland its condenser and the inter-

be designed according to the voltageof the constant is to work it. The same that coilthat -current supply for X-ray work will also be available uses the practitioner for producing high-frequency currents by means of the
must

D'Arsonval transformer. In the treatment of patients by high-frequency currents a galvanometer is advisable which is built on
the hot-wire principle, measuring up to 800 ma. Other apparatus which is sometimes used is a couch,

by the method of auto-conduction,in which the patient is enclosedentirely within the primary solenoid. Currents are then induced in the patient'sbody as they are for treatment
in the secondary of a Tesla transformer, and a Geissler hands willglow brightly, tube held in the patient's although he can feelno directeffects the current. of

be already stated, high-frequency currents may obtained by using a D'Arsonval transformer with a large static machine, which again will also be available for
As

X-ray work, though it is to be remembered that the output even a large staticmachine, either for X-ray work of for the production of high-frequency currents, is much less than that of a properly constructed 12-inch induction the alternating coil. In electric -lightingcircuits where current from the main is available,this source may be
or

used' for the production of high-frequency currents by means of a step-up transformer, by which the voltage is of a spark gap, raised to about 6,000 and then, by means

solenoid, high-voltage high-frequency be obtained, but the terminals of the currents may step-up transformer are dangerous to life. Leyden

jars,nd a

CHAPTER
THE FARADIC

II
CURRENT

I
a

current." The term "faradization" was invented by Duchenne for his treatment by the induced

The

primary

current

obtained from a small induction coil, after its discoverer,Faraday. Such an induction coil consists of

coil of insulated wire wound on a reel containing a soft iron core, with a spring interruptor inserted in the circuit between the cells of the battery and the coil, to break the battery current rapidly and regularly. The coil requires
current of about 300 and is usually driven by two,
a
ma.

to work it satisfactorily,

sometimes three,Leclanche cells of large size, which may be either wet or dry cells. The current from the cells,being rapidly interrupted by
or

the mechanical spring contact, and circulatingin the coil magneti rapidly magnetizes and dearound the soft iron core, the latter,thus setting up a rapidly varying
electro-magnetic effect in the field surrounding the iron Comparatively speaking, the magnetization of the core. is developed slowly, whilst its demagnetization at core the break of the battery current is sudden, and therefore the current that is induced in the coil of wire around the magnetic core is produced practically only at the break, and is therefore a unidirectionalcurrent which flows in the directionalong the wire as the battery current. same

Another

reason

current

for the negligiblequantity of the induced " " is that it is devedeveloped at loped make

in the contrary directionto the battery current, and is thus resisted. The imidireotional induced current at
43

44

ELECTRICAL

TREATMENT
as

break

is what

is known

the primary

faradic current,

and, reinforcing the battery current, produces the spark breaker. This spark is much thicker and at the contact stronger when the iron core is pushed in, because the primary
is then much stronger. By means of a derived circuit formed by joining two wires to the two ends of the coil, the induced current can be made available for treatment. It is of a very much higher voltage than the battery
current

which is responsible for its production, and partly owing to this reason, and partly to the high self-induction of the neighbouring turns of the coil, this current will
current

circuit and through the high resistance of the patient's skin and tissues, although the alternative closed circuit of the coil and cells is available
the

flow through

derived

pressure of about 3 volts, is altogether confined to the closed circuit of the its way through none primary coil and cells, of it making the far higher resistances of the derived circuit and the

for it. The

battery current,

at the low

patient's skin.

The secondary

current."

So far we

the primary coil, and the primary the form of faradis;iithat is most not used in medical In most induction coils there is also a second treatment.

have spoken only of faradic current, which is

coil, consisting of wire, wound

on

much

reel or placed primary coil. It may be either fixed in this position, or, as in the better class of coils, made to slide on and off the
a

larger number bobbin, and

of turns

of finer over the

primary coil, the varying distances of the secondary coil from the primary being shown on a measured scale. These known are as sledge coils. The rapid rise and fall of the magnetic action exerted around it by the primary coil
the appearance of induced currents, of high potential, both at make and break in the secondary coil,that at This curbreak giving very much the stronger shock. rent
causes

at

than

in the secondary coil is of higher voltage that at make, owing to the fall of magnetic action

break

r
being
more

THE

FARADIC

CURRENT

45

sudden than its rise. As previously said, this slower rise of the magnetic action of the primary coil is due to the comparatively slow magnetization of the iron core owing to the battery 'current at make being resisted by
an

induced current
"

in the opposite direction in the

faradic current, or the induced current at make and break in the secondary coil,is thus really an alternating current, but of unequal waves, and
for practically, purposes of muscular or cutaneous stimulation, it is the current at break that produces all the effects. Strictly speaking, the amounts of current at make and break
in the secondary coilare equal,

primary coil. The " secondary

their chemical effectsor their action upon a galvanometer ; but, owing to its lower voltage, the induced current at make has less appreciable physiological effect. much
as

by judged

These

two
"

points

are

easily shown

by

the following

experiments : 1. Join the two

faradic and

binding-screw terminals of a combined galvanic battery by a wire. Pull out the

sledge coil so that the secondary faradic current is at its on the switch for secondary current weakest. Turn If the vibrating and then turn on the battery current. hammer be worked slowly by hand, the needle of the
galvanometer
in opposite directions oscillate with each make and break, and if the sledge the primary the excursions coil be pushed gradually over of the galvanometer needle become larger and larger but

will be

seen

to

time it may be equal in the two directions. At the same of the needle is a quick twitch noticed that the movement if the current only, even only, showing a momentary be so held as to keep the battery current vibrating hammer
running steadily through the primary coil. 2. Fasten two moistened electrodes on to one arm, attached by wires to the binding-screws, and then with the Prachammer. other hand slowlv work the vil)rMtin"j:

46

ELECTRICAL
contraction

TREATMENT
"

tically no

from the primary coil it will act as a solenoid only, and the strength of the primary induced current will be much diminished, while its electro-magnetic action on the surrounding helix of the

the secondary *' break " will be strongly felt. at When the iron core is withdrawn

will be felt at coil pushed right home,

make," even with though the current

secondary coil will fall to a corresponding degree, so that the induced secondary currents both at make and break
is inserted will be much weaker than when the iron core in the primary coil. The iron core has littleor no direct the secondary coil, as practically magnetic action upon all the lines of magnetic force from it are cut by the wires of the primary coil. The two currents The induced current compared." is more rapidly develcpcd ard is cf shorter duration when

the iron

core

is withdrawn,
cutaneous
nerves

effect upon the number quickly

so
a

and it has much for that reason.

less painful The larger

are

of turns the waves

a

of wire in the secondary coil, the less developed and the longer their duration,
a

that

coil with

large number
nerves

of turns
one

produces
a

greater effect upon

sensory

than

with

small

Conversely, when of turns. painful stimulation it will be best desired, as in muscle effects are not -testing, to use a secondary coil with a comparatively few turns of wire,and to withdraw the iron core.
number that is used in practice is 700 turns of comparatively stout wire in the primary coil,and 5,000 turns of a finer wire in the secondary. It is sometimes useful to have two secondary coils, which A
common

proportion

can

be interchanged,
can

which
turns

by

else a long coil of 10,000 turns be tapped at 2,000, 4,000, 6,000 and 8,000 small radial switch and five metallic studs, so
or

that any

be used at will. Strength of the secondary current." The tion regulaof the strength of the secondary faradic current in the

desired length of the roil can

THE

FARADIC

CURRENT

47

better classof medical coilsis effected by slidingthe secondary to the primary, the maximum current being coiloffor on

obtained when the secondary is exactly over the primary. In the smaller and cheaper coils the secondary coil is not the provided with a sledge, but is fixed in position over
primary, and the strength of the current is regulated by slipping a brass tube over the iron core within the primary. When this brass tube is in position,the iron core is prevented

exerting any magnetic influence upon the primary coil,and there will be only very weak primary or secondary faradic current obtainable,while with the brass
from

tube withdrawn both these currents will be at their strongest. Unfortunately, we have no ready means of accurately Being an measuring the strength of the faradic current. effect on the needle of an ordinary galvanometer, and its amperage is too small to affectan instrument working on the principleof a hot wire, like the milliamperemeter in use with high-frequency There are one or two clumsy instruments availcurrents. able
no

alternating current, it has

for measuring faradic currents, but none convenient Meanwhile, by experience of the enough for general use. particular battery in use, one gets to know roughly the proper position of the sledge coil or of the brass tube, duce according to the type of battery, that is required to prothe necessary physiological effect.

Another convenient way of guessing approximately at the strength of the faradic current produced by the coil in
any given position is to test its effectwith properly wetted hand, before applying electrodesupon the skin of one's own

the current to the patient, and again to test the degree of muscular contraction of the muscles of the thenar electrode to the ball of the eminence by applying one thumb, the other being held in the closed palm of the other

good rule always thus to test the strength of the current before applying it to the patient, o and if this rule is insistedn, we shall avoid giving the
hand.
a

Indeed, it is

48

ELECTRICAL
an

TREATMENT

patient

current for which occasional dose of maximum The way in which this neither he nor we were prepared. is by the small switch which accident usually occurs

is provided with the better medical coils for changing from the secondary to the primary current getting out of from knob, marked one place. This switch is moved

P, usually placed to the left, to another knob, marked S, close beside it on the right,and itis very easy for the switch to be moved to P from S without the operator being over of it, either by an accidental touch, or by someone else having touched the battery, perhaps for cleaning or It should, therefore, be made dusting purposes. a rule
aware

always

to look at the position of this switch before commencing treatment faradism, because if the switch with

is turned

towards

P, and

the iron

core

is pushed

home,

the maximum

strength

administered, whatever

current of the primary will be is the position of the secondary

coil. It should be remembered that in the regulation of the faradic current the position of strength of the primary the secondary coil has no effect upon it, the primary current being varied in strength by pulling out the movable In those batteries where the iron core is fixed iron core.
for the hammer the magnet of the interrupter, by pushing in the brass is weakened the primary current tube which slips over the fixed iron core.

and

acts

as

Choice between
"

primary

and secondary

currents.

Since Duchenne's
have been

time, sixty years laid down to govern

tions ago, various indicathe choice between

of the primary and the secondary faradic currents It has been commonly in treatment. said that the primary current should be used for the stimulation of deep-lying
the
use

organs,

as

the

stomach,

bladder,

rectum,

and

tines, intes-

while the secondary current has more effect upon the limb muscles and in stimulating the cutaneous sensory For use in an electric bath the primary current nerves.

THE

FARADIC

CURRENT

49

should be chosen. Personally,I invariablyuse the secondary current for allpurposes of cutaneous and muscle stimulation, the skeletalmuscles or of the viscera. whether of I have found, by experiment on cats, that the secondary
faradic current
nerves

acts excellentlyin stimulating the motor

th^ animals being under by chloroform, and also that the muscular walla anaesthesia contract well in of the stomach, bladder, and rectum
to the bladder and rectum, tetanus when

the electrodes are

as

applied directlyto them.

a means

The
"

faradic current

The

use

of diagnosis. of the faradic current in the diagnosisof neuromuscular

conditions is invaluable. When both nerve and muscle are healthy, with a rapidly vibrating interruptor powerful current, if the electrodes, and a sufficiently properly moistened, are applied to the skin over a motor behind the ear, allthe muscles nerve nerve, such as the facial

are thrown into active tetanic contraction. supplied by the nerve The contraction is developed sharply and as suddenly on the stoppage of the suddenly, and ceases The reaction of the nerve to faradism is then current.

use, said to be normal. If a muscle be atrophied from long disor from a disease causing slow wasting, as in a lesion of
proof myopathy or gressive muscular atrophy, then the brisknessof the faradic reaction is diminished, and the contraction is lessin quantity, slowly and relaxes less and is both developed more
a

neighbouring

or joint, in

case

as in a facial quickly. When^there is a lesionof a nerve, or neuritis Bell'spalsy, the nerve soon losesits excitability

to faradism, and if the lesionbe

severe

will

longer contract at all when This is the reaction of degeneration in over the nerve. its excitability being lost at the same time the nerve, both to faradism and to galvanism. The condition takes
no

the muscles faradism is applied

one,

a
^^^

^^feof ^^nof

few days to develop, and is often preceded by a wave from the site hyperexcitability passing down the nerve the lesion towards the periphery. Thus, one or two

50

ELECTRICAL

TREATMENT

days after the development of a facial palsy, it is sometimes possible to demonstrate this hyperexcitability of the by applying the electrode in front of the ear over nerve
the reactions of the facial muscles to the parotid, when the faradic current will be brisker, and developed with a weaker current, on the side of the lesion than on the

sound side. Although the secondary current, yet the waves

faradic current is an alternating developed at are unequal, that

break being far the stronger, and it is therefore possible to speak of a kathode and anode for the faradic current as in the
case

As in the latter form of current, the contraction of galvanism. is produced more strongly at the kathode. When

there is a
to
over

nerve-lesion, no reactions will be obtained faradism if the electrodes are applied to the skin the muscles in the ordinary way after the lapse of a
severe

week to ten days from however, in these cases

If, the time of the nerve injury. needles thrust into the muscles be

contraction substituted for the ordinary pad electrodes,some be seen around the negative pole, even in cases will of degeneration of the advanced wasting with reaction of

of spastic paralysis, such as the late rigidity ness of hemiplegia and spastic paraplegia, the normal briskof reaction of the muscles is somewhat altered, the
slowly developed and not contraction being rather more Sometimes in hemiplegia or in pararelaxing so suddenly. plegia, due to a transverse lesion of the cord, the muscles
waste
a

muscles. In cases

at firstrather rapidly, and

were

faradic battery
it would

at hand

flaccid; and unless to take the electricalreactions

are
a

be easy to mistake such

case

the lower

such as a poliomyelitis, or either of the two latter conditions, after the lapse of a week from the commencement the faradic reof the symptoms, actions
neuron,

for a lesion of a neuritis. In

diminished, or lost of the muscles will be much altogether. If the faradic reactions, on the other hand,

THE
are

FARADIC

CURRENT

51

is intact,and normal, itis certain that the lower neuron that the lesion,if any, is affecting the pyramidal fibre in the cord or brain. In functional paralysis, also, the reaction

of the muscles to faradism will be perfectly normal. In the o majorityf cases of infantile paralysis, or acute anterior poliomyelitis,the paralysis at firstis more porarily widespread, and many more groups of muscles may be temparalysed than ultimately results. Thus the whole be completely paralysed of one lower extremity may at first for two or three weeks, though permanent wasting may in some only occur of the groups of muscles below the

knee, especially the tibialis anticus and extensors of the toes, with perhaps partial wasting of the quadriceps extensor femoris. The thrombotic and hajmorrhagic lesion in
that has the anterior horns of the spinal grey matter destroyed the trophic centres of these muscles has at the time temporarily paralysed through shock the neighbouring centres for the remaining muscle groups of the lower extremity, and occasionallysuch functional paralysis
same

of these remaining muscles may

persisteven

for months

if

untreated. It is in such cases nosis, that faradism is so useful in diagfor those muscles whose trophic centres are destroyed faradism, and are permanently paralysed will not react to
while those muscles whose voluntary power is merely temporarily inhibited through shock will react briskly to faradism. Thus the electricalreactions, taken from a
week to ten days after the onset of the paralysis,will give an extent unerring prognosis as to the true and permanent

of the paralysis, though without this test the only way of deciding on the extent of the permanent paralysis is to wait for the onset of atrophy in the stricken muscles. muscle responds with a brisk contraction to the faradic current, it may be taken as certain that the lower motor neuron supplying that muscle, anterior born to the muscle is cell,anterior root, and the mixed nerve
a

Tf, then,

52

ELECTRICAL
converse

TREATMENT

intact. The

proposition does not always hold good, for sluggishness of contraction to faradism may be present in cases of reflex wasting of the muscles from joint disease,
"

in also in myopathy, chronic cases of spastic paraplegia, and in hemiplegic rigidity; that is to say, in cases where the lower motor is or neuron even the limb and at times when arthritic atrophy
as
"

it is called

uninjured,

muscles are cold and stiff. Further, in total transverse lesions of the cord, the muscles of the lower extremity may waste rapidly, and lose all their electricalreactions both

and to galvanism, although no lesion whatever be or of the lumbar grey matter may peripheral nerves discoverable post mortem.

to faradism

Motor
there

points.
are

testing of muscles certain points on the skin, known

"

In

the

ally, electricas

motor

contraction points, which on stimulation give the maximal for the particular muscle. These roughly correspond to into the muscle, and the point of entry of the motor nerve
to though they are subject a certain latitude of variation in their position in different they subjects, are sufficiently Erb has published charts of to be charted, and constant

the

motor

points, which

dealing with

usually copied into books There is, however, no electrical treatment.

are

these points, or to use such charts necessity to remember in electrical testing, for it is far better to find the motor

for oneself, point of the muscle that is being examined which is easily done by stroking the testing electrode over the muscle while faradism is being applied, the sitewhence
the maximal

contraction

is obtained

being

the

motor

point. Of the limb muscles the two motor points that are most likely to give trouble in finding are those for the extensor hallucis longus, which is low down on the front of the leg
not

far above

the

and ankle-joint,

that for the pronator

is generally best obtained at a point just internalto the biceps tendon at its insertion into the radius.

radii teres, which

THE

FARADTC

CURRENT

53

The corresponding muscles of the two sides will always to the same react in almost an identicalmanner strength current, so that ifonly one limb is at fault the reactions of of the muscles in the opposite limb should be taken as the required standard. One electrode, is the indifferent electrode, usually a flat

leaden plate, covered with flannelor chamois leatheror webbing, itisbest thoroughly moistened with warm water; and to the back or frontof the chest,or the patient appliedeither
may sit upon it. The active or treatment electrode should be a circular 1 inch in diameter,set on a handle, pad about the pad being similarlycovered and moistened. Special

testing electrodes are made with a key on the handle for making contact. If such is used, care should be taken " as that the key isso fitted to make'" the contact, and not
Personally, I prefer not to but an ordinary treatment special testing electrode,
to break the current.
use
a

electrode

of the size mentioned, and to interrupt the current by placing the finger on the vibrating hammer of the induction coil while the other hand holds the electrode on the muscle to be tested. In this way single induction

shocks may, if thought necessary, be used. In many of the testing electrodes supplied, the insulation of the key isinsufficient, there is a leakage of current, while ifthe and

method I use be adopted there can be no question of the interruption the current. The testing electrodeshould of be made too small ; 1 inch in diameter is quite small not
for all purposes except testing the tongue and or of the facial palate. When testing the interossei some muscles, the edge of the electrode may be used, and in enough

differe testing the intrinsic muscles of the hands or feet,the inelectrodeis better placed on the palm or sole,so as to send the current through the part. It has been suggestedto make testing electrodes with one handle carrying the two electrodes,of very small size, however, a bad plan to have placed quite closetogether ; itis,

54

ELECTRICAL

TREATMENT

a muscle, electrodes close together on the skin over as the current then does not penetrate properly, and it rent stronger and more will be found that a much painful curis necessary to produce the required contraction than

the two

when

the indifferent electrode is placed at

distance.

CHAPTER
FARADIC
GENERAL

III

TREATMENT
MALNUTRITION

used in the treatment of in emaciation atonic muscular conditions, as resulting from long illnesses, rickets, anaemia, etc. That daily
may

The

faradic current

be

a period of weeks applications of faradism over may stimulate has been proved by its effect beneficially metabolism on the growth of young animals, a litterof puppies being

divided into equal numbers

same

and

kept

under

conditions as regards surroundings by the faradic one of the groups being exposed to treatment Those treated by this daily for twenty minutes. current considerably more than those untreated, although previous to the experiment inappreciable. the differences were
after several weeks
means

precisely the and diet, but

weighed

The

best way

of

general malnutrition patient being immersed

applying is by means in
a

the

current

in

cases

of

of the electric bath, the bath and the two warm

large, flat electrodes connected to the secondary coil, one electrode being placed behind the patient's back, and the cases rickets have been other at the feet. Many of severe remarkably reported as improving under this treatment, have also cases as of chlorosis and other forms of anaemia, and cases of prolonged debility following long illnesses, such
as

influenza, septicaemia, typhoid

causes

fever, empyema,
in

and

other It may
manner,

of chronic suppuration, etc. be said that general electrification applied

using faradism from
55

this

the secondary

coil in the

56

ELECTRICAL
be
a

TREATMENT
most

electricbath, may

useful

adjunct

to the ordinary

they are not of such cases when of treatment getting on well. Thus in chlorosis iron is sometimes very headaches or indigestio badly tolerated, either causing severe

methods

tolerance of when this is the case, be procured by being careful to the drug may sometimes after food, and in very dilute administer it always soon form either as a chalybeate water, or by adding half a

Although,

"

tumblerful of water

to each

are yet occasionally cases is either very slow or the condition may even remain stationary. The addition of arsenic to the medicine should by the treatment then always be tried, but sometimes

dose of the iron mixture met with when improvement

"

when everything may be seen in rickets, else has appeared to fail. The same in weakly, puny, anaemic children, whose digestion is or very irregular and whq do not gain in weight and size as they

the faradic bath may

start improvement

for their age. After typhoid should do normally fever and influenza, prolonged debility is quite common pression and is sometimes accompanied by considerable mental de-

and general and loss of memory, lack of initiative, Here also general electrifailure of the mental powers. fication by faradism may be of the greatest benefit.
NEURASTHENIA

to an American physician, this term, which we owe Dr. Beard, who described the condition in 1879, is meant debihty, or nerve a condition of nervous weakness, nervous

By

exhaustion

which

occurs

in

of subjects

both

frequently between of adult age, most and 50. It has often been ascribed to the hurry and but that this is untrue needs stress of modern lifein cities, only
a

usually the ages of 30

sexes,

upon

little experience of such cases, and women occurring in men the strain of competition whom
success

portion considerable proof leisured habits,

a

for

living

or

for

social

bears but slightly. On

the other hand, it

TRAUMATIC

NEURASTHENIA

57

is sometimes
men

and

women

said that neurasthenia results from such having too Httle to do, that it is due to

their excessive leisure allowing them time for too much selves, self-introspection and consequent dissatisfactionwith them-

may
no

the morbid symptoms engendering of what be called the disease neurasthenia. Though I have
thus

doubt that this is a predisposing cause of a certain degree those who have of importance in a certain number of cases, the large experience of a hospital out-patient department by the large number occurof cases ring will be struck at once both in men who are fully occupied, but and in women
yet not manifestly overburdened, of life. This condition of nervous

congenital or intellectual centres to

some

to

the ordinary duties weakness is,then, due hereditary inability of the higher

by

face the everyday problems and emergencies, of ordinary life a breakdown of their powers is temporary, cases though in many that in many others
"

the normal

recovered, as though the capacity is never out. machinery had become prematurely worn Traumatic neurasthenia." A very important group
of
cases

" as traumatic neurof neurasthenia is that known asthenia," in persons who have received a definite occurring but yet which has exerted severe, injury, often not in itself a profound system of the sufferer, effectupon the nervous

who isusually,in this group of cases

and congenitally prone to nervous proportion of these cases, which

as

" neurotic habit In a certain weakness. may follow accidents, such

"

also,of

matic railway accidents, and are often classed as cases of trauby neurasthenia, the neurasthenia is accompanied definite symptoms of paralysis and anaesthesia, and other hysterical stigmata, which will be described under the heading of Hysteria (p.65). sub-group of cases especial interest is formed separately

of traumatic neurasthenia of following head injuries, of cases

as the result usually slight concussions, frequent enough of fallsin the hunting field or of driving accidents. Here

58

ELECTRICAL is injury sufficientlysevere

TREATMENT
to
cause

the

definite injury to

the brain, consisting of meningeal ecchymoses, and superficial haemorrhages and lacerations of the brain substance

itself. In

more

severe

cases,

fractured base, depressed

fracture of the skull, and larger meningeal haemorrhages less prolonged loss of consciousness, to be or more cause

followed later, after the graver symptoms have subsided, by neurasthenic symptoms of the most aggravated type. following injury, if In the large of the cases

majority

the appropriate long time, the

treatment

is carried out

for

sufficiently

prospects of ultimate complete recovery are good, as there is often no congenital weakness of the have seen to be so higher intellectual centres, which we important of
a

part

the concussion produces the same condition of instability of these centres ; but, as the lesi"3ii may be recovered from, so the prospect of recovery
It is,however, the neurasthenia it produces is good. most essential that prolonged mental and physical rest upon patients suffering from symptoms should be of from

neurasthenia. to the brain resulting from

of the development In these traumatic

of ordinary cases the

cases

injury

enjoined

neurasthenia year's withdrawal from being often necessary as

traumatic

the result of head injuries, a all mental fatigue and excitement a preliminary to the resumption of
as

the ordinary duties of life. Cases of traumatic neurasthenia."

of traumatic
neurasthenia will suffice as

Three

instances

examples, the giving a typical clinical picture of the disease. symptoms In the first,E. W., aet. 34, a market-gardener in a large
way

into by an omnihe was run when bus^ from his seat from a height of 8 feel thrown and was into the roadway, striking his left hip and spraining his His head was right knee severely and ricking his back.

morning

of business near in London,

London,

was

driving

light

van

one

not

but injured,
move

he

was

very

not

for several days.

stiff as a result, and could Ever since the accident he

TRAUMATIC

NEURASTHENIA

59

has felt depressed, with loss of memory, forgetting everything he has the utmost difficultyin keeping quickly, and Complains of his accounts. hundredweight was pressing on back of his head. The headache side of the back of his head over more severe about three times
to
a

sensation as if a halfthe right side of the spreads from the right

the vertex, and becomes Walking a seems week.

affect his back, so that his legs drag. Has occasional dizziness, as though he were going to fall. Any noise, such as a train whistle, or the noise of the children in the
house, worries him intensely, and he has become ver}^ irritable. Since the accident he finds great difficultyin keeping
awB-ke, and has become a very heavy sleeper,especially for the firstfew weeks after the accident. He has no energy to dread all the details of his business. now, and seems

Physical
nothing lumbar

examination abnormal,
save

of

the

nervous

system
over

some

tenderness
after the

elicited the third

accident, though the first the neurasthenic symptoms persisted. This was day he had been in London since the accident, and he
spine, eight months

had

in the interval ; but the sight omnibus of them in the streets, he says, made him feel quite sick with two fright. In this patient there were causes which
not
seen an

aided in prolonging the period of his mental and physical to work, which collapse. Firstly, his too early return forced upon him, as he had no one to take his place was
in the business and look after his men;

the

strain and anxiety produced negotiations between his solicitor and the omnibus on the question of compensation.
mental

and secondly, by prolonged

company

the question of compensation negotiations on following an accident are a frequent for alleged injuries

Legal

of of the prolongation of the symptoms neurasthenia which it is often the aim and
cause

traumatic the

of object

to describe as malingering. company years, however, the clinical entity of traumatic

defendant

Of late
neuras-

60

ELECTRICAL

TREATMENT

thenia has become

medical in railway accident and other compensation cases. in a proportion of The early disappearance of the symptoms the cases after the legal negotiations have been completed,
whether satisfactorilyin a financial sense is no proof of the symptoms the reverse, to malingering ; and it is an undoubted
cases

generally recognized, not only by the ence profession, but by judgeswho have had experi-

to the plaintiffor

having

been

due
some
condition

fact that

do not

get well, but remain in a permanent instability and inability to work. of nervous

A good example I saw in

pensation of the cases which get well after coma doctor, a big Irishman of 6 ft. 4 in.,

into from behind run sitting in a train that was The noise and confusion were terrific, an express. and many persons were severely hurt, but he himself escaped however, without any bodily injury. He lost his nerve,

who by

was

completely, and a few days later gradually developed a typical hysterical left hemiplegia, with hemiansesthesia on the left side,and with contracted and loss of the special senses

that side, amblyopia, and unilateral loss of colour- vision. This last symptom he was not aware he possessed, for with both eyes open he could recognize colours perfectly. The presence of the symptom without
his being alone sufficientto disprove the theory of malingering, which indeed was not put forward. While the legal negotiations for compensation
aware

visual fieldon

of the fact

was

to were the company proceeding he was unable fast disappearing, and attend to his practice, which was he was instead thinking of selling it. He was getting worse

with

of better, and a certain degree of incontinence of Yet, within a week both sphincters developed. of his he began to claim being settled by the railway company, improve, and he rapidly got well and was able to resume

his practice. Many would, no doubt, be tempted to declare this to be a case of malingering, yet I am perfectly 1^ was not so. certain

TRAUMATIC With

NEURASTHENIA

61

be contrasted a similar case this may which in the case of a navvy, set. 35, who gradually occurred developed the same symptoms of left hemiplegia, etc., a few days after being struck on the head by a fallingbrick.

of compensation was absent here, yet, in spite of treatment at various hospitals,the symptoms persisted for four and a half years until I saw him unrelieved element in 1898. He

The

attended for over nine months in the electrical department at St. Mary's, where I treated him with strong faradism administered with the wire brush, proveme with the result of eventual complete recovery. No imwas seen

he had

on

two

for the first two months, during which hystericalfits, occasions severe preventing

His very slow recovery, in spite of the most energetic treatment, is an example of in the more obstinate persistence of the symptoms have been already allowed to run cases on which

his attendance for a few days.

for

long time.
as a

He

navvy developed an recently

wages

returned to work, earning full for the next seven years, but has hysterical paralysis with contracture

of the right hand, following on an accident during his work in excavating a new road, when he was struck in the abdomen by the handle of a barrow, after which he vomited
some

admitted to hospital on this account, of and gradually developed the hysterical contracture hand, stillcomplaining for months of pain in the right the abdomen, though nothing wrong could be discovered
blood.
was

He

this occasion he brought a lawsuit for compensation, successfully against his employer eight months after the accident, though the paralysis was than on the former occasion, and much less severe
on

examination.

On

to improve as soon as treated with the wire commenced brush. A feature of the case, excluding malingering on both occasions, was the blueness and coldness of the hand

affected with the hysterical contracture.

Traumatic

neurasthenia

in children," Traumatic

62

ELECTRICAL
may
case
on occur even

TREATMENT

neurasthenia One

She was the roof of a house. rather badly concussed, afterwards suffered from and for several months indicative of traumatic She symptoms neurasthenia.
was

who from

was

struck

in children after head injuries I have seen is that of a little girl of 5 the head by a piece of iron gutter falling

peevish and cross, could not told to do ; she preferred remember anything she was to be solitary, being unable to bear the noise of other children playing. Though here also an action was brought,
out of court, no settled for a substantial sum one could suggest that a child of such immature age could be affected by the worry of legal negotiations, or that she

restless at night, and while in the daytime she

was was

with night terrors, afflicted

which

was

was

malingermg.

Insomnia
"

and

other

symptoms

in neurasthenia.

is sometimes in neura prominent symptom asthenia, in others sleep may be deeper though and heavier than usual, the patient awaking tired and unre-

Insomnia

freshed.

doctor in busy care a under my was practice, with a good deal of nightwork, who much annoyed by his neighbour's dog, which on several occasions continually during the night, keeping him awake. This started insomnia, so that the slightestnoise kept him a typical neurasthenic, awake, and he gradually became

I have

had

barked

being fearful of crossing the road, and in constant dread He had to give up his practice of going out of his mind. for a time, but eventually He recovered completely.

exhibited

symptom

which

may

almost

characteristic of neurasthenia : an symptoms about his numerous and ailments" " logorrhoca." has been named which Headache
occurs

be said to be excessive flow of talk

a

symptom

is

common

symptom In
one

in two

types.

of the disease, and the pain is situated at the

back of tlie head, as a dull pain which may spread down the cervical spines, some of which may be acutely tender.

WAR

NEUROSES

63

In the other the sensation is more one of compression, as of a heavy weight upon the top of the head ; or the being driven into the be as if a nail were sensation may
or of the head (the so-called davus hystericus), the top of the head may appear to be opening or shutting. A dread of crossing open spaces (agoraphobia), of being or

top

or any place from which there is not a shut up in a room free exit, such as going to church, or a concert or theatre I is sometimes distressing symptom. a {claustrophobia),

the symptoms the latter accompany produced by irregular,rapid heart, with the central excessive smoking scotoma and loss of central colour-vision that are typical have
seen
"

of tobacco

amblyopia.
"

Another

case

"

lady, typically

neurasthenic could not bear to travel alone in a railway carriage for a long non-stop run, the fear of being shut in alone for so long so upsetting her that on one occasion
when she was leftunexpectedly by pulling the alarm signal. In alone she stopped the train

other

cases,
"

morphia, cocaine

over-indulgence in drugs alcohol, be the exciting cause may of the appearance

"

of neurasthenia.

"Shell-shock,"
of
cases

war

neurosis, etc." Large

of grave neurasthenia have developed, as of prolonged strain of life in the trenches, with irregular little sleep, in soldiers in whom or the concussion of
a

numbers the result

neighbouring shell explosion or the blowing in of a dug-out, or burial beneath the fallen-in parapet of the trench, has produced temporary unconsciousness followed
by of paraplegia period of amnesia, with variable symptoms deafness, mutism, of functional type, tremors, blindness, stammering, tachycardia, battle-dreams, etc.
a

usually show a family history of nervousness definite neuroses, years their nervous and for months or even control is lessened. Such
cases

or

Sudden
or

noises, music, thunderstorms,

once

an

air-raid, at

aggravate

the noise of guns the symptoms of fear,

64

ELECTRICAL
a man

TREATMENT

is quite untrustworthy for self-controlin The faradic current is very useful in such an emergency. the treatment of these symptoms, of some when combined

and such

with suggestion of

paraplegia or monoplegia, mutism and deafness may often be cured completely in a few minutes, but many of the paraplegias

cure.

Functional

only gradually, though brisk faradism.

recover

helped

much

at

firstby

Treatment
cause

of neurasthenia."

Removal

of the exciting

is necessarily the first care in the treatment is often a most of the disease, while electrical treatment to the more general methods of treatment. useful

adjunct

Prolonged rest is advisable in the of majority ccses, some best be treated by the Weir-Mitchell method which may

of

of isolationfrom friends and letters,massage and overfeeding. Greneral electrification by means of the faradic bath is

usually the most efficacious means of applying electricity in these cases, the patient being immersed up to the neck in

bath, with two large flat electrodes applied, one to the back, the other to the feet,connected to the secondary
a

warm

coil of a faradic battery. that the current is turned on

Care should

always
so as

be taken
to avoid

quite gradually,

all possibility of giving the patient a shock, the strength from the minimum of the current being gradually increased

until the patient begins to feel it as It should not be continued for more minutes
as
a

tingling in the toes.

than

ten

or

fifteen

rule, but the strength of the current may be slightlyincreased with advantage at subsequent treatments. The effect is refreshing and sedative, induces sleep, and
promotes

respiratory exchange

Traumatic

hysterical

generally. and metabolism paralysis." For those cases

and anaesthesia, of hysterical paralysis, with contracture follow injuries, already described, the as such as may faradic bath
treatment

is not
means

so

by

suitable as the more stimulating of the wire brush. This electrode

a

is made

in the form of

paint-brush with stiffwire bristles,

HYSTERIA

65

and it should be dabbed on the skin, not stroked along the surface. The skin should firstbe wetted, as by this means the resistance of the horny layer of the epidermis is much

diminished, and the strength of the current correspondingly increased. The secondary coil should be used ^preferably turns of thin wire, as it is our a coil with a large number of
"

increase the cutaneous sensory effect as as much possible. The muscular contractions produced be strong, yet the patient may feel nothing will,of course,
now object

to

powerful battery be used sufficiently (and often the full strength of the current available is required the anaesthesia will gradually diminish in intensity
a

at first,though,

if

and

extent.
HYSTERIA

disease peculiar to women, disturbance of the uterine and to be associated with some from the Greek functions, this affection derives its name
a

Formerly

believed to be

womb. frequently in men,

vffTEpa
name

It

is

now

known

to

occur

not

in

and the and in children of both sexes, has therefore lost its special significance. Although

the derivation of the word suggests a pathogeny of the disease which modem knowledge has shown to be quite unfoimded, yet the term is clinicallyof use to denote a

malingering, and which condition which is in no sense The term differs in many respects from neurasthenia. " functional " is often applied by some physicians to symptoms which do not appear to be dependent upon an

hysteria " being avoided partly on organic basis, the word account of its old associations of derivation, and partly from fear of making a definitedecision in the diagnosis of
"

the absence of organic disease. The term "functional thus often used very loosely, and is applied, on the hand, to groups of symptoms would which by some

"

is

one

be

called hysterical, and, have no known morbid

on

the other hand, to diseases which anatomy, such as paralysis agitans

66

ELECTRICAL

TREATMENT

and many

of hysteria may be epilepsies. The phenomena very protean in their manifestations, and may mimic organic disease sometimes very closely such as an hysterical joint,
"

which

may

be mistaken
too,

for

tubercular

joint hysterical ;
disseminated

paraplegia,

may

closely

resemble

sclerosis. The various symptoms which may be met with in hysteria best grouped, for the purposes of convenience, under are five heads :

X. Motor.
2. Sensory. 3. Special
senses.

4:.Visceral.
5. Psychical.

be either paralytic or spasmodic, for both weakness and and it is not uncommon together in the same rigidity to occur affected limb. One

1. Motor

symptoms

may

limb only may be affected (hysterical or monoplegia), both arm and leg of the same side may be similarly stricken or hemiplegia), both lower extremities may be {hysterical powerless

When {hysterical paraplegia).

or

the

arm

is affected,
a

together with the leg, there is, as considerable rigidity of the forearm muscles and the fingers being flexed at the metacarpo-phalangeal

either alone

rule, hands,

joints,

are while the interphalangeal joints rigid in extension. The fingers,at the same gether, time, are strongly adducted toand the position of the hand strongly resembles

be tonic or Hysterical spasm may rhythmical ; the latteris sometimes calledhysterical chorea; It may affect some of the neck muscles and simulate
that
seen

in tetany.

form of tonic torticollis. A not uncommon spasmodic hysterical spasm or contracture is a clenching of the hand, the fingers being tightly flexed into the palm, with the thumb outside. This condition may persist, if untreated,

for years,and organic shortening of the muscles and tendons

HYSTERIA:
may
ensue, so

MOTOR

SYMPTOMS

67

that it may
even

out the hand,

is sometimes
though,
on

met

be quite impossible to straighten under an anaesthetic. Flaccid paralysis with, especially in hysterical paraplegia,

the other hand, the most extreme rigidity of the whole body may be present. This rigidityin cataleptic states may be so great that the whole body, from the neck
downwards,
a

with the lower extremities, may poker, and may be moved as one piece. As a rule, in hysterical paraplegia, even

be rigid like
if there be

rigidityof the legs, the tonic spasm does not fix the thighs degree as is seen in organic spastic to the pelvis to the same paraplegia. In the latter condition, if one leg be taken hold

of by the ankle and pulled aside, the other leg follows it,as though drawn by a magnet, owing to the tonic spasm of
the muscles fixing the thighs to the pelvis,so that the hipis joint scarcely moved, but the pelvis is flexed on the spine. This is a sign very characteristic of organic spastic

paraplegia, and differentiatesit from functional paralysis. A form Functional muscular atony. of functional functional paralysis which I have designated by the name
"

is very liable to be mistaken for organic I nerve injuries. have seen many cases secondary to lesion is wounds, fractures, etc., though no actual gross It is characterized by extreme necessary for its production.
muscular
atony

flaccidity of the paralysed muscles, with notable limb, and cyanosis of the periphery^ emaciation of the hand or foot, due to vaso-motor paresis. There is no anaesthesia
or

sense

loss rule, though there is subjective of increased of position. The deep reflexes are somewhat what and the faradic and galvanic reactions are somepain
as
a

diminished, though
as

there is no

tion reaction of degenera-

may

p cyanotic reaction (see. 137) Although the paralysis is of functional be well marked. of suddenly produced by means origin,cure is never
nerve cases.

in

The injuries.

suggestion or brisk faradism in these be extremely slow jo^ months, .may

Improvement
even

and

for years.

68

ELECTRICAL

TREATMENT

knee- and ankle are as a -jerks not, rule, increased in functional paralysis, tliougli there may be a pseudo is sometimes very difficult -ankle clonus, which In hysterical to distinguish from the true form.

The

The reflexes.
"

plantar reflex is either flexor or absent altogether, while in true spastic paraplegia there is an extensor plantar reflex generally obtainable. The abdominal,
paraplegia the

reflexes will not other superficial hysterical anaesthesia, though in organic be altered in the cerebral lesions these are generally diminished on

and conjunctival,

side opposite to the lesion in the

brain.

In hysterical

rigidity, there is almost without derangement, always observable a good deal of vasomotor the periphery of the limb being generally cold, clammy,
paralysis, with
or

and

blue.

A definite inconsistency in the strength of the affected muscles is a most useful diagnostic sign of a functional

paralysis. Thus, in a case of paraplegia the patient may appear to be quite unable to extend the knee after it has been passively flexed,though, when the leg has been placed
straight again and the patient is directed to keep the be done with considerable force, leg out stiff,this may the inconsistency in the available power tensors of the exof the knee being a conclusive sign of a functional

In the absence of any anaesthesia of the paralysed limb in hysteria, faradism must be given with caution. The wire brush should not be used, but faradism
"

paralysis. Treatment.

should be applied by using a moistened rollerelectrode,the large indifferent electrode being placed under the middle The strength of the current should be just of the back. sufficient to produce slight visible contractions of the real pain, though as strong muscles, but should not cause a able. conveniently be borne is advissensory stimulus as can The hammer

arranged to

run

of the interruptor should therefore be at a fairlyhigh speed. It is not advisable

HYSTERIA:
to

SENSORY

SYMPTOMS

69

by fastening the two electreat hysterical symptoms trodes to the parts to be treated, and then to turn on on

and leave it running for the fifteen or twenty The action of the minutes allotted to the treatment. faradic current in hysteria is mainly through the psychic
the current
sensory effect it produces, and the personal efforts of the time operator are therefore necessary, aided at the same by continual encouragement to the patient as to recovery.

often to be obtained with a large battery, because of its greater impressiveness, than Similarly, in the treatment with a small one. of hospital
patients, I always prefer to treat with large and reliablemachines
cases

For this reason

better effects are

in the electricalroom rather than use a smaller

apparatus in the ward, where the general surroundings of capped the patient are too sympathetic, and the operator is handi-

subconscious antagonism which may be quite covery. sufficient to determine a negative result instead of re-

by

2. Sensory

symptoms."

sesthesiamay be met with. is generally over certain points, such

or

Either anaesthesia or hyperHypersesthesia. when present,

as

over

though

the vertebral spines, the groins the so-called ovarian tenderness this region may be hypersesthetic also in a man.
"

"

be diffusely may hypersesthetic,or the end of a stump may become acutely Anaesthesia may be complete tender after an amputation. half of the body (hemior partial, and may involve one rarely,
a

Occasionally, though

limb

be or only the paralysed limb may anaesthesia),

recorded his opinion in hysteria is always the thesia so often demonstrated result of unconscious suggestion to the patient by the If, he says, special physician's methods of testing.
be taken in the method of testing the anaesthesia in a has not previously been examined, hemipatient who
care

Babinski

has

anaesthetic. that the hemi-anaes-

anaesthesia is never That this may

found.
be true of
a

certain number

of

cases.

70

ELECTRICAL
am

TREATMENT
but

willing to grant, is as genuine symptom

convinced tliat the as any otlier hysterical sign, and I have known have themselves noticed, patients who before ever being tested, that they had lost feeling on
am

side of the body, usually the left side, and that their hearing and eyesight on that side were also diminished in
one

acuity. A not

uncommon

form is

"

"

stocking-and-glove

anaesthesia,

and leg being anaestheticup to a circular line drawn round the wrist and knee respectively. Patchy areas of loss to touch or pain may also be found on the
trunk

the hand

paralysis. The hyperareas aesthetic above alluded to may act as hysterogenetiu zones ; that is to say, when pressed upon, the patient may
motor

irrespective of any

into hysterical convulsions or exhibit other hysterical psychical phenomena. if present, Headache, thrown is usually vertical, sometimes causing a sensation as of being the head opening and shutting, or as if a nail were driven into it {clavusystericus). h be affected by hyperaesthesia or anaesthesia. The eyes may be excessively sensitive to plete Comlight, or one be temporarily amblyopic. eye may
may loss of perception of light in both eyes, or amaurosis, When there is hemianaesthesia, the eye on seldom occurs. be amblyopic, with a greatly contracted that side may
3. The special senses

be

field and

ing loss of colour-sense, and smell, taste, and hearon be similarly defective. Rarely the that side may be extremely contracted : visual fields of both eyes may the so-called 'pin-point fields hysteria. of
sensation of a lump rising in the throat {globus is due to irregular contractions of the oesophageal hystericus) Due to a similar cause are walls or pharyngeal muscles.
tumour, phantom both caused by

muscles and Joint-disease may

and the so-called hysterical peritonitis, irregular contractions of the abdominal intestinal walls.
be simulated, the best-known form

HYSTERIA:

VOCAL

SYMPTOMS

71

being the hysterical hip, in which the general symptoms disease. simulate hip-joint

may

The speech may be aphonia being not afEected,hysterical at all infrequent. The voice is reduced to a mere whisper, owing to inabilityto adduct the vocal cords in phonation.

Seen with the laryngoscope, the cords appear

very

widely abducted,

of adduction occurring attempting to phonate. spite of this apparent paralysis of adduction, perfect power of coughing is retained, the full explosive expiratory efiort necessary for
on

slight movements

In

this being proof that adduction of the cords has taken This inconsistency in the place in the natural manner.
power

of the adductors is the best evidence of such an being functional. The tolerance of laryngeal aphonia

examination that is shown by these patients is often remarkable the pharynx and larynx often being partially
anesthetic. Mutism,
or

hysterical aphasia,

complete a single word, although the power of understanding everything that is said or written remains unimpaired.

with.

There

is apparent

is occasionally met inability to articulate

There is a considerable likelihood of these cases being diagnjsed wrongly as motor aphasia, and it is very important
to distinguish them

of the two is usually found in young women, mutism and is often It produced by some mental shock, emotion, or worry. has also been frequently seen as the result of shell-shock, and may be accompanied by hysterical total deafness.

ment clearly from the latter, as the treatconditions differs widely. Hysterical

panied vibrant, harsh tone, unaccomby any expectoration, is also not very uncommon. In young girls this hysterical cough has been named, " cynohex hebetis" or the barking cough of puberty, owing

Spasmodic

cough, of

to

in sound to the bark of a dog. Anorexia, or complete loss of 4. Visceral symptoms. bone. Vomitappetite, may reduce the patient to skin and
a

supposed

resemblance

"

72

ELECTRICAL

TREATMENT
to be due

mg, often supposed for months

cause

to

some

gastric ulcer, may be accompanied quantities of blood, bright red, due to gum-sucking such
as

organic by small
or

some

other semi-voluntary mistaken for hsematemesis.

cause,

As

easily be which may rule, these patients are

greatly emaciated, and if the vomiting and false hsematemesis have continued for many months, as in I have had under observation, the well-nourished a case condition and ruddy lips of the patient may at once give
not

Such vomiting clue to the hysterical nature of the case. be accompanied by anuria, and the may material ejected It is difficult understand how to may even contain urea. such anuria can continue for days, or even weeks, with
a

daily average of not more urine being passed, without

a

than

two

or

three

ounces

of

serious constitutional symptoms

have

cases carefully watched arising, yet several most been recorded. Ballooning of the intestines from

arrest of peristalsisand accumulation

occur, constipation, may and may cases with an hysterical tendency,

of gas, with obstinate follow laparotomy in especially in

-vromen.

This protuberance

one was of the abdomen of the most in the epidemics of hysterical dancing obvious symptoms mania that occurred in the late Middle Ages.

of respirations, to as many 90 to 100 in the minute, may as amounting It for a few days. persist for several hours, or even is the only condition in which the rate of the respirations with

Dyspnoea,

excessive

frequency

exceeds the pulse-rate, with the possible exception functional sympHiccough may as a occur tom, of asthma. though usually it is met with in profoundly debilitated There is a close nervous connection between the states.
ever

lower end of the intestine and the respiratory centre, and hiccough is not infrequent after operations on the rectum,

especially for cancer. it is likely to cause

occur

last for several days, when It may considerable exhaustion.

nervous

It may

in the

course

of other

diseases, and I have

HYSTERIA:
seen

PSYCHICAL

SYMPTOMS

73

it severe

in hemiplegia with weak

attacks,

in

progressive

muscular

heart and emotional hypertrophic atrophy, in pseudo-

muscular paralysis, etc. Palpitation and tachycardia are

hysterical in origin, and there may difficulty distinguishing the neurotic form of tachycardia in from the larval form of Graves's disease,in which there is

also occasionally for a time be some

cardiac disturbance without the usual ocular or thyroid In the latter the increased rate of the heart symptoms. is more less constant, and persists even during sleep, or though
to
a

less degree. In

neurotic tachycardia

the

increased rate will be paroxysmal, and will cease entirely during sleep. Throbbing of the abdominal aorta is sometimes excessive, and may occasion a good deal of discomfort
culty and anxiety to the patient. There ought to be no diffiin diagnosing the condition, yet I have several times known a wrong diagnosis of aneurysm to be made. Pyrexia is hard to understand as an hysterical symptom, instances have been recorded, and yet undoubted

of which the extraordinary ranges of 110" and 117" have been unaccompanied by any grave constitutional rences symptoms, and have been recovered from. Such occursome

in

of h3rperpyrexia should always suggest fraud, and in the of instances this has been detected, such

majority
as

on the rubbing the bulb of the thermometer sheet or blanket, or heating itbefore the fireor in a poultice, being most commonly However, as already said, employed.

means

few

have been carefully tested and fraud excluded. 5. Psychical met with in hysteria include symptoms
cases

convulsions, which may usually be distinguished from epilepticfitsby their longer duration, persistent struggling, talking, and attitudinizing, without loss of the pupil reflexes. Double consciousness a curious mental state in which the patient suddenly passes from one personality to another totally different, thus living
or
"

tival conjunc-

two

alternate different existences, each,

as

rule, totally

74

ELECTRICAL
"

TREATMENT ^may alternate with sleep-walking

treatment

unconscious of the other or insanity. even

Treatment

of

hysteria." The

sensory, visceral, and

psychical symptoms vary with the age and sex of the patient, as well as with the form and character of the symptoms present. Hysterical

of the of hysteria will

convulsions may

often be arrested by a strong painful stimulus, especially by steady pressure upon the supraorbital nerve the eyebrow. at the point where it crosses

Should

cataleptic state supervene, strong faradism, To applied with a wire brush, will be the best treatment. get the best results, the skin should be wetted, and the
a

wire brush dabbed, not stroked, upon the skin. Hysterical ancesthesiamay often be cured in the same way by faradism,
though there is always be more cBSthesiamust great liabilityto relapse. Hyper^ delicately handled, for if drastic

measures

sensitive applied, as strong faradism to the hyperareas, the patient may thrown into even.be

be

hysteroid convulsions, or such a state of terror and resentment be aroused that it will be difficult exerto cise may him her. In such a or any further control over
case

it is often wise to commence hyperaesthetic limb, if such

by placing the is the affected area, in the

treatment

faradic bath.
met

with

on

hypersesthesia is not infrequently the stump of an amputated limb, a condition Such

In easily be mistaken for painful neuroma. which may distinguishing these two diseases, it should be remembered occur that painful neuromata only after there has

been suppuration, so that if the wound tion after the operahealed by first intention, then it is highly probable
that the hypersesthesia is hysterical. Again, in the latter the excessive tenderness is mainly superficial, often the lightesttouch appearing to cause ; great distress while in true painful neuroma the pain is not brought out unless
case

there is a certain amount of pressure is limited to the neighbourhood of the

on

the part, and it After applyscar.

HYSTERIA:

PATHOLOGY

75

ing weak
area

faradism by

means

of the faradic bath, the sensitive

should be gently rubbed with a roller electrode and a gradually increasing strength of current turned on. At the same it is important time, while applying the treatment
to encourage

the trouble will soon influence that reflex psychical impressions the enormous have upon the nervous system in hysterical patients.

the patient with the assurance that be cured and disappear, because of

Some by sparks

hysterical from

cases

respond

better to

treatment

the static machine or by high-frequency to It is difiicult say which form of current will currents. but the choice should be serve the better in any case,
between

these three

brush ; sparks frequency treatment.

are

faradism, with or without the wire frotn the static machine ; or the high:

Galvanism

and

sinusoidal currents

of less value.

Pathology.
There

The pathology of hysteria must be understood if the best results are to be attained in its treatment.
"

is usually a strong hereditary taint of neurosis epilepsy, insanity, or the like ; and there is frequently an doubted superadded to unelement of fraud or maUngering
"

The hysterical symptoms. latent, and only be brought out by influenza, or

condition
some
severe

lie may illness,

bodily

or

due to
centres

temporary
over

are mental shock. The symptoms loss of control of certain of the higher

an

normal else to an automatic and abrestraining influence of higher on lower centres, auto-inhibition. The excessive emotional attacks and
ones, or

lower

hysterical fits will be instances of the former condition, illustrate the while hysterical paralyses and anaesthesias Bernheim latter. For some years I have taught, following
that the psychical auto-inhibition which produces of Nancy, hysterical paralysis and anaesthesia is precisely comparable to the hypnotic state. by These disorders of function are not accompanied is nor in the nerve cells, any gross or microscopical change

7fi

ELECTRICAL

TREATMENT

it probable that there is any nutritional change at first, later if the morbid hysterical states though this may occur At first,however, the hysterical paralysis remains uncured.

of motion, sensation, instantaneously cured by the

stimulus. of This be may impressions,
or a

or

special
a

sense

may

be

effect of by conveyed
as

reflex sensory the suggestion

psychical evoked at Lourdes,

such
as

the

of

fire. The

sudden longer that

religious enthusiasm mental shock or fright,

or spasm, anaesthesia remains is it to remove by treatment,

hysterical paralysis, cult diffiuncured, the more

and

the longer it takes

to

do

so.

It is therefore important

that the treatment

should

be energetic, though not necessarily very ^painful, be made to impress the patient's attention and efforts should for the apparatus employed, for the cure and respect

is produced centres by

by
means

reflexly affecting the

other special senses. cortical centres is altered,and the inhibitory effecton centres taken off.
As
an

psychical of stimuli applied to the skin or the In this way the excitability of these lower

higher

illustration of what is meant by the sudden removal of this process of auto -inhibition, the effect of suggestion in hysterical unilateral amblyopia and loss

of colour-vision may be cited. The acuity of vision in one eye is then much reduced, and, though this is generally
to the patient, there is loss of colour-vision in unknown this eye, though colours are normally perceived by the other. On placing trial frames with two prisms, one base

upwards,

before the eyes, other base downwards, it will then be vertical diplopia is produced, and found that, if the patient is made to read the test types with both eyes open, the upper and lower images will be
the equally well read, corresponding to the previously ascertained acuity of vision of the good eye. Coloured

objects

will also be

equally well in the upper and lower images, though if the good eye be now covered it will be found that
seen

HYSTERIA:
tho

PATHOLOGY

77

colour instantaneously fades out of the remaining image, and- the sight of that eye becomes amblyopic, as before, as soon as the patient's attention is directed vision of that eye has been shown, proving the disability to be of a functional nature. Malingering is excluded, for the reason
an

to

it. Thus

inconsistency

in

the

that the patient is nearly always unaware loss in the amblyopic eye, and if asked
are

of the colour-

whether colours is in the affirmarecognized as well as usual the reply tive, is indeed the case both eyos open, because as with

by the good eye as well. the colours are then seen The visual fieldis often much contracted in hysteria, and, if perimeter charts are taken, it will be found that

the field becomes

is carried on, a fields both eyes are so contracted that they do not extend of more than five degrees around the fixation point, the socalled pin-point fields of hysteria. A similar bilateral
contraction of the fields may be met with in cases of double hemianopia, in which, after the lapse of some months, a small area of central vision returns around the fixation

contracted as the test In a few cases helical contraction. the

more

and

more

point.

Great contraction of the fields may also be met with in retinitis pigmentosa and in choroiditis. True hemianopia does not occur in hysteria, but it may be simulated
irregular contraction of the fields which the in contraction is much side than the other. greater on one In one such case I was able to produce complete blindness by
an

by suggesting to the patient that she should lose her sight on the other side as well. On the next morning she woke tressed disup quite blind and unable to see light, being much

thereat, and crying and sobbing all day on account permanent. of her loss of sight, which she supposed was Vision was restored to her that evening by the process of
suggestion, aided by passing weak galvanic shocks through her eyes, and tellingher that the current was being gradually increased, and that the flashesof light which she saw

78
as

ELECTRICAL

TREATMENT

becoming the result of the retinal stimulation were brighter and brighter, though a as matter of fact the current was not being altered.
CONVULSIVE
TIC

Facial spasm may be due to a partial lesion of the faccor of the pons near the facial cortex, centre in the motor from pressure as in cerenucleus, or a lesion of the nerve bellar
partially recovered facialneuritis. In neither of these is faradism of any service,and the term " *' Severe forms of tic does not properly apply to them.
tumour,
or

from

this facial spasm the facial nerve.

foramen, in injection the

are

best treated by alcohol injection of be done at the styloEither this may mastoid
separate branches

or

face

" tic douloureux," should tional which is its sensory equivalent. Convulsive tic is a funcspasm which may affect the face or other groups of muscles, and does not depend upon any organic lesion,

be

parotid region. distinguished from

be treated by Convulsive tic of the

may

but may

reflexly by cold, or by emotion, unconsciou like. A slight form of the mimicry, and the ing affection is familiar to most of us in the form of a twitterbe produced
" live blood " or of the muscles of the eyelids,known as if the bird in the eye." This is especially apt to come on

"

proafter longed It may for hours at a continue mental stress. keep the patient awake most of the night. time, and even In such a severe Treatment. attack the spasm may

subject

is

run

down

in health,

or

worn

out

"

generally be arrested at once by the application of faradism. Two circular pad electrodes,about an inch in diameter,

should be employed, one placed over each eye, and a weak current turned on, using rapid interruptions. The current should be sufficiently strong to be distinctly felt,but not
real pain. Five minutes' treatment usually in seen suffices. Convulsive facial tic is not uncommonly boys, and I have several times seen it cured by faradic
to
cause

CONVULSIVE
treatment

TIC

79

Its effect is produced carried out as above. through its strong sensory stimulus acting reflexiy as a hyperexcitable As the centres. motor sedative on Gowers* says, "it is important to remember that strong
sensory

have more impulses from the seat of the spasm than any other agency to raise local resistance power and arrest over-action. This opposition of reflexinfluences
a

is

familiar fact."
the
use

only a weak interruptions of the current. This form of treatment would have the least sensory effect,and is really contrary to his advice quoted above.

cates page, he deprein of electricity the treatment, and says that voltaic current should be employed, with no
on

Yet,

the

same

French authors
is
common

use

the term

"

tic

"

in

wider

sense

than

amongst

head

many

with ataxy muscles, and

English 'writers,classifyingunder this chronic forms of muscular spasm combined of the limbs, as well as of the head, facial

does not articulation. Electrical treatment In spasmodic torticollis seem of any avail in these cases. faradism is sometimes of service. Galvanism is the form

usually ordered ; but, in my experience of electricaltreatment faradism has been of at least equal service, which is, however, not saying much. Sometimes faradism of the muscles has spasm
systematic greatest

the opposite side to those affected by the been said to relieve, and, undoubtedly, in certain cases be of the exercises may
on

collis, tortiof spasmodic is the only according to my experience, neurectomy likely to cure treatment the condition. In addition to
ser\nce. a severe case
on the excision of a piece of the spinal accessory nerve side of the affected stemo-mastoid, it is generally advisable to divide the posterior branches of the upper four on the opposite side (Keen'soperation). cervical nerves Even then a certain amount of spasm may remain in the splenius or trachelo-mastoid or complexus of one side,
"
"

In

Manual

of Diseases of Nervous

System,"

2nd

Edit., ii. 268.

80

ELECTRICAL

TREATMENT

which must then be treated by careful massage, the daily performance of head exercises.
NEURALGIAS

and

by

During
no use

the inflammatory
;
on

in the treatment

stage of neuritis,faradism isof the contrary, its employment

the pain. After the inflammatory will aggravate stage has subsided, however, pain in many cases persists,due to one for example SCiatic Li some cases, of two causes. neuritis, the perineuritic inflammation of the sheath of the
may give rise to adhesions, which remain after the inflammation has subsided, and the dragging of these
nerve

keep up the adhesions upon the sheath of the nerve may that pain almost indefinitely. This is the class of case does well by stretching the with Swedish massage
.nerve

and forciblemovements. such drastic treatment

Care must be taken not to apply during the stage of acute or subacute inflammation of the nerve, or the severity of the increased. I have symptoms will probably be much
known many
cases

of sciatica made

much

worse

by

the

too early application of massage.

The

sheath

sidence of persistence of the pain after subinflammation of the of the primary perineuritic is a neuralgia limited to the distribution of the
other
cause
nerve.

affected

In

these
no

cases

adhesions, and there is course nor of the nerve, flexing the hip, keeping

the pain is not due to diffuse tenderness along the

on

does traction
the knee

the

nerve

by
the

extended, produce

pain so characteristic of the firsttwo varieties of sciatica. In this form of sciaticaeither faradism or galvanism may be case which of the greatest benefit,and I have known a severe

by rest in followed typhoid fever, and had defied treatment bed for two months, disappear completely after two weeks' treatment both currents. The faradism is best applied

with by a rollerelectrode rubbed along the back of the thigh and buttock, with a large pad as the indiflerentelectrode bent

NEURALGIAS

81

strength of the current should he sufficientto produce weak contractions of the muscles, but The treatment not to induce pain. of subacute and chronic

round

the calf. The

sciaticneuritis by Chapter V.

means

of galvanism

will be described in

Neuralgic pains may be met with in the limbs or trunk but it is other nerves, along the distribution of many especially in the head that neuralgia is apt to be severe

at the back of the and frequent. Occasionally it occurs head, along the course ; but of the great occipital nerve it is most usually met with in the distribution of the trigeminal,
or

limited to

fifth cranial nerve. portion of the face

or

slighter forms are front of the head, as the

The

forehead, eyebrow, side of the nose, or gums. The term "neuralgia" as used here is meant to include pains which have no organic basis, while those only nerve which to be
are

dependent
as

upon

actual lesion of

nerve

fibres are

symptoms of neuritis. When pains due to organic disease, however, become chronic, such as or tabes dorsalis, they are those of chronic rheumatism

described

"

frequently spoken of as neuralgic." Neuralgic pains in the trunk or limbs must investigated before it is decided that they

"

be carefully
are
a

true

neuralgia, and not due to a chronic rheumatic muscular fibrositis, disease rheumatoid arthritis,neuritis, or some of the spine such as caries or tumour, or of the spinal cord
tabes dorsalis. Again, chronic pains suggestive of of chronic Bright's neuralgia, though really symptomatic disease or diabetes, may a easily mislead the unwary

such

as

"

mistake which

would
to the

routine examination of the pulse and urine prevent. Often the pulse will give a valuable clue
a

may

which elucidation of vague pains and other symptoms be attributed to neuralgia or to hysteria. otherwise

rolling the pulse imder the finger will detect the hard artery with thick walls, which is an indication of arterio-sclerosis with its attendant train of evils, either Gently

82

ELECTRICAL

TREATMENT

in the form of present or threatening, chronic Bright's disease, gout, asthma and chronic bronchitis, cardiac

hypertrophy,

or

plication of these comn of arterio-sclerosis,euralgic pains in the limbs head are a not infrequent symptom. Needless to say, angina pectoris, etc.

In any

faradism is likely to prove a failureif used in the symptomatic treatment diseases. of these An
exception
may,

however,
as

be made
or

in the

case

of

rheumatic hip

the sharp muscular pains accompanied by stiffnessaround the shoulder, or neck. For this form of muscular rheumatism

myalgia

such

lumbago,

faradism, given with a roller electrode as strong as can conveniently be borne, may have an immediate effect in diminishing or even abolishing the pain and stiffness. The
best resultswill be obtained if combined faradism and galvanism are time with the rollerelectrode, given at the same the battery being so arranged that the rolleris the anode, of 7 to 8 ma. of constant current used in addition to the faradism. Sometimes after an attack of pleurisy a severe persistent remain in the side, possibly assoneuralgia may ciated

and

current

seen

with the presence of pleuritic adhesions. "given in several of such the greatest relief
use

I have
cases

by

of the rollerelectrode and faradism, and the rapid cure and disappearance of pain which had remained for months in despite of other forms of medical treatment.
the

Severe neuralgic pains in the head

or

face

are

confounded with other causes of headache. headache severe paroxysmal, of cerebral tumour, when for neuralgia in the early stages. is liable to be mistaken
An alveolar abscess, or suppuration in the antrum of Highin the frontal sinuses, may more, or also be overlooked and the pain ascribed to neuralgia. Dental neuralgia is

apt to be Thus the

of faceache. The pain is a true reflex neuralgic pain, though it is started by an irritation or actual inflammation of a peripheral twig of the same
a

very

common

form

NEURITIS
nerve.

83

Faradism is not, however, a good mode of treatment of such cases, as there are better ways open to us of relieving the pain. In true dental neuralgia, in which there is not actual continuous irritation a twig of the of by cariesof a tooth going on, a stiff dose of fifteen nerve

within an hour, and may pergrainsof quinine often relieves manently Electricityis sometimes of cure the trouble. great use in the treatment of severe rheumatic neuralgia
of the face, but in the form of galvanism, not faradism. form of facial neuralgia known as Similarly, the severe trigeminal neuralgia or tic douloureux is not amenable to

faradism,but requiresalcoholinjection of the

NEURITIS

nerve

trunks-

A frequent instance of a neuritis due to a locally acting form of facial is the common cause paralysisor Bell'spalsy,

due to exposure to chill. The facialbeing a motor nerve only, with the exception of the gustatory and secretory fibres that run in the chorda tympani, the paralysis is

preceded or accompanied by pain or any sensory Although at firstthe paralysis may be comsymptoms. plete and the angle of the mouth drawn over to the opposite to with inability close the eye, yet both the nerve and side, muscle will respond to faradism, and the facial muscles for willnot losetheir faradicexcita,bility a week to t^n days. In the slighter in which the nerve fibresare scarcely cases,
not

than pressed on by inflammatory exudation, the nerve does not lose its faradic excitability altogether, but the
more

diminished to muscular contractions will be somewhat faradism, with at the same time slight hyperexcitability to galvanism, equally to kathode and anode, the anodal
closing contraction being the more sluggish of the two. This is known as a partialform of the reactionof degeneration.

Faradism should never be used in the treatment of liEicial in paralysis any of itsstages,and it is usefulonly in

84

ELECTRICAL

TREATMENT

the diagnosisof the severityof the lesion, and thereforein the prognosis. After the paralysisof the face has lasted two or three days, an alteration the electrical of excitability
can there of the facialnerve usually be detected: At first is hyperis often a short period during which the nerve excitableboth to faradism and to galvanism, so that when the testing electrodeis placed upon the exit of the nerve

close to the mastoid the muscular contractions of the paralysed side of the face will be made evident with a tractions weaker current than is necessary to provoke similar con-

of the facialmuscles on the sound side,when the testing electrodeis placed in the corresponding position behind the other mastoid. This wave of hyperexcitability is followed by diminished excitability f the nerve to both o
currents, and in
severe

of the nerve as the reaction of degeneration of the nerve, and is to be distinguishedfrom the reaction of degeneration of ent time and is differthe muscles which develops at the same
power known

by total loss of conduction to both currents. The condition is

cases

in type. {See 129.) p. Although the amount ability of diminution of faradic excitthe muscles may be taken as a measure of the of about ten days after the severity of the lesionof the nerve onset of the paralysis,yet return of faradic excitability the first is by no means symptom of commencing recovery.
In
covery sign of commencing reparalysisthe first of facial is always the return of tonic contraction of the facial muscles, so that the face becomes straighteragain and the deformity is less marked, although the paralysis for voluntary
cases

is stillas complete as before. Usually some return of voluntary power in the muscles commences weeks before the return of faradic excitability. Blepharospasm is a reflexspasmodic contraction of
movement

the orbiculares palpebrarum of the two eyes, and is due nerve, of generallyto irritation terminal branches of the fifth ending in the ocular

conjunctiva

or

cornea,

either from

NEURITIS:
or as the conjunctivitis,

BLEPHAROSPASM
result of
a

85
or

corneal It is usually associated with photophobia, but it ulcer. is not due only to the irritant action of lightfalling upon the eye, as it may be continued when the patient is placed in a dark room, or it may be present in a blind eye. Reflex blepharospasm may also be produced by irritation of branches of the fifthnerve, as by carious teeth; or other the spasmodic closure of the lids may be associated with photophobia set up by irritation of the retina from the
a

foreignbody

action of

very bright light.

similarcondition that may of a bright arc lamp or the X-rays, is generally due to an Exposure of the retina to the sun's acute conjunctivitis. rays directly,as by using an insufficiently-smoked glass to observe a solar ecHpse, may, by damaging the retina
produce permanent bUndness, associatedwith photophobia, but no

Snow-blindness," and the follow exposure to the action

"

conjunctivitis.
cases

Blepharospasm
only, in

conjunctivitis

be partial and affect one may eye there is a long-continued stubborn where of that eye. The condition then simulates

ptosis, since the eyelid is partiallydropped over the eye ; but this reflexcontracture of the orbicularis may be dis. tinguished from ptosis by the fact that the eyebrow on

that side hangs lower instead of higher, as it would do in a case of weakness of the levator palpebrae. In true ptosis
the eyebrow is permanently raised by the tonic contraction on that side,causing wrinkling of the of the frontalis forehead in the unconscious effortto aid the weak levator

palpebrse in raisingthe upper lid; whereas in the case of blepharospasm simulating ptosis the eyebrow is pulled by the contraction of the orbicularis, the forehead remaining smooth. This form of blepharospasm is sometimes "ptose volontaire." Other causes spoken of as of
"

down

thisform of ptosis are : (1)diplopiafrom slight strabismus, dilatation the pupil on the same and (2) paralytic side. of foreTrue ptosisis always associated with wrinklingof the

8"

ELECTKICAL
on

TREATMENT

head

that side, unless there is paralysis of the frontalis

also.

In myasthenia gravis there is commonly lateral biptosis with smooth forehead, due to the associated tive weakness of the frontales,and this appearance is so distincmuscle

of this rare
at
a

disease that the disease may glance by its means.

may
occur
as

often be recognized

Hysterical blepharospasm
tic
or

[see 78),or it may p.

part of persist after the

convulsive

tivitis conjunc-

other reflex irritant

blepharospasm

which produced the has been entirely cured. In the treatment

cause

of blepharospasm it is clearly necessary to search carefully for any irritantreflex cause, such as a slight conjunctivitis corneal ulcer, or foreign body. In the absence of what may

be thought sufficientcause of this nature, the diagnosis of functional blepharospasm may be made, and in this group faradism to the eyelids may arrest the spasm of cases An instillationof cocaine into the eye may completely.
to also be successful, either alone or as supplementary Circular pad electrodes should be the faradic treatment. each eye, if both are afiected. used, one being placed over

The current applied should not be strong ehough to cause weak contractions of the pain, but justenough to cause facial muscles.
HEMIPLEGIA

Hemiplegia
treatment
a

may when

be benefited to
it is due to
an

dic certain extent by faraorganic lesion. This has

a

stimulating effect,and will aid in preventing the wasting ensues ; and at the same of the muscles that commonly time it improves the sensibilityto tactile and other sensations, localizing or power of and the stereognostic sense

and appreciating the various forms and weights of objects. Unless the anaesthesia is profound, as may occur in some lesions at the back of the internal capsule, or the dorsal
is or portion of the crus pons, the treatment best applied by means of the roller electrodeto each limb tegmental

HEMIPLEGIA

87

separately, the indifierent electrode being applied to the middle of the spine. In the majority cases the anaesthesia of
is of the type known
part is the most
as

cerebral," in which the most paralysed is to say, the foot anaesthetic; that

"

and hand are more paralysed and also more anaesthetic than the ankle and wrist, and these latter than the knee and elbow. In lesions of the posterior portion of the

internal capsule, the so-called " sensory crossway " of Charcot, or, again, of the tegmental region of the crus or the anaesthesia pons involving the fibres of the fillet, produced
one

in is different type to that just described, involving half of the body, face, neck, trunk, Hmbs in

and

equal degree. anaesthesia in these cases

about
or

Occasionally, though
is
so

rarely, the

deep that hard

deep pricks of the skin on the affectedside may unfelt ; and I have known one such case, due to

pinches be practically
a

thrombosis
motor

in the dorsal region of the pons, in which the disturbance was transient only and completely recovered from, but the hemianaesthesia was deep so that

lying in bed the man was when the affected side he was upon unable to feel the bed, and said that it felt to him as if he were suspended in him; Anaesthesia the air with the bedclothes hung over

and permanent

of so profound a degree as this may be improved by using the wire brush electrode, the skin being previously wetted, and the brush dabbed upon the skin, not stroked along it.

faradism used in this way is occasionally very useful in the improvement of the anaesthesiaand the motor of partial paralysis down one side, it is weakness in cases Though
of no benefit in old-standing cases in which the late rigidity that is associatedwith sclerosisof the motor fibres in the pyramidal tracts has set in. Much the same applies to other spastic conditions, as

combined When

disseminated sclerosis, ataxic paraplegia, sclerosis,lateral sclerosis,and myelitis;

spasticity is well-marked,
spasm,

adductor and extensor

the limbs being rigid in with knee- and ankle-clonus

88

ELECTRICAL
extensor

TREATMENT

plantar reflex present, contra-indicated in the treatment. and

DISSEMINATED SCLEROSIS

tlien faradism

is

In the early stages of the disease faradism may be of the greatest service in aiding the disappearance of the paralysis. In this curious disease the mode of onset is often practically sudden, or very acute, with considerable loss of power in one or both legs, as a rule. Sometimes the
motor

weakness

is hemiplegic

in distribution,

or

ocular

be the first symptom, or paralyses, causing diplopia, may sudden partial blindness in one eye, or aphonia, or sphincter
of disease, and the fact that it usually attacks young the females under the age of 30, a diagnosis of hysteria is not uncommonly made instead of organic disease of the

trouble.

Owing

to this multiplicity of modes

of onset

considerable ical number, of cases of disseminated sclerosisresemble hysterowing to the variability in the paralysis stillmore, progress of the symptoms, which often improve to a considerable indeed, almost as far as actual recovery. If a diagnosis of hysteria has been previously made, it will or less appear to be considerably strengthened by the more
extent
"

central

nervous

system.

Some,

indeed

rapid recovery

which

then

ensues.

This

type

seminate of dis-

or sclerosis always relapses, however, sooner later, and recovery is never quite perfect ; that is to say, the patient is always left a little weaker after each relapse, never quite reaching the previous state of health. Other

of the disease develop slowly and steadily, and these likely to exhibit the classical symptoms more are of inwith the characteristicintention co-ordination of the arms,
cases

tremors,

scanning speech, and nystagmus. to The cases that are difficult recognize

as

disseminated

sclerosisare those of the so-called paraplegic type, in which in the legs, or less rapid loss of power there has been more and extensor with sphincter trouble, increased deep reflexes,

DISSEMINATED

SCLEROSIS

89

plantar reflex,but without

the intention tremors, Disseminated

syllabic utterance. essentially a cerebro -spinal disease, and in this latter type in evidence, but the cerebral and the spinal symptoms are bulbar signs are in abeyance. Often it is impossible to be

and

mus, nystagsclerosis is

certain of the diagnosis, but a chronic paraplegia in a young woman, with littleor no anaesthesia, but with increased

deep reflexes, ment, extensor plantar reflex, and sphincter involvewill always be very suggestive of disseminated sclerosis, and the diagnosis will become almost certain if, in addition, there are any signs of cerebral or bulbar involvemen such the head
or on
as

inco-ordination of the

arms,

tremor

sitting up, staccato

speech, nystagmus,

of plopia, di-

optic atrophy. It is in the relapsing type of disseminated or insular is often of considerable sclerosisthat electricaltreatment service. Many of these patients are of neurotic disposition,

modified form of Weir-Mitchell treatment will often succeed best. Massage, faradism, with good feeding,plenty of milk, and rest in bed for three or four weeks, will be

and

the best linesto proceed upon ; and though itis undoubtedly littleor no benefit may true that in a number of cases ensue, cannot do any harm, yet, at any rate, the treatment

and may occasionally be followed by an immense amount The faradism should be applied by the of improvement. roller electrode,with the indifferentelectrode applied as a
large pad over the cervical spine. No strong measures should be adopted in the shape of powerful currents, as may occasionally be done with advantage in hysteria, the

being of only sufficient strength to cause This should be given weak contractions of the muscles. for twenty minutes. treatment, daily before the massage
current

employed

TABES

DOKSALIS

In tabes dorsalis, again, faradic treatment times will someassist in diminishing the anaesthesia and sensation of

90

ELECTRICAL

TREATMENT

in the legs, and the ataxy may be also at the numbness same time correspondingly benefited. Very occasionally a considerable functional element may be superadded to
a man the organic disease present, and I have seen ing sufferfrom well-marked tabes, with partial optic atrophy, typical hysterical shuffling of the with who walked

feet, and whose and the visual

almost completely analgesic, skin was fields extremely contracted. Energetic treatment with faradism in his case with the wire brush dissipated the greater part of the anaesthesia and soon analgesia, whilst his gait and vision improved very much. Not much is to be hoped for, however, from electrical
treatment

in the large

of majority

cases

ataxy

is much by movements

better treated with

means

of tabes, and the re-education of the

vised of regular exercises on specially deinstruments, such as Frankel's steps; The lightning

pains are not, in my experience, benefited at allby faradism, This treatment. or, indeed, by any other form of electrical is, perhaps, the most difficult all the symptoms of of tabes to relieve. I have once seen the pains practically cured ol heat baths, and in two or three instances I have seen the pains diminish very much, at the same took place in the ataxy and time as marked improvement
a course

by

of the disease,while the patient was being other symptoms Intravenous injections energeticallytreated by mercury. tions of salvarsan, followed a fortnight later by intraspinal injecblood collected by a of the patient's own pains remarkably. venesection, sometimes control the severe have In early cases, especially if the symptoms developed at all acutely, I generally treat with inunction of the
serum

of the oleate of mercury, 10 per cent., made up with lanoUn, time give the biniodide of mercury by and at the same If attention is paid to the gums and teeth, the mouth. it is remarkable how long the of majority the patients can without showing any signs continue this treatment
of mcrcurialiwm.

FARADISM

HEADACHE

91

HEADACHE

I
a

or

it is of the neuralgic type, and due to excitement overstrain,headache may occaother form of nervous sionally be relievedlike magic by the use of faradism. It

When

is especiallywhen the pain is frontal that this form of treatment is capable of giving relief, though ifthe headache is of the throbbing variety and made much worse by slight
the pain stooping, faradism is contra-indicated.When is dull and aching across the forehead,such as may result from straining the eyes and the attention at a picture gallery, the treatment is best applied by two soft circular

pad electrodes placed one on each temple, though in some it answers better to place one electrodeat the root cases of the nose and the other at the back of the head below the occipital protuberance. The patient should always be either lying
on
a

couch

or

comfortable chair when the treatment with the head slightlythrown back. Five minutes only of the treatment should be given at a time, but it
may

sitting back in is being applied,

repeated after an interval of ten minutes, if necessary. Another form of functional headache which may be relievedby faradism is the neurasthenic type. In this the variety, the pain is frequently a dull weight on
to be top of the head, or the top of the head may seem bursting. Or the liftingofi as though the head were

be

pain may nail being resemble the sensation of a A hammered into the top of the head {clavus hystericus): typical instance of this form of headache occurred in a

baker, set. 42, who was sent up from the country on ness account of the constant pain, and sensations of nervousmon and inabilityto work. He slept heavily, as is comin these
cases,

yet feltno

better and unrefreshed in

the morning. He complained of a constant sensation at " the top of the head, as though it were all alive,"and as

92

ELECTRICAL

TREATMENT

going to burst. As he had been in becoming tais condition for twelve months he was alarmed himself. Cross the fact that about -questioning elicited before his symptoms he lost a about a month commenced favourite daughter from diphtheria, and the mere ence referthough
were

liishead

to the

was subject over

lose control

of applied by means two circular pad electrodes, one to the back of the neck the vertex, a gentle current being and the other over gradually turned on and increased to the point when it
was

and in a nervous bowels constipated.

sufficientto make him partially his emotions. He was evidently run down state, the tongue slightly furred, and Faradism

began

to be strongly felt,but

not

painful.

Stroking the

the vertex, the suggestion was then put electrode over that he was now strongly before the man going to get better, be cured ; that he would wake up and that he would soon

in the morning ; that his refreshed, bright, and happy nervousness and headache would disappear ; and that he be able to return to work. These suggestions would soon
were

was

constantly repeated to the patient while the faradism being applied, care being taken that the man's attention told was not distracted by anything else, and he was

to give

him

his whole attention to all that and done for him.

was

was

being said to

to the merely as a means by suggestion, and though no hypnotic state treatment was produced, yet the constant reiterationof the suggestion now that he was going to get better so influenced his subliminal

Faradism

thus

used

sensations from consciousness that the morbid which he had suffered for so many months soon disappeared This and he recovered perfectly and returned to his work.

element of treatment in the treatment one

suggestion is a most important of all functional or neurasthenic and the faradic battery, with its strange noise symptoms, thus be used as an important powers, may and unknown

by

adjuvant

in producing

the receptive state of mind

in the

DILATED

STOMACH

93

patientnecessary for the implantation of suggestionsas to his speedy recovery.

DILATED

STOMACH

In the atonic form of gastrectasisfaradic treatment may be of very considerableservice,but before deciding upon the use of faradism in a case of dilatedstomach it is important to exclude the existence of any obstruction at the pylorus or in the first part of the duodenum as the cause

of the dilatation. Obstructive dilatationof the stomach is most commonly due to one of two causes : (1) cicatricial from peptic contractionof the pyloric end of the stomach ulceration, carcinoma of the pylorus. Less comand (2)
inon
or

of obstructionwill be stricture the pylorus of first part of the duodenum from adhesions around the
causes

liveror gall-bladder from other causes of localperitonitis, or tum and kinking of the pylorus from a shortened lesseromenholding it up against the liver. Usually it will not
to be difficult distinguish between obstructiveand atonic dilatation the organ by the presence of visible peristalsis of in the former, appearing as a slow wave of contraction

be made can passing from leftto right. If this symptom it out definitely, is decisive evidence in favour of the diagnosisof obstruction. The presence in the region of the pylorus of a tumour which can be feltby palpation must
not by any

be taken as positiveevidence of malignant disease. In young infantspyloric obstructionmay be

means
a

due to

congenitalthickening and hypertrophy of the walls the pylorus,which may be feltas a tumour between the r.f from navel and epigastrium,and in adults who have suffered
peptic ulcerationof the pyloric end of the stomach or first part of the duodenum, a tumour, due to inflammatory

thickening of the walls of the pylorus and localperitoneal adhesions,may precisely simulate a malignant growth in the pylorus, not only when palpated through the abdominal wall, but even when exposed to view at a laparotomy.

94

ELECTRICAL

TREATMENT

useful means of diagnosis in cases of dilatation of the stomach is by chemical examination of the gastric In cases contents. of gastric carcinoma there is almost Another Always complete absence of free hydrochloric acid in the vomit or in the products of gastric digestion withdrawn by the stomach tube after the administration of a test meal. In cases of peptic ulcer, on the other hand, there is,in the of majority
cases,

large

excessive secretion of hydrochloric acid, or hjrperchlorhydria, which can easily be recognized by testing the stomach contents by Giinzburg's reagent, or by the dimethyl-amido-azo-benzol
test.

very

we

more

often, be a history of prolonged for some years ; while in the case of malignant disease have usually to deal with a primary dyspepsia of not than a few months' duration occurring in a patient

will also, dyspepsia, probably

There

past middle life, who has not previously suffered from indigestion. Undoubtedly, however, a certain number of
at
or

start in the scar of an old ulcer. gastric cancers Gastrectasis due to atony of the muscular walls of the long-continued as the result of chronic gastritis, stomach occurs

faulty feeding, or debilitatingdisease, as

the secondary result of chronic culosis. anaemia, Bright's disease, or tuberas

of dilatation of the stomach chloric the gastric contents usually contain either no free hydroacid, or else a much smaller percentage than the It is, therefore,obvious that absence normal 0*22 per cent. of free hydrochloric acid will not decide between atonic dilatation and carcinoma, but the diagnosis must be made other points into consideration, and after taking many especially the presence or absence of gastric peristalsis. Even this latter symptom may lie latent for a time in cases
a case pyloric obstruction, and I have known of pyloric carcinoma causing dilatation of the stomach to be under observation in hospital for a week before peristalsis

In this atonic form

of marked

was

observed, although

it

was

constantly looked

for;

DILATED
As

STOMACH

95

said, it is in the atonic form of gastrectasis that faradism may be of great help in the treatment. It however, be applied by means must, of an intragastric electrode to the interior of the stomach, in order to make sure of the faradic current stimulating the muscular coats.
If itis attempted by
means

1 have

to treat the muscular

if one

and the other to the back of the chest, no good effectswill be produced, as the current becomes diffused in the abdominal walls and other tissues, causing strong contractions in the abdominal in the muscular walls muscles, perhaps, but none of the stomach itself. One of the electrodes must be passed the oesophagus into the stomach, while the other is over the front of the applied to the skin of the abdomen

electrodes on is applied in front over

of two

walls of the stomach the surface of the sldn, even

the stomach

down

stomach. The intragastric electrode is made of a stiffwire core about 18 inches long, ending in a small grape-shaped knob. From the knob to its upper end the wire core is covered insulating material, such as a rubber smooth with some it. To the other end of the wire tube drawn tightly over is fixed a binding screw, to which the wire from the core
battery is attached. If this special form of intragastric be electrode is not obtainable, a very serviceable one can improvised with the assistance of an ordinary rubber tube, such as is used for washing out the stomach, and a 2-feet length of insulated copper wire. After lubricating the stomach tube with butter or stomach with is placed in a comfortable position on a couch and given a drink of half a pint of water or other liquid, and then the tube is passed into the Next, the insulated copper wire is lubricated stomach. and pushed down inside the stomach tube tilla length of glycerine, the patient
about lower
IG inches beyond

the teeth has been

passed.
to expose

The wire

inch of the insulating covering should have been previously removed,

of the copper
so

as

the

96

ELECTRICAL

TREATMENT

metallic core, which should be bent round to form an oval loop, but not too broad to pass easily into the rubber stomach tube. The other end of the copper wire
from tube beyond

ing project-

the end of the stomach the teeth to one can then be attached by a movable binding screw of the wires from the battery, while the other wire from the battery is attached to a moist pad electrode applied to the

front of the stomach. The current employed be just to provoke visible strong should sufficiently contractions of the abdominal muscles, and it should be for about ten minutes. This treatment allowed to run
skin
over

the

should be repeated every other day for three weeks or a A current which is just month. strong enough to provoke contractions of the abdominal muscles will be scarcely felt in the stomach, especially after it has been running
for

The current minutes. electrodes from the bare copper tube into the of the stomach
a

few

passes between

the two

stomach,

and

so

to the stomach

terminal at the bottom liquid contents of the walls on its way to the

surface electrode, thus directly stimulating the muscular It is in order to ensure the copper walls of the stomach.

terminal in the stomach tube being in contact with liquid in the stomach that the patient is made to drink just before the passage of the tube. I prefer this method of applying intragastric faradism because it is possible to wash out the stomach first before passing the copper wire
inside the rubber tube ; and I think it is usually advisable thus to wash out the stomach previously.
to the stomach

down

In practice I generally {seepp. 101 and

use

combined

127), and

faradism and galvanism it is then easy to

tell if the intragastric electrode is properly in position by turning on a few cells of the galvanism and noticing if If the needle indicates any current. the galvanometer

does not move, then in good working are

(supposingll the other attachments a it that the stomach order) must mean

VISCEROPTOSIS

97

concontact with the stomach tents, electrode does not make be pushed in slightly and, and the copper wire must if necessary, a little be slowly poured through water must a funnel into the rubber stomach tube.

The

effect of the treatment

a

is to

cause

immediately

sensation of warmth and well-being in the proved, cases epigastrium, and in many gastric digestion is imas evidenced by the return of hydrochloric acid

afterwards

in the gastric juice when previously it has been absent. At the same time, other evidences of dilated stomach the
"

splashing sounds of succussion and vomiting will also diminish ; while the skin will become clearer, the patient will complain less of eructation, nausea, and insonmia, and
"

will put

on

weight.
VISCEROPTOSIS

Sometimes

the stomach

becomes

of its muscular walls,and at the same to the level of the navel or lower.

dilated through atony wards time displaced downThis condition

is called gastroptosis,and is often a part only of a more general dropping of the viscera and intestines through atony and lengthening of their suspensory ligaments. The
for this condition is enteropcomprehensive name " tosis,"'or visceroptosis,"in which not only the stomachy but the liver, intestines,spleen, and kidneys all share in
more
"

It is usually met the general displacement downwards. walls with in women after 30 or 40, whose abdominal are slack and whose muscular tissue generally is deficient; whose lives are almost entirely sedentary ; and who have
always suffered from chronic constipation. In the treatment of this condition the aim must be to increase the tone and vigour, not only of the muscular but also of the intestines and walls of the stomach itself, time bracing the of the abdominal walls, at the same
system
H

nine. generally by douche baths, massage, and strychFaradism be of the greatest service, and it may

98

ELECTKICAL

TREATMENT

is best applied by using one intragastric electrode according to the method already described ; while the other wire from the battery is attached to a roller electrode, which is best applied over the course of the colon, starting in the
the ascending colon, passed upwards towards right groin over the liver, then across the abdomen and downwards

should be given for about ten minutes, and is then best followed by another ten minutes' treatment of the intestines. The stomach tube and intragastric electrode are withdrawn, and after
over

the descending colon.

This treatment

for the patient to recover from the thus produced, the wire is attached unpleasant nausea to a rectal electrode and the treatment then given as for constipation in the following section.
two
or

three minutes

useful way of treating this condition of gastroptosis with constipation and atony of the abdominal muscles is by means of the three-phase sinusoidal current, one wire

Another

being attached to the intragastric electrode, another to a rectal electrode, and a third to a flat,moist pad or roller [See Chap. XI., electrode on the skin of the abdomen.
p.

299.)
CONSTIPATION

One
current

of the most successful applications of the faradic is in the treatment of chronic constipation, a form

of treatment which has not received from the medical profession the attention that it deserves. Obstinate constipation due to with in young women, deficient muscular power of the intestinal walls, originated a often through of life, or anaemia, sedentary mode ally, neglect to establish regular habits in childhood. Occasionthough
far less frequently,
a

is so frequently met

constipated habit of bo"7el is met suffered neither from anaemia nor

similar irregular and with in men, who have ness, other debilitating illpersons suffer from

and who
this symptom

lead active lives. Many

only
on

certain diet, especially milk

foods,

CONSTIPATION
or

99

if they go to residein a district where the water owes its hardness to an excessive amount of dissolved chalk. Other cases, again, have developed constipation only after
some

gastric ulcer, gall-stones, pericolitis, disease,in which the occurrence uterine or ovarian of a has been followedby adhesionsthat have localized peritonitis
a permanently crippled the peristalticction of the bowel. Although faradism to the bowel may be of a certain in this lattergroup of cases, it is amount of benefit even first mentioned that especially in the class of case chronic constipation is most surely relieved, and a

illness, such

as

by regular habit of bowel reinstated, this form of electrical treatment. if not all, have already Many such cases, forms of drug treatment, such as daily pillsof aloes, belladonna, and strychnine, or saline water, Epsom salts,senna, and the like, and though relieffor is gained by their use, no permanent cure of the moment

tried

numerous

the constipationis likelyto result. I have seen many such cases cured by the use of the faradic current applied by means of a rectal electrode, and I am convinced of its efficacy.

The large bowel gradually becomes so dilated and its muscular in long-standing cases of chronic coats so attenuated
o constipationthat littler no power of unaided recuperation remains to the patient. Faradism, when applied to the large intestine, a causes circularcontraction at the point

ally experimentinnervates the in an animal if the pelvic nerve which lower portion of the bowel be exposed and stimulated by the faradic current. A similar result, though less marked, follows the direct application of the electrode to the wall of the large intestine.
'

waves of stimulation,and slow peristaltic the bowel from that point. This may be

spreading along
seen

In the treatment of constipationby faradism, allthat is necessary besides the faradic battery and its two conducting
wires is a rectal electrodeand

ctal electrodeconsists of

rollerelectrode. The stout wire about 6 inches

a

100

ELECTRICAL

TREATMENT

long, ending in a small metal knob at one end ; at the other it is screwed into a metal cup on the inside of which terminal of the is a female screw, which fits the screw ordinary handle electrode. The 6-inch length of stout wire
of the rectal electrode is covered by insulating material from below the metal knob down to the metal cup in which it is fixed, thus leaving exposed only the metallic terminal

knob.

lie on the back on a couch, and patient must the electrode is vaselined and inserted into the bowel for Before insertion, the elec3 inches. a distance of about trode

The

has been attached to its handle and one of the wires leading to the faradic battery, and the patient's clothes is be so loosened that the front of the abdomen must with the roller electrode. The easily exposed for treatment
secondary coil so placed as to give only a weak current, and the rollerelectrode is then wetted with hot water and applied to the If the secondary coil has been well front of the abdomen.

battery is

now

started running

with

the

pushed back, the patient will probably feel nothing, but if now the coil be slowly pushed over the primary, the abdominal
muscles will presently show signs of contracting to the current, although the patient very likely stillfeels, The current should not be used in a strength nothing.
greater than will produce gentle visiblecontractions of the muscles. abdominal When the desired strength of current has been attained by thus pushing the secondary coil over the primary, the the surface roller electrode should be slowly pressed over following more less the line of the or of the abdomen, the caecum colon, beginning over and ascending colon in
.

the right inguinal region, and the abdomen ribs, across above left side
over

so

up to the right lower the navel, and down the

colon to the sigmoid. The be slow, and thus movements of the roller electrode must to the large intestine is a sort of massage combined with its direct stimulation by means the faradic current. j It, of

the descending

COlsrsTiPATioM

ioi

and stated in directions issued with the faradic apparatus by the electrician,that the primary faradic current should be used for stimulation of the intestines ; personally, I
in which faradism only the secondary coil in all cases is required. The duration of the treatment should be
use

about twenty minutes, and should be continued every other day until the process has been repeated from fifteen to twenty times, Gene-^^ally should speaking, the treatment It is best given in the be maintained for at least six weeks. mediate morning about an hour after breakfast, and often the imis that the patient feels a effect of the treatment desire to go to stool. Although it is much to be desired
that either the doctor or a skilled nurse should give the it is not impossible for intelligent patients to treatment,

learn to learn
most
to

apply

it themselves,
out

just as

wash

his

stomach

may patient for himself. In the

may obstinate cases of constipation the treatment be given daily, but in the it majority will suffice if it be given three times a week.

Galvanism

should

never

be

employed
coats
so

for this treatment.

It stimulates the muscular better than faradism indeed, not

"

of the bowel no well; and there is

always
mucous

considerable risk of producing electrolysisof the when in contact with a membrane of the rectum

is being bare metal electrode while the constant current reasoning might be thought to used. Although the same

contra-indicate the use of galvanism with the intragastric electrode in cases of dilated stomach, yet the conditions are then slightly different. The metal knob or terminal
of the intragastric electrode should not be in contact with the wall of the stomach, but hidden inside the rubber ; or else if a stout stxjmach tube (asI always use it

myself)

insulated electrode be used without passing it down inside a rubber stomach tube, then the terminal knob dips into to prevent the liquid stomach contents, which would serve

162
any

ELECTRICAL

TREATMENT
if only weak

electrolysis of the wall of the stomach, were the danger currents used. However,

electrolysis is a real one, and in treating the stomach by this serious. For that reason, the faradic method, when using galvanism to augment such
treatment,
as

of producing its effects might be

in the combined

I always take care current at least once

3
to

method to be described later, to reverse the direction of the galvanic to use more than a second, and never
nurse
or

skilled, attendant, however gastric be allowed to use the galvanic current for intrashould in which for any treatment or or rectal treatment, the electrode has to be applied to a mucous membrane.
4
ma.

No

should be allowed to use Faradism, on the other hand, galvanism in this way. or cannot produce electrolysis, and though a clumsy nurse
no fortiori,patient,

of

course,

patient may administer a sharp shock, yet no serious harm is likely to result. Its bark, so to speak, is worse than its bite. The constant current is much insidious in its more burn may easily be produced without action, and a severe

pain being caused at the time. therefore, be most serious.

very nmch
.
.

Its bite may,

...,

PKOLAPSE

Prolapse

infants and cases which do not yield to ordinary methods of treatment, faradism by means of the rectal electrode may be called into requisition. It is more likely to be required in old people whose
muscles are losing their tone, and whose tissues are shrinking from senile causes, depriving the rectum thus of its The treatment be previous mechanical support. may applied in the
same

is liable to occur of the rectum in old people, and in obstinate

in young

way

as

for constipation, though

a

the

roller electrode is not necessary, and instead on the front of the abdomen placed
case.

pad will meet the

moist

Prolapse of the Uterus

and displacements due to laxity

PROLAPSE

OF

THE

UTERUS

103

of ligaments may also be most advantageously treated The method of application is by the faradic current. similar in principle to that employed for the treatment

similar in constructio of constipation. A stout bougie electrode, to the rectal electrode,is passed into the vagina up to itsposteriorfornix,and the other electrodeemployed
may be either a rollerelectrodeor a moist pad placed on If, as is not unlikely the case, the front of the abdomen. there is chronic constipation present also, then the roller electrodeshould be employed on the abdomen in the manner

described in the section on the treatment of constipation (p.100). The treatment, as in the former class of case, should be given three or four times a week, for a period of
minutes, and should be maintained for from six to eight weeks. I have known chronic prolapse of the womb, which had previously necessitated the persistent use of a pessary, cured by this treatment, and at the same time the chronic constipation from which the patient suffered about twenty

disappeared. With
some ones,

of which be made to vibrate quite slowly, four less,being not difficulto obtain. t even It is effectedby fixing an aluminium wire, bent to a sharp angle, upon the rigid interruptor bar and unscrewing the so that the excursions of the interruptor contact screw
the interruptor can beats a second, or

faradic batteries,especially the an apparatus is supplied by means

more

expensive

hammer
apparatus

against the magnet

is

must

be

larger. If this

giving faradic treatment to the then the muscles are not tetanized stomach or other viscera, by the current as they are when the interruptor is running

used when

at the ordinary speed of thirty

Inforty per second. stead of a tetanic contraction, the muscles are thrown into rhythmic, clonic contractions, varying regularly in speed with the alternationsof the interruptor. By thus allowing the muscle to relax momentarily after each brief contraction
or

it is sometimes thought that better resultsmay

be

104

ELECTRICAL

TREATMENT
use

achieved ; but, personally, I prefer the electrode with the interruptor working

at

of the roller its ordinary

speed;
COMA

This condition, induced by

may
an

ing, alcoholic or opium poisonor respiratory or cardiac failure under an anaesthetic, In advantageously be treated by the faradic current.

operating theatre an emergency coil is often kept ready for use, should the occasion arise. It consists of a powerful ruptor. interdry cell driving a primary coil with a hammer

fixed a primary coil is permanently secondary coil, and the starting switch has three or four A pair of stops graduating the strength of the current.
Over the wires and disc-electrodeson handles are permanently fixed to the binding screws, on so that the only preparation of the battery necessary is to w^ the electrodes and turn on

the starting switch. In heart has failed under an

cases

the respiration or anaesthetic, the wet electrodes where

should be placed, one upon the epigastrium or heart, and behind the sternothe other at the root of the neck just By this means mastoid muscle. respiration may be stimulated by producing contraction of the diaphragm through faradization of the phrenic nerve, and contractions of the heart muscle itselfmay also be provoked.
from alcoholic or opium poisoning, of coma be of the especially in the latter, faradism may the current may poisoning utmost service. In opium be applied with a small disc -electrode, or with the wire brush to the limbs and trunk, a flat pad as the indifferent electrode being applied to the spine. The current should be sufficiently strong to provoke well-marked muscular
contractions. Its value lies in its powerful stimulation of thereby preventing the patient from resensory nerves, lapsing into that depth of coma which is so dangerous

In the treatment

to life from

respiratory failure. Strong sensory stimulation produced by this means is a far

or

the liabilityto cardiac

HYSTERICAL
safer
coma means

CONVULSIONS
at

105

of

keeping

bay

the dangerous

depth

of

in poisoning by opium than the old-fashioned means for hours, until he of walking the patient up and down dies from exhaustion perhaps as much as from the poisonous effects of the drug.
HYSTERICAL CONVULSIONS

Are

best

arrested

by

large flat pad should one thigh, as the indifferent electrode ; while for the active inch in diameter one about electrode a round pad the chest and limbs. This is a better means of application than that of using two disc-electrodes in close proximity in this on the limbs or trunk, as should be used
on

faradic stimulation. strong be applied to the spine or

latter

case

the

neighbourhood is much
in very the wire brush

electricity is practically confined to the lation of the electrodes, and the general stimuless for th^ same strength of current.
severe

Except

to use it will be unnecessary for this treatment, it is a much more as

cases

is likely to reduce the patient to tears and sobbing, and to induce a state of terror which reacts badly on the condition of the nervous painful

form

of application, and

Care must, of course, be taken that the diagnosis of hysterical convulsions is correct, and that the conviilsions are not epileptic, apoplectic, or toxic in origin. The
system.

strength of current
one

that is likely to get the best results is good, though

not

which

will readily produce contractions.

violent,

muscular

Catalepsy, whether
may

due to hysteria
same
commence

or

to other

causes,

usually be arrested by the though care should be taken to

on current, weak a fatal sj^ncope.

form

of treatment,

account

of

paratively with a comthe danger of

producing

CHAPTER
THE

IV
OR DIRECT

GALVANIC,

CONTINUOUS,

CURRENT

SuLZER,

in 17G2,

when the tongue

the track of the continuous current he noticed the peculiar sensation produced in its being touched by two pieces of lead and on
was
on

Galvani silver which were also in contact with each other. the firstto lay the foundation of our knowledge of the was
or continuous the phenomena

produced

after studying first observed, in 1789, by his wife, who convulsion of the muscles in a frog's leg by

constant

current

battery,

attaching one end of a metallic conduct^or to the muscles Volta, soon after-' and the other to the lumbar nerves. at the same problem, and discovered wards, also worked the voltaic pile, which bears his name, of alternate composed discs of zinc and copper, separated by pieces of acidulated moistened card. It is in memory of these two pioneers in the field of electricalscience that this form of current is often

referred to

as

galvanic

or

or constant current continuous it because the flow of current from

name voltaic. The is also applied to cell which produces it

is steady and tjontinuous. When supplied from the electric " direct " current, to lighting mains, it is often called the distinguish it from the alternating current of some electricbe obtained either may circuits. This current from primary batteries or modifications of the original batteries or accumulators, voltaic pile, from secondary or from motor generators or dynamos.
lighting

The

Leclanch^

battery.

"

The
as

continuous
a

current

is

obtained .from primary action. The commonest

batteries
primary
106

result of chemical battery used for medical

GALVANIC

CURRENT

107

work is the Leclanche, in one of its many ^modifications. The ordinary wet Leclanche cell consists of an outer foursided glass vessel, holding from one pint to a quart, which
is about

one-third filled with saturated solution of salIn this is placed a rod of zinc, amalgamated ammoniac. better, a cylindrical plate of zinc, to or, with mercury, which is soldered a wire connecting it to the negative

electrode. Inside the cylindricalplate of zinc dips a carbon rod, with its lower end packed in a bag of crushed carbon dioxide, or pyrolusite. To and rough-grained manganese
the top of the carbon rod is clamped a leaden cap, attached for the fixing of the wire of the to which is a binding screw positive electrode. When this battery is not working, there is, theoretically,no

chemical action ; but when

of the positive and negative electrodes are eitherdirectly or through a resistance,then chemical action is set up in the battery, and an electriccurrent flows

the wires gether, connected to-

from the zinc to the carbon, and through the circuit of the time the zinc is gradually wires back to the zinc. .At the same dissolved, with the formation of zinc chloride, while dioxide gas is slowly given off, and the manganese ammonia
This cell,when in good order, gives a current of good strength, having a voltage becomes polariz3d if the current of 1'5, but the carbon soon is taken out rapidly through a low resistance, so that the is reduced to
a

lower oxide.

voltage of the cellrapidly falls. If,however, the cellisleftto itself for a time, itgradually recovers, so that itisa cellwell

adapted forintermittent work, in which heavy currents are not or required, as in medical electricity, for telegraph purposes.
By
" "

polarization

is meant

the covering of the surface

of the negative or carbon element with bubbles of hydrogen, as the result of the decomposition of the electrolyte by the be" considered The cell may now passage of the current.
as
a
a

zinc-hydrogen cellj with

of

zinc-carbon cell whose voltage of the battery falls.

voltage of only 0*82, instead voltage is 1*5, and, therefore,the

a

108

ELECTRICAL

TREATMENT

In order to oxidize the hydrogen at the negative element, perand thus prevent polarization, a variety of manganese oxide bon, called pyrolusite is used and packed around the carincorporated with it. This substance can or slowly hydrogen to form water, unless too oxidize the nascent
the strong a current is taken from the cell. If that occurs, cellbecomes polarized ; but after a period of rest the action of the pyrolusite slowly depolarizes the cell again, and its

voltage will be found it was before.

to have

risen to much

the

same

as

Instead of a wet cell,the parts may be arranged as called dry eel], such as that of Hellesen or Obach. latter consists of a insulating asphalt carbon rod, which

so-

This

on an zinc cylinder casing, mounted is placed the base. In the centre is surrounded by the depolarizing mixture,

gum

oxide diconsisting of nearly equal parts of manganese and plumbago made into a paste with 1 per cent, of This is tragacanth, pressed into the required form.

in paper and surrounded with the electrolyte, 15 per cent, of made of 85 per cent, plaster-of -Paris and flour mixed to a thin paste with saturated sal-ammoniac solution. This electrolyte occupies the space between the

wrapped

depolarizing mixture and the outer zinc casing. Over the depolarizer and electrolyte is placed a paper ring, above layer of ground cork, then another paper ring, surmounted by a bituminous seal, through which a small glass tube is passed to act as a vent for the gases liberated which
a

is

by th? action of the cell. The voltage of these dry cells is slightly higher than that of the wet cell,and they last fairly well, though they cannot be renewed as the parts dry cellsmust be bought as the of a wet cell can ; but new

old

ones

become

worn

out.

Electrical units." The

pressure or electric than that of one
outer

volt is the arbitrary Unit of less electromotive force, and is a little Daniell cell. This cell consists of
a an

glass

or

porcelain vessel containing

zinc cylinder

GALVANIC

CURRENT

109

standing in

solution of dilute sulphuric acid.

Inside the

zinc cylinder stands a porous pot containing a rod of copper immersed in a saturated solution of copper sulphate. When the cell is in action the zinc dissolves in the sulphuric acid,
zinc sulphate, and the liberated SO^ ion sets free copper from the copper sulphate solution, and copper is deposited upon the central copper 'rod, which therefore

forming

grows thicker. is 11.

This cell is verj^ constant,

and

its voltage

The

unit of resistance

resistance of a in cross 1 sq. mm.

is the ohm, and is fixed as the 106 cm. high and column of mercury section,weighing at 0"C. 1 4*4521 grammes.

This is equal to the resistance of in thickness and a little 1 mm. over

The

unit of electric current measure of the current that will flow through a resistance at the pressure of 1 volt. In medical electricity of 1 ohm the ampere is too large a unit to be convenient, and the
thousandth part of instead.
an

wire of pure copper 50 yards in length. is the amfere, and is the

ampere,

or

milliampere

(ma.)is

is the coulomb a term scarcely ever required in medical electricity. It is the quantity of flowing electricity represented by a current of 1 ampere

employed The unit

of quantity

"

for

one

second.

coulomb

may

of electricity which, a solution of silver nitrate in a silver voltameter, causes deposition on the platinum kathode of 0*001118 gramme of silver. In electrical engineering a larger unit is more quantity
commonly

also be defined as the passed through a when

used

of 1 ampere The unit of capacity, or storage-power of a condenser, for electricity, the microis Leyden jar, such as a
or fardd,

the amfere-hmir ; that is to say, a current flowing for one hour, or 3,600 coulombs.

the millionth part of a farad. A condenser has the capacity of one farad, which would require one coulomb of electricityto charge it to the pressure of one volt.

The

unit

of electric energy

is the watt, and is the

110
measure

ELECTEICAL

TREATMENT

number

of the rate at which work is being done. The of watts consumed is obtained by multiplying the

of of volts of electric pressure by the number Thus a current of amperes of current flowing. -ampere -J 100 volts will do work at the rate of 50 a at pressure of number
watts.

The

amount

of work

done

in watt-hours,and

1,000 watt-hours, or of Trade unit for electric supply, and, before the war, cost usually about sixpence for electric lighting. It could,

is usually reckoned is kelvin, the Board

be manufactured in this country halfpenny in large power stations. Seven hundred and forty-six watts are
one

however,

for about

one

equivalent to

horse-power : a force which will raise a weight electrical of 550 lb. to a height of 1 foot in one second. One thousand watts, or a kilowatt,is the unit of electric energy commonly ing used by electricalengineers in measur-

the power of large machines. Since the number of watts, or rate at which work is being done, is the product of the voltage multiplied by the amperage, it wdll be clear that a current of 1 ampere
amount pressure of 200 volts will do exactly the same of work as a current of 2 amperes at a pressure of 100 volts. In reckoning the comparative efficiencyof machines
at
a or

electriclamps, it is usual to quote the number of watts Thus them. the ordinary 16-candlerequired to work power metal filament lamp requires about 20 watts to make therefore
on

it glow brightly, and a 16-candle-powerlamp

willconsume lamp on a circuit of 240 volts a The lamps must power will require only 0*08 of an ampere. be specially made for the different pressures, and if a

circuit of 100 volts 0'2 of an ampere, while giving the same candlea

lamp

designed for
to
a

100-volt circuit
soon

were

accidentally

fitted on

the current was tiirned on it would glow with intense brightness for a fraction of a second and then be destroyed. Hence the voltage of the lamps is always indicated upon the glass
as

240-volt circuit,as

GALVANIC

CURRENT

111

incandescent lamps, with tungsten modern filaments enclosed in bulbs filledwith nitrogen at rather less than atmospheric pressure, have a still higher efficiency, using only J watt instead of IJ watts of electric energy
bulbs. Some known for each candle-power. These are as sometimes half-watt lamps, and are especially adapted for street and shop lighting. {Seep. 317.)
tively galvanic currents of comparalow voltage, Ohm discovered that in any circuit the resistance is inversely proportional to the strength of From this he deduced the law that bears the current.
"

Ohm's

Law.

For

his name

The strength of the current in amperes is equal to the electromotive force in volts divided by the resistance
:

"

C E

in ohms." This may be expressed by the formula, E C the strength of the current in amperes, ^, where
=

the electromotive force in volts, or EMF, and R the This law does not apply except in a resistance in ohms. duced modified form to currents of high voltage, such as are proby static machines, or currents of high frequency, in which the current practically passes only along the surface " *This is known as the skin effect." of the conductor. If the conductor is wound in a spiral,the self-inductionset
up in the neighbouring
turns

of wire acts

as

an

enormous

resistance. When dealing with of supply of the current,

an we

electric battery as the have to reckon in the

source
sum

of

or the internal resistthe resistances of the individual cells, ance of the battery, in addition to the sum of the total resistances in the external circuit. Thus the equation may

E
.
. .

be written C

"

f"~r

"

*"

indicating the total internal resistance

of the battery. Small Leclanche cells have a higher internal resistance than large ones, the resistance of
the latter being about 0*7 ohm

when

Batteries

and

accumulators.

in good working order. The arrangement

--

112

ELECTRICAL

TREATMENT

of the cells in a battery will vary according to the work If a high voltage is required, that it is required to perform. and no great amperage of current, as in the treatment of patients with the galvanic current, then a large number large more or of small cells must be used, instead of one ones. These small cellsmust be coupled up in series; that is to say, the zinc of one cellmust be joined a wire to the by carbon
number
one

pole of the next, and so on throughout the whole of cells employed, the unattached carbon pole at

end of the battery and the unattached zinc at the other being fixed to the wires, which are fastened to the treatment of coupling up the cells, electrodes. By this means

the total voltage of the battery is the sum of the voltages of the individual cells. Thus, a battery of forty cells will have an available voltage of 60 volts when the cells and
working parts are new and bright. This high voltage is necessary in medical treatment because of the high resistance in ohms offered by the skin, The resistance of the even when thoroughly moistened.

skin to the passage of the current from two ordinary pad electrodes may be taken, on the average, as This resistance R is very great in comabout 3,000 ohms. parison

moistened

with r, the sum of the internal resistances of the if we estimate the internal resistance of each cell even cells, E 60 high as 4 ohms. Thus, C as 60 3^000
=

=^

rT^

-fl

Now, 19 ma. 0*019 ampere, or 19 ma. is a fairly strong current for medical therapeutics, and will rarely be required, except in the treatment of sciatica. Hence, a battery of

forty cellswill be found amply

for all the purposes sufficient It will be noticed how of galvanic treatment. small a proportion the internal resistance of the battery bears to the external resistance namely, that of the patient's
"

skin and tissues ; and the internal resistance r of the battery may safely be neglected in working out the sum to find out either the milliamperage, the voltage, or the

GALVANIC

CUREENT
two

113

resistance of the circuit, when known. are

of the three factors

Far otherwise is it when a large amperage of current is required at a low voltage to heat a cautery, or to drive a To heat a cautery a high voltage is not necessary, motor. but a large volume of current is required often 20 amperes.
"

To

obtain such a current from a primary battery, large be used, and they must be coupled up in two cells must groups, the cells arranged in parallel. In each group all

the zincs
to make

are

t joinedogether, and

in effect one

also all the carbons, so as large cell of large surface. The total

but than that of one cell, voltage of each group is no more diminished, being the the internal resistance is much

resistance of one cell divided by the number of from a multiple-cell cells. To obtain the maximum effect be so arranged that the internal battery the cells must resistance r of the battery equals the resistance B of theaverage

haps external circuit. In cautery work R is very small, per0*06 ohm, and therefore if C is to be than not more large, it is of the utmost importance to keep r as small as
lators chromic acid cells or accumupossible. For this reason large Leclanche cells, whose should be used. If even

internalresistanceis 0*7 ohm,

with
a

were

used to heat
=

cautery E
*

resistance 0'06 ohm, using the equation C of

-p

in order to get 20 amperes of current we should require at least thirty-six cells,arranged in two groups of eighteen ticable each group arranged in parallel. This is an impraccells, for this purpose, and even to use this number fail to give such of Leclanche cells would soon number ing becomheavy on a current, account of the cells soon

therefore, unsuitable polarized. Leclanch'j cells are, for this class of work, requiring heavy currents ; and it convenient to use a small battery will be found far more
of accumulators, whose internal resistance is extremely low, and therefore eminently adapted for this kind of work,
I

114

ELECTRICAL Accumulators
can, moreover,

TREATMENT

give out a heavy current lators, at a steady rate for a comparatively long period. Accumufully charged, may be reckoned to supply when current at a pressure of 2 volts per cell,until about 75 per
cent, of their charge is exhausted.

A two-cell accumulator battery, coupled up in series, with a capacity of 45 ternal ampere-hours, will, owing to the almost negligible inresistance of the cells, be able to supply enough for the largest surgical cautery. Its weight will be about 24 lb. In medical and surgical practice, it will be found most convenient, therefore, to use a battery of
current

for cautery work, or to light incandescent with the cystoscope, the sigmoidoscope, for illuminating the interior of the mouth and throat, or other
accumulators lamps for use
In most districts it is comparatively purposes. easy to get these small accumulators recharged at a low cost pwing having made to the advent the small of the motor-car

accumulator for ignition purposes

comparatively A

familiar

object.
Secondary
or

batteries
one

or

accumulators."

which may source of electricitysuch as a battery of primary cells or They are usually built up of lead plates in dynamo. a
sets

storage cell is

be charged

ary secondfrom a

of three, each

secondary

cell having

one

positive

The positive plates are covered with a paste of peroxide of lead, and the negative plates with spongy lead. The plates dip into a dilute solution of sulphuric acid, 1 part of acid to 5 parts of water ; and the
and two
negative plates. receptacle to hold the plates may be of celluloid,ebonite, lead. Binding-screws, with wires, are attached to the or lead at the positive and negative plates. The spongy negative plate, and the lead peroxide at the positive in the acid electrolyte,form an electric cell in which the spongy lead is positive and the peroxide of lead negative. When by a wire through an the terminals of this cell are joined
external

circuit, then

current

passes from

the spongy

GALVANIC

CURRENT

115

lead through the liquid to the lead peroxide, and out through the positive binding screw attached to the peroxide plate.
2 volts. In this This cell has an EMF of a littleover process the spongy lead dissolves in the acid to form lead sulphate, which is deposited on the plate, the hydrogen

the oxygen of the peroxide on the other The acid is plate, on which lead sulphate is also formed. thus gradually used up, and its specificgravity falls, and
combining
with

time the voltage of the cell drops below 2 ; this occurs about three-quarters of the total electric when charge has been withdrawn, and the cell should then be recharged before being used again. If a dynamo or battery after
a

positive cellsis connected to this lead cell, to positive, and negative to negative, and if the EMF or battery is greater than that of or voltage of the dynamo

of large primary

the lead cell,a current will flow into the lead cell in the direction, and the effect of this is to reverse reverse the formed previous chemical process, so that lead peroxide is rethe positive plate, and spongy lead on the negative. This is what is meant by charging the cellor accumulator. There is no actual storage of electricity such, but as
on

the work chemical

a the charging electric current causes dissociation in the storage cell, so that the

done

by

chemical affinitiesf the spongy lead and peroxide of lead o dilute sulphuric acid are again available for comwith the bination, with the accompanying evolution of an electrical It will be noticed that the anode or positive plate, current.

and the kathode or negative plate, are so called because the binding-screws and wires attached to them in the external circuit are respectively positive and negative, though in the
cell itselfthe so-called negative plate,
or

spongy

lead, is

positive to the peroxide plate. A storage cell is, therefore, directly comparable to a Leclanche cell,in which the zinc in the cell is positive to

the carbon, though the binding-screw to the zinc terminal are negative,

and

wire attacheci

116

ELECTRICAL

TREATMENT
practically
a

Accumulators
resistance, and
cautery

have

negligible

internal

they

are

where a through a very low resistance in the external circuit. Their " being capacity is spoken of in terms of ampere-hours," the rate of discharge in amperes multiplied by the number
work, of hours it can

therefore excellently adapted for heavy current has to be driven

They
they must
or

must
not

be maintained. be kept vertical, or be

or jolted,

the acid will spill, and the plates are liable to break,

the peroxide of lead is liable to become detached from the be allowed to positive plate. Lastly, they should never

remain long in an undischarged state, as they then rapidly deteriorate. Their EMF and capacity improve after they
have

been charged and discharged several times, owing to the increased formation of spongy lead on the negative plates ; and they are kept in the best condition if they are
constant

in

as steady use, and are recharged as soon their voltage fallsbelow 1*8 volts per cell. For therapeutic use, the galvanic current will be best tention obtained from a battery of dry cells,which requires no aton the part of the user, and which will give a

fair current with moderate for about a year. daily use When exhausted, these cells will have to be replaced by new ones at a cost of 2s. 6d. each, unless their voltage can be described above, so that a battery of forty as renewed ifin fairlyconstant cellswill cost about "5 yearly to renew, The faradic battery, on use. the other hand, is much as the renewal of the two large cells required cheaper to run,
to drive the

twelve months, of it.

by

coil will cost only 8s. every six or of work demanded according to the amount

Tests for polarity." All galvanic batteries should be

the m.aker so as to indicate the sign of the is negathat is to say, which binding screw tive electrodes ; positive and which positive. Since the zinc is the electrodissolving in the solution, while element, thezinc marked

GALVANIC the current

CURRENT

117

flows in the cell from the zinc to the carbon, it is obvious that the current leaves the battery and enters the wires of the external circuitfrom the carbon or negative is therefore attached to the positive electrode the zinc, which is the positive element, is ; while attached to the negative electrode. The zinc terminal of element, which the battery will, therefore, be marked by a negative sign, while the carbon terminal will be marked by the positive
-,

sign, "+-. It is always

wise, however,
trust

to

test the 'battery

oneself,

entirely to the instrument maker, One way and to test the poles is quite a simple matter. is to connect two wires to the binding screws of the battery, cells,dip the two free and after turning on twenty or more ends of the wires into a tumbler of water, holding the

and

not

to

points about | inch apart. The point which bubbles most is the negative electrode, and is that attached to the zinc element of the battery. This bubbling is due to the evolu
to the decomposition tion of hydrogen, owing of the Unless platinum or gold electrodes are used, there water. at the positive electrode, will be no bubbling of oxygen

owing to the oxidation of the metallic points. Another way of testing the poles of the convenient battery is to use a piece of pink litmus paper. When the

litmus is moistened, if the two

are

attached to the battery are upon the wet litmus, after turning on a few cells the negative bright-blue mark on the pink a electrode will make litmus, owing to the production of alkali at the negative

free ends of the wires that placed about J inch apart

electrode. Similarly, acids are produced at the positive electrode, which turn blue litmus pink ; but the change in colour is not nearly so pronounced colorati as the blue disof the pink litmus by the negative electrode. A special pole-testing paper is made of white absorbent This substance paper impregnated with phenolphthalein. has the property of turning pink in the presence of a trace

118

ELECTRICAL

TREATMENT

consequently, if moistened, the negative pole produces a bright pink spot upon it. When once the battery has been tested and the poles are correctly marked, it is impossible for the polarity to become changed until the battery is taken to pieces and the of alkali, and
cells renewed. If, however,
the

electric-light main

is

used, reducing the voltage through a shunt resistance, then the polarity of the binding-screws for the attachment of the electrodes may easily become changed, owing
to

having been turned round, the wall-plug attachment unless it is of the old-fashioned concentric pattern. Effects of galvanism on the skin." The action of the two

ma.

ferent. difthe skin and tissues is somewhat poles on If the wires be attached to two equal-sized electrodes 1 inch diameter, and a current of 2 to 3 of about passed after applying the moistened electrodes to

the skin at a few inches apart from each other, it will be noticed that the negative electrode, or kathode, is much If the electrodes be left the more painful of the two.
closely applied to the skin, and a current passed continuously for half an hour
electrolysis of the skin or the electrode one found, This is
ulcers which
more

tude of that magnior more, on

ably probremoving

will take
more sore

place;

take
occur

liable to

places will be considerable time in heahng. if the surface of the electrode

mon presses unevenly on the skin, a result which is very comfrom bending of the electrode, or from a depression in the plate electrode occurring at the point of attachment of the binding- screw.

be allowed to touch the skin, have and all electrodes which metal surfaces should be covered with padded webbing, or chamois leather, or
metal

Bare

should

never

to the cover padded two purposes : first, by retaining moisture, electrode serves it makes good electricalcontact between the metal of the electrode and the skin ; and, secondly, it prevents burn*

other

absorbent

material.

This

EFFECTS

OF

GALVANISM

ON

SKIN

119

ing of the sldn to a great extent, the electrolyticaction taking place in the moisture of the pad instead. The webbing or chamois leather surface of the electrode should
be

made

quently. easily removable, and should be changed freOne great danger in using old, worn pad electrodes is that a corner of the metal disc or plate may come

with the skin, and if a continuous current of any strength is being employed, and the pad is not being for pracburn will quickly occur, moved about, a severe tically all the current passing through the. pad will then the exposed metallic contact with the skin, owing to the far smaller resistance at this spot. If the electrode be allowed to remain in contact with the skin for some rush through minutes, the skin will be found afterwards to be bright red from dilatation of the superficial vessels ; and if the current density be too great, then after some minutes small yellow blisterswill appear, which break down into ulcers and are The patient's somewhat painful and troublesome to heal. g sensations are not always sufficientuide to what is occurring,

in contact

and though he will probably feel considerable discomfort, he may not draw sufficient attention to what is happening passing a continuous current until it is too late. When
or more through padded electrodes for more of 3 ma. spect than five minutes, it should always be made a rule to inthe skin under the electrodes,especially the negative electrode, every few minutes, and if any suspicion of

ment the electrode must be moved or the treatstopped. To ensure safety, it is better always to use between the more, several thicknesses of lint, ten or even

blisteringis seen

wetted before being fastened in position, invariably dry more or less rapidly from the warmth of the skin, and therefore it
even

electrode and the skin. Padded electrodes,

though

thoroughly

will be necessary to wet the pads again every six or seven Chamois leather will be found to retain the minutes. dries, and, when moisture longer than flannel,which soon

120
new,

ELECO^HICAL

TREATMENT

any

flannel covering to plate electrodes will hardly retain sent moisture at all on account of the greasy dressing prein the material. This should be washed out with soap
a

and water.
rule, hot water the electrodes but in ;

is all that is necessary for wetting case the electromotive force of the battery should be scarcely sufficient, the resistance of the be further diminished, and the current correskin may spondingly xVs the pads with strong wetting solution of sodium bicarbonate. This is better than using salt solution. After a pad electrode has been in position for
some

increased, by

drying
amount

time, and the continuous current running, the by a fall in the of the pad will be accompanied of current passing, and yet at this time the patient

often complains of a burning sensation under the pad. This is due to commencing electrolysisof the skin, owing to the disappearance of the moisture from the pad ; the Although remedy will be to wet the pad again thoroughly. by thus diminishing the resistance more current is allowed
to pass, yet the process of

electrolysis is transferred from the surface of the skin to the interior of the pad, and the

burning sensation ceases. It is of some importance

to remember

of pain produced, or the danger of the passage of a continuous current, depends very largely upon the size of the electrodes which are in contact with the skin ; that is to say, upon the density current per

that the amount burning of the skin, by

of

not square inch of electrode. As a rough measurement, more than 1 to IJ ma. face of current per square inch of surif of either electrode should be used for treatment,

is allowed to run steadily without moving the flat electrodes, each if two electrodes. For example, 6 inches by 4 inches, are used in the treatment of a case of the current

sciatica,by application to the buttock and leg, then not more than 24 ma. much of current should be employed. On the upper extremity not more than half this amount

EFFECTS
should be exceeded.

OP

GALVANISM

ON

SKIN

121
area

WJien, however, there is a large

of skin contact, as in Apostoli's method of electrolysis of in is uterine fibroids, which a large wet clay electrode applied
to the front of the abdomen
as

150
.

ma.,

or

even

more,

for the positive pole, have been used.

as

much

an

Again, if the patient's body is immersed to the neck in larger currents be passed electric bath, much may

through the body

the skin, than by 4 inches.
can

without causing any be passed through an

an

pain

or

to injury

electrode 6 inches

of the electric bath the whole area skin in contact with the water acts as an electrode ; and though the parts nearest the met-allicelectrode which conducts

In

the electricity from the battery to the water will receive a greater density of current in proportion than the distant, yet a large quantity of current parts of skin more
be passed through the body without the density of that current per square inch of skin surface approaching On the other hand, when the electrode surface in of 1 ma.
may
contact

with

the skin is made

as

very
on

small, then

small

strength of current,
cause severe

shown

pain. In an extreme if electrode for electrolysis, the negative electrode is attached to the needle, and the point applied to the skin, the
passage of
even

the galvanometer, may case, as in using a needle

ma.

of current

causes

sharp pain, like

the sting of a wasp. It must be remembered that the negative electrode, or kathode, is the more painful of the two, and its action is more stimulating than the positive electrode, or anode, which has
certain

sedative

properties.

The

electrode is the stimulating electrode, and causes The negative muscular contractions than the anode.

negative brisker is

also the active electrode which is used in the electrolysis of In electroplating it is the negative electrode naevi, etc.
to which
are

attached the metallic

that objects
a

have

to

receive the coating are the not pages

silver, gold, or place to enter into

with

nickel. These physiological

122

ELECTRICAL
of

TREATMENT
the
we

discussion
nerve

the action of

constant

current

on

with

and muscle tissue, and describing its effects

on

as

shall content ourselves illustrated in medical

treatment.

EflFectsof galvanism
current

muscle,"

If the continuous of moistened

be applied to the skin by means electrodes, and a current of about 4 or 5 ma. the moment

turned

on,

at

of application of the current, and for as long as it passes, will be felt a sharp, stinging sensation or gentle pricking, according to the density of the current per square inch of electrode contact with the skin. If one of the

electrodes is a small disc of about 1 inch in diameter, and if it be applied to the skin over the motor point of a muscle
the point where the nerve supplying a muscle enters it- at the moment of of contact the electrode with the skin the muscle will contract with
"that
over
"

is to say,

sharp twitch, and then will remain quiescent. Although the muscle twitches at the moment of application its motor point, yet it is not of the wet electrode over thrown into a seriesof contractions, or tetanus, as happens
a

when the interrupted or faradic current is used. When the electrode is removed, there is, as a rule, no visible contraction, because wdth a normal muscle there is no visible contraction produced at the break of the current, unless
too powerful to be borne. the current is very powerful The contraction produced at the moment of application " or at make," of the current is called the contraction KCC. That produced at the break of the current is
"

known

as

the

opening

contraction,

or

KOC

;
=

KCC

kathodal

closure

contraction,
=

contraction, closure contraction ; KOC anodal opening contraction. and AOC With normal muscle, the contraction produced by the
"

ACC while kathodal opening

anodal

closure of the current at the kathode, KCC, is decidedly stronger than that produced by the closure of the current
at the

anode, ACC.

This is usually written KCC

"

ACC.

EFFECTS
As has

OF
been

GALVANISM
said, KOC with

ON
normal AGO

MUSCLE
muscles
are

123

just

the
seen,

opening
except

contractions

and

not

Personally, I never use, with powerful currents. " " do I advise the use of, a special testing electrode nor interruptor on the handle. This interruptor is with an
very liable to fail in its insulation, so that the patient is likely to get a full shock of current at a moment when the operator thinks it is not possible ; and, again, with an

interruptor

the handle the operator himself is very liable over, to get a shock in his fingers when least expecting it. Morewhen testing electricalreactions with it, it is less
on

suitable than

muscular difficult distinguishbetween to

ordinary electrode, because with faint contractions in a degenerated muscle it is very

an

jar given

the muscle by the interruptor. It is electrode in the action of moving better in muscle testing to hold the electrode firmly much the on the point to be tested, and to interrupt or reverse
to current at the battery.

small contraction and the the slight movement of the

a

The interruptions of the galvanic current are best done by moving the firsthandle of the double collector on and knob which is unattached to a cell; this is off the dummy

If there is only a single collector usually the second knob. terrupt handle, with a combined battery the galvanism is best inby moving the De Watteville switch from G to F, and vice versa, or with the connection at one
a

ing plain galvanic battery by breakby moving of the binding -screws

the electrode wire. Although the weak currents of medical batteries do not produce tetanic contraction of normal muscles, but only a twitch on closure of the current, this
rule does not apply to powerful currents at higher voltages, as at 100 to 240 volts, such as are supplied by electriclighting companies, or the 300 to 550-volt currents supplied
to the trolley wire
or

railways.

If by
a

third rail of electric tramways tween accident a good contact is made beor

the skin and

wire carrying

one

of these heavy

cur-

124
rents,

ELECTRICAL

TREATMENT

then tetanus of the muscles is set up justas hy strong faradism or an alternating current ; and if the hand happened to grip the wire, the unfortunate person may be
unable to let go, and may Electrotonus. When
"

suffer severe
a

burns

or

death.

along

nerve,

galvanic the excitability of the

current
nerve

is passed at the points

where the current enters and leaves it is augmented at the This can be shown kathode and diminished at the anode. in an isolated muscle-nerve preparation of a frog's sciatic
nerve
across

and
two

gastrocnemius

muscle.

If the

nerve

be

laid

non-polarizable electrodes between which a weak it galvanic current is flo\7ing, will be found that stimulation by single faradic shocks or by other mechanical of the nerve,
means

of constant

contractions when kathode, and weaker

strength, will produce stronger muscular of the applied in the neighbourhood

contractions

applied nearer to the anode, than when no galvanic current is passing. Thus, the passage of a steady galvanic current through a nerve along its length raises the excitability of the in the neighbourhood nerve of the kathode, and depresses
when

The heightened exit in the proximity of the anode. citabili kathode is spoken in the neighbourhood of the of as katelectrotonus, and the lowered excitability near the anode as anelectro tonus. The conditions of an isolated muscle-nerve

preparation, in medical applicabe exactly imitated however, cannot tions, lies deeply imbedded, surrounded because the nerve

by muscles and other conducting tissues, and the reactions to the different. Owing on are this account somewhat be applied directly to the fact that the electrode cannot
nerve,

little distance from it, but only to the skin at some by the lines of force from the electrode pass into the nerve diffusion of current both in an upward and in a downward

direction, so
the
nerve

that there

are

two

virtual poles produced

"

in
a

the action of each electrode a polar and peripolar of opposite sign. That is t'o say, in the nerve

by

I
I

ELECTROTONUS
zone,

125

and a peripolar anodal zone, and similarlyan anodal polar and a kathodal peripolar zone will be developed in the neighbourhood the anode. Owing to this presence of four of
that is being tested,instead of the two poles in the nerve poles in the case of the isolatedmuscle -nerve preparation frog,we shallget four different to the poles of the reactions

under the kathode there is a polar kathodal

instead of only two, as in the frog'snerve. In this latter case, PflUger long ago showed that contractionsonly occurred owing to the sudden appearance of a positivestate of electrotonus. Now this positive electrotonus is set up
at the kathode at the make

of the current, producing katWhen electrotonus, and thereforethe contraction KCC. the current is made at the anode, there is a lowering of
electrotonus

tion, stimulaACC, at the anode at make of the current. When the current is broken, the positive electrotonus at the kathode instantaneously falls to a negative state, and therefore there is no contraction,KOC, from the break of the current at the kathode. At the anode, however, at break of the current there is an immediate rise of electrotonus from the negative state of anelectrotonus to the h reversed or positivecondition, which, as Pfliiger as taught to produce a contraction, AOC. us, stimulates the nerve
Thus, in the isolated muscle-nerve preparation there are only two contractions,the KCC produced by the stimulation
at the kathode at the make of the current of the nerve and the AOC or anodal opening contraction produced at the anode at the break of the current. If,instead of merely slowly making and breaking the
current sent through the
we so nerve

(anelectrotonus), therefore no and

suddenly

reverse

paratio of the muscle-nerve prethe directionof the current,

that the point which was previously anode is now made kathode, we shall find that we obtain distinctlystronger contractions than by simply making and breaking the
cufrent slowlv.

This is due to the fact that

on

reversing

126

ELECTRICAL

TREATMENT

the direction of the current, the kathodal closure positive stimulation is superadded to the anodal opening positive rise of electrotonus at the same namely, point of the nerve at the point which was just previously anode and has now
"

Another way kathode. suddenly been made of putting Now, we it is to say that KCC is superadded to AOC. have seen that in the human trode conditions, owing to the elecfrom the being necessarily placed at some distance
nerve,

and

the
we

nerve,

the current in its passage not being limited to but being diffused into the surrounding tissues, four
"

have

ACC, KOC,

KCC, contractions namely, possible ACC AOC, KOC, new ones, the two and and having been seen in the muscle-nerve preparanot tion.
The KCC is always the strongest, the normally next, followed closely by the AOC, and the KOC, indeed, is very difficult to obtain,

ACC
KOC

coming last.

and only with very strong currents, too painful to be borne. As previously mentioned, sudden reversal of the direction of the current produces stronger contractions than simply making and breaking the current.
It is in order to avoid h*,ving four poles on the nerve that is being tested that in muscle testing it is necessary to have one electrode, the so-called indifferent electrode, placed at a distance, as thus obtained are more
on

the back

or

constant

and

chest. The results less liable to error

than if the two

limb, electrodes be placed upon the same each other. It will be noticed, especially if at all near that stronger contractions are moreover, obtained after

letting the current run for a few seconds, and then quickly one made reversing, than if the reversals are after the This stronger contraction is due to other without pause. the condition of katelectrotonus, and therefore increased by the passage of the constant excitability,set up in the nerve be wanting if the reversals current, which effect will

be made

in each direction too frequently.

This katelectrotonic effectupon the nerves

by produce(i

KATELECTROTONUS

127

the passage

of
the

constant

current

is well
are

seen

when

combined

faradism
muscles
at
same

and

galvanism
This
"

time.

can

applied to the be done when two

for galvanism and one one separate batteries are used for faradism by joining the negative pole of the galvanic battery to the positive of the secondary coil, and then attaching
"

the electrodes and theirwires to the negative pole of the By this coil and the positive pole of the galvanic battery. the faradic current has to pass through all the arrangement ing cellsof the galvanic battery that are being used, before reachthe patient, and the galvanic current has to pass through These arrangements the coil of the faradic apparatus.
rent, resistance to the passage of each curand therefore the strength of the galvanic or faradic be slightly weaker than if they current will, in each case,
an

interpose

extra

applied directly from the battery in the ordinary way, of cells for galvanism, and the using the same number same position of the coil on the scale for the faradism. The effect, however, after turning on a few cells of the
were

galvanic battery, will be shown by increased strength of the muscular contractions obtained by a given strength of faradic current, increased roughly in proportion to the This strength of the galvanic current thus turned on.
effect be easily demonstrated by using single faradic shocks, moving the interruptor slowly by hand, and noting the point on the scale of the secondary coil where muscular
can

contractions firstbegin to appear. cells of the galvanic battery, when

now

Then

turn

on,

say, ten

will be
or

seen

anode the kathode.

resulting from the same to be considerably stronger, whether the kathode is applied to the muscle, though stronger with

the muscular contractions single faradic shocks

In the so-called combined batteries that are made, with both faradic apparatus and separate cells for faradism and galvanism, both currents are led to the same pair of binding screws, of a switch, known as and by means the De Watteville switch, either faradism oj:galvanism may

128

ELECTRICAL

TREATMENT switch
as

be used separately ; or, by turning the only, the combined current may be used

half-way

described, just

the galvanic cells and the faradic coil being thus coupled up in series.
The

instrument

makers

are

very

point that be coupled

the galvanic cells and up in series, and sometimes

liable to overlook the the faradic coil must they

are

justas

likely to couple them

and
when

up in parallel ; that is to say, negative pole of galvanism to negative pole of faradic battery, positive pole to positive pole. If this has been done,

using the combined current the faradic contractions instead of stronger as the galvanic will become weaker This faulty method of coupling up current is turned on. the faradism to the galvanism will not matter so long as

the two

used separately, but will only affect The easiest treatment. the results of combined current home way to test the battery for this point, after it has come
currents
are

from

the makers,
to
a

shocks

is to apply slowly interrupted faradic the point on muscle, noting the minimum

nrst scale at which slight but definite contractions are seen ; then, with the De Watteville switch placed half-way

between

F and G, turn on about ten cellsof the galvanism, and note if the muscular contractions resulting from the faradic shocks are made stronger or weaker. If they are made stronger after turning on the galvanic current, then
the apparatus has been coupled up in the right way ; but if the contractions are weaker instead of stronger, then the faradic coil and the galvanic cells have been coupled

instead of in series,and this has to be altered. up in parallel, The easiest way to alter it is to undo the wire connections of the special cellswhich drive the faradic coil, and
then

that the wire which was previously attached to the zinc of the battery should then be fixed to the carbon, or copper, according to the make of battery that
reverse, so

is being used. By doing this, the direction of the battery current in the primary coil is reversed from what it was

REACTION

OF

DEGENERATION

129

before, and consequently the extra induced primary current, and the induced currents in the secondary coil, will be also reversed in direction. Now, it is only the induced
current at break
so

apparatus,

which is of any that the current

practical use in a faradic of a faradic battery is

interrupted ; practically unidirectional, though of course and, therefore, one may speak of a positive and a negative pole for the faradic current, as we do for the current from
a

battery of galvanic cells.

REACTION
OF

DEGENERATION

The continuous current, when applied to normal muscle, stimulates the nerve-endings in the muscle, so that the resulting contractions are quick twitches, similar to those

produced
nerve

single faradic shocks. supplying the muscle has been

by

When,

however,

the
nerve

then injured,

the

degenerates and the muscle substance also becomes altered this is the case, the application and degenerates also. When the muscle or motor point of the faradic current over
longer produces any contraction, even with as strong a be borne. Application of the continuous can as current longer produces the quick twitch as in the no current now
no

of contraction is seen : a slow to sluggish contraction, slowly developed and relax, though often a larger contraction than the same
normal

muscle ; but

new

type

strength of current would produce in the normal muscle. " is called the This phenomenon reaction of degeneration." This form of contraction is produced by the direct stimulation of the altered muscle substance by the continuous current, not by any stimulation of the nerve-endings in The excessive contraction of the degenerating the muscle. muscle to even weak galvanic currents of 1 or 2 ma. hyperexcitability to galvanism." In addition to these phenomena, there appears
"

is called

tion alterain the relative strength of the contractions at the kathode and the anode. Whereas in normal muscle the

an

130

ELECTRICAL

TREATMENT
t'
.

closure contraction is stronger than the anodal " ACC, KCC the nerve when closure contraction, or is degenerated as the result of an acute lesion there is a kathodal
change in the polar reactions, and very often it will be found that KCC ACC, or even that ACC " KCC.
-

Sometimes,

in the

more

acute

forms

of

nerve

injury,

as in crutch especially in lesions of the musculo-spiral nerve, or sleep palsy, besides the above described forms of change of reaction, it will be found that tetanic contractions in the

paralysed muscles, may at either the kathode

be set up by closure of the current

or

anode. These changes, known as the reaction of degeneration, do not occur the nerve and muscle both waste when

slowly, as in progressive muscular atrophy. The it is often spoken as reaction of degeneration, or RD, damage to the of, occurs only after sudden or acute very
nerve-cells in the anterior horn of the spinal cord, or fibres proceeding from these cells to supply to the nerve in the paraThus, RD the muscle. will be found lysed
muscles in cases of infantile paralysis, in which the anterior horn cellsin the spinal cord are acutely damaged ; in neuritis of the nerve tion trunks, as the result of inflamma-

in facial paralysis, crutch and sleep palsies, etc. ; or in acute inflammation of the peripheral as in multiple neuritis. endings of the motor nerves,
or

pressure,

as

seen

The

muscle or taken place to the nerve nerve-cell in the cord ; and, therefore, it is clear that the electricalchange is not due impulses from merely to the cutting off of the nervous

alterations in electrical reactions of nerve are not found immediately after the damage

and has

above.

Four

to

changes become
changes
nerve

elapse before the electrical tural noticeable, and since about this time strucseven

days

can

be demonstrated tissue, the

and

muscle

microscopically in the be due to changes must

chemical alterations in those structures. In some loss cases injury, of faradic excitability of nerve

REACTION
may

OF

DEGENERATION

131

not be fully marked

for quite three weeks, fair contractions long as a fortnight or more being obtainable as
nerve

after the injury. Reaction of degeneration in the

is shown

by the

loss of power of conduction either of faradic or galvanic impulses along it ; normally, stimulation with either nerve a motor current over produces brisk contra'ction of the muscle supplied by it, tetanic contraction in the case of the interrupted current, and a single twitch in the case of the galvanic. Reaction of degeneration in f there the nerve differs rom RD in muscle, for in the nerve
are no one

polar changes and

current

no

to

and not to the other.

preservation of contraction All that happens is

to the rapid disappearance of conductivity of the nerve be either current. Before this takes place, there may a noticeablefor a day or two, soon after the injury,slight

in to either current, degree of hyperexcitability the nerve on the damaged sideelicits so that stimulation of the nerve stronger muscular contractions than on the sound side. from This wave passes down the nerve of hyperexcitability

the siteof the

is succeeded by diminished excitabil by complete lossof power of conducand finally tion Although there may be this s of the electricaltimuli. and in complete condition of RD, as described,in nerve

injury, and

muscle, yet this does not imply that it is impossible for voluntary stimuli to pass along the nerve cular and eUcit muscontraction, a condition which may not uncommonly be seen in the recovering stage of nerve injuries in lead and

in the muscles neuritis, forearm.

RD is never
met

on

the extensor

aspect of the

with in the slow muscular atrophy of the myopathies, or in the atrophy of muscle following myositis, unless the nerve elements have been damaged
also.
In the condition known ischsemic myositis as there is no reaction of degeneration found^ {see 199), p. time the nerves unless at the same supplying the muscle

132

ELECTRICAL
also been

TREATMENT myositis is a condition due to interference with

or

have

Ischsemic injured.

of primary contracture its blood supply from

of muscle tight bandaging,

the too

tight

develops at once, application of splints. The contracture and is thus easily to be distinguished from a paralytic The muscle takes time to appear. contracture, which but the reactions to faradism somewhat, and to galvanism will be brisk and of normal character, though probably not so powerful as in the corresponding muscle upon the sound side. In certain cases of ischsemic
usually wastes myositis, as of the flexors in the forearm resulting from in tight bandaging or splinting in cases of injury the neighbourhood the ulnar nerve of the wrist, the median, or even by the pressure at the same time as the may be damaged

anaesthesia, wasting of the skin and nails, and reaction of degeneration in the hand muscles will appear at the end of the first week. The essentialfeature of the reaction of degeneration consists in the loss of the faradic excitability of the muscle, When while it stillretains its contractility to galvanism. is not of the contraction to galvanism this is the case, in normal the brisk, twitching character seen muscle, is produced by the stimulation of the motor nervethe endings in the muscle by the galvanic current when circuit is closed. Instead, a slow, sluggish contraction is which be of greater volume than the twitch of the same muscle to the same strength of current in health, but slowly. slowly developed and relaxes more which is more Thus loss to faradism, and preservation of contraction to
seen,

muscles

suffer.

In

this

case

there

will be

which may

galvanism, with sluggish contraction, is the essential point of the reaction of degeneration. The polar change, is not, by any means, " KCC ACC always present, and hvperexcitability to also usually galvanism This change, described
a

disappears
as

weeks. after some of degeneration, is indicative of

reaction lesion of the lower

REACTION
neurone
"

OF

DEGENERATION
"

133

damaging the either sudden, acute, or subacute the nerve anterior horn cell in the spinal cord, or its axon fibre proceeding from the spinal cell to its motor nerve"

to be associated The change seems ending in the muscle. with the loss of the fibrillationof the muscle, the sluggish to galvanism recalling that contraction which remains

in sarcoplasm, or undifferentiated protoplasm, stimulated by the galvanic current.

seen

when

previously said, hyperexcitability to the galvanic is not always present in cases or injury current of nerve If the nerve damage to the nerve cellsin the anterior horn. As is completely destroyed,
as

when

divided by

hyperexcitability to

seven or muscles time the excitability to galvanism eight days, and at the same will be found to be diminished, as compared with the normal, though the contractions, when evoked, are

does not galvanism lose their irritabilityto faradism after

stab wound, The appear.

sluggish, and the polar change will be present, giving ACC " KCC. This same condition of complete reaction of degeneration will be seen in the worst cases of infantile

paralysis, when the nerve -cells are completely destroyed ; and this absence of hyperexcitability to galvanism, with be taken KCC, ACC " may sluggish contraction and destruction of the complete When the injury nerve-cells, or severance of the nerve. is only partial, hyperexcitability to galvanism is usually found, and this sign is thus one of the points of partial
as

evidence

pointing

to

This does correspondingly better prognosis. to apply, however, to facial paralysis, in which, not seem even severe with the most paralysis, with no permanent with
attempt at recovery is hyperexcitability
or

RD,

appearance

of contracture,

there

months.

present, usually for galvanism ferentia It is possible that the facial muscles, being difthis difference in type of the platysma, owe
to

ment of their reaction of degeneration to the fact of their developbeing distinctive from that of the skeletal muscles.

134

ELECTRICAL To
sum

TREATMENT

up

Reaction

of degeneration consists of

"

of contraction to faradism. 2. Preservation of contraction to galvanism, {a)Sluggish contraction.

1. Loss

with

(6)Hyperexcitability. " KCC. or (c)ACC (d)Kathodal or anodal

=

closure tetanus.
"

Reaction

of neuritis or of damage to the anterior horn cells. There are various degrees of partial RD, with corresponding differences in the prognosis as to the severity and duration of the paralysis.
"

RD,

as

of degeneration may it is called in less severe

be incomplete
cases

partial

Thus, the reaction to faradism may be only diminished, and not lost entirely, with a sluggish reaction as compared with the sound side. In the slighter cases the reactions to
also be reduced, with slight sluggishness of In others, a littlemore contraction and no polar change. severe, with the reduction to faradism the galvanic reactions be about normal in strength, or slightly excessive, may

galvanism may

with sluggishness of contraction especially marked to the anode, while yet remaining brisk to the kathode, while " ACC. KCC Reaction of degeneration is more easily demonstrated
in the facial muscles in cases of Bell's palsy, especially in the orbicularis oris, than in any other muscular Hyperexcitability to galvanism wasting. also persists longer in the facial muscles than in any other wasting, being often well marked the paralysis. twelve months after the onset of

The presence
always

of hyperexcitability to galvanism will be measured by comparing the strength of contraction in the corresponding muscle on the sound obtained

If the muscles side, using the same strength of current. both sides are affected,as in multiple neuritis, then the on question as to the existence of hyperexcitability must be

judgedfrom

experience of the usual strength of contrac-

PARTIAL

REACTION

OF

DEGENERATION

135

tion obtained from the particular muscle that is being tested with the strength in milliamperes, or, roughly, the number of cells that are being used. For example, in well-

marked

reaction of degeneration in the facialmuscles, contractions be obtained to the anode with only two may

or cells, a current of J ma., while normally six to eight cells will be required to obtain a contraction. In the thigh and back muscles, currents of 5 to 8 or 10 ma, are sometimes

needed to demonstrate the contraction of normal muscles. Sometimes a form of partial reaction of degeneration is met with, as in facial paralysis or lead neuritis, in which
is only slightly impaired and the the voluntary power faradic reactions of the nerve and of the muscles are but little diminished; while the galvanic reactions of the

muscles show

the signs of RD

above

described
"

especially

the sluggish contraction to the anode, which may also " KCC. Reaction of degeneration does not, give ACC loss of therefore, mean always that there is complete
in the stage thing is seen voluntary power ; for the same of recovery of the nerve, when voluntary power may return in the muscle before any faradic reactions can be obtained and while the galvanic reactions are stillsluggish, perhaps hyperexci table, and ACC either "KCC. or Tetany. This is a condition of muscular spasm affecting especially the distal muscles of the extremities hands in the so-called and feet. Slight instances of it are common
=
"

"

carpo-pedal contractions severe children. In more

in rickets in very young volve cases the muscular spasms inthe muscles of the face, back, and abdomen, causing
seen

rigidity of expression, slight opisthotonos, and contraction of the abdominal muscles ; so that at times there may be difficulty in separating the disease from tetanus. some
The
the

flexed condition of the forearms in the spasms, with interosseal position of the fingers (flexed the metaat but
with
-

carpo-phalangeal, together joints),

straight at the curious

the

inter-phalangeal
known
as

symptom

136

ELECTKICAL

TREATMENT
serve

Trousseau's sign, will always from the grave disease.

to distinguish the lesser

As has been said, tetany is common in rickety children, especially when there is much diarrhoea. It is seen in the

chronic diarrha3a of tuberculous peritonitis,dysentery, and ; after sprue ; in gastric dilatation ; in suckling women in the extirpation of the thyroid gland, and sometimes
of acute fevers, such as diphtheria. In the severe spasms the pain is intense, though these are not common. Trousseau's sign is the production of the spasm by firm for instance, to the limb gripping of the main artery or nerve
course
"

so as gripping the arm art"ry. This pressure probably

one

to

compress at the same

the brachial time

of the main nerve Chvosteh's sign is the excessive irritability the facial of nerve, so that a quick, light stroke across the skin in front of
or
more

compresses trunks to the limb.

the

ear

will produce

sudden

contraction

of the facial

muscles, especially of the orbicularispalpebrarum. The electricalreactions in tetany are remarkable

in that

the

are contractions with the galvanic current obtainable with far weaker currents than in normal muscle. With normal muscles the opening contractions that is,

opening

"

KOC
current

and

AOC

"

are

scarcely

required is almost too t being especially difficulto obtain. be the opening contractions may
than
the

obtainable, because the painful to be borne, KOC It is said that in tetany

more

closure contractions : AOC An anodal opening tetanus has also been described ; that breaking the current is to say, on the muscle has been thrown into tetanus at the anode. It is important
from
to distinguish the reaction of degeneration

easily obtainable KCC. " ACC or

that met

with in the chronic muscular

atrophies

progressive muscular atrophy or chronic anterior atrophy, and arthritic poliomyelitis, idiopathic muscular In progressive muscular atrophy, the wasting atrophy.

due

to

takes

place

very

slowly, and

therefore the

faradic

PARTIAL

REACTION

OF

DEGENERATION

137

reactions diminish gradually, pari passu with the galvanic reactions, so that both ultimately disappear when the muscle has completely atrophied. Occasionally,however,
parts of muscles, waste more rapidly than others,and then RD, or a partial type In such a case of reaction of degeneration, may be seen. in this disease,certain muscles,
or

lose itsreaction to faradism and. give " KCC, a slow, sluggishreaction to galvanism, with AGO while the rest of the muscle may give a fairlybrisk twitch part of
a

muscle may

both to the faradic and galvanic currents. In such a case it is possibleto observe a double contraction on stimulation : first, brisk twitch a of the muscle with galvanism of the undegenerated part, followed immediately by a
sluggish contraction of the part that is degenerating. In the myopathies, or idiopathic muscular atrophy, RD is
never seen

certain degree of sluggishness of contraction vanism, will be observed both to faradism and to galin arthritic atrophy [see a condition also seen
; but
a

p.

148).

In spastic paralysis, as in spastic paraplegia due to or old myelitis,or lateralsclerosis, in the rigidityof old

hemiplegia, the reactionsto faradism and to galvanism will be similarly altered,slightlymore to difficult obtain, and
sluggish. The same in the muscular reactions change is seen when a limb is blue and cold; either from exposure to disorder,as syringocold, or in conditions of vaso-motor myelia,
more

disease and neuritis, Raynaud's In this condition, which I term

neuroses. other trophothe cyanotic

reaction, the sluggishness of contraction to

faradism

and to galvanism will pass off at once, and the normal brisk twitch to either current will reappear after a few minutes' soaking of the part in hot water.

Myasthenic

reaction." This is

curious form

of

reaction usually met with in cases of myasthenia gravis, in which the affected muscles gradually or rapidly lose

138

ELECTRICAL

TREATMENT

their excitability to faradism whilst being stimulated ; that is to say, their faradic excitability rapidly becomes The disease affects adults mostly between exhausted.
20
not

and

30,

and

its

cause

and
a

pathology

are

as

yet

progressive asthenia, and be rapidly many muscles of the limbs, face, and trunk can voluntary exhausted by repeated contractions, whether

understood.

There

is

or

due

to

developed

faradic stimuli. the muscle, which

soon a a

the reaction is well responds briskly at first to

When

faradic shocks,
of
a

weakens,

minute
even

to

minute

contract

to

state, if the muscle

strong has been

until in from three-quarters longer and a half it will no faradic current. Even in this

exhausted

to faradism

only,

it will stillcontract fairly well to voluntary stimuli ; and if these be repeated quickly for a similar interval, it becomes paralysed for the time being to voluntary stimuli
to
as

well

as

to

faradism.
though the

It
no

well to the galvanic current,

got voluntary

still react be response can

or

will

efforts of

patient

to

faradic

stimuli. The rapid exhaustion of the muscle to faradism is the " " myasthenic reaction essential point of the which Jolly described in 1895. It has to be distinguished from the
reaction of degeneration, which it resembles in the point that the muscle will stillrespond to galvanism after it has lost all its faradic excitability. The essential point to be recognized is the disappearance of the faradic reactions

under
to
occur

observation, and
after only a into the sent

been

this may occasionally be observed very few single faradic shocks have muscle ; if these initial responses

of the muscle to the faradic current are overlooked, the error of diagnosis of reaction of degeneration will probably The exhaustion of the muscle to faradism and be made.
to voluntary

after a time, if the muscle is effort recovers leftto itself, until it is similarly again exhausted by renewed

stimulation.

MYASTHENIC
There is little or

ELECTRICAL
no

REACTION

139

muscular wasting in this extraordinary disease,the symptoms consisting of a variable the whole progressive, affecting muscular weakness, on the face, limbs, trunk, and bulbar muscles. There is

very frequently bilateral ptosis,with a smooth forehead, the usual compensatory wrinkling of the frontalisbeing absent owing to the weakness of this muscle. The other facialmuscles usually involved are the sphincters of the
'

eyes and mouth, the orbicularis alpebrarum and orbicularis p Weakness of the lower jaw in chewing, and varying oris.

degrees of ophthalmoplegia are also extremely common. Nasal voice,owing to weakness of the soft palate,especially towards evening or after much talking; nasal regurgita
choking attacks, with paroxysmal attacks of dyspnoea and cyanosis, in one of which the patient may die suddenly, are the usual symptoms, in addition to the limb and trunk weakness. The myasthenic electricaleaction,although extremely r characteristic the disease,is not absolutely pathognoof monic, it has been described as occurring in many and forma of nervous disease,such as hemiplegia, cereother bellar neurasthenia,and the muscular dystrophies. It was, indeed, first described by Benedikt in 1868 as the Reaction der Erschopfbarkeit, ten years before the first
tumour,

of myasthenia gravis was published. On the other hand, the myasthenic reactionhas been found to be absent in undoubted cases of myastheniri gravis.
case

the nerve-cellsand fibres appearing perfectly normal under the closest scrutiny. The only findings of importance have been, in a number of cases, an enlargement or lympho -sarcoma of the thymus, and an infiltration the affected muscles with lymphoid of cells.

lesion of the nervous for the symptoms, account

No

s}4temhas

been found to

CHAPTER
GALVANISM

{continued)
occur

Muscular
damage

wasting
nerve

may

locally from

disease

or

Lesions of the of the muscle. lower motor neurone will be followed by atrophy of the in proportion to the muscle fibre supplied by the neurone, to the latter. The lower motor degree of damage neurone
to the

supply

comprises
axon

the anterior horn

prolongation, the motor as in the

or

cell in the spinal cord and its or anterior root fibre, which is continued to the muscle, ending within the nerve
Lesions

muscle
centre,

end-plate.

of the

be acute, poliomyelitis, may forms of lead palsy ; or paralysis ; or subacute, as in some be chronic, as in progressive muscular they may atrophy. be acute, subacute, or too, may Diseases of the nerves, chronic.
or

spinal trophic in infantile as

Lesions of the upper

motor
cause

neurone

in the brain

pyramidal tracts sometimes hemiplegia or in total transverse

wasting of the

muscles may of the myopathies, or it may result from a myositis due to inflammation tissue, or from an primary of the muscular from pressure on the ischsemic myositis such as may occur

muscular wasting, as in lesions of the cord. Primary in the various forms occur

or muscle from a tight bandage splint, squeezing out the blood from the muscle and setting up a condition resembling a primary rigor mortis in the living tissue. Arthritic

atrophy,

again, is reflex to disease of certain

amount

neighbouring

joint,

and

after prolonged enumerated, the muscular wasting limb or hmbs primarily concerned.
140

of muscular atrophy also follows disuse. In all these conditions, briefly is local, affecting the

MUSCULAR

WASTING
are

141

Certain
muscular

general

conditions

namely,
pyaemia,

wasting which may diabetes, cirrhosis of

also associated with less profound ; be more or the

liver, tuberculosis,

rickets, anaemia, starvation, sprue, and in neurasthenia tabes dorsalis, and Friedreich'sdisease. In these

diseases the muscular wasting is general, and is an expression dependent of defective nutrition and metabolism the particular disease with which it is associated. upon There are certain points of difference in the wasting of muscles, according as it is dependent upon disease of the or spinal anterior horn cells, is due to neuritis, hemiplegia, l or myopathy, jointesion, is consequent upon one of the conditions
causing general wasting, such as anaemia or starvation. The diagnosis must, therefore, be accurate, as the treatment

and prognosis will necessarily differin the various groups.

INFANTILE

PARALYSIS

Acute anterior poliomyelitis is an acute affection of the anterior horns of the spinal cord, produced by a toxaemia

due to

bosis of microbic invasion. Thromtakes place in small vessels in the anterior horns^ minute haemorrhages occur, and, as a result, the motor cells
one or more

forms

in the anterior horns are damaged and destroyed. The process is, therefore, a very acute one, and the motor nerves supplying the muscles rapidly degenerate, owing to the destruction of their trophic spinal centres. The muscular toms, paralysis is complete from the time of onset of the sympand the limb liesflaccidand the muscles rapidly lose
their tone, and
waste.

Within

very

few

days

those

muscles whose spinal centres are completely destroyed will lose their reaction to even strong faradic currents, and will show sluggish contraction to galvanism, and the polar
change

ACC

"

KCC.

Almost

apparent paralysis is much remains

as
a

invariably the degree of the greater at firstthan that which

permanent

of

case

is a

type result ; for example, a common child of 3 years who is attacked by an indefi;.

14^

ELECTRICAL

TREATIVIENT

i nite malaise and fftverishness,s kept in bed, and on the next day it is found that both lower extremities are completely of the lower extremities paralysed. Yet eventually one tially, only parmay regain full power, while the other recovers the anterior tibial muscles and the peronei atrophying more or less completely, and the flexors and calf muscles

Not uncommonly all the muscles wasting to a less extent. be completely destroyed, and in a below the knee may few cases (fortunately every muscle in both lower

rare)

extremities Acute

may

be

completely

and

permanently

paralysed.

in the poliomyelitis may, though rarely, occur I have met with occurred case adult, and the most severe in a policeman, aged 48, in whom there was complete
"

paralysis of all the muscles permanent of both and lower limbs, abdomen, trunk, thorax, and of all the arm muscles, with the exception of the right deltoid, spina ti

and biceps, and of the left flexors of the fingers. After the first ten days or fortnight from the onset of the disease the electricalreactions, taken under an anaesthetic
if the patient is
muscles
recover are

young child, will decide for us what permanently destroyed, and which are likely to
a

Those which and may be improved by treatment. preserve faradic reaction at the end of the first fortnight less completely, and their more or will eventually recover
recovery may

massage

and

be often considerably hastened by patient galvanism, applied daily if possible. A flat

electrode, G inches by 4 inches, well soaked in hot water, should be closely applied to the middle of the back and fastened in position by a bandage, while a moistened disc electrode, IJ inches in diameter, should be used for the by being rubbed systematically over treatment the muscles
The negative electrode, or kathode, requiring treatment. should be used for the treatment, while the anode is applied be lifted ofl to the spine. The treatment electrode must

the skin after each stroke, so

as

to break the cuxrent,

as

if

INFANTILE

PARALYSIS

143

this is not done the muscle will not contract and the full benefit will not be obtained. The strength of current employed should be, as a rule, about 6 ma. Another is to use very useful method of treatment reversals of the galvanic current, or voltaic alternatives,

Fig. 13.

"

Metronome

current

leverst

r.

as

limb demands sometimes called. If only one treatment, two flatelectrodes are moulded on and fastened ment, to it at the two extremities of the part requiring treatand the number of cells turned on to give a current they
are

of 6

ma.,

current

be

more

the current being then reversed by turning the This may reverser at intervals of about a second. of a mechanical conveniently done by means

144
reverser,

ELECTRICAL
such
as
a

TREATMENT

the spindle of which is prolonged Pohl's commutator to work a small (Fig. 13). The battery current is led on to the commutator, and the electrode to two binding screws connected to wires are fastened the two mercury cups on one side. The pendulum of the is set to beat at the rate of half-beatsin a metronome
metronome,

.two

up to continue working for about wound lower extremities require twenty minutes. If the two baths, the treatment, it is most convenient to have two foot-

second, and

water, with one electrodeconnected containing warm to each, one of the patient's feet being placed in each bath. This method is very efficacious, nd saves a a considerable being a necessity in hospital amount of manual labour,

of infantile paralysis which have been neglected will often improve under steady galvanism and massage, as the muscles which have been only partiallydamaged often require persistent stimulus before
cases

practice. It is remarkable how

they with

can

severe

be voluntarily used. I have seen a girl of 15 who for six months had been unpoliomyelitis, able
a

self, chair or to pick up anything by herimprove so much under this method of treatment, it twice a week, that she although she could only obtain became quite independent of other help. In bad cases the treatment should be persisted in for at least six months,
to get up out of

and the massage

or

may

be continued with benefit for a year

eighteen months.
SUBACUTE AND

CHRONIC

POLIOMYELITIS

Subacute

poliomyelitisis occasionallymet with affecting quent the muscles of the extremities. It is not very infrein cases and recurrent lead poisoning, in of severe

which the ordinary form of wrist-drop and, perhaps, deltoid from lead neuritis) prominent symptoms. are paralysis(also In these mixed cases of neuritisand poliomyelitisthere will be the usual paralysisand wasting of the extensors of the

SUBACUTE

POLIOMYELITIS

145

fingers and of the wrist, with escape of the extensor ossis tion, metacarpi pollicis and extensor primi internodii. In addiintrinsicmuscles in one or both hands, atrophy of the in the thenar eminence and two outer dorsal interossei,will indicate an additional poliomyelitis, which
niost marked

of the hands usually develops subacutely, the weakness to two and the wasting reaching its height in from one months, and then becoming stationary. Sometimes in lead poisoning the poliomyelitis may attack the forearm alone

distribution of the muscles affected may closely simulate the usual wrist- and finger-drop produced by neuritis. The weakness may then forearm ; and another point of be limited entirely to one
without

neuritis occurring, and

the

distinction from

neuritis will be that the muscles will be affected in groups according to their spinal segmental case the extensors of the fingers,the supply. Thus, in one
extensor

nodii, the extensor primi interossis metacarpi pollicis, paralysed together and the extensor carpi ulnaris,were
side, the weakness having

on

one

gradually developed during

two

permanent without any pain or In this case the involvement of other sensory symptoms. the ulnar extensor and escape of the radial extensor of the the chief clue to the diagnosis of poliomyelitis wrist were months

and remained

instead of neuritis, since the radial extensors are supplied by the fifth and sixth cervical segment, and the ulnar extensor, of the fingers and thumb, from with the extensors
the seventh cervical. It is of the utmost
of prognosis to make

importance
a

correct

the point of view diagnosis between polio-

from

aiyelitis and neuritis, because the former condition will be permanent, while the latter will almost certainly recover

under proper treatment. Another common mistake

is to diagnose

these

cases

of progressive muscular of subacute poliomyelitis as cases the atrophy, recognizing their spinal origin, but making mistake of considering them as chi-onic progressive anterior

146

ELECTRICAL

TREATMENT

poliomyelitis, and therefore of bad prognosis, instead of recognizing the subacute nature of the process, which reaches two, and then becomes arrested. its height in a month or
In lead poisoning this form of subacute poliomyelitis is not even uncommon, affect all four extremities ; and may

but true progressive muscular atrophy, causing death, is an extremely rare sequel of lead poisoning, though I have
In the subacute form of spinal paralysis just described the reaction of degeneration on electricaltesting
seen

it.

of will not be so well-marked as in cases the faradic and galvanic irritabilitywill diminish almost equally, although the galvanic irritability is always retained longer than the faradic, with sluggish reaction, but giving KCC " ACC.
of the muscles neuritis. Thus

Treatment

of the subacute

and

chronic

forms

of of poliomyelitis consists of injections strychnine hypoIf the muscles dermically, with massage and galvanism. give fair reactions to faradism, then combined faradism still

employed, or the method sinusoidal current may give good results. The same be pursued as described of applying the galvanism should of acute poliomyelitis. If combined under the treatment

and

galvanism

may

be advantageously

is decided on, the strength of the "faradism and galvanism galvanism must be less than when used alone, as the addition of the faradism would otherwise be painful. Reversals rupted of 3 to 5 ma. should be used, combined with slowly inter-

interruptor of the faradic battery terrupti than four inshould be so arranged as to give not more per second, and the strength of faradism used

faradism.

The

visible contractions of shoald be justsufficientto cause Then, the muscles before any galvanism is turned on.
after placing the switoh of the combined battery in position for the combined or current, after connecting the negative pole of the secondary faradic coil to the positive pole of the galvanic battery if two separate batteries are used, the electrode wires are connected to the two remain-

SUBACUTE
ing binding
screws

POLIOMYELITIS

147

of the two batteries,and the galvanism is slowly turned on. If the two batteries have been properly connected up, the addition of the galvanic current,
reversals, increases the strength of the muscular contractions which are being produced by the slowly interrupted faradism, so that the contractions due to the
even

without

faradism, which were crease inpreviously only just visible,now in strength in proportion to the amount of galvanism turned on in addition. This increased irritability of the
motor
nerves

is due From

to the electrotonic effect of the galvanic

current.

3 to 5

the direction of the current

should be sufficient, and ally should be reversed mechanicma.

a about once second. Tliis form of current is very convenient and useful to or leg baths, or with the give in arm electrodes strapped on to the limbs, and with a mechanical reverser, such as the

The patient may be leftwith perfect safety for treatment, the required time of i^ie without the slightest danger of electrolysis of the skin. If, however, the galvanic
metronome.

is not reversed frequently, there is considerable risk of burning the skin, and quite ugly sore places may be produced. The patient will complain of a feeling of.
current

sharp pain and burning, especially dry, and electrolysisthen commences

as

the pad begins to to take place at the

surface of the skin instead of in the moist substance of the Re-wetting the pad makes the contact with the skin pad. better, and therefore allows of more current passing, yet it stops the feeling of burning, and the danger of electrolysis of the skin is less. Whenever galvanism is being
continuously without reversals, at a strength of 3 ma. for five minutes or longer, great care should more, or be taken in the of adjustment the pad to the skin, to see its whole surface, and that the that it presses evenly over given

metal of the pad, or the wire leading to it, is not anywhere in contact with the skin. It is a good plan, too, to take ofE the pads for re -wetting half-way through the treatment.

148

ELECTRICAL

TREATMENT

On the whole, not much benefit is to be looked for from in subacute and chronic poliomyelitis, electricaltreatment whether the galvanic, faradic, or any other form of current
be employed. ability The condition, is,however, so serious a disto the patient that electrical treatment should in always be given a trial, addition to any other therapeutic measures that may be thought necessary, such as massage,
exercises, the administration of strychnine or other drugs. In subacute and even ently chronic muscular wasting apparof spinal origin, between the ages of 21 and 45, it is
a

good

rule in every

case

to consider the possibility of

Gummatous meningitis, or a gumma syphilis as a cause. damaging the spinal roots in the cer\dcal region, may cause

rapid muscular
perhaps symptoms

neuralgic pains, and wasting, with severe of the lower extremities and other weakness of a spastic paraplegia due to pressure on the The
more
a

spinal cord. region, but,

itselfas

process may affect the lumbar frequently, the syphilitic fests process manigummatous neuritis implicating the nerves
same

of the lumbar and sacral plexuses, causing pain in the lumbar be mistaken for lumbago, followed by region which may

wasting of the thigh or leg muscles, and variable degrees of in sufficientdoses in anaesthesia. Biniodide of mercury these cases will probably arrest the progress of the disease ;

and
to

in the progress

unless majority,
too

the process has been

allowed

eventually will recover Their recovery may be hastened by employing completely. galvanism and faradism, preferably in the form of the Syphilis,it is true, may rarely originate combined current.

far, the

muscles

subacute or chronic form no these unfortunate cases

administration of mercury will also be of no avail.

ARTHRITIC

of anterior poliomyelitis ; in improvement will follow the ment and iodide, and electricaltreat-

ATROPHY

Is

reflex muscular atrophy occurring in the muscles which

REFLEX
are

MUSCULAR
a
or joint

ATROPHY

149

capable of moving or injured has become

limb that has either been diseased. It is more especiallythe abductors of the joints which atrophy most, such as the deltoid in cases of lesion of the and the

shoulder-joint,

glutei for the

form of muscular wasting is very usually, but erroneously, ascribed to disuse of the too rapidly for this,and is often much limb ; but it occurs This hip-joint.
more

same

rington marked than disuse could possibly account for. Sherhas shown experimentally that divisionof the posterior at roots supplying the neighbourhood of a joint, the is time that the joint injured, prevent the onset will
occur
means

of arthritic atrophy of the muscles that would This posterior roots had been left

if the
that

uninjured.

atrophy is the result of a reflexprocess, whereby arthritic travel up afferentimpulses from the damaged limb or joint to the spinal cord by the posterior roots, and there, by
means

fluence to exert an inof collaterals the anterior-horn cells, upon the nutrition of these cellswhich leads to a certaindegree of wasting of the muscles supplied by them. If the posterior roots have been destroyed previously to lesion, the joint then these muscles will not waste, owing to the absence of the inhibitoryinfluence of the afferent impulses upon the trophic muscle centres in the anterior horns. Examples

of arthriticatrophy are the wasting of disease or injuries the glutei and thigh muscles in hip-joint wasting of the deltoid and spinati in of the knee-joint,

or joint, of the osteo-arthritis tubercle of the shoulderand forearm muscles in osteo-arthritis tubercle of the wrist. or The best treatment of arthritic muscular atrophy is

daily massage and faradism. The faradic current should be applied as a wave current, the electrodes being fixed

in position for the particular muscles to be treated, and wards then the secondary coilslowly pushed forwards and backover the primary, so as to produce alternate tetanization and relaxation of the muscles. The Bristow coil
may

be used with advantage in these

cases.

150

ELECTRICAL

TREATMENT

HEMIPLEGIA

When

of organic origin, hemiplegia is usually accompanied by a certain degree of muscular wasting of the limbs
some cases

on

the paralysed side. In

suggest some though the absence
as

the wasting

is

so

excessive

to

myelitis, additional neuritis or poliotion of any reaction of degenera-

The wasting is not due will exclude this complication. to simple inaction of the paralysed limbs, since an equal degree of immobility may be present in functional hemiplegia,
in which such wasting does not occur. The atrophy way dependent on the lesion of organic hemiplegia is in some
so upper neurone affecting the nutrition of the anterior horn cells in the spinal cord, which correspond to fibresof the pyramidal system above, that the the damaged muscles supplied by these trophic centres rapidly waste,

of the

the appearance electrical reactions will become

fari passu

with

of spastic rigidity. The

both faradism and galvanism twitch of healthy muscle, and

altered, sluggishness to replacing the normal quick

a

stronger current

will be

required to elicitthe contractions than on the sound side. RD, There is no however, which is only found in lesions of the lower neurone, either of the anterior horn cells or
That is to say, there of the nerves supplying the muscles. is no disappearance of the faradic reactions with preservation hyperexcitability of the contractions to galvanism, and

with polar change, ACC " KCC. A similar condition of muscular wasting of the lower to is seen in extremities from an injury the upper neurone
cases

to

of total transverse lesion of the spinal cord due either fracture, dislocation, or to myelitis. In these cases

rapid wasting of the muscles of the lower limbs ensues, with sphincter complete flaccid paraplegia, absent knee-jerks,
paralysis, total anaesthesia, and extensor plantar reflex. Extreme
occur,

perhaps

faint, sluggish

yet

no

RD

is

seen,

muscular wasting may the reactions both to faradism

HEMIPLEGIA

151

and to galvaniam being rapidly lost. This wasting used

to be ascribed to

descending myelitis involving the lumbosacral region of the cord ; this has been shown not to be
a

so,

the anterior horn cellsshowing absolutely no changes. Now, in hemiplegias it is not at allinfrequent for joint-

lesions to be developed, especially in the distal joints the of fingers ; though occasionally a large joint,uch as the s

extremely disorganized by Charcot's Joint-lesions, therefore, in hemiplegia will joint-disease. be an additional cause of the onset of muscular wasting.
shoulder, may become

Sometimes

the periarticular adhesions

in these

cases

cause

ment pain on movement such extreme of the limb that no treatby massage or electricityis feasible at first. Radiant

heat baths may then be of service, and, later,light massage. After this has been done for a week or two, electricaltreatment by combined faradism and galvanism, as already

described, may be advantageously added, and later still, late rigidity is becoming manifest, the sinusoidal when current will be of more service. A frequent question to
arise is whether
movement

of

the periarticular adhesions limiting the jointhall be broken down forcibly and the s
an

joint moved
case

ment anaesthetic. Although this treatmay undoubtedly be of the greatest service in the fixed by local injury disease, it is far less or of joints

under

successful in the case of joints whose fixity is the result of neuritis or of hemiplegia ; and, as a general rule, it will be far better to trust to long-continued massage and passive
movements,

down

the

exercises, than to break arthromotor adhesions forcibly. Usually, if this is done,

with

there is considerable swelling and local reaction, with intense for some littletime, tenderness, preventing all movement

and the adhesions very rapidly form before.

NEUKITIS

again

as

densely

as

This is
one

an

which

disease, but the term is extremely common has been very loosely used, especially by the

152

ELECTRICAL

TREATMENT

laity,for all sorts and conditions of muscular

weakness and wasting, paraesthesia, and even neurasthenia, that it will by be advisable, first,to indicate briefly what is meant neuritis. The
term
"

or signifies inflammation of a nerve nerves," and the process may be either acute, subacute, or inflammati time, the cause of the nerve chronic. At the same may be local, such as the pressure of a crutch or the exciting cause the musculo -spiral nerve, of the disease may be a toxin acting through the circulation

on

symmetrically on both sides of the body alike, such as alcoholic or diphtheritic neuritis. Common examples of local neuritis are facial palsy,
to brachial neuritis, and injuries the nerves of the sciatica, upper limb or brachial plexus, due to pressure, direct violence,

of local neuritis are those due to gout or rheumatism forms are tuberculous ; while rarer leprosy and ascending or migratory neuritis. Syphilis
etc.

Numerous

cases

is

not

nerves,

of local neuritis of the cranial due to their implication in a gummatous meningitis, and the lumbar or sacral plexus sometimes suffers
uncommon

cause

similarly.

Toxic, multiple,
produced

neuritis is commonly by long-continued overdoses of alcohol, lead, or

or

peripheral

arsenic ; by diabetes, diphtheria, or in the East is a well-known cause, of vitamines in the diet usually from

beri septicaemia. Beridue to a deficiency

the
use

of

an

unvaried

diet of polished rice, in which the subpericarpal layers of the rice grain containing the vitamines have been Both tubercle and rheumatism are removed. occasional
causes causes

of multiple neuritis, though act locally.

FACIAL PARALYSIS

more

commonly

these

Facial paralysis is most due to one commonly of two causes : (a)chill to the side of the face from exposure to draught, often during sleep ; this type is sometimes a

FACIAL

PARALYSIS

153

no or called rheumatic, thougli there is little evidence to show that rheumatism plays any part in its production. (6)Middle-ear disease. on come palsy due to chill may within a few minutes of the exposure to cold, or it may be noticed on or waking up in the morning especially after sleeping ing Probably the old superstition, that fallout in the open.

(a)Facial

asleep with the moonlight shining on the face produced drawing over of the face, is connected with the observed fact that exposure of the face when asleep at night is often followed by facialparalysis. The condition of the nerve has
been stated to be one of degenerative neuritis,most intense at the outer end of the Fallopian canal, and in the peripheral

fibres; not an interstitialneuritis, as might be expected. Facial paralysis due to chill is not very infrequently accompanied anaesthesia to light touches of the cheek and forehead, due to the synchronous involvement of the terminal
some

by

The muscular palsy exposed branches of the fifth nerve. is complete at first,in all except the slighter cases, and involves the upper and lower muscles equally, notably
the

frontalis and

the

the supranucleal* type hemiplegia.

orbicularis oris, which escape of facial paralysis met with

to the sound

in in

The face is thus drawn of the mouth

over

and the philtrum The forehead is smooth contraction of the sound muscles. on the paralysed side, and all the wrinkles are diminished in prominence. Tears overflow down the cheek on account

side, the angle being displaced by the tonic

of the paralysis of the orbicularis palpebrarum allowing the punctum of the lower hd to fall away from the globe ; while food collects in the cheek, and the cheek hangs a

little and flaps in talking, and the lips cannot grasp the cup in drinking, and saliva is apt to dribble out of that comer Owing to the paralysis of the stapedius of the mouth.
muscle, which is supplied from the seventh Loss be noticed as a symptom. cusis may
nerve, or

hypera-

diminution

154

ELECTRICAL

TREATMENT

the anterior two* present on of taste, too, is commonly volvemen thirds of the tongue on the affected side, owing to the inof the chorda tympani fibreswhich run with the
fibres of the facial in the Fallopian canal as far as the geniculate ganglion, whence they diverge into the pars intermedia Wrisbergi. This loss of taste is usually present
motor

in the so-called rheumatic due to involvement cases

facial palsy,

disease. In

of the nerve few instances, however,

well as in those from middle- ear of rheumatic facial

as

palsy, the taste fibres appear to escape entirely, perhaps being damaged owing to the facial nerve outside its exit from the stylo-mastoid foramen. A certain amount of

monly aching pain, usually referred behind the ear, is very compresent for a few days after the onset of rheumatic facial palsy, a symptom lead to a mistaken which may The diagnosis of middle-ear disease. amount of the facial deformity
is
no

criterion of the

severity

as much neuritis, for the face is often pulled over the slight cases which may be perfectly well in a month, as in those which take many before much ment improvemonths

of the at firstin

is noticeable. The electrical reactions will vary according to the In the slightest cases, severity of the damage to the nerve. such as those which occasionally develop within twenty-

four hours of an operation on the mastoid for middle- ear disease, the full reaction of degeneration is not met with. There will be no preUminary stage of hyperexcitability of the
nerve

the faradic reactions will never be entirely lost, only diminished actions while the galvanic rewill show only a trace of hyperexcitability, and the
"

to faradism, and

kathodal

be the stronger, closure reactions will always though they will be a littlemore sluggish and prolonged Sometimes than the normal. this sluggishness of closure to the anode than contraction will be more pronounced
to the kathode.
over

although voluntary power the facial muscles is completely lost at first,and the

In these

cases,

FACIAL

PARALYSIS
to

155

mouth

is

drawn

over

the

other

side, the

toni"

contraction of the paralysed muscles returns very quickl", so that even on the next day it may be noticed that there is less deformity, and in a few days scarcely any difference sides when the face is at rest, although the weakness will appear in acts such as showing By the end of a month there may be the teeth or smiling. difference detectable even no on movement.
may
seen

be

between

the two

chill,which make that a degenerative neuritis is present in all cases of facial paralysis such as has been described in a few of the fatal If such were it is inconceivable how so, perfect function could possibly take place in a month ; recovery of in is found while if the lesion is a perineuritis, as
cases.

ear

It is such disease or

cases

as

this, subsequent

to

either to middleit difficultto believe

disease, causing paralysis by pressure on the nerve fibres contained within the nerve sheath, it would be quite easy to understand how the absorption of the perineuritic
ear or

would set free the fibres from pressure, so that recovery of function might take place completely within a very few weeks. On the other hand, if the lesion were a degenerative neuritis,
nerve

interstitial inflammation

of the

sheath

months

would

could commence, in which five to of the regeneration of other motor nerves, six months may be taken as a fair average.

have to elapse before recovery of function by judging what we know from analogy

of facial paralysis require from three to six months for recovery, and in a large number of them motor recovery is not perfect, although the musclee

The

more

severe

cases

sufficienttonic contraction to bring the face perfectly straight again, and so hide all the deformity. has been comIn the most severe in which the nerve cases, pletely
may
recover

mastoid and no tonic operation, the deformity remains permanent, contraction of the muscles takes place. Such permanent and complete facial paralysis is fortunately not very
as

destroyed,

by

accidental division in

156

ELECTRICAL
;
even

TREATMENT
cases

common

in
nerve

severe

sufficientpower

of conduction

ance usually returns to allow of reappearof tonic contraction of the paralysed muscles, thus obliterating the pulling the face straight again, and
along the

deformity,
the
same

after time no

six

months

or

more,

although

at

voluntary

be regained. muscles may becomes this tonic contracture will be drawn

over

over power whatever In the more severe

the
cases

may of the mouth the naso -labial fold will be deeper, and the palpebral fissure be mispartially closed, so that the paralysed side may taken

overdone, and the face too much, so that at rest the angle be drawn over to the paralysed side,

for the sound side,and vice versa. It is often impossible to say in the early stages whether is one the case of complete and permanent paralysis, in fibres are entirely destroyed, or whether which the nerve

fair degree of recovery may take place. The firstsign of recovery will be the return of tonic contraction commencing is less drawn over, of the muscles, so that the mouth and
a

the

deformity

appears

less. This

tonic

contraction

reappears

over

before there is any return of voluntary power the muscles ; and, as I have said, in severe cases the

tonic contraction may though no voluntary

bring the face quite straight again, repower, or scarcely any, is ever gained.
cases,

after the lapse of a week to ten days, the fully tion-will degenera-developed type of reaction of be seen on electricaltesting of the muscles. That is to say, there will be no muscular contraction produced on stimulating the facial nerve, either at the stylo-mastoid foramen or in front of the ear, with either the faradic or the Faradism similarlywill provoke no congalvanic current. traction
severe

In the

the muscles ; while when applied directly over there will be hyperexcitability and sluggish contractions to galvanism, the muscles giving definite contractions with
a

current

of 1

ma.

or

less,with

the polar change

ACC

"

KCC.

FACIAL

PARALYSIS
no

167
an uncommon
complication

(b)Facial
may
occur

paralysis is by

means

middle-ear disease, and it of suppurative When in various ways. facial palsy occurs

of a chronic otitismedia, spontaneously during the course it is due to a spread of the inflammation to the sheath of the nerve, which has become exposed owing to the

advancing caries in the petrous portion of the temporal bone. during an exacerThis form of facial palsy always occurs bation the middle- ear suppuration, and it is always a of
very
severe

the

ear

recovery occurring. There is generally considerable pain in and behind at the time of its onset ; but this is due to the ear
as

form

of paralysis, littleor

no

disease, and not,

in the rheumatic form, to a synchronous fifth nerve neuritis of exposed portions of the and the

cervical plexus. A common cause

operation of facial paralysis is an for the chronic suppurative on the mastoid middlebe of the most disease ; and this form of palsy may ear be slight and transient. The most severe type, or it may
t type is due to actual injuryo complete and permanent or division of the nerve at the time of the operation ; and it will be recognized by marked twitching of the facial

muscles at the time of the injury,hich is immediately w followed by complete paralysis of that side of the face. There will be found, on testing,complete loss of taste on the anterior two-thirds of the tongue on that side. This is now a rare event in surgery, owing to the frequency with which ment the operation is practised, and the consequent improvein technique. A severe type of facial paralysis is also very liable to follow mastoid operations in which a heavy mallet is used. Although the nerve not be may
actually touched by the chisel,yet it may suffer from the haemorrhage into the shock of the blows, which causes

sheath

of the nerve the nerve.

in the Fallopian canal, thus

compressing

Perhaps the commonest

form of facialparalysis follow-

158

ELECTRICAL

TREATMENT

ing mastoid
or even a

hours some operations is that which ensues whole day, after the completion of the operation

or It is obvious that this cannot be due to any injury com occurring at the time of the operation pression of the nerve but it is apparently due to an inflammatory neuritis of the from the action of anti nerve sheath, possibly sometimes

septics used to syringe out the cavity, or sometimes, per haps, from slow oozing of blood into the Fallopian cana This form of paralysis is the least compressing the nerve.

and is sometimes quite transient, recovery following within two or three weeks, with little alteration of the reactions being noticed. Some cases, on the other electrical
severe,

hand, which develop several hours to more severe, are and take some

day after the operation, before the months

face is practically straight, and even then the recovery is more apparent, owing to, the tonic contracture, than a real
return

of voluntary power. Facial paralysis sometimes occurs as multiple neuritis,due either to diphtheria

an

event

in

or

to alcoholic

thus as a symptom when it occurs poisoning. Most commonly, in toxic neuritis, the paralysis is unilateral, though to the nerve may occur occasionally it is bilateral. Damage

from haemorrhage the brain,

or

in the Fallopian canal or at the base of be pressed on by tumours in the nerve may pontine, or even nerve may be sheath, or the nerve chronic meningitis, due to tubercle cerebellar the the
as or

the posterior fossa, such a tumour growing from a

implicated in
or

an

acute

or

by syphilis. It is occasionally pressed on blade of the forceps during delivery by instruments,

to

face thus appearing paralysed from birth. In these cases it is often the upper muscles only which suffer; namely, the frontalis,corrugator, and orbicularis palpebrarum.

Intracranial

lesions not

infrequently

cause

facial

be due to the involvement of the paralysis. This may in the inflammatory exudate of a meningitis, such nerve
as

tubercular

or

or syphilitic, posterior basic ;

or

it may

be

DOUBLE

FACIAL

PARALYSIS

159

due to pressure from a hasmorrhage from fractured base, or direct compression of a tumour in the posterior fossa, whether cerebellar, pontine, etc. Indirect pressure from
tumours

of the cerebral hemisphere, especially of the occipital lobe, occasionally damages the facial nerve.

There is also a form of symmetrical neuritis of the intracranial due to syphilis portions of the two facial nerves, in the secondary stage, that occasionally produces double facial paralysis. When it is nearly always this occurs

accompanied involvement

by double

nerve

deafness due to synchronous

nerves,

and

of the two auditory bilateral deafness. Double

causing absolute facial paralysis may

easily be overlooked, owing to the lack of any deformity of the face. It will be recognized by the absence of facial expression in speaking, the cheeks flapping slightly, and closing, the eyes instead rolling up so as to show the white sclerotics. Testing the facialmovements demonstrate the paralysis, total inability to will at once When this move any of the muscles being then apparent. the eyelids never

ness deafsyndrome of double facialparalysis and double nerve is met with, it is a sure evidence in almost every case a seen case Of cerebral of syphilis, though I have once tumour in the posterior fossa in which this combination of
present in addition to other cranial nerve facial paralysis without deafness also paralyses. Double occurs rarely in alcoholic neuritis, diphtheria, lead palsy,
symptoms
was

other forms of toxic polyneuritis. It is, of course, from bilateralmiddle-ear disease, possible that it may occur

and

though

I have

never

met

such

case.

Intracranial lesions

by loss of taste, are not accompanied of the facial nerve taste owing to the separation of the chorda tympani fibres from the facial nerve at the geniculate ganglion. The type of muscular paralysis will be of the infranuclear due to rheumatism or middleas type, just in those cases disease. ear

Nuclear

paralysis of the facial nerve

may

occur

from

160

ELECTRICAL

TREATMENT
acute
as

polioencephalitis inferior, an nature of the pons of the same

inflammatory

lesion

acute

infantile paralysis.

WTien it

paralysis of the whole of the face, upper as Haemorrhages or softening at the lower part of the pons, and tumours of this region, may both sides. one or also implicate the facial nucleus on
occurs,

it will cause well as lower.

Nuclear
nerve

palsy will be distinguished from a lesion of the plegia outside the pons by the probable presence of hemiand perhaps hemianaesthesia on the opposite side,
simultaneous
same

and
on

by

the

paralysis of the sixth side, causing paralysis of the

nerve

nucleus

movement conjugate

of both eyes to the same side. It has often been of the facial muscles, the frontalis and asserted that some have their nuclear origin from orbicularis palpebrarum,

the lower portion of the third nucleus, and facial nucleus, the fibres thence passing down longitudinal bundles to join the facial nerves

not

from

the

the posterior on their exit.

innerThe orbicularis oris was also similarly asserted to be vated not from the facial nucleus but from the region of More the hypoglossal nucleus. recent researches, and disproved especially experimental work, have, however,

these assertions.

Treatment
" "

of facial paralysis." The

common

type

of

facial palsy is best treated for the first rheumatic week by fomentations to the side of the face, and keeping indoors, with avoidance of all exposure of the face to cold
or

draught.

At

the

although

time, galvanism should be commenced, tion there is not any reaction of degenerasame

present yet. In addition to the fomentations, it is a The galvanism useful plan to blister the skin behind the ear. be applied by means two small electrodes, of should
one

held close underneath the ear, the other h inch wide and 2 inches long. This latter is the treatment electrode, and should be stroked
circular of

diameter l^-inches

over

the face,

down

the forehead, round the eye, and the cheek along the direction of the fibres of the
across

FACIAL

PARALYSIS:

TREATMENT

161

on that side zygoma tici, and then around the mouth The anode must be used for the treatment electrode, on account of the great sensitiveness of the skin of the face. The anode is less painful than the kathode, and the

can thus of current necessary for the treatment be better borne. From 3 to 5 ma. should be employed daily,for about fifteen ten nuAutes minutes, or, better still,

amount

risingin the morning, and again on going to bed at night. Care must be taken that there are no cuts or sore places on the skin to be treated,on account of the great pain the
on

surface ; and for produces when it touches a raw ment this reason it is advisable for a male patient that the treatshould be given before shaving rather than after.
current

The

most

sensitive place

upper eyeUd and above be usually borne from the anode fairlycomfortably. can The facial muscles, being really differentiated platysma react to slips,are very superficial, and for that reason
smaller currents

the skin of the face is the the eyebrow, but 4 to 5 ma.

on

than

are

necessary to stimulate the limb

ten days, when the reaction after the first of degeneration is well developed, the hyperexcitabilitj; of the paralysed muscles to galvanism is so great that they
cases,

muscles. In many

Another pecuwill react to as small a current as J ma. liarity of the facialmuscles is that they retain their hyperlonger than the limb excitability to galvanism much
hyperexcitability and polar change being more or often noticeable twelve months after the onset of the paralysis. The treatment by galvanism should be persisted in until
muscles,
some
.

the face has become off, in

case

straight again, when it should be left the tonic contracture that is then occurring

should become too marked and so draw the mouth over to the paralysed side. This excessive tonic contracture thus spoils the cosmetic effect which a moderate degree
of contracture
L

performs most

usefully. After the galvanism

162

ELECTRICAL
some

TREATMENT time previously, as have become contracture

soon

is stopped, and indeed for

any

as

ent apparsigns of commencing it is a useful plan for facial massage to be given daily after the application of the battery treatment. The

patient may being taught

the

very
to

along
over

two

zygomatici the frontalis. I usually tell the patients to do this day when they have a spare five or three times a

self, often do this efficientlyhimrub with the tips of the fingers the orbiculares and and around

minutes. Massage to the face"is indicated if there Facial spasm. becoming are signs of the contracture excessive, and if, in addition to the contracture, there is any clonic facial
"

spasm developed. This isa most distressingand troublesome symptom, and is met with only in those cases of severe facial paralysis in which the resultant contracture has excessive. Facial massage is the only treatment, treatment being contra as any form of electrical -indicated, it is liable to increase the spasm. Faradism is especially become

harmful

in this respect ; and, indeed, the faradic current be used at all for facial paralysis under any should never This form of facial spasm does not concircumstances. sist
of clonic convulsion of the whole side of the face, but rather of isolated twitchings and fibrillary contractions of various facial muscles. It is when the orbicularis palpebrarum
is thus affected that the symptom becomes particularly distressing to the patient. Stretching the nerve, or,

better, alcohol injection, been performed for its relief; has this has the temporary efiect of reproducing the facial

paralysis,but the spasms are liableto return unless ^which is not impossible ^the facial paralysis on this occasion This form of clonic facialspasm must remains permanent.
"

"

clonic fibrillary contractions which occasionally take place in the orbicularis palpebrarum " live blood," as it is called. of healthy persons This can often be arrested at once by gentle faradism to
the
"

be

distinguished from

FACIAL

PARALYSIS

163

Facial spasm due to irritation the muscle for five minutes. from the pressure of a cerebral or cerebellar of the nerve tumour, or a patch of softening in the neighbourhood of
the facial centre, might also be mistaken for the form the late subsequent to facial paralysis and accompanying contracture, unless the history of the case is carefully gone

into. Facial paralysis due to a supranuclear lesion involving the pyramidal fibres in the pons, crus, internal capsule, or the cortical centre for the face in the ascending frontal
convolution, must be distinguished from nuclear or inframent. nuclear lesions,and it does not require any electricaltreatIn the supranuclear type of palsy, the whole face is not equally paralysed, the muscles which are bilaterally associated escaping namely, the frontales, corrugators,
"

brarum. orbiculares oris, and, to a less degree, the orbiculares palpeThe weakness, too, is usually more evident on than on emotional movement voluntary movement of the face ; thus, showing the gums will bring out the weakness
more

case

emotional smile. Occasionally this sign is reversed, and when such is the ithas been said to indicate a lesionin the basal ganglia ; of
to
cases

than

an

but

A certain number this is not constant. complete facial paralysis, usually secondary disease, in which no recovery has taken ear
many months, have been treated by facial nerve being divided close to

of

middle-

place after nerve-grafting, the

angle of the jaw and the peripheral portion sutured into a slit made in the sheath of either the hypoglossal or the spinal A certain number accessory nerve. of partial recoveries

the

have

recorded, but (see pp. 216, 218).

been

others have

been

made

worse

SCIATICA

sciatic neuritis, is often most successfully Sciatica relieved by treatment with the constant current.

Sciatica, or

164
commences as

ELECTRICAL
a

TREATMENT

due often nerve, perineuritis f the sciatic o to a spread of inflammation to the nerve sheath from a lumbago, or rheumatic fibrositis. is a common It symptom in the gouty or rheumatic state, and it is not infrequently
from sitting a cold,wet seat. Influenza, on acquireddirectly typhoid, and sometimes other fevers may leave sciatica from a penetrating to as a sequel. Direct injury the nerve cause. wound is a lesscommon

from sciatic is Ttf be distinguished neuneuritis sciatic ralgia, which is a referredpain feltalong the course of the
s sciatic, ometimes for months after the true inflammatory or antecedent sciaticahas passed condition of the nerve This type of pain may persist in spiteof constant away. rest in bed formany weeks, and although there may be tender

there will spots on pressure along the course of the nerve, be no true pain produced by extension of the nerve in the act of flexingthe thigh with the knee straight. This form but itreacts very quickly n of sciaticeuralgiaisnot common,
to strong galvanism, and I have known

such a case which had lasted eightmonths afterenteric for fever, spite two in of in bed, improve at once with strong galvanism months' rest

d of the nerve, and after a fortnight'saily treatment the pain had entirelydisappeared. Tabetic pains in the thighs and legs may be mistaken for sciatica, though their sudden darting character and in both limbs should sufficeto distinguish symmetry
along the
course

Similarly, or chronic arthritisof the hip-joint, the pains of peripheral neuritis,may be mistaken for sciatica. Inflammatory growths or tumours in the pelvis involve the sacral plexus, and thus cause may pains but usually the extent of the anaes; resembling sciatica thesia and muscular wasting and weakness will distinguish or them from an ordinary sciatic neuritis. Tumours
them. pachymeningitis in the spinal canal may
also simulate

sciatica. The pain of sciatica very variable in its occurrence. is

I
Sometimes it is worst
it
comes
on

SCIATICA
on

165

exertion ; but,
or sitting,

worse

when

commonly, especiallywhen lying

more

in bed at night, often waking the patient up in the early hours of the morning. With some, even violent exertion no it may be severe. cause may pain, although at night

with the hip flexed and the knee pain at the back of the thigh and buttock, and the pain is often referredto the back of the knee, or the ankle. Tender spots may be found on direct in the middle of the buttock, or in pressure over the nerve Extension of the nerve kept straightwill cause the region of the posteriorsuperior iliac spine. Rarely will there be any anaesthesiaof the leg or muscular wasting, cases these additional signs of though in chronic severe neuritismay be present. In the early days of a sciatica

there may
may
course

be

become

increaseof the Achillesjerk, while laterit lost. The knee-jerk diminished, or even of
an

will not be affectedby sciatica.

disease, Hip-joint

of especiallythe chronic rheumatic arthritis old people, ; may cause pain simulating a sciatica and it is said that

the rheumatic inflammation may even spread from the to joint involve the nerve sheath. Undoubtedly it is not to fmd the two conditions sciatica uncommon of and chronic in the same patient. rheumatic arthritis co-existing

In the early stages of sciatica continued in bed is essential, by that means flamed as rest only can the inbe kept at rest. The patient should, morenerve over,
"

Treatment.

be encouraged to keep the limb as straightas possible in bed, as every time the thigh is flexed tension is put In order to keep the limb rigidlyat rest, upon the nerve. some recommend a Liston'slong side splint to be applied ; but thisis usually intolerable patients with sciatica, nd to a it is better avoided. However, patients with sciaticaalways find it extremely irksome to remain in. the same position for long, especiallyif,as sometimes happens, the bed a water sciaticahas been bilateral. For this reason,
willbe found exceedinglyusefulin the treatment

of sciatica,

166
as

ELECTRICAL

TREATMENT

it enables the patient to lie comparatively easily, and he will be lesslikely to be kept awake by pain. So long as there is any pain at night, and the patient is thus prevented from
sleeping,

suppository of half a grain in oil of *' lights theobromine should be applied the last thing before This method of administering morphia is preferable out."
a

morphia

sciatica,and there will be less risk of setting up the morphia habit in patients of unstable more will-power, as it will be much easy, if necessary, to
to hypodermic

in injection

disguise the fact that morphia is being used at all,to omit all mention of the word, and speak of theobromine positorie suponly. have for controlling the we effective means severity of the pain in sciatica, and for arresting the progress of the inflammation of the nerve sheath, is the application

The

most

It must, however, be carefully applied, and the battery must be in good condition and of ample strength. If the following directions are carefully carried out, early disappearance of the pain is to of galvanism
to the thigh and

leg.

applied while the patient liesin bed, and two flatplate electrodes of thin lead sheet, covered in front with flannel, with a mackintosh backing, must be used. One should be about 7 inches by 4
current

be looked for.

The

is to

be

inches,the other much larger,12 inches by 8 inches.They must be thoroughly wetted, and the smaller electrode, after being
wire, is to be placed along the middle of the buttock on the affected side, so that the patient may lie directly upon it. Beneath the electrode must be placed a

attached to

folded towel to prevent

the bed from

large electrode is to be folded across thigh, above the knee, and in order ip make it fitthe leg comfortably and keep in good electricalcontact, a piece of be cut tissue or thick layer of cotton wool must gamgee rather

being wetted. The the lower part of the

the electrode and thoroughly wetted and placed inside it next the skin, the electrode then being moulded around the gamgee tissue so as to fit as close as

larger than

SCIATICA possible. A

167

must mackintosh also be placed under the leg to prevent the bed being wetted. The wire attached to the electrode at the buttock is to be fixed to the anode bindingscrew of the battery ; while the leg
or

folded towel

electrode is to be attached to the kathode. The current be turned on slowly, cell by cell,until from 15 now must
is registered by the galvanometer, for which strength twelve to fourteen wet cellswill be required, or ten to twelve dry cells if they are new. This current is
to

20

ma.

be maintained for five minutes, and then gradually increased by turning on more cells until 25 to 30 ma. is registered; being maintained the current this at
to

level for another be given twice

should in severe a cases even or oftener if the pain recurs. When the electrodes have been properly coupled up to the battery, they need not be taken

fifteen minutes.

This treatment

day,

off, and
collector;
to

the
an

only switch to intelHgent nurse

to

be
can

moved
on

is the current easily be instructed

a

apply the electrodes and

turn

given

number

of cells, and off the current after a stated interval. After the first application, the morning and evening treatments should be lengthened to half an

then to

turn

hour.
electrode of 7 inches by 4 inches for the buttock, having a surface area of 28 inches, a current of 30 ma. will 1 ma. per square inch, which have a density of only just over Using
an

is well within the maidmum of IJ ma. per square inch that is safe for the skin for continuous application with ordinary causes a covered electrodes. Even a current of 30 ma.
as the strong stinging sensation which is about as much bear for the firstten minutes, but after that patient can

the sensation may the galvanometer

are new

and

less,although If the cells marks as strong a current. in good condition, it will be found that the

and usually does get much

current

increases after the shown by the galvanometer first two or three minutes, owing to the more thorough

168

ELECTRICAL

TREATMENT

ance wetting of the skin and consequent diminution of the resistally of the circuit. With thoroughly wetted pads, especiif some ance saline or soda is used for diminishing the resistthe pad, the patient's resistance can be brought as Usually, unless 750 ohms. low as 1,000 ohms, or even special care is taken to reduce the resistance of the skin, the
on

trodes ordinary covered elecpatient's resistance between two applied to the skin may be taken roughly as about 3,000 ohms.
as of sciaticag described above, I have said that the anode should be applied to the buttock. This is for the reason that the anode is somewhat the more

In the treatment

sedative of the two

less painful sensation electrodes,and causes It is not, however, of to the skin than the kathode. great importance whether the anode or kathode be applied for this appears to be as to the buttock, and the reason follows. With and leg as is not the
nerve,

the two

above
same
as

electrodes applied to the buttock described, the effect on the sciatic nerve lated if two electrodes were applied to an isoflow along the
our nerve

the current wbuld In from the anode to the kathode. is lying inside the limb at some nerve when

patient's case the littledistance from

the electrodes,and is surrounded by other tissues of equally that only a good conductivity ; thus it comes about itself, small fraction of the current passes along the nerve

the remainder passing down the limb through the muscles, blood, lymph, etc. In the neighbourhood of the two electrodes, the lines of force of the electric current radiate in
all directions into the limb ; thus from the buttock electrode some in of the lines of force strike the sciatic nerve
an

upward direction, and others strike it in a downward direction. Hence there will be a bipolar effect upon the sciatic nerve whether the electrode used at the buttock is
the anode or the kathode. {Seep. Of late years, in the treatment

124.)
sciatica,the
salicylate of

principle of cataphoresis

or

of acute ionization with

SCIATICA

169

The negative success. soda has been used with much tissue or with a electrode is well covered with gamgee dozen layers of lint and thoroughly wetted with a 2 per
cent,

solution of salicylate of soda, and position on the buttock in the usual way.

then

placed in
saUcylate

When

of soda is thus used for ionization,the active electrode must be the negative or kathode, since it is the ions of acid salicyl radicle of the salt that it is required to force into the tissues

It is to be remembered of the electriccurrent. that acids are attracted to the positive pole, and alkalis to the negative pole ; therefore, if salicylate of soda be
means

by

placed on the negative pole the acid salicyl ions will enter direction to the general flow of the the tissuesin the reverse
the positive electrode, while the Thus, alkaline soda ions will remain on the kathode pad. when cataphoresis with salicylate of soda is used in the
current
on

their way

to

of sciatica,the negative electrode must be placed on the buttock, though, with the exception of the reversal of the poles, the general directions for the application of the treatment will remain the same.
treatment

A point that requires attention is the form of the screw attachment for the wire to the electrode. This should be low and flat as possible, otherwise the weight of the as patient resting upon the electrode makes the screw press that portion of the electrode unduly upon the skin, and The wire leading from the electends to produce a sore. trode

be carefullyprevented from touching the skin of the patient, if it is covered with cotton, cr even silk,as it is so likely to get wet, and if pressed against the skin is sure to produce a sore place. The switch must be turned
on

to the battery must

gradually without producing any breaks of the current, or else the patient will get strong pleasant and very unshocks, and when the required volume of current is obtained the battery should be left untouched until the
treatment current

is ended.

collector are

batteries with a simple form of preferable to the more

this
reason,

For

170

ELECTRICAL
"

TREATMENT

" " " in batteries, nurses' patients' or which the electrode wires are inserted into the side of the battery a very insecure fastening, as they are liable to

batteriesknown

as

"

heavy and when described in the treatment

out,

drop

currents

are

being

used

as

of sciatica, very

unpleasant

shocks may

be given to the patient. has When the time for application of the current elapsed, the current must not be switched off suddenly, but the collector handle should be turned back slowly to zero

before the wires are unfastened. Sometimes the collecting does not work smoothly and evenly over the switch studs, and in this case the current will be interrupted suddenly
shocks will result. If this is found to be the case with the particular battery employed, it will be best to turn on the required number of cellsfirst, and then, after and applying the electrode at the buttock, gradually to apply ment the electrode at the thigh ; similarly,when ceasing the treatthe lower electrode is to be bent flat and the thigh

gradually liftedout of it. By this method the resistance is gradually diminished or increased respectively, so that the
current

is applied

or

withdrawn

without

any

noticeable

shock. As

is immediate in cases rule, improvement of acute sciatica treated by this method, the discomfort of lying for
a

in any one position passes off, and especially the patient will be able to lie upon either side. After the inflammatory stage of the neuritis has subsided,
more

than

few minutes

and the pain that remains is mainly neuralgic, then massage to the limb with extensive passive movements of all the is joints of the greatest service in completing the cure.
sions prevent the formation of adhepassive movements around the sheath of the nerve, which, if treatment is delayed, drag on the nerve and keep with every movement, These
neuralgic pain for months or years after the up constant inflammation has entirely subsided. In severe cases, the fibrous adhesions and fibrous tissue in the sheath of the

SCIATICA
nerve

171

fibresand cause muscular wasting tion and anaesthesia in addition to the chronic pain, and operahas frequently been successful in relieving this condition
compress

the

nerve

by

incising the

nerve

bundles

longitudinally and

separating the fibrous tissue. On the other hand, in the early stages of sciatica it is a creases great mistake to order massage, as then it invariably inis indeed only to be expected when we consider what must be the result of forcible traction and It is, therefore,somea what pressure upon an inflamed nerve. delicate and important point to decide at what precise the pain,
as

ments, stage it will be safe to order massage and passive moveas if it is given too soon the patient is thrown back, and if it is delayed too long convalescence may be unduly judgeby the following protracted. The physician must

points : If the constant pain and discomfort while lying for more than two or three minutes in any one position in bed has passed off, and the patient can lie on his side and flex the thigh in bed without producing pain ; if pressure
upon

in the buttock and upper of the nerve part of the thigh does not evoke tenderness ; and if it does not produce pain to lift the heel up 18 inches from the the
course

be considered The massage safe to commence and passive movements. movements should be free and extensive, being gradually increased in force after the first day, and should be repeated

bed, keeping the knee straight, then it may

There is often some duced pain and stiffnessprotime, and it will be a good plan to give after the first the galvanism after the massage in order to relieve any pain produced by it. In some be used with cases radiant-heat baths may advantage alternately with the galvanism or massage. The application of blistersdown the thigh along" the course
is also a of the sciatic nerve have no faith in it and never
common

daily.

treatment,

but

use

it. Nerve-stretching

and acupuncture

are

methods

that have been advocated ;

172

ELECTRICAL

TREATMENT

personally I strongly disapprove of both. Medicinal iodide of by treatment aspirin at first, followed by potassium, should be persevered with for a fortnight at
but

the commencement be completed by

Buxton,
or sum

of the attack ; while convalescence may course of baths at Droitwich, Bath,

Harrogate.
up, the treatment
on a

To

of
a

an

consist of absolute rest

water

sciatica should bed, with daily,or twiceacute

"

daily, careful application

galvanic current especially cataphoresis with salicylateof soda, as described on p. 1G9 ; aspirin by the mouth, followed by iodide of potassium, of
strong
to prevent and later,massage and passive movements adhesions and to break down those in process of formation. Radiant-heat baths, with a strong arc light turned on the

lower part of the back, are also very useful when the acute stage has passed and the patient is able to get about, but has not completely lost the pain. The full galvanic or hydro-electric bath may now be taken instead of the galvanism

described above. I may mention here that the Schnee or four-cellelectric bath is absolutely useless in the treatment of sciatica,and as sometimes given in hydropathic establishments, with a
to the thigh,
as

current

of 3 disrepute.

or

ma.,

only

brings galvanic treatment

into

BRACHIAL

NEUIIITIS

Brachial neuritis is the term applied to an inflammation of the various cords of the brachial plexus above the points to the limb, of emergence from the plexus of the main nerves
the circumflex, musculo cutaneous. median, ulnar, and musculo-spiral, Brachial neuritis is commonly of rheumatic
or

gouty

origin. It may

of the arm and such direct cause

most

direct exposure to cold no shoulder, but in the majority cases of be traced. A great many cases of this can
a

follow

in the last thirty painful affection have been seen years to follow an influenza attack, and the condition is

BRACHIAL

NEURITIS extremity
cases

173

precisely comparable in the lower limb.

in the upper Occasionally

sciatica arise from the

to

spread of inflammation from neighbouring structures to I have seen stances inthe nerve very severe sheaths, and of it dependent upon tuberculous adenitis of the
pleurisy, phthisis of the apex of the lung, and septic infection of the wound of an operation in too, to the the deep tissues of the neck. Direct injury,
neck, tuberculous

plexus as a whole may sometimes be caused by fallsupon in these cases due to violence, the the shoulder, though pairment motor palsy as a rule largely overshadows the sensory imquite the reverse neuritis due to rheumatism,
"

of what obtains in brachial gout, influenza, or the spread

sheaths

of inflammation
structures.

to

the

nerve

from

neighbouring

Brachial
occurs

gouty

neuritis, exclusive of the traumatic cases, as in men as frequently in women ; and in them the likely to be latent than to have tendency is more

shown

by overt itself
one

It will joint-inflammations. thus

constitute

of the possible signs of irregular gout, such as eczema, neuralgias, iritis,angina, glaucoma, and others to mention here. too numerous Indeed, left-sided brachial be mistaken for angina pectoris on account neuritis may of the cardiac distress that may be present as a symptom. This is analogous to the pain that is feltdown the left arm

ably and in the side of the neck in angina pectoris,and is probmechanism. produced by a reversal of the same
very acutely, and arm may be intense. The pain may be referred at firstto various points, such as the back of the shoulder, the forearm, or the inside of the elbow.

Brachial neuritis often then the pain in the whole

commences

The pain will be increased on movement of the arm, ally especiby raising it in abduction ; and there will be persistent on tenderness of the nerves pressure. Even the skin of the

hyperaesthetic as the pain increases. At in the most acute cases this stage there is very commonly
arm

may

become

174

ELECTRICAL

TREATMENT

and oedema of the back considerable swelling of the arm, of the hand and wrist. The skin of the hand and arm of the limb falls perspires excessively, the temperature and the several degrees as compared with the other arm,
limb feelscold and the hand will appear bluish. There will be almost complete inability to move the arm ; but this by is due less to actual involvement of the motor nerves paralysis than to the and consequent In the intense pain caused by all attempts at movement. trauma, there will be of majority cases, except those due to little no wasting, though slight wasting of the whole arm or is not
sensory
very
rare.

the inflammation

The

stress of the disease fallsupon

the

is pain and and the prominent symptom on pressure, which is persistent tenderness of the nerves The pain, as in sciatica,is often increased on movement. therefore be misat night, and may taken paroxysmal and worse
nerves,

for neuralgia. Other trophic evidences of the impairment of sensory nerves are thinning and glossiness of the skin of the fingers,

of sensibility with atrophy of the finger-pads, impairment portant, imto light touches and pin-prick, and lastly, but most fixation of the joints due to periarticular adhesions.

These adhesions, like the other trophic effects,occur most at the periphery of the limb, and thus it is the interpartial dislocation phalangeal joints which suffer most,
backwards with considerable distortion taking place in the It is the periarticular tissues which suffer cases. worst tions from the fibrositis that causes these adhesions and limitaof movement,
no new

articular surfaces. Next is apt to shoulder-joint escaping. The treatment

most

adhesions forming between the to the fingers and wrist, the

suffer most,

the

elbow

usually is

of

these postneuritic

troubles joint

massage and careful passive movements, machine, producing preferably on the arthromotor the best results. Breaking down the adhesions under

tedious, prolonged

BRACHIAL
an

NEURITIS

175

anaestheticshould be avoided, as, though this treatment appears attractive in theorj, the results are disappointing ; are worse than before, as the forcible and often the joints
straining or rupture of the adhesions sets up anew fibrositisaround the joint, and the pain produced
severe

the
is
so

that practically no

for many
return
as

be borne can passive movements days afterwards, and the adhesions consequently before, or even worse.
"

as
as

of acute brachial neuritis, of sciatica,necessitates immobility of the limb so long the active inflammation lasts. This will be determined The treatment

Treatment.

presence of persistent tenderness and pain on the nerves, pressure over and hypersesthesia of the skin and of the muscles. During this stage the limb should be treated

by

the

by moist heat, covered over with a thick layer of cotton wool, night and fastened to the side in a sling. After a week to a fortthe pain is probably abating ; but of this treatment,

drug treatment
salicylates and nightly morphia,

will help to a certain extent. alkalis by the mouth, and

Aspirin
probably

or
a

injection of
will be

one-eighth to one-sixth of a grain of Some necessary. authors recommend

instead, but
its anodyne

injections cocaine of

effectis less,

greater. and the danger of setting up a drug habit is even Morphia is withheld by some practitioners in practically all circumstances, on account of their dread of the formation

able valuof the drug habit, but, properly used, it is the most remedy in the Pharmacopoeia, and in the intense pain tainly sciatica or brachial neuritis its use is most cerindicated during the acute stage. Occasionally atropine or scopolamine may be combined with it advantageously of
severe

movements

in neurotic No massage or passive subjects. flammato of the limb must be allowed so long as the instage of the neuritis persists, but galvanism

from the may be employed with benefit as in sciatica,even first. It should be given, as in sciatica,by applying the anode to the region of the inflamed nerves and the kathode

1V6

ELECTRICAL

TREATMENT

to the peripliery of the limb, but differencesin detail will

have to be observed. The anode should be

3 inches in diameter, and piece of flat sponge, or gamgee

large circular pad electrode, a thick should be applied over

a

tissue,rather larger than the

The kathode electrode,thoroughly wetted with hot water. should be a large rectangular plate, similar to that used for the thigh in sciatica,and is to be wrapped round the forearm and wrist in the same manner, a piece of thoroughly
wool being laid on the inside The of the plate before it is moulded round the forearm. two purposes addition of this extra layer of cotton wool serves
wet

gamgee

tissue or

cotton

prevent undue pressure of the plate electrode upon any bony prominences, and also to hold a sufficient amount good electricalcontact with the of water to ensure skin during the fifteen to twenty minutes' application of
:

to

the current ; for the ordinary flannel covering of the plate is apt. to dry in a short time, thus increasing the resistance,

of current passing, and at the same time producing a sensation of burning ; and, indeed, actual then take place. When this electrolysis of the skin may burning sensation occurs, taking off the pad and re-wetting it stops the burning sensation, although more current now passes, owing to the diminution of the resistance between When the two the metal plate and the tissues of the body. in position the current should be turned on be employed, may slowly, and a strength of 10 to 15 ma. reckoning the area of the positive electrode as about 9

diminishing the amount

electrodes are

The current should be applied daily, or twice daily, and a good plan will be to paint the skin above the clavicle where the anode is going to be placed with an anodyne inches. paint composed of equal parts of chloral and menthol, and containing 1 per cent, of morphia hydrochloride. If this is before the anode is applied over done just the spot and the
constant
current

will convey

passed, the cataphoretic action of the current the drugs through the skin from the anode.

EKB'S

PARALYSIS

177

and thus the sedative action of the anode upon the inflamed nerves may be increased by the local action of these drugs Cataphoresis, with salicylateof soda, using upon them. the negative pole, should, however, be tried first, as described in the treatment of sciatica(p.168).
In favourable
after
a cases

appeared the pain may have completely disfew days, but bad cases, especially if

treated wrongly with massage and movements at first, may hind continue painful for many months, and then may leave beimpairment in dulling of permanent signs of nerve
wasting, glossy skin, periarticular sensation, muscular adhesions, etc. Neuralgia of the limb may remain, as in after the actual neuritis or inflammation has passed sciatica,
away,

and

then

massage

and

Swedish

exercises, tonic

treatment,

and change of air may

be necessary to complete

the

cure.

BRACHIAL

PLEXUS
are

INJURIES
common

to Injuriesthe brachial plexus

on

the shoulder, or of wrenching of the arm, is that One of the commonest of the neck of the humerus. Erb's or Erb-Duchenne known as paralysis. Du-

resultsof falls or of fracture

chenne described this particular form of brachial paralysis in new-born children ; it is due to direct traction on the upper roots of the plexus, the fifthcervical nerve, which
is the highest and therefore the most oblique, suffering the Sometimes the sixth nerve most. suffersalso, and in the of scar of these cases of birth palsy there is a mass

majority

tissue at the outer edge of the scalene muscle involving the junction the fifthand sixth nerves, though itis the fifth of
nerve

faradicstimulation of the two nerves separately will show when the plexus is exposad for operation. The result of this plexus lesion, division of the fifth damaging the anterior primary that always suffersthe
more, as

cervical nerve,
certain group
M

is to

cause

pure

motor
arm

paralysis of
and

of nxuscles in the upper

shoulder,

178

ELECTRICAL
a

TREATMENT
no

sensation, as
to be

rule, being entirely unafEected, with

on

ference dif-

detected, even

careful testing with cotton

lesion there of this fifthcervical nerve will be complete paralysis of the deltoid, supraspinatus and infraspinatus, biceps, brachialis anticus, and supinator longus muscles, and in some the patients those in whom plexus is high or prefixed there will be also paralysis of the pronator radii teres and the two radial extensors of the wrist.
" "

wool or pin point. In a severe case

will waste and show the full reaction of cases degeneration, and in many of the severer there is or to flex the forearm. permanent inabilityto raise the arm

These

muscles

the sixth primary division is paralysed as well as there will be weakness of the latissimus, triceps, the fifth, and pectoral in addition to these other muscles ; but leaves the escapes, as its nerve usually the serratus magnus In more widespread sixth cervical close to the foramen. When
lesions of the plexus, or of the primary nerves it, all of the muscles of the forearm and hand

which form
may

It is only in lesions of the fifth primary nerve anaesthesia is produced ; when the sixth is also involved, there is light anesthesia of the outside of the hand and

suffer. that no

thumb,

and

of the circumflex

area

on

the outside of the

upper arm. Occasionally partial lesions of the fifth primary trunk occur either from neuritis or as the result of trauma, only the deltoid and spinati muscles being paralysed, the biceps

and remaining muscles escaping. This form of paralysis is very difficultto distinguish from a neuritis of the circumflex
as

and suprascapular nerves, which sometimes occurs dislocation of the result of direct violence in downward

This accident produces a traumatic neuritis ; while of the circumflex by directly stretching the nerve time the infraspinatus muscle, whose tendon is at the same
the humerus.

attached to the greater tuberosity of the head humerus, is torn away from the suprascapular nerve,

of the

which

BRACHIAL

PLEXUS

INJURIES

179

its under however, there is more

enters

it

on

anaesthesia
case

on

surface. In this form of neuritis, likelihood of the presence of some the outside of the upper arm than in the

of a partial lesion of the fifthtrunk. Paralysis of the lowest cord of the plexus, the first dorsal, or Klumpke paralysis, as it is called, may result

downwards and tackviolent wrenches of the arm over the firstrib as wards, stretching the firstdorsal nerve it rises to join the eighth cervical in the plexus. abnormality is present -in the form of a cervical rib growing from the transverse process of the seventh cervical vertebra, and then the firstdorsal nerve
an

from

Sometimes

has to rise higher than usual and be bent at

angle to reach the plexus.
In these
cases

rather sharp

of cervical rib, is neuritis of the firstdorsal nerve which may be bilateral, not infrequently set up about the age of puberty, with the

side resultant symptoms of pains in the neck and down the innumbness of the arm, and anaesthesia along a strip of the inside of the forearm down to the wrist, and atrophy,
of gradual onset, of the intrinsic hand
muscles.

Treatment
most
nerves severe are

of
as

brachial
a

plexus

T injuries."he

those in which the upper involved, especiallywhen the fifthcervical nerve

rule, are damaged,

forms,

perhaps even ruptured. The main question, then, to decide, if the case is seen within the first have been actually torn, few weeks, is whether the^nerves and whether operation is required in order to repair the mischief as far as possible by performing primary suture of
the torn
nerve nerve

has

been

stores operation rethe continuity the better chance there is of complete taking place, while the longer the regeneration of the nerve period that elapses before the divided ends are brought

when

It may be taken as has been divided, the sooner

trunk.

an

axiom

that

the less chance there is of any recovery taking place. ~Two years is, perhaps, the limit beyond which it is hopelessto any recovery from suture of a divided together

expect

180
nerve.

ELECTRICAL

TREATMENT

therefore, Erb's palsy, such as those of due to fallsupon the shoulder in adults,or occurring in the question as to whether the fifth new-born children, has been torn is an anxious question to decide. It nerve is impossible,from the clinical to signs of the paralysis, be in sure on thispoint, week beforeany reaction either the first i of degenerationhas shown itself n the affectedmuscles, or
cases,

In

guide in these to be actually ruptured in this way, it will be safer to wait six months terference. before consideringseriouslythe advisability surgicalinof
therefore,be our for the nerve rare certain proportion of cases, although the to yet the injury the paralysismay be complete at first, has not been severe, nerve and though slight reaction of degeneration appears on electrical testing after the first
a

later. Experience must, cases, and as it is most

In

week, yet voluntary poWer

soon

commences

to

one and complete recovery may ensue In more severe there injuries, may be wellmonths. marked reaction of degeneration,yet signsof recovery may

in from

return, to three

ten weeks, with eventual complete return of power aftereighteen months or two years.

appear after eight

or

The only cases in which operation is certainly indicated from the first those in which the arm has been paralysed are stab wound in the neck, or in which, as fall,here isparalysisof the lower limbs severe t the paralysisof one or both arms, which may type of Erb's paralysis. In the former case

from

the result a of in addition to resemble the it is practically

certain that one of the nerves of the plexus has been divided by the knife wound ; while in the latterthere has been fracture dislocation the sixth cervical of vertebra,and there is almost certainlypressure being exerted upon the

spinal cord by

nectomy piece of bone, removal of which by lamimay completely cure the patient. Meanwhile, the paralysed muscles should be treated
a

daily with galvanism by the labilemethod, the indifferent being a flatplate placed behind the neck, while electrode

BRACHIAL

PLEXUS

INJURIES

181

is the kathode) a the treatment electrode (in these cases round disc 2 inches in diameter, attached to the usual form of handle.

supported that the paralysed muscles are not allowed to remain iu a constant position of passive extension. Paralysed and likely to recover, more wasted muscles are much and do
so

Massage, too, should be employed and the limb in a sling, care being taken as far as possible

in

mated. shorter time, if their attachments are kept approxiThus, in the case arm biceps the foreof a paralysed

should be kept at a right angle, and in the case of dropped wrist the hand should not be allowed to hang in that position, but the wrist should be kept extended by light splint, or similar apparatus. For dropped WTist I find the following apparatus sufficient a leather glove, :
a

from

sired, which the ends of the fingers may be cut off, if dehas sewn into the inside of the back of the fingers interphalangeal and thumb five tapes at the level of the first joint.These tapes pass under the back of the wrist of
to a broad stout piece of on the glove and are firmly sewn flat elastic,4 inches in length. The upper end of this is in turn fixed by strong webbing to a padded leather armlet
worn

With this apparatus the hand the elbow. be used for many can purposes, and there is no danger forming in the wrist and fingers, as when of joint-adhesions

just above

Such a gloverelaxation splint is worn. for me extension apparatus for the wrist has been made Lewis, of Westmoreland by Mr. Henry Street, W., and
a

"

"

so-called

also by Allen and Hanburys. It is,however, practically impossible to treat the deltoid muscle in this way, owing to the difficultyof keeping the
This is the only muscle which constantly abducted. the clavicular portion of the pectoral having raises the arm, only an adductor action on the arm when it is held straight
arm

out

contraction of the latter muscle prevents the natural action of the deltoid acting alone, from the arm which would sweep outwards and away

in front.

The

182

ELECTRICAL

TREATMENT

middle line. The supraspinatus muscle assists the deltoid very slightly in raising the arm, also rotating the humerus inwards ; but this muscle is almost invariably time as the deltoid, as, although paralysed at the same
the
yet supplied by two different peripheral nerves, both the deltoid and the spinati, supra- and infra-,receive their motor fibresfrom the same of the plexus, primary nerve the fifthcervical. Sometimes these three muscles are paralysed

they

are

partial neuritis of this uppermost nerve of the plexus, from direct exposure of the neck to cold, the onset being marked by considerable pain in the neck and shoulder. The prognosis in these cases is usually
a

together from

good, though many months, elapse often a year, may before the deltoid regains much Persistent of its power.
massage

and

galvanism

will, however,

aid their recovery

considerabl}'.
may be the result of a similar neuritis of the long thoracic from exposure to cold, or from the pressure of a heavy weight, such as the corner

Serratus magnus

paralysis

of

pressing above the clavicle when carried on the shoulder. Another cause palsy of serratus magnus is violent muscular action of the scalenus medius, through
a

heavy

box

which the long thoracic nerve I saw in a young man who

This form of paralysis developed sudden paralysis of

runs.

the serratus magnus ming while using the side stroke in a swimThe onset of neuritis of the long thoracic is race. accompanied by a good deal of pain above the spine of the
scapula and along its vertebral border, which may persist I do not consider this neuralgic pain a for many weeks. contra-indication to treatment of the paralysed muscle

suffer in a similar way, causing paralysis of the rhomboids, the levator anguli scapulae, and the upper portion of the serratus magnus, and often the middle and lower iibrea of the trapezius.
nerve

with galvanism. The posterior scapular

may

This grouping

of paralysis I hav"

seen

as

the result of

MUSCULO-SPIRAL

PARALYSIS

183

gunshot wounds, and also from muscular strain in a labourer heaving earth out of a deep ditch up on to the who was bank over his left shoulder. At the end of a strong effort

he felt a sudden shooting pain in the left side of his neck at once and at the back of his left shoulder, which was

followed by weakness of the limb, so that he had to give He ultimately recovered completely under up his work. by massage and galvanism. treatment

Trapezius
pp. 216-18.

paralysis." "Sfee under

Cranial

Nerves,

MUSCULO-SPIRAL

PARALYSIS

forms of nerve of the commonest paralysis Owing to its winding course of the upper extremity. round the humerus close to the bone it is peculiarly exposed
one

This is

of its damage in this way are pressure by a crutch, and pressure during or sleep, either by the weight of the head upon the arm, by the arm hanging over the back of a wooden chair. This
to pressure, and the two
most
causes

frequent

Sunday paraparalysis has been named lysis," in frequenters of publicowing to its occurrence houses sleeping off the effectsof a Saturday night debauch
form of
nerve

"

in

wayside ditch, or in a wooden chair with the arm thrown over the back of it. The pressure of a crutch in the higher against the humerus axilla compresses the nerve during sleep or anaesthesia,and up than when it is injured it is owing to this reason that in the sleep palsy of this
a

triceps usually escapes, while in musculospiral palsy due to the pressure of a crutch the triceps is lesion The most obvious result of the nerve usually weak.
nerve

the

is dropped

wrist, there being complete inability to extend The supinator longus either the wrist, fingers, or thumb. isparalysed in addition to the extensors in the forearm, while

in lead neuritis the supinator longus, the extensor ossis and primi internodii pollicisescape. This differencein the
extent

of the palsy makes

it easy

to

lead differentiate

184

ELECTRICAL

TREATMENT

paralysis from musculo-spiral paralysis. In the latter there is generally at first some the back of the over numbness thumb, index and middle fingers,and the outside of the back
of the hand,
as

far down

the fingers

as

the first inter-

joins phalangeal joint, where the supply of the radial nerve There will be partial tactileanaesthesia that of the median. and analgesia over this area for the firstfew weeks, the loss
of sensation usually

disappearing

before

the

return

of

voluntary power. in alcoholic Musculo-spiral paralysis sometimes occurs during the day while the patient has been awake, subjects of pressure. It is difficult and without any obvious cause

for if the paralysis were to understand how this occurs, to the action of the circulating toxin on the nerve,

due
the

Possibly in all effectsshould be bilateraland symmetrical. these cases there is some slight trauma which escapes notice, being on the brink of neuritis on account of the the nerve may be patient's alcoholic habits. Occasionally the nerve

damaged

by being torn by the sharp edges of the bone in fracture of the humerus, in which case, of course, the paralysis dates from the moment of the accident ; or the nerve
may

be implicated later in the callus formed during the in the healing of a fracture of the bone. A stab wound the nerve, may similarly sever upper arm traction and forciblecon-

been said to produce a traumatic of the tricepshas even its cause, neuritis of the musculo-spiral. Whatever
musculo-spiral paralysis is of sudden or almost sudden onset, and for this reason and because the muscles supplied by it in the forearm are not covered with a thick layer of tissue as, for instance, the hamstrings are, the reaction of degeneration is very pronounced in the extensor in the forearm in such cases. In the most severe
of the
nerve, as

muscles lesions

is actually divided by a stab or a bullet wound, the hyperexcitability to galvanism in ordinary cases that is generally seen of crutch or when the
nerve

sleep pais} is absent, and

the

form

of the reaction of

MUSCULO-SPIRAL

PARALYSIS is complete

185

degeneration that

is found

loss of faradic

reactions, with diminution of excitability to galvanism and very sluggish contractions. Powerful currents are required

sion the contractions, and within a month of the divibe only visible on the contractions may of the nerve reversing the direction of the current suddenly, while the
to evoke

plain make

and break of

current

of 10

ma.

may

cause

scarcely any contraction. Moreover, the contractions at the anode do not show the usual excess over the kathode for very long ; for when after a few weeks a strong current is necessary to evoke the contractions, the kathode closure
" ACC. contraction is then usually the stronger, KCC In the cases of moderate severity there will be also complete faradic loss in from one to three weeks, but there will be marked hyperexcitability to galvanism, a current of 1 to

producing distinct contractions, sometimes brisker to the kathode, though there is to the anode, sometimes difference between the strength of the KCC never as much

IJ ma.

and

and muscle. the contraction to the anode is more than to the kathode, though the amplitude of the
be about equal. Treatment. In the treatment
may
"

ACC

as

with

normal

nerve

Not

frequen in-

sluggish
contractions

of musculo-spiral lesions

our

will be the re-establishment of motor is never very deep power, since the sensory impairment or troublesome, and pain is either triflingor absent. If chief
concern

the wrist-drop is complete at first, with no voluntary power in the supinator longus or any of the extensors of the wrist, fingers,or thumb, it will be a difiicult matter to decide until
a

fortnight has elapsed whether the lesion is a division of the nerve one or of only moderate

complete

severity. With the establishment of the reaction of degeneration a further clue will be obtained, as those cases where the hyperexcitabilit
to galvanism

is most

to be

of complete severance oi definite anaesthesia over

cases

marked will not turn out The presence of the nerve. the distribution of the radial

186

ELECTRICAL
on

TREATMENT

the outer side of the back of the hand, fingers,and thumb, as high as 3 or 4 inches above the wrist, will be an lesion of the nerve, as additional evidence of a severe
nerve

definite anajsthesia over

cases

this

area

is often absent in slight

of musculo-spiral paralysis, which recover quickly. Since the nerve is rarely the seat of a rheumatic or gouty perineuritis like sciatica, with pain as a prominent it will be unnecessary to treat the case with prosymptom, longed
rest, for the lesion in the large
not
an

o majorityf

cases

is

inflammatory

one,

nerve,

the motor

nerve

but merely a crush of the whole fibres especially being damaged.

An

extension apparatus for the wrist, as described above (p. 181),should be worn, and the extensor muscles in the forearm should be treated by galvanism daily by the labile method, and also well massaged. The principle of
will be to keep the muscles as far as possible in good condition pending the recovery of the nerve ; but fibreswill depend upon the degree the recovery of the nerve
the treatment

of the damage, With

and littlecan
a

be done

to hasten

their recovery.

crush, littleor no voluntary power over the extensors may return for four to six months, and full power will not be regained for eighteen months to two The large years. of sleep and crutch palsies are,
severe

majority
a

however,

less
at the

severe

than this, some

degree of power

returning

month. The galvanism will be best applied by wrapping a large flat electrode round the arm above the elbow, and using a ment round disc electrode, IJ inches in diameter, for the treat-

end of

ment, electrode. The kathode should be used for the treatfrom 5 to 10 ma. of current being employed, according to the strength of contractions obtained. In the slighter

in which the muscles do not entirely lose the faradic forms in which xecovery reactions, and also in the severer is commencing and the faradic reactions are returning, itisa
cases

good method to use combined faradism and galvanism for instead of galvanism alone. It is best not the treatment

MUSCULO-SPIRAL
to
use

PARALYSIS

187
a

means

rapid interruptions for the faradism, but to employ of interrupting the faradism slowly, about two
a
as

or

three times

second, such to the Wagner hammer.

muscles
are

not

aluminium weight fixed on By using this mechanism the tetanized by the faradic current, but are.
an

Better results will be able to relax after each contraction. than by using either current alone. obtained by that means The strength of the faradism to be employed in this combined

be ascertained by testing the muscles first with single faradic shocks, obtained by working the When interrupting hammer by hand. this is done, it will

method

must

be found that when the secondary coil is pushed sufficiently to the primary, muscular near twitches are produced by

thus

while practically is felt at the make of the current, even nothing when the break current is too powerful to be borne. The strength of the break faradic shocks should be so that, before

interrupting

the battery current

adjusted

turning muscular

on

but distinct any of the galvanic cells,weak Then, turning on the twitches are produced.

galvanism, a strength of 5-7 ma. should be employed, the addition of which, by setting up a condition of katincreases the excitabilityof the electrotonus in the nerve,
nerve so

that the

faradic shocks

now

produce

stronger

contractions. Either this combined be applied by the current may labilemethod as described above, or two flatelectrodesmay be strapped on to the arm, one round the wrist and the other

the elbow, while the galvanic current is reversed regularly about twice a second. The reversal of the current
above
may
on

be employed, may special reverser driving a Pohl's commutator 144). (p. such as a metronome The combined current ismost easily obtained from a combined battery containing both the galvanic and faradic apparatus,
a

be performed the battery, or

by

hand

with

the

current

reverser

with a De Watteville switch for using either the faradism or the galvanism from the same pair of binding-screws. For

188

ELECTRICAL

TREATMENT

obtainiug the combined current, the switch must be placed in the middle line, half way between F and G. Some authorities recommend the sinusoidal current for In my opinion, the the treatment of muscular wastings. ordinary sinusoidal current, or alternating current obtained from the electric-lighting alternating current mains, is far too rapid in the period of its alternations, which varies

according to the dynamo used in the installationfrom about 40 to as high as 110 per sec. This rate of alternation is as
rapid, or even exceeds the speed of, a fast working hammer of a faradic battery, and as a result the muscles are tetanized, which is,I consider,not desirable. Dr. Morton has designed an
alternating current
two
or

dynamo

to work

at

periodicity of only

three cycles per second, and he claims good results for this method of treatment. The machine is made by Messrs. Schall,and the type of current somewhat resembles that of a galvanic battery working with slow reversals described above ; but the changes in the electromotive as force are much more smooth and less jerky, and thus are less efficient producing in
ULNAR-NERVE

muscular

contractions.

PARALYSIS

musculo-spiral palsy, ulnar-nerve paralysis may be the result of pressure upon the nerve during sleep. Either be damaged moreover, by pressure of these nerves, may due to a prolonged strained position of the arm while an
anaesthetic is being given. The name postancesthetic lysis parahas been given to this form of nerve lesion,and in this way one or more of the branches of the brachial plexus may be sometimes damaged. The ulnar nerve may be damaged

Like

blow upon the elbow, or by fracture of the humerus at its lower end, by a stab wound, or by inclusion of the nerve by
a

in callus

as

the result of fracture in the neighbourhood

common across

of

the elbow

Perhaps the most

nerve

-joint.

cause

is a wound

cutting

to of injury the ulnar the front of the wrist. This

ULNAR-NERVE

PARALYSIS

189

is very often the resultof putting the hand forcibly through a pane of glass,or of a slash from a knife. When the nerve
is thus divided, it is most firstsees the case and sews that the surgeon who up the wound should be careful to look for the two ends of the divided nerve and sew them together ; for unless this is done a permanently clawed and
useless hand is almost certain to result. With such an injury is most important it
to test the

important

sensation of the fingers so as to decide whether or not the has suffered. The ulnar nerve takes median or ulnar nerve its origin from the inner cord of the brachial plexus, and therefore derives nearly all its fibresfrom the eighth cervical and
firstdorsal roots.

In

low

or

possible that the second dorsal may fibresfor the interossei, and in a high or pre-fixed plexus the nerve gets a very definite bundle from the seventh root carrying
nerve

post-fixed plexus it is motor send into it some

motor
no

gives

flexor carpi ulnaris. The branch in the upper arm, where it is fairly the

fibres to

well protected from injury until it winds round the inner condyle to enter the forearm between the two: heads of the

flexor carpi ulnaris. In the forearm the ulnar nerve supplies this muscle and the inner half of the flexor profundus digitorum by branches arising near the elbow ; thus, wounds
above or at the elbow will paralyse these in the middle of the is damaged muscles, while if the nerve forearm or below, the flexor carpi ulnaris and profundus digitorum will escape. In the former case the wrist will of the ulnar
nerve

be abducted somewhat on and there will clenching the fist, be inability to flex the terminal phalanges of the little and ring fingers. The dorsal cutaneous branch arisesfrom the ulnar about 2 inches above the wrist, and passes backwards to supply finger and inner side of the dorsum and sides of the little the ring finger. Hence, a wound at the wrist dividing the below the point at which the dorsal cutaneous ulnar nerve

branch is given off,will not

cause

anaesthesia of the dorsum

190

ELECTRICAL

TREATMENT

faces. of the little and ring fingers,but only of their palmar surAt the wrist the nerve gives ofE the muscular branch

and flexor which passes deeply between the abductor brevis minimi digiti muscles, and then along the course plying of the deep palmar arch beneath the flexor tendons, supthe hypothenar muscles, all the interossei,the inner lumbricals, the adductor pollicis, and the inner half of the flexor brevis pollicis. This branch is,therefore,a by a fall purely muscular branch, and it may be wounded
two

the wrist and hand on to a sharp piece of glass or a spike. In this event, the muscles above enumerated will waste, but there will be no anaesthesia produced. As a
on

paralysis of the interossei and the the hand will assume the clawed shape, the first phalanges being retracted and the two distal phalanges partially flexed, the two ulnar fingers being
result of the muscular two inner lumbricals

affected. The hypothenar eminence will appear wasted, and there will be hollowing between the thumb and index finger on the dorsal side, owing to the atrophy of the

the

more

first dorsal interosseus muscle, while the outline of the The metacarpal bone of the index finger will be prominent.
thenar eminence will not be wasted, owing to the preservation of the abductor and opponens pollicis,but there will be.hollowing between the thenar eminence and the palm of

the hand

of the atrophy of the adductor pollicis and inner head of the flexor brevis pollicis. The terminal or superficialpalmar branch of the ulnar is almost entirely a branch, supplying only the palmaris brevis muscle cutaneous
on

account

in addition to the integument on the inner and palmar side of the hand, the littlefinger, and inner half of the ring finger. This terminal branch may be injured alone, with resulting anaesthesia on the palmar and inner side of the muscular paralysis, or it may be divided in injury addition to the deep muscular branch by the same level of the wrist. at the

hand

and

no

In

some

persons the ulnar

nerve

is constantlv

pressed

ULNAR-NERVE
upon

PARALYSIS

191

in its passage round the internal condyle in every act of flexion of the elbow ; an ulnar neuritis may be thus set up, causing pain and tingling along the distribution of the people to notice after leaning on one elbow for several minutes that the inner " gone to sleep," with weakness side of the hand and fingers has in straightening the two inner fingers. This is due
nerve. common

It is quite

for many

to

temporary
same
or

The

by being stretched. paresis of the ulnar nerve condition continued for a longer time, as when

a will cause under the influence of an anaesthetic, pressure, or sleep palsy, of the nerve. Ulnar paralysis is to be distinguished from lesions of the inner cord of the brachial plexus or of the eighth cervical

asleep

and first dorsal roots, and also from spinal lesions dorsal and eighth cervical segments. at the level of the first The former will be recognized by the distribution of the

from differingsomewhat muscular paralysis and anaesthesia the approxithat of ulnar palsy. Moreover, in most cases mate it is site of the lesion will clearly determine whether that has suffered,although, the inner cord or the ulnar nerve gives off no branch from the point of since the ulnar nerve arm, its formation until it enters the flexor aspect of the forea

lesion of the

nerve

at its point of origin from

the

inner cord and also at the bend of the elbow will produce symptoms. precisely the same Since the inner cord gives off the inner head of the

lesion of the inner more extensive muscular paralysis than an cord will cause be now ulnar lesion. All the intrinsic hand muscles will deep flexors of the fingers, wasted, with the superficialand the long flexor of the thumb, and the flexor carpi ulnaris.

median

as

well

as

the ulnar

nerve,

to its formation by near the inner cord is damaged the union of the eighth cervical and first dorsal primary divisions,there will be, in addition, weakness of the sternal implication of the portion of the pectoral muscle, through internal anterior thoracic nerve, anaesthesiaof a strip along

When

192

ELECTHICAL

TREATMENT

tlie inside of the forearm internal cutaneous nerves,

due to the internal and lesser tensor and also weakness of the ex-

indicis, minimi digiti, and secundi internodiipollicis, due to implication of the posterior division of the eighth the musculocervical and first dorsal nerves which joins spiral. Sometimes
by
a

the firstdorsal

nerve

downwards wrench of the arm the nerve over the firstrib. This lesion will simulate an ulnar palsy in causing wasting of the intrinsicmusculature

alone may be damaged and backwards stretching

of the hand ; but the thenar muscles escape in ulnar palsy. The anaesthesia, too, willdiffer that in ulnar palsy involving f the littleinger and inner half of the ring finger ; while a lesion
"

dorsal nerve of the first produces a strip of anaesthesia along the inner side of the forearm as far as the wrist, and does In certain cases it is not include any part of the hand.
to be injuredithin the possible for the first dorsal nerve w spinal canal close to the cord, when, in addition to the above

there will also be paralysis of the sympathetic pupil-dilator fibres,so that the pupil will remain medium
symptoms,

small, and will not dilate in shade. Treatment. The treatment of lesions of the inner on the same was cord or of the ulnar nerve general lines
"

in musculo-spiral paralysis, though, as there is no wristdrop, there will be no necessity for any extensor splint When the lesion to the ulnar is low down at apparatus.
as

for the electrode is to place the wrist, a good arrangement the hand fiat,palm downwards, upon a flat disc electrode, while another disc electrode is laid upon the back of the Galvanism hand. should be employed, and the current
to twice a second, the of from once strength of the current being from 5 to 10 ma., according to the strength of the contractions obtained. Faradism will

reversed at

rate

be of less use in the treatment of ulnar palsy, though when to return, the combined the faradic reactions are commencing
current

with slow faradic shocks may

be given.

ULNAR-NERVE

PARALYSIS

193

The prognosis in ulnar palsy depends, of course, on the as from pressure during slightinjuries, severity of the lesion,
to improve sleep, usually commencing It is in the cases of divisionof the nerve

within
near

fortnight.

the wrist that

there is especial danger of the nerve remaining permanently paralysed, for the surgeon's attention is very likely to be
more

directed to picking up and reuniting divided tendons than to examining the condition of the ulnar nerve ; and
some

it is often not until patient is becoming more

days afterwards, when

the

the loss of sensation over the discovery made was that the ulnar nerve and divided at the time of the injury. Reopening of the wound is now necessary, and secondary suture of the divided ends of the
nerve

accustomed to the wound, that the ulnar distributionis noticed,

be performed. This late suture of a is much less likely to be successful in entirely cut nerve restoring its functions than is a primary suture, and recovery is stillless likely to ensue should the wound have
must

suppurated. Even if the nerve

under

favourable circumthe most stances, has been divided, complete return of

perfect sensation and motor power is scarcely to be looked for under twelve months, though certain forms of sensation recover earlier than others. has shown that peripheral sensation consists of three separate forms : (1)Deep sensibility or sensations ^ of pressure, which may be actually painful, and which are perceived by the muscles, tendons, and deeper structures through
motor

Head

the medium of sensory fibres running with the to the muscles ; (2)protopathic sensation, or nerves

sensations of pain to pin-prick, etc., including recognition of extremes of temperature of heat and cold ; (3)epicrUic
sensation, or finer sensations of touch, including accurate localization, and recognition of milder degrees of warmth and coolness. Of these, the third does not overlap in its peripheral distribution, while protopathic sensation and deep sensibilitydo overlap considerablyin the distribution

194

ELECTRICAL

TREATMENT

For example, in the of neighbouring peripheral nerves. case of a divided ulnar nerve, epicriticsensation will be lost finger and the over the inner side of the hand and the little
inner half of the third finger, corresponding accurately with

distribution of the nerve, while sensation to pin-prick will be only partiallylost on the inner half of the third finger, but completely lost on the littlefinger; deep
the anatomical
sensibility,also, will be but littleimpaired on the third finger,though completely lost on the littlefinger.

These different forms of sensation do not recover taneously simulafter suture of a divided nerve, epicriticsensation taking very much longer than the protopathic. The latter, in in six weeks, and be completely recovered in ten weeks, after which the liabilityto trophic sores disappears. Motor recovery does
a

favourable

case,

may

commence

to return

not

commence

and

until from five to six months after suture, take twelve to eighteen months before complemay tion, to return while epicriticsensation does not commence

until ten months have elapsed, being complete in about Occasionally, especially after secondary twelve months. suture, protopathic and deep sensibility recover, while at time there is no return of epicriticsensation or of the same

the muscles remaining permanently wasted. For the hand, it is much more important for the patient to get return of a fair degree of sensation than that the intrinsicmuscles of the hand should recover ; for if there is
motor

power,

deep anaesthesia of the littlefinger and inner side of the hand, the value of the hand is very considerably impaired a sentient as and prehensile organ, as the littlefinger will
be constantly getting in the way and be in danger of injury, time there will be great difficultyand, while at the same

indeed, impossibility of recognizing If, however, protopathic sensation

return, it will make
a

by objects

the touch.

and deep sensibility considerable difference to the usefulness

of the hand,

even

though the interossei remain permanently

wasted.

LESIONS

OF

THE

MEDIAN

NERVE

195

MEDIAN-NERVE

PARALYSIS

Like paralysis of the ulnar nerve, that of the median nerve may result as part of a brachial plexus lesion,or the
nerve

in Like the arm, or forearm. may be injured the axilla, arm ulnar, it gives no branch above the elbow, entering the fore-

between the two heads of the pronator radiiteres, which it supplies. In the forearm it gives off muscular branches
" ""

the

The

cutaneous. anterior interosseous and the palmar median nerve receives fibres from all the five roots

that enter the brachial plexus, and it conveys motor fibres to all the flexor muscles in the forearm except the flexor

carpi ulnaris and digitorum, which

the inner half of the flexor profundus are supplied by the ulnar. The outer head of the median carries the, motor fibres for the pronator radii teres, the flexor carpi radialis,pal-

torum, maris longus, and a few fibres to the flexor sublimis digitime it also carries sensory fibres while at the same to the skin of the palm of the hand, the thumb, and outer
three fingers. The
motor

inner head of the median carries the fibres for the portion of the flexor sublimis,

major

the outer half of the flexor prothe flexor longus pollicis, fundus, two outer lumbricals, the thenar muscles, and the but
nerve
no

sensory fibres. Like the ulnar, the median minal supplies part of the dorsum of the fingers, the tertwo phalanges of the index and middle fingers,and
cutaneous

the outer half of the dorsum of the third finger.

of the terminal two phalanges

of median -nerve paralysis lines as ulnar paralysis. The nerve is will be on the same from stab wounds, but in liable to injury the upper arm
"

Treatment.

The treatment

never

by suffers,like the musculo -spiral, compression against the bone. In the forearm it may suffer from pressure on
flexor aspect, especially during sleep, or from the pressure of a tight bandage or splint ; but it is lesscommon the

jthan ulnar paralysis from

this

cause.

Stab wounds

and

196

ELECTRICAL

TREATMENT and sometimes

nerve

tliewrist may divide the nerve, gashes across it is involved in scar tissue, although the

may

not

have been

injuredt a

this latter case

thumb

In the time of the original wound. the patient will complain of tinglings in the

and two outer fingers, with occasional pain, which is evoked or increased by pressure over the site of the scar. I have seen case a paralysis of partial median-nerve
tissue in the slight amount of scar upper part of the forearm, the result of a stab wound several weeks previously. There was slight but definite

thus produced

by

distributio the cutaneous anaesthesia to touch and pin-prick over of the muscles of the median, with weakness supplied by it, and also very definite diminution of the briskness of these muscles to the faradic current, though there was no hyperexcitability to galvanism or polar change. The wound was reopened and the scar tissue dissected off,

ful with the result of almost immediate return of power. Caretesting on the morning following the operation showed improved, and there was now that the grip was much
scarcely any detectable anaesthesia. Moreover, I took the faradic reactions again, and found that the briskness of reaction now much increased, of the flexors to faradism was

like those of normal muscles. artisan,declared that he found his hand was

much

more

The

man,

an

much stronger from the anaesthetic. came round and lessnumb as soon as had disclosed two rings of thin scar tissue The operation
he

surrounding the upper forearm, but the nerve

or

at all narrowed.

in the of the median nerve did not appear to be nipped there This case is evidence that it is possible
part

muscular weakness, partial anaesthesia, and very of faradic excitability to result from without any destruction of slight compression of a nerve fibres. Apparently the compression of the scar the nerve tissue sufficientpartially to obstruct the conduction of both motor and sensory impulses along the median nerve, without damaging the fibres enough to set up degenerawas

for actual diminution

MEDIAN-NEEVE
tion, so

paralysis

197

that removal of the compressing scar improvement followed by immediate in the

It is,in fact, merely an in which a nerve

tissue was

symptoms. indefinite prolongation of the condition " " is when it has as gone to sleep

the weakness, the result of slight pressure. In this case tingling, and anaesthesiapass away in a few minutes after the pressure is released. there the neuritis of the median is at all severe, The will be marked trophic changes in the skin and joints. skin becomes thin and glossy, especially on the fingers,and if sweating is often profuse. This sweating does not occur

When

the
to

nerve

is divided, until the regeneration has proceeded

the stage of return of protopathic sensibility. Besides the glossy skin, the finger-pads become wasted articular and pointed, and the nails striated and brittle. Peri-

causadhesions form about the phalangeal joints, ing tortion. stifi;ness the fingers and sometimes considerable disof Massage, passive movements and of the joints,

will be the best line of treatment, case, though great patience is required in a severe eighteen two years elapsing before there is much improvement. months or
persistent galvanism

Sometimes
ulnar, and

of neuritisof the median and of the radial also, results from the too tight
a

severe

form

application of a bandage wrist or of a fracture of

as
a

of a sprained one of the bones in the forearm ; tion result,the muscles waste, with the reaction of degeneraappearing, and later,contracture of the flexors of the
myositis may This late contracture, be

for the treatment

fingers. Ischsemic

combined with this together with the pericondition. articular adhesions of the interphalangeal joints, cripples the hand for many months, from one to two years often elapsing

before method

moderately severe of treating such

case cases

entirely. A useful baths is by electricarm a

recovers
"

ing porcelain or earthenware bath of the required shape, holdfrom 2J to 3 gallons. The forearm is immersed in this,

198

ELECTBiCAL

TREATMENT

to the skin completely, and with sufficientwater just cover the electrode wires are attached to two paddle- or racquet
-

shaped copper electrodes,the anode behind the elbow, the kathode at the fingers. Using the constant current, the
current

marks until the galvanometer for about This should be allowed to run about 40 ma. ten minutes, and then for another ten minutes the current Owing a second. should be diminished and reversed once
on

is slowly turned

to the fact that the current

the water of the bath, or of the arm, only a proportion of it passes through the limb roughly about one-third, but varying with the amount
"

alternative path through through the water and the tissues

an

has

the shape of the bath, and the extent to which the the limb. The sinusoidal current from the alterwater covers nating in the treatment of use electriclight mains is of little of water,

these

cases

in of neuritis, my

has shown The above

arm

ing opinion, when the muscular testthat the muscles do not react to faradism.

method

bath
on

is very

of using the constant current in current convenient if the constant

an

is

available

the current
source

the electriclighting mains, because the cost of able used is then negligible ; but if the only availof the current is a galvanic battery of wet or

dry cells,it will be advisable not to employ this method, because the wastage of current will be a heavy drain on the resources of the of the battery, since two-thirds or more current that is being used in the treatment of the limb is
being wasted in the water. Unless, therefore, current is lators, available from the mains or from a battery of accumuboth electrodes should not be placed in the same

of the wires may be attached to a large flexibleplate electrode and fastened around the upper arm, while the hand rests on the kathode {seep. 228). With
arm

bath, but

one

this arrangement that is marked

on

there will be no wastage of current, all the galvanometer passing through the

than 7-10 ma. tissues of the limb, and therefore not more Care must, however, be taken that the must be employed.

VOLKMANN'S

CONTRACTURE

199

anode is applied to the upper arm, and that blisteringof the skin is not allowed to take place, owing to the use of too strong a current, or drying up pf the electrode covering,
or

unequal pressure of the metal upon the skin.

ISCHvEMIC

MYOSITIS
too

Another very serious result of the

of
a

tight application

bandage

myositis

the soft tissues of the limb is ischsemiC (p.131). This is produced by the tightness of
upon

squeezing the blood and lymph out of the limb, and thus damaging the nutrition of the muscles, so that a condition resembling a premature rigor mortis is set up. The

the bandage

condition known

was as

described by

Volkmann,

and

In

some

and affects the biceps or flexor muscles of the forearm. of these cases the nerves endings do not and nerve

Volkmann's

contracture,

is sometimes quently fremost

appear to be damaged, and then there is no alteration of the electrical reactions, although the muscles are contracted is primary, occurring contracture paralysed. The within a few days of the application of the tight bandage, tracture and is thus easily to be distinguished from the late conand

lesion and its consequent resulting from a nerve Moreover, in ischaemic myositis there muscular wasting. involvement, such as anwill be no other sign of nerve aesthesi

finger-tips, etc. In the skin, wasted of majority cases of ischaemic myositis that I have met with, however, there have been, in addition to the primary
glossy

involvement by the signs of nerve action pressure of the bandage, as shown by anaesthesia and reof degeneration of the muscles.
muscular
contracture,

The contracture

in ischaemic myositis is very obstinate

and resistant to treatment,

prolonged massage and passive over a period of many movements months being the only times remedy short of lengthening the tendons. This is somedone by splitting the tendons, and then lengthening them, but
it involves
a

long and

tedious operation.

300

ELECTRICAL

TREATMENT

surgeons practised by some quicker way out of the difficulty has been to take a piece out of the bones of the forearm, thus shortening the whole limb, so that the flexor tendons

will then allow the fingers to be straightened out.

NERVE INJURIES
OP THE

LOWER

EXTREMITY

The

nerves

less frequently of the lower extremity are much t injuredhan those of the upper, due to the facts lumbo-sacral

plexus is shielded from injury in the pelvis, and also to the greater size and strength of the thigh and leg affording more protection to the nerves. involved in The lumbar or sacral plexus is sometimes

that

the

and pain in the limb with rapid muscular syphiliticremedies. wasting should suggest the trial of antiliable to It is true that the sciatic nerve is much more
g syphiliticummata,

than is the brachial neuritis from cold, gout, or rheumatism by gunplexus, and it is also sometimes directly injured shot wounds or a stab. Similarly the anterior crural nerve
in the groin or be occasionally injured by a wound front of the thigh, causing wasting of the quadriceps extensor
may

and weakness

of extension of the knee, with loss of

knee-jerk.
the thigh or buttock have been a -of frequent cause of complete or partial sciaticparalysis. In the external popliteal the latter, in the of cases Gunshot
wounds

majority

is the chief sufferer. portion of the nerve In the leg, the peroneal nerve, or external popliteal, b as it is also called,is sometimes injuredy pressure under
anaesthetic, or by a blow where it is liable to injury as it winds round the neck of the fibula. This injuryay m result from a slip between a railway carriage and the platform,
an

jamming the
pressure
on

leg below the knee.

is seen

the

nerve

slaters, from lying on one work on a floor or roof. the nerve, there will be paralysis of the peronei, and

of in the trade of carpenters and the joists side across while at As a result of this crushing of of

Another

cause

PERONEAL

NEURITIS:

TREATMENT

201

extension of the toes and dorsiflexion of the ankle, with of anaesthesia the dorsum of the leg,ankle, and foot. There will be foot-drop, necessitating the foot and knee being raised high in walking ; a stepping gait, the foot flapping and being turned inwards. A gouty, diabetic,or rheumatic or portions of it, sometimes occurs, neuritis of this nerve, causing pain along the front of the leg, and weakness and wasting of the tibialis anticus, the extensor longus digitorum, the extensor longus hallucis, or the peronei. Either one or more groups of these muscles may thus suffer in one leg.

Treatment

of peroneal

neuritis." In the stage of

one, complete muscular paralysis,if the neuritis is a severe developed reaction of degeneration, there will be fully-

and

therefore the constant

current

is the only

form

muscular contractions. evoke treatment good method of giving the electrical will be to fasten a fiat plate electrode by bending it around the part of the leg, and tie it on with a bandage to be prevent it from slipping. The electrode must, of course, thoroughly wetted, and the foot then placed in water in a
upper

current

which

will

of A

shallow foot-bath. The other electrode should then be placed in the water with the foot, and the current turned is registered by the galvanoon until a strength of 8 ma. meter.

should then be reversed in direction about once a second, either by working the current reverser on the battery by hand, or else by means of the metronome As the faradic reactions return, with automatic reverser.
The
current

it is a good plan to apply recovery of the nerve, commencing the combined faradism and galvanism in this way, by turning

the switch of the combined battery halfway between F and G, or by connecting the positive pole of the galvanic
battery to the negative of the secondary faradic coil,and connecting the electrodes to the remaining two bindingscrews,

if a combined battery is not available. Another way of applying the current, which is also use-

202

ELECTRICAL

TREATMENT

ful, is to fasten the indifferent electrode to the thigh just above the knee, and use a rollerelectrode for the treatment

electrode, connecting it to the negative pole or kathode of the battery. Using the kathode thus for the treatment
is combined electricity. Massage should also be given separately, best daily, and passive movements and movements of the muscles executed against graduated resistance will form an important part of the of massage
treatment,
as soon
as

by roller electrode, a certain amount with the application of the

there is

power, or in which

suffered completely. This combination of passive movements and the execution of movements ciple against graduated resistance form the prinof what method
is
"

from the commencement has the whole nerve

slight return of voluntary in those slighter cases

not

usually called

Swedish

massage,"
cure

which is a most

useful

in adjunct

the

of the

slighter cases of muscular paralysis due to neuritis,and in the later stages of recovery of those cases in which the paralysis is complete at first.
TUBERCULOUS NEURITIS
rare.

This is comparatively
case

I have

once

seen

severe

apparent of multiple neuritis in which the only cause was a widespread miliary tuberculosis, ending fatally. Alcoholic neuritis is common with enough in conjunction but in those cases tuberculosis, the alcohol is pulmonary the prime factor, and the pulmonary tuberculosis is largely dependent upon the diminution of resistance to tubercle invasion, owing to the condition of chronic alcoholism. The
is of the type familiar in multiple neuritis in these cases possible that the alcoholic neuritis, but it is, of course, development may precipitate of tubercle in an alcoholic

subject

the

occurrence

action of two
the
on
case

taneous of multiple neuritis,by the simulas possible causes of neuritis,just in arsenic.

seen occur

one

of alcohol and side I have also

Severe brachial neuritis during the development

TUBERCULOUS

NEURITIS

303

tuberculosis on that of very rapid and fatal pulmonary side. Tuberculous neuritis may also affect the feet,as I have seen several times, causing severe, almost continuous
pain for weeks in both feet, with wasting of the skin and muscles of the feet. This latter condition, with hyperaesthesia of the skin of the feet, and irregular pyrexia, and perhaps with signs of tubercle in the lung, kidney, or elsewhere, is, I think, characteristic of tubercular neuritis. Electrical treatment may be of a certain amount of use in allaying the pain which is a prominent feature in tuberculous neuritis. The constant current should be used, with both the feet placed in warm water in a foot-bath, together with the anode ; while for the kathode a large flatelectrode is used and applied to the lower part of the back. The

principle of cataphoresis may also be taken advantage of, donna and the foot painted first with an anodyne liniment of bellaand aconite ; or, instead of using a foot-bath, the
foot may ment, be wrapped in lint soaked in this anodyne liniand a flexibleelectrode attached to the anode bent the round the foot outside the moist lint. By this means belladonna and aconitiewill be carried through the skin by

the cataphoretic action of the constant

anode.
ASCENDING OR MIGRATORY

current

from the

NEURITIS

Is

rare

it may

affection, most commonly septic in origin. Thus, pheral affect by extension the brachial plexus, after a peritwig has been involved in a septic process from a

wound,

pheral whitlow, etc. Starting with pain along the peribranch of the netve involved, local muscular wasting

may

follow,and later,wasting of other muscles proximal to the part first affected,by the extension upwards of the septic The process is usually very slow, process along the nerve.
a years. I have thus seen spreading neuritis of the brachial plexus, causing severe the pains down the arm and hand, with glossy skin of all

taking many

months,

or

even

204 fingers and

ELECtEICAL

TREATMEN'T
follow an joints,

operation of the brachial There was a slight septic infection of plexus in the neck. followed later by pain in the hand, the wound, which was This is a most difficultcondition to treat, anodyne etc.

fixation of the interphalangeal exposing the three upper nerves

liniments, menthol and chloral paint, and cataphoretic constant being the most successful. In this case the current
anode must be applied to the neck above the clavicle,and in an arm the whole of the forearm should be immersed Great care bath with the kathode. be taken that must no electrolysisof the skin is permitted, and the skin under

the anode above the clavicle must for any signs of blistering, the anode
every few minutes

carefully watched being lifted up gently

be

for inspection of the skin. The strength than 10 ma., of current should not be more and the anode should rest on a bed of cotton-wool soaked in the anodyne

liniment.

the pain of a and. excessive, the question of operation for division of the posterior spinal roots may have to be considered;
very severe brachial neuritis is constant
cases,

In

in which

CHAPTER
GALVANISM
CRANIAL

VI

(continued)
NERVES

The due

cranial

nerves

are

frequently involved

by

neuritis,

either to pressure from an hydrocephalus, or to involvement

intracranial growth or in an acute or chronic origin.

nerve

or meningitis of tubercular, syphilitic, carcinomatous

The
may

optic

or

second

cranial

nerve."

This

by optic neuritis and a subsequent secondary it may degenerate slowly from optic atrophy, or primary optic atrophy. The former is a common symptom, in cerebral tumour,
is met

be damaged

and in other

causes

cranial of increased intra-

pressure ; while primary or simple optic atrophy disseminated sclercsis, tabes dorsalis, with in syphilis,
.

Leber's family type of optic atrophy, and as a result of preson lesions of the optic tracts, chiasma, or optic sure or behind the globe. nerve

recommended of optic atrophy, usually the primary tabes and late syphilis.

Gtalvanismis sometimes

for the treatment form, and also for

In the application of galvanism for the treatment of disc electrodes should be used, two padded optic atrophy 2 inches in diameter, attached to the anode and held against the temple, while the other should be smaller, 1
one

inch in diameter, attached

stroked
over

to
or

the

kathode,

and

gently

softly pressed under the A strength of 2 to 3 ma. should be used, and if eyebrow. the eyelid is too tender to permit of the kathode being stroked over it,the electrode should be pressed gently under

the upper

lid

the eyebrow

and the current

reversed at intervals of about

205

206
once

ELECTKICAL
per second.

TREATMENT

of the normal retina produces a sensation of flashes of light in the eye, brilliantwith the kathode, and of a of a bluish tint, more
more

Stimulation by this means

It is best to have the two violethue with the anode. the eye and one on on the electrodes close together, one

temple, rather than that the indifferent electrode should be placed on the back or on the back of the neck. This is because with the latter method the current would be diffused

through the skull and its contents, while by keeping the two electrodes as close as possible the current is confined to the eye and its immediate neighbourhood, and the

brain is thus less affected. A very convenient method is to If use rapidly reversed galvanism by a Leduc motor.

strong currents
one

are

electrode

on

passed through the brain by placing rents each side of the head, and reversing cur-

may

intense giddiness and nausea than 5 ma., of more If the electrodes are held over the region be produced.
on

of the angular gyrus may be produced.

I have
never

each side, coloured yellow vision

so-calledgalvanism of the optic nerve do the slightestgood in tabetic optic atrophy, but it may be of benefit in tobacco amblyopia or in similar conditions
seen

in retrobulbar neuritis. Galvanic the eyes are sometimes of use in while curing hysterical blindness, and in these cases, is being applied, the patient should be made the current

of toxic amblyopia, or shocks passed through

to keep

the eyes shut, and

as with strong reassurances that will result as soon as the eyes electricaltreatment is finished.

encouraged at the to the improvement

are

same

time

opened

in vision after the

blindness consists of diminished acuity of tion vision of varying degree, usually with peripheral constricof the fields. In rare cases this peripheral constriction
is great that only about 5" around the fixation point remain, the so-called pin-point fields,which are usually bilateral. More commonly, there is greater peripheral
so

Hysterical

HYSTERICAL

BLINDNESS

207

in the other, with, at eye than constriction in one the same time, greater diminution of acuity of vision, there are hysterical hemiansesthesia and especially when

hemiplegia, deafness, loss of taste and smell on the side. Sometimes the peripheral constriction is much

same
more

marked on one side than on the other, resembling somewhat i the half-fieldsn hemianopia due to a lesion of the visual In the centre or of the optic radiations or optic tract.
hysterical
there is marked peripheral constriction fields in addition to the of the remaining halfblindness on one side, whereas in hemianopia of organic
case,

however,

'

origin there is littleor remaining half-fields. Sometimes

to amount

no

peripheral constriction of the

may

hysterical amblyopia

be

so

intense

as

loss of perception of light in The pupils will,however, react normally one or both eyes. to light, time belladonna or some unless at the same similar drug paralysing the sphincter of the irishas been placed
to actual apparent
on

the

with conjunctiva

intent to

deceive.

of hysterical blindness and of the pupil I have known kept up for four years, and to have deceived at least two eminent practitioners before the

combination fraudulent dilatation

Such

fraud

A combination of fraud with hysterical is,indeed, quite common, symptoms and is probably to be explained by the peculiar mental attitude of hysterics, ing who are in a condition of self-hypnotism and usually cravwas

discovered.

for sympathy, of which they get less than they think for this combination reason they deserve. Another of hysteria with deceit is a congenital moral obliquity, often approaching the border line of actual insanity, from which they suffer. This is, I think, well shown by the numerous cases of clairvoyants and mediums who have been detected
in fraudulent practices to assist their performances. Ocular paralyses." Paralyses of the third, fourth

sixth cranial nerves, causing different varieties of cases paralysis of the ocular muscles, have been in some
or

208

ELECTRICAL

TREATMENT

Before attempting to electrical treatment. apply the current, however, it will be necessary to determine accurately which of the ocular muscles are at fa^^lt.

benefited by

paralysis." This may be due to a lesion of the third nucleus in the floor of the aqueduct, or to a tumour, meningitis, fracture, or other mischief involving
in the wall of the cavernous sinus, or its passage through the sphenoidal fissureand the back of the orbit on its way to the muscles of the eyeball. The muscles supplied by the third or oculo-motor nerve the third
nerve

Third-nerve

in its course

the superior, internal, and inferior recti, the inferior oblique, the levator palpebrae, the ciliary muscle, and the sphincter of the iris. Paralysis of this nerve will therefore
are

ptosis, or dropping of the upper eyelid, and external strabismus, the eye being turned outwards and slightly downwards, with almost complete imaddition, the pupil will be medium dilated and

be followed by complete

mobility.^In

fixed,and there will be complete paralysis of accommodation. In shghter cases the ptosis may be incomplete, and there

the eye towards the middle will be partial ability to move line ; or one or more branches of the third nerve may be picked out by a lesion of the nucleus or of a division of the in the orbit. nerve
The commonest cause paralysis is syphilis, of third-nerve in the form either of a gumma or meningitis or gummatous sane of tabes, in which disease and in general paralysis of the inpartialor complete third-nerve paralysis isverycommon. The Argyll-Robertson pupil, or loss of pupil reaction to

lightywith preservation of reaction to accommodation and in pracconvergence, is also a post-syphilitic tically phenomenon generati due to nerve-cell nerve-fibre deor every case, and
The
never

in the neighbourhood electrical treatment small that no at the time.

nucleus. of the third-nerve of the ocular muscles is

as

very satisfactory,inasmuch
are

they

are

out of sight

and

so

apparent

obvious results of stimulation are Again, the through

conjunctiva,

OCULAR

PARALYSES

209

has to be applied, is so sensitive that It is best to instila only weak currents can be employed. couple of drops of 10 per cent, cocaine solution into the eye before applying the current. Galvanism should be used,

which

the current

good plan is for the operator to hold one electrode, hand, and to apply the current to moistened, in his own the eye with the tip of the forefinger of the other hand. and
a

tip of the finger should be applied as much to the side of the eye as possible over the muscle which is to be treated, The though no contraction of the muscle will be seen.
The

other electrode should be a round disc electrode applied to the temple, justas in treating optic atrophy. The duration of the application should be about ten minutes,

the direction of the current being frequently reversed. In myasthenia gravis ocular paralyses are commonly
present, though to The time.

the degree of weakness varies from time facial muscles almost invariably suffer also, especially the frontalis, orbicularis palpebrarum, The lower jaw, too, frequently drops and zygomatici.
towards
meal, owing to early fatigue of In this disease treatment the masticatory muscles. of be of benefit, though the affected muscles may sometimes

the

end

of

not

much

is to be

hoped

for in the

of majority

cases.

etiology of the disease is uncertain, no lesion being fibre, or muscle end-plate, cell, nerve present in nerve though many with round of the muscles show infiltration lymphocytes. The
The
motor

fifth cranial

or

and sensory nerve, third, fourth, fifth, and

mixed carrying the sensory fibresfor the sixth and most of the seventh

trigeminal

nerve

is

four of which are exclusively motor cranial nerves, loss of in function. Paralysis of the fifthnerve will cause power in the masticatory muscles on one side, the following muscles being paralysed and wasting : masseter, temporal, internal and external pterygoid, mylohyoid, anterior belly No contractiop of the digastric, and the tensor tympani.

210

ELECTRICAL

TREATMENT

will be feltin the masseter or temporal on that side when clenching the teeth, and in opening the mouth the lower jaw towards the paralysed side, owing to unopposed will fall away

action of the external pterygoid of the sound side. Reaction of degeneration may be obtained in the masseter, to though it may be difficult demonstrate if the overlying

facial muscles

fifthnerve
front of a
nose,

paralysis of the will cause anaesthesia of the half of the head in line joining two auditory meati over the vertex. the
are

normal.

The

sensory

This includes the forehead, eye,

cornea,

nose,

and conjunctiva, of and hard palate, the anaesthesia ceasing at the junction the hard and soft palates, and the anterior pillar of the both of smell and of taste on the same side will be impaired or lost after a short time, owing to loss of the trophic influence of the nerve on the sensory

cheek, chin, inside of inside of mouth, tongue,

fauces.

Usually the

senses

mucous

membrane.

develop owing
consequent

Corneal ulcer or may conjunctivitis to the anaesthesia of the cornea, and the

of gritty particles, while the accumulation corneal reflexwill be lost. The treatment -nerve of fifth paralysis will depend on If it is due to an intracranial gumma, iodide of the cause. of potassium and intravenous injectionssalvarsan must be given ; but if due to the pressure of an intracranialgrowth no medical treatment will be of any other than syphilitic,
ot the wasted masseter and temporal service. Treatment may be attempted with galvanism, using the kathode with 5 to 6 ma.

in which electricity The chief disease of the fifth nerve is likely to be of service is trigeminal In neuralgia.
be sometimes this most serious neuralgia the pain may allayed by passing a constant current of 4 or 5 ma. through the face,placing a round disc electrode over one of the tender
spots, such
as
on

side of the chin.

of, and
a

the cheek-bone below the eye, or at the The cataphoretic current may be made use

saturated solution of cocaine and guaiacol should

AUDITORY

NERVE

211
a

be applied with the anode, the kathode being fastened to The treatment the back of the neck. plate electrode over by trunks at of alcohol injection the nerve foramina is,however, a far more certain means

their deep

of arresting the pain of this disease. Neuralgia of the face and by means head may also be relieved in suitable cases of Wimshurst the static spray or negative breeze from the
static machine The seventh with

{see 330). p. nerve or facial

or

has

already been

dealt

(p.152).
eighth

Electricity is sometimes of deafness, galvanism being used in the treatment the best form of current to employ if tinnitus is a prominent

The

auditory

nerve."

The external auditory meatus symptom. filledwith water, the head being held on one anode is used for treatment,
"

should be side. The

electrode is screwed in

being attached to a laryngeal stiffwire insulated nearly to its end, which is placed into a small knob. This knob
in contact

the

meatus

with

the

water,

while

the

is attached to a round disc electrode and held side. A constant current against the mastoid on the same should be turned on gradually, and should be of 5 ma. A good plan is to combine allowed to run for ten minutes.

kathode

rupting with slow pulsating faradism, the interbeing so arranged as to vibrate slowly, hammer about twice per second. Care should be taken not to interrupt a the constant current, strong galvanic and not to use current, as a disagreeable shock and vertigo might be thus this treatment

produced.

Considerable

improvement

in hearing

sometimes

results from this method

purative middle
symptoms.
-ear

of treating chronic non-suplabyrinthine catarrh, with commencing has

frequently met with, " shellassociated with mutism, in soldiers suffering from be forms of suggestion treatment Various may shock." been

Hysterical

deafness

successful in curing it, such

as

applying

loud tuning-

212

ELECTUICAL

TREATMENT

fork to the teeth.

Faradic shocks, pushed to the painful

use.

degree, may
VAGUS

also be of
AND

SPINAL
are

ACCESSORY

NERVES

included affections of the soft palate, vocal cords, sterno-mastoid and trapeziimuscles. both sides Paralysis of the SOft palate may occur on
this head in bulbar palsy due to chronic degeneration of the nucleus ambiguus, or motor nucleus of the glosso-pharyngeal and
vago-accessory
nerves.

Under

It may

also occur

in bilaterally bulbar

as syringomyelia and tumours palsy due to other causes, cause will be postdiphtherit of the medulla ; but the commonest neuritis. On one side only the soft palate may

be sometimes paralysed in hemiplegia, or by a unilateral lesion of the medulla, in syringomyelia, or by meningitis implicating the vago-accessory nerve on one or tumour side Lead poisoning and syphilis may also of the medulla.
cause

phonation the raphe of the soft to the sound side, while at rest over the arch of the palate will hang lower on the paralysed side. Stimulation of the velum by faradism will not provoke a contraction on the paralysed side, while by galvanism a
palatal palsy. palate will be drawn

On

sluggish contraction may be evoked ; that is to say, there is RD. A laryngeal electrode should be used, insulated except at the tip, which is rested against the soft palate, and interrupted
or

reversed

given, using a current of 3 ma. should be a flat plate applied to the spine in the cervical region. This treatment may accelerate the recovery of the soft palate in post-diphtheriticparalysis, and possibly also

galvanic shocks should be The indifferentelectrode

in myasthenia. In the rare cases sequent to diphtheria, I have seen

by

of chronic bulbar palsy this treatment followed

considerable improvement

Laryngeal
a

fairly common

and recovery in two cases, paralysis." Loss of voice, or aphonia, is condition due to hysterical weakness of

of tl^e a,4ductiou vocal corda.

There is whisperingvoice,

APHONIA

213

with inability to phonate aloud ; and when the larynx is examined with the laryngoscope the vocal cords are seen to be of the normal brilliantwhite colour, but widely separated,
of adduction and only making very slight movements to phonate. Proof that the adductor on the attempt weakness is functional and not organic in origin is afforded

of an inconsistency in the power of the adductors, because, although they will not adduct the cords when attempting to phonate, yet in the reflex act of
by the demonstration coughing they act perfectly and close the glottis previous to the explosive expiration producing the cough.
comcondition of hysterical aphonia is most monly in young women, is apt to recur met with and like other hysterical symptoms. It at various times, has been frequently met with in soldiers suffering from

This

may of shell-shock, and combined ^be with hystericaldeafness. If of recent onset, it can often by electrical treatment, be cured at once though the
certain

forms

faradic
than
"

current

better for this purwill be much pose the galvanic. The laryngeal electrode should

be used a stiff wire ending in a small knob, and insulated from its binding*screw attachment up to the base of the knob. This electrode can be bent into any shape, and when

used
a

for intralaryngeal application it should be bent at right angle at a distance of two inches from its end. The

faradism used should be moderately strong, and should be previously tested with a suitable electrode upon the thenar powerful to produce brisk coneminence, being sufficiently tractions of the thenar muscles. The Wagner hammer of the faradic battery should be set to vibrate as rapidly and as loudly as possible,and then, before starting the machine, the electrode should be rapidly introduced over the back of the tongue into the larynx, so that the knob shall liesomewhere

the vocal cords. The battery should then be started, and the current application continued for periods of three or four seconds, the cutrent being now

between

214

ELECTRICAL

TREATMENT

ing started and stopped by a finger controlling the interruptThis is better than using a switch attached hammer. to the electrode itself, such as is supplied on the handle of
testing electrode." It is a much more certain way of stopping the current, and has the advantage of stopping time as the current the noise of the battery at the same
a
"

is arrested. functional or hysterical aphonia In a great many cases of. a rapid cure will be effected by this faradic treatment, the patient being encouraged to speak after the current has been turned on and ofi three or four times. Another way of treating the larynx is to use two small disc electrodes, and to hold one on each side of the neck against the larynx. With this method, either faradism or be used for stimulating interrupted galvanic shocks can the laryngeal muscles, and it is sometimes used in abductor current of paralysis of the cords, due to neuritis or injury the re-

laryngeal

nerve.

be unilateral or bilateral. When palsy may unilateral,it may be due to a lesion of the nucleus or of the foramen, from vagus between the medulla and the jugular

Abductor

rent meningitis or a growth, or to a lesion of the vagus or recurThe recurrent laryngeal on laryngeal in the neck. the left side is given off from the vagus in the thorax, and by winds round the aorta, and therefore may be damaged
a mediastinal tumour. When the vagoor aneurysm accessory is damaged at the base of the brain, or by a nuclear lesion of the nucleus ambiguus, the soft palate, as well as the vocal cord, is paralysed on the same side as the lesion,
an

while in recurrent laryngeal paralysis the vocal cord will be paralysed alone. in of the vocal cords is a common symptom myasthenia gravis. In this disease the muscles soon become fatigued, and whispering voice after a spell of talking, or
at the end of the day, is due to the fatigue of the laryngeal

Weakness

muscles.

Strong faradic or galvanic shocks

are

not indicated

HYSTERICAL in the treatment

MUTISM

215

of myasthenia, on account of the exhaustion of the muscles that can be produced by this means, at all events by faradism, the so-called myasthenic reaction. Hysterical mutism. This is a complete loss of speech
"

by any generally unaccompanied (see paralytic symptoms ante). It is usually seen in young women menof an hystericaltype, often as the resultof some tal

of functional origin, and

shock

or

prolonged anxiety.

It consists of complete loss

of all articulate speech, with preservation of the power of hearing and understanding everything spoken or written, and of the power of writing. It is to be distinguished from hysterical aphonia, and from aphasia of organic origin. From the former it is, of course, guished distineasily and at once by the fact that in hysterical mutism the patient is unable to speak a single word, while from aphasia of
organic origin the distinction may be much more In the mutism cases there will very likely be some

difficult. history

of

shock or excitement, but there will be no sign of right hemiplegia, such as is generally present in aphasia of organic origin. In hysterical mutism there will be perfect to understand all that is said or written ; but ability
nervous

the aphasic is almost invariably unable to write, and there may also be inability to understand spoken words or written characters ; that is to say, the aphasic will almost certainly
also show signs of agraphia, and perhaps also of alexia
or

amnesia. Hysterical mutism is especially likely to yield to electrical but either faradism by the wire brush, or treatment, sparks from the static machine, should be used rather than galvanism.

Laryngeal
laryngeus, is
a

epilepsy,
form

laryngeal

vertigo,

or

ictus

of reflex epilepsy which is especi* in the ally likely to occur o subjectsf bronchitis, or in those who have developed a stenosis of the glottis from
ulceration of the cords, fever. The attacks are
as

may

happen

after typhoid

typical

epileptic attacks, but

216

ELECTRICAL

TREATMENT

preceded for a few seconds by a definite laryngeal aura of a ticklingsensation in the larynx accompanied by a slight feelingof suffocation and vertigo, and they are quite distinct
quency the frethe laryngeal crises of tabes. I have seen of the attacks much diminished by regular intra laryngeal applications of faradism on alternate days, but

from

at

the

same

time, in suitable cases,

course

of bromide

should be given. The sterno-mastoid

and

trapezius

muscles

are

and supplied by the spinal portion of the accessory nerve, in cases to the vago-accessory at the jugular of damage foramen these two muscles will be paralysed and degenerate in addition to the soft palate and vocal cord muscles. These nerve fibres originate from the spinal cord as low down the sixth cervical segment, and join the vagus within the skull. The
as run

upwards

to

and trapezius muscles may, of cervical lesions of the cord, due to myelitis or chronic there will be additional pachymeningitis, in which case symptoms of spastic paralysis involving the lower limbs,
trunk, intercostals,and forearms. When the spinal accessory high in the neck, the sterno-mastoid and is injured trapezius will be paralysed without the vocal cord or

sterno-mastoid therefore, waste as the result

by operations near be injured palate. This nerve may the angle of the jaw,as for ligature of the lingual artery, in the operation of nerve-anastomosis for facial paraor lysis, in which the peripheral end of the divided facial is sometimes united to the spinal accessory, sometimes nerve to the hypoglossal nerve. The nerve pierces the sterno-

mastoid muscle at a point higher than where it leaves it at its middle posterior border. Between iti^ point of exit from the sterno-mastoid and its entry into the trapezius, the
is divided accidentally during an uncommonly operation for excision of tubercular glands in the neck, in This muscle, which case the trapezius alone will waste.
nerve

not

although it is also supplied by the third and fourth cervical

ATROPHY
nerves,

OF

THE

TRAPEZIUS
"

21?

generallywastes with virtualcompleteness upper, middle, and lower fibres as the resultof such a division of
"

The nerve is also sometimes the spinal accessory nerve. for the treatment of spasmodic tordivided intentionally ticolli on the central side of its entry into the sternomastoid muscle.
As
a

result,of

course

the trapezius,as

well as the stemo -mastoid, will waste. The appearance of the back and shoulder in atrophy of the trapeziusis characteristic.The shoulderappears more from behind, owing to square and hollowed out, especially

the loss of the thick muscular portion attached to the acromion and occiput. The clavicleis now visiblefrom behind, and the shoulder-bladehangs rather higher than itsfellow, due to the lack of the downward pull of the lower fibres and the unopposed action of the levator anguli
time, owing to the scapulaeand rhomboids. At the same loss of the middle fibres the vertebralborder of the scapula hangs further out from the middle line of the back, and

the scapula appears slightly winged, the lower border being tiltedinwards by the pull of the rhomboids. Paralysis and permanent atrophy of the middle and lower portions only of the muscle on one side may result from injury the third and fourth cervical branches ; nerve of
this occurred in
a

height

on

in consequence of a severe to his left shoulder, causing an

a

man

fall from
enormous

ha^matoma at the back of the neck. During the process of wasting after acute neuritisor the injury, electrical reactionswillbe those of degenerating
muscle, RD of varying degrees being found. Treatment should be given by daily applicationsof galvanism by the

labile method, the indifferent electrode being placed low down on the back, using a large round disc electrode for the kathode or treatment electrode, and a current of 7-8 ma. of divisionof the spinal accessory nerve, elec^ treatment willbe of no availunless the divided nerve trical

In

cases

218

ELECTRICAL

TREATMENT

sion has been sutured. This is usually not possible after dividuring an operatio" for the excision of of the nerve is probably tuberculous glands in the neck, as the nerve buried in a mass of glands, and a large piece of it is probably
excised along with the glands. the neck has divided the nerve,
persistent
treatment

If

accidental stab in then suture followed by

an

by

galvanism

of the paralysed muscle

months.

may after from

covery result in resix to twelve is not

Double

trapezius

palsy with atrophy

common un-

in the muscular dystrophies, in which both upper and lower portions of the muscle may completely disappear both sides ; but when this muscle becomes affected in on

progressive spinal muscular atrophy usually remains intact until late in the I have
once seen

the upper
course

complete double atrophy follow operation for clearing away tuberculous glands from both sides of the neck.

portion of the disease. of the trapezius

Bilateral atrophy of the trapezius does not cause falling forwards of the head unless the complexus and other deep cervical muscles attached to the occiput are also involved,
as

may

occur

in progressive muscular

atrophy,

or

chronic

meningitis.

Sprengel

shoulder is

condition of congenital malformation

of the shoulder due to atrophy or non-development of the middle and sometimes the lower fibres of the muscle, causing the angle of the scapula to become tilted and to hang farther out from the medial hue of the back. In some there is present a bony junction of these cases between the upper border of the scapula and the transverse
process of the neighbouring The hypoglossal nerve
may
or

vertebra.

be

by injured

an

supplying the tongue muscles operation about the floorof the mouth, side after the performance operation for facial paralysis in
on one

the tongue may

a

waste

nerve-anastomosis which the distal end of the divided facial nerve of

has been

AFFECTIONS

OF

THE

HYPOGLOSSAL

NERVE

219

sutured into a slitcut in the sheath of the hypoglossal I have seen a case of facial nerve. from resulting paralysis nerve viously, -anastomosis which had been done two years prein which the stemo as well -mastoid and trapezius, as ment of one-half the tongue, were wasted, though no improvehad taken place in the facial paralysis. The tongue in also wastes, usually bilaterally, chronicbulbar paralysis, due to an atrophy of the hypoglossalnucleus. This occurs as a lateevent in the course of amyotrophic lateral sclerosis, or in syringomyelia,and in progressivemuscular atrophy,
vascular lesionsof the medulla. The tongue appears small and wasted,and ismuch ridged, with fibrillary tremors ; while the patient cannot protrude it beyond the
tumours
or

teeth. Stimulation of the tongue by faradism or galvanism to willshow diminished muscular contractions both currents. One electrode hand, while the may be held in the patient's bare end of the other wire is used as the testing electrode. In
in other cases of rapid wasting of the muscle, the reaction of degenerationwill be found. While testing with galvanism, only a few cells should be
to the injuries nerve,
or

The to used, sufiicient give a current of about 3 ma. galvanic current stimulates the nerve -endings of the sense of taste, so that an acrid metallic, coppery taste will be noticed by the patient. This is stronger to the kathode than to the anode. This taste will also be perceived when the face is being treated for facialparalysis by

galvanism. In myastheniagravis benefit may sometimes followpersistent treatment of the tongue, palate, and pharyngeal muscles with galvanism, in those cases in which the bulbar there symptoms of weakness are prominent. In thisdisease
is usually no recognizablewasting of the tongue, though theremay be considerable weakness of the upper and lower due to nuclear facial muscles. In chronicbulbar paralysis,

lesions,there is almost always paralysisand

wasting

520

lELECTRICAL

TREATMENi?

of the orbicularis oris together with the atrophy of the In rare tongue. cases of chronic bulbar palsy there may be also great weakness of some of the upper facial muscles,

the orbicularis palpebrarum

and

the frontalis. Daily

creasin in-

injections strychnine, of
may

the

occasionally cause common type of

marked

with persistent galvanism, improvement, though in

amyotrophic to be of the sHghtest service. Bulbar symptoms also wasting may without muscular from symmetrical lesions above the medulla, in the occur pons, crura cerebri, internal capsules, or of the motor
cortex.
as condition is then known pseudo -bulbar is of no benefit. Electrical treatment

chronic bulbar palsy sequent to lateral sclerosis I have never seen galvanism

This

palsy.

CHAPTER
GALVANISM
PERIPHERAL
OR

VII

{continued)
MULTIPLE
NEURITIS

With

of lead neuritis, which is mostly a motor neuritis and confined to the upper extremities, due to chronic poisonmultiple neuritis is most commonly ing the exception

with alcohol.
sometimes

It is

fairly

common

theria, sequel to diph-

to diabetes, and

poisoning, rheumatism, tropical countries multiple neuritis occurs after beri-beri and It is thus always due to some malaria {see p. 152). culating cirlesion coninfectiveprocess, and the nerve sists degeneration of the axis of a primary parenchymatous cylinders. The condition is usually acute or* subacute, but

occasionally to arsenical septicaemia, and other fevers. In

toxin

or

chronic, as the drug is continually renewed after each period of forced abstinence improvement in the symptoms. and the subsequent Lead neuritis,in the large of cases, ispurely motor,

alcoholic neuritis may

become

almost

majority

trophic symptoms neither pain muscular tenderness, nor in skin, nails, or joints appearing ; painful cramps in the muscles, especially in the calves, are not uncommon.
nor

other forms of peripheral neuritisthe inflammation is of mixed type, motor as well as sensory, of the nerves though often in post-diphtheritic and sometimes in arsenical In most and in diabetic neuritis the symptoms
almost entirely sensory ; numbness and anaesthesia of the legs, with ataxic or cular gait, are often prominent, with little no evidence of musweakness or foot-drop, so that these cases have earned
the titleof
"

are

pseudo-tabes." Treatment, in the acute

"

stage of multiple neuritis,

222

ELECTRICAL
there is much

TREATMENT tenderness, it will not be in the treatment unless it is

when

pain and

advisable to employ galvanism hath. possible to apply it in the form of the galvanic electric In the most acute cases the pain and hypersesthesi^, may be
t S9 illense
as

to necessitate wrapping

the limbs in cottonwool.

Until this excessive tenderness passes off, no galvanism, massage, or strychnine injections be tolerated. will
In the less severe be employed method
cases

both massage

daily from

and galvanism may the commencejnent ; the labile ent should be used, the indifferof the limbs to be treated,

of applying the current electrode being fixed to one the kathode

a

and
6-8

ma.

being used for the active electrode, employing large padded disc electrode, with a current of The current may also be applied with advantage

of the "Schnee four-cell bath. Care is necessary in many cases of multiple neuritis to of the hamstrings and gastrocnemii, prevent contractures

by

means

legs remaining constantly flexed and the dropped. Passive movements, regularly applied, counteract this tendency.
from the
OCCUPATION NEUKOSES

feet

will

Various
commonest
"

met of fatigue spasms are with, the " as or writer's cramp," of which is known

forms

scrivener's palsy." An occupation neurosis declares itselfmainly symptoms

"

by
"

four

symptoms body which or

tremor the pain, weakness, spasm, and being referred especially to the part of the limb

with the repeated movement Thus, in writer's cramp the of the particular occupation. spasm affects particularly the small muscles of the hand the thumb and index finger, so that the pen or moving and is either dropped pencil is held with increasing difficulty At the forced through the paper by jerky or movements. time, the hand is tremulous in writing, and neuralgic same

is concerned

in the wrigt and forearm, especially pain is complained of

WRITER'S

CRAMP

223

the front of the wrist and in true writer's cramp are

These symptoms only noticeable during the act of writing, the hand and limb being perfectly normal for other The disease is more likely to declare itself movements.
near

the elbow.

in

neurotic
as

with subject,

family heredity for

nervous

ailments,
common

to do,

as
a

hysteria, epilepsy, insanity, etc. It is most in those who have long hours of cramped writing in lawyers' clerks, rather than in those who cultivate domestic

free style of writing, as reporters. Exciting causes that are usually present

are

illness, worry about money affairs, and other family titoubles. It is often precipitated by some local disease affecting the due to a draught blowing arm, as muscular rheumatism from
an

open

window

the commencement

muscular the limb may be congenitally weak from some such cause infantilehemiplegia, or a slight attack of infantile as an paralysis in early childhood. In the treatment of writer's it is m6st to inquire closely necessary, therefore, cramp
into the onset of the affection,and not only to examine the limb itself for any signs of local disease,but also to examine the nervous thoroughly for any signs of grave system is found, organic disease. If any such local or general cause be in the main directed towards its the treatment must if possible,though at the same time rest for the limb, cure, be beneficial. electric baths, may Treatment. In the treatment of ordinary writer's cramp, absolute rest from writing is the essential part ; and
perhaps
"

the right side, periostitis, even or organic spinal disease, as proof some gressive Or, again, atrophy or syringomyelia.
on

while daily massage,

a

galvanic

arm

with a In the and other worries, will help in completing the cure. adoption of a different pen and style of slighter cases arrest the progress of the disorder, or if the writing may

change of air and

scene,

baths, and if possible complete rest from business

leave his business it may be possible for him Electrical to perform most of his writing with his lefthand. patient cannot

224

ELECTRICAL
alone of occupation to failure; but in

TREATMENT
neuroses

treatment

doomed

conjunction

is almost certainlyment with, the treat-

may

treatment outlined above, various forms of electrical be of service;

Other occupation
cramp,

neuroses

that

are

met

with

are

telegraphist'

man's piano and violin player's cramp, hammerbesides. Cessation of the particucramp, and many lar is essential for them all. occupation There is another form of writer's cramp met with in

excessively neurotic individuals, in which the muscular mencement spasm and inabilityto write are most marked at the comof the day's work, or if anyone not perfectly familiar to them is near This is not a or watching them. fatigue spasm, but a habit spasm, or tic, and has been
I have seen this form called "pseudo-writer's-cramp." ideas of self-consciousness and associated with morbid mental depression. Such cases require general moral tonic
treatment,
scene,

sometimes Weir-Mitchell treatment, change of etc., rather than cessation from writing, massage, or
arm.

galvanism to the

SPASMODIC

TORTICOLLIS

Or spasmodic wryneck, is a form of spasm closelyallied to Indeed, the spasm turning the the occupation neuroses. be originated by the constant repetition in drawing a thread through as movement, of one leather, swinging a riveting hammer, etc. The condition

head to

one

side may

is to be distinguished from wryneck due to organic causes, of the neck muscles, cervical such as rheumatic fibrositis the neck is fixed caries, enlarged glands. In these cases in one position, and there is usually definitepain on movement, the neck twist is usually while in spasmodic torticollis clonic spasm, and though perhaps distressingthrough its

frequency and intensity, yet the spasm cannot be said to be actually painful. It is, in reality, a form of tic or habit spasm, and is a morbid reiterationof a jnoveflaent

SPASMODIC

TORTICOLLIS

225

originallyvoluntarily performed either on account of some or peripheral irritation, because of defective vision of the Constant that side, or for some similar reason. eye on
repetition of the movement, first, gradually becomes more

though entirely voluntary at

and
more

in response to the idea of the movement, becomes riotous in degree as the voluntary inhibition withisdrawn. Thus the spasms are usually worse when the patient is alone or unobserved, and, indeed, the patient in may have difiiculty demonstrating the morbid condition to the medical attendant. is frequently towards the Spasmodic torticollis more

automatic at last so that the spasm

left side, and consists of clonic spasms of the right sternomastoid, usually in association with the leftupper trapezius, splenius,complexus, trachelo-mastoid, and oblique muscles. Occasionally the head is turned to the right, and then the leftsterno-mastoid with the right posterior cervicalmuscles

There are generwillbe concerned in the faulty movement. ally to be found in the patient other signs of nervous instabilit deficientwill-power, hysteria,or other hereditary

neurosis. Echolalia, or

words or sentences those around, is a curious psychical symptom combined with spasmodic torticollis.
In the treatment, any peripheralcause be attended must

the impulsive repetition aloud of just spoken either by the patient or by

sometimes

for the origination

to, and regular of the movement exercises of the head and neck muscles should be performed daily before a mirror. Massage to the affectedmuscles, and

In certain obstinate good. also galvanism, may do some or cases where the spasm is only to one side,with little no bilateralretrocollic spasm, division of the spinal accessory

side, with division of the posterior branches on the other, may effecta of the four upper cervical nerves Relapse, on the other side, is unfortunately somecure. times
nerve
on

one

with. Galvanism should be applied

p

met

as

constant

current

of

226

ELECTRICAL
ma;

TREATMENT

3 to 4

to the back of the neck and to the sterno -mastoid The positive pole should be applied affected by the spasm.
over

the muscle near its insertion into the clavicle, using a ; while the negative round disc electrode IJ inches across

electrode,as a flat plate, is applied to the nape of the neck. The current should be applied twice a day for fifteenminutes time gentle faradism of the oppoat a time, and at the same site stemo-mastoid will usually increase the good effect.
KAYNAUD'S
DISEASE

or

form of vaso-motor tropho -neurosis defective circulation, the slighter forms of which are
an

This is

extreme

familiar to

us

as

dead

fingers chilblains. and

In Raynaud's

disease the extremities become cold and blue, and loss of tissue from small patches of gangrene are of not infrequent occurrence along the edges of the ears and the pads of the fingers. Occasionally larger areas of necrosis are seen, involving one or
more

fmger-

or

toe

and -joints,

even

lost above the ankle in this way. less symmetrical. There more or
no

the whole foot may be The condition is usually

is generally little or

pain, the deadness.

sensations being

more

of numbness

and

Raynaud's

disease is to be distinguished from

chronic

ergotism, from erythromelalgia, and from local asphyxia and cyanosis due to endarteritis and peripheral neuritis. It is also possible that the cyanosis of the extremities due to congenital heart disease might be mistaken for it, or the blue pigmentation due to silverpoisoning, or to the taking of blue or acetanilide. In erythromelalgia the methylene

affected extremity

swells up and becomes hot and livid, with swollen veins when the limb is hung down for a few or minutes, though there may be little nothing abnormal to be seen when the limb is kept raised. The pain, too, is

then throbbing and severe. it from Raynaud's

is,
moreover,

These two

points

serve

to distinguish

disease, and erythromelalgia usually associated with local endarteritis,

RAYNAUD'S

DISEASE
as

227
or

neuritis, or sclerosis.

some

spinal disease,

tabes

disseminated

Treatment.
constant-current

"

Kaynaud's

galvanic being carefully kept covered and warm in the intervals, in the winter time loose gloves being constantly worn. The

disease is best treated with baths given daily, the limbs

baths may be either full hydro -electricgalvanic baths, as already described, or the applications may be local by means than one limb requires of arm-baths or foot-baths. If more
be passed through the body the current may of the patient from one arm-bath to the other, as in the four-cell Schnee bath. The current should not be interrupted,
treatment,

but should be given continuously for twenty minutes arm the at a time daily. If only one requires treatment, limb should be placed in an arm-bath, with the forearm immersed up to the elbow, the fingers just reaching the electrode at one end of the bath. About 30 ma. of current

should be used, of which it may be reckoned that 10 ma. are affecting the forearm and hand, the rest passing between the electrodes through
reonly. If both arms quire treatment, two arm-baths should be used, and one electrode dipped into one, and the other electrode into the other in the water, Then, with both forearms immersed bath.

the water

of gradually until 10 ma. to run for twenty minutes. current are registered, and allowed has the positive electrode in the bath one The arm which

the current

should be turned

on

should have the negative electrode the next day, and No acid or salt should be put in the water, since vice versa. day
this addition diminishes the resistance of the water,

and

thereby wastes

more

current.

ordinary galvanic battery of eighteen cells will be of current quite easily capable of supplying the 10 ma. if the cellsare dry cellsand new between the two arm ; -baths but if only a single bath is used, with both the electrodes dipping into the water, it will be rather too great a strain

An

on

the small cellsof an

battery, since they ordinary dry-cell

228

ELECTRICAL

TREATMENT
as

will be supplying current three times case, out and will therefore be worn

fast as in the former

more

quickly.

As

ar

large plate electrode, well covered with alternative, one flannel or other wetted material, may be wrapped round the above the level of the water in the bath, care upper arm
that the electrode does not touch the water at all. Then all the current that is used is confined to the tissues of the forearm if only the hand is dipped in the water

being taken

be other electrode. If, however, the forearm completely plunged in the water, and the electrode applied to the upper arm, most of the current is dissipated into the with the in the region of the elbow, and does not affectthe lower part of the forearm and hand unless nearly as much current is used as when both the electrodes are dipped into the
water water,
one

at each end of the bath.

Erythromelalgia
means.

may

by this also be beneficiallytreated

CHILBLAINS

(ERYTHEMA

PERNIO)

Chilblains, one

condition somewhat but produces differenteffects. There is more in Raynaud's and itching and less cyanosis than

of the circulatory tropho-neuroses, is a ease, alliedto dead fingers and Raynaud's disswelling disease,

followed by peeling of the skin, and in bad cases and bleeding of the skin. Though there is
as
a

by cracking
never

grene gan-

on

result, the effect of the temporary malnutrition wards, the tissues is seen upon the nail as it slowly grows fora deep furrow corresponding to the date of the chilblain,

its effect upon the nutrition of the showing matrix of the nail. Various methods of treatment Treatment. have been and
"

advocated

for chilblains,

one

the mouth, on the the administration of calcium inflammatory swelling of the chilblain supposition that the is an oedema dependent upon a diminished percentage of Some in the blood. cases, undoubtedly, do calcium salts but certainly not all. Ichtliyol benefit by this treatment,

of the salts by

more

recent

being

CHILBLAINS

229

by the mouth has also been strongly advocated. Probably is by means the most effective and reliable treatment of A very efficientmethod, if begun sufficiently electricity.
early, before the chilblainshave reached the cracked and bleeding stage, is to use combined faradism and galvanism

and foot-baths. A large electrode attached to the over the positive pole should be wrapped round the arm elbow, and the hand placed spread out in water over another
arm-

in

The constant curpad electrode attached to the kathode. rent cates should then be turned on until the galvanometer indi5 ma., and then the faradic coil current should be turned gradually until the muscles are gently tetam'zed. It is to be remembered in administering combined galvanism faradism that the galvanic and faradic batteries and
on

be coupled up in series (see. 25); that isto say, that one p pole of the faradic battery is to be connected with the pole of ing opposite sign of the galvanic battery ; while the wires leadmust
to
two

the electrodes for treatment

binding-screws,
on

are

remaining

one

on

attached to the the faradic battery

and the other

or

the galvanic. In combined batteries provided with a de Watteville switch so that either current both can be led out of the same pair of binding-screws,

the battery should always be tested after being sent home, even as the instrument-makers, when skilled electricians,
always pay attention to this point. For instance, originally fitted up with wet supposing the battery were Leclanche cells,and the two cells for driving the faradic

do not

coil when exhausted have been replaced by dry cells; it the wires connecting the will then be necessary to reverse poles of the cells,as with dry cells the centre rod is carbon to is zinc, the reverse arrangement and the outside case that in
cells,while other wet cells have the zi^c placed outside the carbon, as in the dry cells. Faradism has a better effect on chilblains than has the
some

wet

direct current,
bath.

pleasant when given in a water and is more The effectof the soaking of the skin in water is not

230

ELECTRICAL

TREATMENT

good, however, especially in cold weather, in those persons with bad circulations who arc liable to chilblains,and it is therefore preferable to which
reason

in treatment of electrical For this moistening of the skin is not necessary. treatment by high-frequency currents is preferable,
use
a

form

using

electrodes on the condenser couch, the vacuum electrodes being applied locally. Hot paraffin-wax baths have recently been used with
vacuum

some

success,
wax,

the hands
kept
means

or
an

feet being immersed

even

daily in

the molten
or

at

even

more

by

of

an

of 105" F. electricheater at the bottom temperature

of the bath.
GRAVES'S
DISEASE

disease as it is goitre, or Basedow's on the Continent, is partly a neurosis, and partly named due to faulty metabolism from excessive hypersecretion

Exophthalmic

of the thyroid gland. The three most important symptoms are tachycardia, exophthalmos, and goitre. In addition, staring eyes, due to retraction of the upper eyelids,tremors, flushes and sweats, vomiting, diarrhoea, amenorrhoea, anaemia, pigmentation of the skin, insomnia,

and

other

mania, may supervene. and even neurasthenic symptoms, Rarely, some may be unilateral,such as the of the symptoms tion. goitre,the exophthalmos, the flushes, sweats, and pigmentaThe disease is very limited to young women, being usually between generally commencing the ages of 20 and 30, though it has been met with under 20. There is often a history of mental shock or worry,
uncommon men,

in

such

sick relative ; there is often a history, too, in the same family, such as torticollis the of of other neuroses " Brissaud, epilepsy, or torticolis mental of spasmodic type
as

nursing

"

insanity,

or

migraine.

The

to treatment,

may atrophy of the thyroid, with all the symptoms has followed some years later. myxoedema,

and

disease is often very resistant sionally continue for several years. Occaof

r B
^^^^K

GRAVES'S

DISEASE

231

It is not every case which presentsallthe typicalsymptoms 4-r\m as described tom above. The most easily recognizedsympone

is the staringeyes, due to the retraction the upper of thus exposing the white scleraaround the cornea. eyelids, If this symptom, described by Stellwag,von Graefe, and others,is absent, as sometimes happens, the disease may easily be mistaken. The most constant symptom is the tachycardia, and certaincases present the symptom of persistent

tachycardiawithout any ocularsymptoms or goitre; and yet from the historyof the onset, with the presence of sweats, etc., it is other neurasthenic symptoms, flushes, probable that these cases are to be classed in the same group as Graves's disease, and they are sometimes spoken " larvalGraves'sdisease." of as

The treatment of Graves'sdisease may be grouped under four headings :

"

Treatment.

1. Greneral management 2. Drug treatment;

of the

case.

3. Operation for removal of the thyroid gland. treatment. 4. Electrical 1. The general management of a case of Graves'sdisease Rest, isperhaps the most important part of the treatment. both physical and mental, is essential, avoidance of worry

with country life, and excitement, and regular hours. Quiet as an occupation,an hour's rest beforelunch, and gardening half a mile as the limitfor a daily walk, should be the line
for a year or two. If the tachycardia, of treatment, if possible, dyspnoea, and other symptoms are severe, complete on rest in bed or on a long couch must be insisted for several weeks. 2. The drugs that are usually employed in the treatment belladonna,nd bromides. More a of thisdiseaseare digitalis, on the suggestioni of Moebius, a drug named recently,

has been employed. This is prepared from aniithyroidin the serum of sheep whose thyroid glands have been pre-

232

ELECTRICAL
by

TREATMENT

operation. I cannot say tliat 1 liave in which I have seen any particular benefit follow in cases used it. It is, moreover, costly. 3. Removal of considerable portions of the enlarged provemen imthyroid by operation has been followed by immense
viously removed in many hands, is
cases.

in experienc operation, even a such patients very dangerous one, often bearing any form of inhalation anaesthetic extremely badly. Destruction of the glandular tissue may be attempted
The

in other ways, such as ligation of the superior thyroid arteries, or by injection the gland with boiling of Next to these methods in value is exposure of the water.

goitre to repeated doses of X-rays. If the whole gland is extirpated there is danger of the disease being complicated by the symptoms of myxoedema. Operation is sometimes urgently needed when there is
ing evidence of compression of the trachea or oesophagus, causdyspnoea or dysphagia. Division of the isthmus of the

gland may

then suffice to release the trachea from Various methods

sure. pres-

4. Electrical treatment."

have been

by advocated by different observers ; namely, treatment the faradic current, by galvanism, by X-rays, by cataphoresis with iodine, and by electrolysis of the gland.

Vigouroux's treatment

by

means

of faradism

by Charcot. The method recommended differentmodes of application of the current : {a)faradization of the carotid, (b)faradization of the eyeballs, (c) faradization of the goitre, (d)faradization of the praecordium.

strongly consists of four

was

The (a)Carotid faradization. positive

"

coil is attached to a cervical spine, while the negative electrode, which is small and olive-shaped, is pressed on the carotid artery, J inch

duction pole of the inlarge electrode applied to the

below the angle of the jaw,between the tip of the hyoid bone and the anterior border of the sterno-mastoid. The

GRAVES'S

DISEASE

233

is electrode pressed on the vessel until the pulsations are felt, The vibrations the head being turned slightly away. of the interruptorshould be rapid and the strength of the current justnough to throw the platysma into gentle cone traction This is continued for one and a half minutes, the
the other side. Diminution of the pulsations,pallor of the skin, and lowering of the follow, effects which last longer surface temperature
on

process being then repeated

after repeated applications,

(6)Faradization of the eyeballs. This is done by

"

ing pass-

the

same

olive-shaped electrode around the eyes, using

just sufficient trength s

of current to produce contractions of the orbicularis. This should be done for two minutes being to cause on contraction of the each eye, the

object

blood-vessels the back of the orbit,sinceit islargelythe at congestion of the fatty tissueat the back of the eyes which
the exophthalmos. Faradization (c) ofthe goitre. Leaving the electrodeon the cervical spine in place,the olive-shapedelectrode should be changed for a small flat one about \\ inches square.
causes
"

the thyroid just above should be placed over the episternalnotch, or, if the goitre is large,it should be placed alternatelyon each lobe for two minutes.
This treatment
is supposed to
cause

This

contraction of the ternal in arteries the goitre,and to produce an effecton the insecretion. That the arteriesin the gland are much dilatedin Graves's disease is evident from the loud bruit, systolicin time, that can be heard there by placing the stethoscope over the goitre. This bruit is never heard over the goitrein cases of cysticor parencyhmatous bronchocele.
"

A {d)Cardiac faradization.small flat electrode attached

to the positive pole of the secondary faradic coil

the heart, strong enough to produce weak fibrillary and a current just contractions of the pectoral is applied for between two and
is placed
on

the third leftintercostal space

over

three minutes.

234

ELECTRICAL
As
a

TREATMENT

result of this treatment, after repeated sittings a is rapid improvement, with diminution of the symptoms, the tremor and goitre being the firstto subsaid to occur, side, the exophthalmos and tachycardia are more obstinate and persist much longer. Another method of electrical treatment of Graves's while disease is by galvanization. For this purpose a well-padded flexibleelectrode of 5 inches by 4 inches is attached to the negative pole and carefully applied over the goitre, so that it is in perfect apposition with the skin and pressing the thyroid swelling. The evenly over positive electrode is applied to the back of the neck, and a steady current of 15 to 25 ma. passed through the goitre for twenty It is to be remembered that in Graves's disease minutes. the electricalresistance of the skin is less than in normal persons, and therefore a less number quired of cells will be resend a given milliamperage of current through For this reason the skin than in other cases. great care be taken with the negative electrode over the goitre, must to the thinness of the skin there, it is very easy as, owing
to produce
an

to

unpleasant

burn

through unequal

of the pad, or through using too strong a more than 10 ma. should be used for the firstfew minutes, and care must be taken that the pad is thoroughly wetted.

pressure Not current.

Of the two is in the

majority

forms of electricaltreatment, galvanization of cases to be preferred to faradization in

as
a

Graves's disease ; but if dyspnoea is present is contra-indicated and electricaltreatment probably

necessary.
LEUKiEMIA

symptom,

surgical aid is

AND

SPLENIC

ANEMIA

May

by means cases also be treated with advantage in some of galvanization of the enlarged spleen. The size of the the spleen must vary with the electrode to be applied over
size of the organ ; if the spleen reaches beyond the navel in an adult, a pad electrode of about 7 inches by 4 inches

LEUKEMIA

AND

SPLENIC

ANAEMIA

235

should be applied closely over it,and kept in position on the by means A similar electrode abdomen of a wide bandage. the posterior pole of the spleen should be ajiplied over close to the spine. Care is to be taken in all such applications
that the pad is thoroughly wetted and is The in close apposition to the skin over its whole area. the spleen in front is to be attached to the electrode over of galvanism negative pole, and
on
a

current

and

allowed to run daily treatment

of 15 to 20 ma. gradually turned sistent Persteadily for twenty minutes. by this means has been recorded to

produce considerable amelioration of the s)fmptoms, and I have certainly seen in the size of the great improvement in spleen, with marked reduction in the leucocytosis, occur

leukaemia

had replaced the after the galvanic treatment treatment by arsenic, when arsenic alone had apparently done nothing but provoke severe bilateral herpes zoster on
the trunk.

successful treatment of leukaemia is,however, The leucocytosis in splenic leukaemia may be by X-rays. dissipated, with rapidly great general improvement.
The
most

Eelapse

is, however, appears

liable to
much

the treatment

when lessened.

recur,

the efficacy of

CHAPTER
GALVANISM
ELECTROLYSIS

VIII

{concluded)

method of employment of the galvanic current is largely used fgr the destruction of naevi, hairy growths, and superfluous hairs and small moles upon the skin. It has
also been employed fibroids,scars, and By in the treatment

This

of aneurysm,

uterine

strictures. the decomposition electrolysis is meant

of

stance sub-

into its chemical elements, by the passage of an electric it. The current must be constant in current through

direction, or

chemical decomposition does not occur. Electricity appears to be conducted in one of three ways : (a)by radiation, as in the aerial waves of wireless

telegraphy ;

(6)by metallic conduction, in w^hich the

condition

of the conductor is not altered by the passage of the in by electrolysis, which the conducting subcurrent ; (c) stance by the passage of the current. Theory of ions. ^According to Arrhenius, substances in solution may be divided into two classes : those whose dissociation into their elements, and molecules undergo
"

is decomposed

those whose molecules do not dissociate. Substances of the former class are the electrolytes; those of the latter are non-electrolytic. The only substances which are electrolytes
as

the acids, bases, and salts. Other substances, such sugar, urea, albumin, and colloids do not dissociate
are

at

all when

in

solution, and

therefore

are

not

electrolytes.

Water

that is chemically pure is

a

non-conductor,

therefore to render water

conductor

and of electricity it is

236

THEORY

OF

IONS
an

237

necessary to add to it a small quantity of

or
a

acid, an

alkali,

of these substances is in solution, a certain number of its molecules are dissociated into the two atomic or molecular groups composing it the hydrogen or metal
"

salt. When one

positive charge of electricity, and the acid radicle with an equal negative charge. It is these groups that " ions." Thus, common Arrhenius has named sociated salt is diswith
a

and CI, sodium and chlorine,while sulphuric acid is dissociated into two ions of hydrogen and The more the ion SO*. concentrated the solution the fewer into the ions Na
the molecules that are dissociated into their constituent ions, whilst in a very dilute solution all the molecules may be dissociated into ions. When a is constant current
are

passed through such a solution between two electrodes, the electro-positive ions that is to say, the bases such as come sodium, potassium, hydrogen, and other metals ^willbe"

"

positively charged and will be therefore repelled from the positive pole and attracted towards the negative or

kathode ; these ions are therefore called kations, or cations. The electro-negative ions oxygen, chlorine, iodine, acid
"

radicles,etc. will become charged negatively and will be therefore repelled from the negative and attracted to the These ions are therefore called positive pole or anode.
"

anions.

The

combination kation in the solution containing hydrochloric acid (HCl), whilst in a solution of potash (KOH) the potassium acts as the kation and the hydroxyl group OH is the anion. The rapidity of the movement of the ions in the electrolyte that is to say, the rapidity of the electrolytic action varies directly with the voltage of the current,* and also with the
" "

may be electro-positivein one Thus hydrogen is a and negative in another.

same

element

temperature, action. the more

current.

the cold diminishing and heat augmenting lighter the molecular The weight of the ion rapidly will it diffuse under the action of the

Hydrogen

has

tlie lightest molecular

weight

238

ELECTRICAL

TREATMENT its ion

moves

of all known

substances, and

the most

rapidly. The method

of conduction of the galvanic current through the living body is by means of electrolyticaction, and it is by the application of the theory of ions just described
that the administration of drugs through the skin by means of the galvanic current is to be explained. This process is generally known by the term ionization, or cataphoresis.

salicylicacid are the two drugs used by this in their method whose ions are usually electro -negative chemical relations,and therefore act as anions. On that these drugs must be applied to the skin by means account Iodine and of the negative electrode, since being anions they will be trate attracted towards the positive pole, and will therefore penethe skin and enter the tissues when placed under the

The iodine may be either negative electrode or kathode. painted on the skin, or a solution of iodide of potassium ment may be used to soak the padded kathode in. This treatis used for rheumatic joints, and sometimes for enlarged lymphadenoma. Salicylicacid is best glands, as in

used

dilute 2 per cent, solution of salicylate of soda applied to the kathode or negative electrode. The acid or salicylradicle under the action of the galvanic current will
as a

its way to the positive pole. Ionization, with salicylateof soda, is sometimes very useful in neuralgias, and especially in rheumatic neuritis, as
then
enter

the tissues

on

p. sciatica or brachial neuritis {see 168). The metals and the alkaloids will act as kations during the passage of a galvanic current, and in order to cause them to penetrate into the tissues by means of ionization it will be necessary to apply their solutions to the anode positive pole. Lithium is thus used in the treatment
gouty joints, in so-called rheumatic gout. and of lithium chloride or carbonate is applied on
or

of

A solution lint under

the positive pole to the jointequiring treatment, while at r time iodinemay be painted on the skin under the the same

CATAPHORESIS

239

kathode,
potassium

or

the kathode iodide.

If
a

may large

soaked in solution of is as joint, the knee-joint,

be applied side of the
on

be

affected,the anode and lithium may

the electrode

joint, while moulded closely around one the kathode and iodine may be similarly applied on the It Edison who, in 1890, first other side of the joint. was
for the solution suggested the use of lithium by this means in the tissues of the gouty deposits of biurate of soda ; for lithium urate is soluble in 116 times its weight of water,
while sodium urate requires 19,000 times its weight of water for solution. Thus the foot or hand which is to be treated is placed in a bath of hot water containing 2 per cent, of lithium chloride, and attached to the positive pole ; while the negative electrode, as a large plate, may be applied to the spine. A current of 40 or 50 ma. should be used for twenty or thirty minutes, great care being taken that it is not suddenly interrupted.

Zinc ions are recommended

ulcer, the mode
button-shaped
positive pole.

for the treatment

of application being by means electrodes of differentsizes attached to the

of rodent of bare zinc

Unhealthy
treated by
means

granulating

wounds

may

be beneficially

of lint soaked the wound, and

means

of zinc ions, a pad of several thicknesses in zinc sulphate solution being fitted over

of a density of 1 to

connected to the positive electrode by A current of a bare zinc plate laid on the pad.

the square inch of electrode should be used for ten to fifteenminutes at a time, two or three times a week.

IJ

ma.

to

All the alkaloids

tracted electro-positive,and so are attowards the negative pole. To force them through
are

they must, the skin by means of a galvanic current, therefore, like the metals, be applied by means tive of the anode or posipole. The alkaloids thus used are cocaine, morphine, aconite, and quinine; Each of these has been used for the
treatment

of neuralgias, such astic -douloureux. If a solu-

240

ELECTRICAL

TREATMENT

tion of aconite or cocaine be applied to the positive pole and held against the skin while a galvanic current is passed

for several minutes, it will be found that the skin is or less anaesthetized, a prick not being feltas sharp.

more

That drugs
by
means

are

of Leduc's experiment with two rabbits showing conclusively be killed by the that one of the animals can

undoubtedly introduced into the tissues ionization has been abundantly strated, demon-

introduction of strychnine or cyanide by this process. In his fastened side by side upon a experiment two rabbits were board, and two pad electrodes were closely applied to each,
one

each side of the back of the animal, so that there were four pads in a row A, B, C, D. A was coupled to the positive pole of the battery and D to the negative, while
on
"

B and C were together by a wire, the two animals joined being thus coupled up in series with a galvanic battery. The pads A and D were soaked in a solution of common salt, and the pads B and C in a solution of sulphate of strychnine. The current was then turned on gradually, about 50 ma.

being used. After some time it was found that the C D rabbit developed increased deep reflexes, died in conand later still vulsions. When substituted for this another rabbit was
one

the
new

thing happened, but if,after replacing with reversed in direction,the A B rabbit, the current was
same

one was rabbit died, whilst the new unaffected. Now, in the original arrangement of the current the C D rabbit had the positive electrode C soaked in strychnine solution,

whilst with the A B rabbit the strychnine was applied to the negative electrode B. It is clear, therefore,that the C D rabbit was poisoned by strychnine entering its body from

the positive pole, while the A B rabbit was unaffected by the this strychnine on the negative electrode, though when made positive by reversing the current this electrode was It follows that it is the action of rabbit died also.
the current and not the
that
mere

causes

the

drug

to

enter

the

tissues,

soaking of the skin with the drug in solu-

ELECTROLYSIS
tion.

241

If, instead of strychnine, cyanide of potassium solution is used for the electrodes B C on the two rabbits, B being the negative electrode or kathode, and C the anode positive, it will be found that the rabbit A B will be killed by cyanide poisoning, while the rabbit C D will In this case the cyanogen radicle,being an escape harm.
or

anion, enters the tissues from the negative pole on its way to the positive pole: A simple experiment will demonstrate easilyand quickly tion this passage of the anions and kations, with the decomposi-

of the electrolyte. Moisten a piece of white blotting paper with water and lay it flaton a board or marble slab. Take the two wire terminals of a strong galvanic battery and hold them on the blotting paper an inch apart. Then put a drop of iodide of potash solution close to the negative
wire

an^

and turn

on

drop of starch solution next the positive wire, A bright blue colour ap10 ma. pears of current.

the positive wire owing to iodine driven from the negative wire and liberated in the starch. With a stronger current, small flashes and sparks will appear at the negative pole owing to the rapid oxidation of the potassium around
ions attracted to the kathode. If salicylate of soda is used instead of iodide of potassium, most of the sparks

and burning will appear at the positive pole owing to the further decomposition of the salicylradicle. As was said above, pure water is a bad conductor of the electriccurrent, and requires the addition of a trace of an electrolyte,acid, base, or salt, in order to render it a good It is then decomposed by the passage of a conductor. kations appearing at the current, the hydrogen constant negative electrode as small bubbles, while the oxygen either of copper, steel, etc., or oxidizes the anode if it is made The mechanism of appears as bubbles if made of platinum. this process of decomposition of the water, or electrolysis,
is no by

doubt due to the stress set up in the molecules of water the difference in potential of the anode and kathode.

242

ELECTRICAL

TREATMENT

molecules, charged with equal and opposite quantities of electricity,have entered into to form water, neutralizing their electric combination pelling charges ; but these are again splitasunder under the comand
oxygen

The

hydrogen

force of attraction of the anode and kathode for the separately charged constituents of the water molecule. Just as no evidences of the transfer of these ions is seen of the electrolyte, but only at the poles, so during the passage of an electriccurrent through the body

in the body

except at evidence of dissociation of the tissues occurs the skin in contact with the electrodes. If metallic electrodes in contact with the skin this will be rapidly softare ened
no

the action of the caustic alkali generated at the kathode, and of the acid at the anode, if the bare metal and, therefore, so-called burns will occur
and

destroyed

by

is allowed to remain for long in contact with the skin. Hence, in the ordinary applications of the galvanic current, pads soaked in a solution of some electrolyte, such
as

the metal electrodes so weak saline, are fitted over that the products of electrolysisshall take place within the
a

pads and not upon the skin. Thick pads of felt, Gamgee tissue,or a dozen layers of lint should be interposed between heavier the metal electrode and the skin, when much
be tolerated without damaging the skin than if only thin coverings of lint or webbing are used. With strong currents, however, and prolonged applications, the acids,and alkalis generated may soak through the pads
currents
can

and
when

cause

damage

to the skin.

It is, therefore, necessary

using strong currents for any length of time to it. examine the skin from time to time to avoid injuring The firstsign of injury the skin will be a smarting pain to and the appearance of a small blisterunder the electrode, the skin underneath becoming dark -coloured and ulcerated if the current is not stopped. Nasty sloughing wounds may be thus produced, which take
scars,
a

long time to heal and

leave perm^pent

ELECTROLYSIS:

NiEVI

243

This destructive action of the electrodes is made use of in the treatment of naevi, moles, uterine fibroids,etc.
NiEVI

usually situated about the head or neck ; they be subcutaneous, forming small tumours may under the skin, or they may involve the skin also. They may be large These
are or

small, from small red spots on cheek to a large port-wine mark.

at birth, and often grow

or the side of the nose They are often present

Naevi may With the former method two or the unipolar method. one needles at least are inserted into the nsevus, attached
to the positive and

rapidly if not operated upon early. polar be treated by electrolysiseither by the bi-

the other to the negative pole. Bipolar method." The two needles should be of platinum and should be inserted through the skin into the at about J inch apart, should substance of the nsevus the size of the nsevus be allowed to touch permit
one

this. The

needles must

not

After sterilization, they inserted, and the current must be turned on gradually are to 15 to 20 until the strength of current passing amounts ma. per inch of positive needle. The immediate effect of

another.

turning

on

the current

is to

cause

of the tissues, especially around froth and bubbles of hydrogen

blanching and hardening the positive needle, while

gas

escape of the negative needle, which also becomes few seconds the tissues turn livid around a

the side loose. After

by

needle, when the current must taken out and reinserted in a fresh place, not too close, or This process is to be consloughing is hable to ensue. tinued that enough has been done until the operator judges for sitting,as sloughing of the tissues is to be avoided. Small na)vi can often be satisfactorilydealt with at the first
one

the negative be turned off and the needles

attempt,

but larger
a

ones

may
one,

process is

very painful

require several sittings. TJie and a general anaesthetic is

necessary;

244

ELECTRICAL

TREATMENT

Unless the nsevi are large, the two needles will be sufficient. Each should be held in a special needle-holder with
a

clamp to hold any sized needle. No current the handle is necessary, or even advisable. If the needles are allowed to touch when inserted in the naevus the patient will get a sudden shock each time they circular screw interrupter on
are

touch and
an

released, and, though

anaesthetic, such shocks are of the head and

the patient is under not advisable in the neighbourhood Sometimes neck. partially

insulated needles are used, the needle being covered with a thin coating of rubber or shellac to within a third of an inch of the point. This is to avoid causing electrolysis of the skin at the point where the needle is inserted through it
to reach
a

subcutaneous

naevus.

Such insulations are,

ever, how-

to rarely satisfactory,as thsy render it very difficult insert the needle properly, and also prevent the proper a sterilization of the needle before using point which
"

should always be attended to. A steel needle should never be used for the positive needle because of the indelibleblack stain which it always leaves upon the skin at the point of
entry. For large nsevi a specialneedle-holder, devised by Lewis Jones, may be used, in which three, four, or five needles may be screwed into the holder, arranged like the prongs of a fork, ment this instrunegative. With alternately positive and
the

needles
naevus,

may

be

moved

within

the

and

all parts
This

a as about of it brought

whole
under

treatment.

is specially useful method in those cases is very small and involves where the naevus the skin. As a rule, the negative pole is used for the active electrode. The positive pole should be attached to a flat

Unipolar

method."

plate electrode which wrist, back of neck, away

may
or

be applied around

the patient's

from the head.

an

negative pole, and

any convenient and accessible spot The needle-holder is attached to the ordinary sewing-ne(?dlemay be usod,

ELECTROLYSIS:
as

DILATED
of producing

VENULES

245

there is

no

danger

black spots in the skin

with the negative needle.

head naevi and dilated venules on the face, forebest treated by the unipolar method of or are nose electrolysis. The positive plate is folded close round one
wrist, and
a

Spider

fine sewing-needle

(No. 8) fixed in the

screw

clamp of the needle-holder attached to the negative pole. No current interruptor on the handle is advisable, as the

should be turned on before the needle is applied to The needle must be sterilizedeach time before the naevus. use ; but it is best not to do this by passing the needle
current

fine deposit of oxide may be formed upon the point, which may leave minute black it by heat first, should aftermarks in the skin. If sterilized wards through
a as a

flame,

in this way

be passed two bolized lint to ensure

piece of carthe point being clean. These small on the face, naevi and dilated venules are very common become sometimes especially after the age of 30, and The or large to be worth numerous removing. sufficiently
centre

or

three times through

point of the venule must be carefully looked for, and the needle-point steadily inserted to the base of the naevus

and

held there for from

of current

to five seconds, the strength The immediate required being from 0-5 to 1 ma.
one

the effectof the application of the needle-point is to cause venule to contract and the red spot to disappear ; great care must therefore be exercised and the hand held steadily
so

it is applied. that the needle-point is not moved once The pain of this procedure is considerable, and cannot be borne by a great many persons without flinching. In
case

by it is advisable to anaesthetizethe skin first means of ionization with cocaine, using a circular disc electrode for the positive pole, and applying it, after moistening it that

with cocaine solution, over the naevus. the size of a halfpenny, a current ])e passed through it for five minutes.
under the pad is then tested with
a

Using

disc electrode should of skin

of 4 to 5 ma. If the area

or

pin-

needle-point,it

246

"

ELECTUTCAL

TREATMENT

will be found comparatively analgesicto the surrounding skin owing to the ionizing action of the positive pole in forcing the cocainethrough the skin into the tissues. It is to be remembered thatcocaine, behaves like being an alkaloid, base and is electro is attractedto the negaa tive -positive,nd It must thereforebe applied to the skin under pole. the positivepole in order to make it enter the tissuesby means tially of cataphoresis. With the skin thus rendered para

the pain produced by the electrolysis will analgesic, be considerablydiminished.

If there are many such small naevi and dilatedvenules on the face to be treated,it will not be possibleto treat them all at one sitting. As a. rule,not more than four
punctures for electrolysis should be done without an anaesthetic.Although the immediate effectof puncture of lows the nasvus is the disappearance of the red spot, there fol-

almost at once a slightswelling around the puncture, making it resemble somewhat the bite of an insect or the stingof a nettle. For the rest of the day the area treated will appear somewhat flushed and will feelhot, especially if cocaine has been used ; and it will be well to dust the earth or similar powder. It is skin with a littlefuller's a good plan to treat the two sidesof the face on alternate

days if several sittingsare necessary. Some skins react more than others to the treatment, and in some all trace of the swellingwill disappear in three days, while in others it may take a week before tiie skin looks quite normal
again. The effect the electricuncture is to destroy the walls p of to clot the blood in them by fillinghe t of the venules and tiny branches with bubbles of hydrogen gas, and the current s should be sufficientlytrong to show minute bubbles at

than a couple of the point of the needle ifheld for more dilated seconds. As a rule, with the tiny superficial than the point venules it is not necessary to insert more
of the needle.

ELEOTROLYSIS

SUPERFLUOUS

HAIRS

247

It is important to remember to attach the needle-holder to the negative pole, for if the delibl positiveis used, black inmarks are leftin the skin.
SUPEKFLUOUS
HAIRS

AND

MOLES

Large moles, as in the case of large naevi, are usually best treated by the actual cautery or by excision, the as

length of time required for electrolysis too great, and the is result less satisfactory. Small moles one -eighth of an inch across or less may, however, be well treated by electrolysis and the resultantscar is lessnoticeablethan with cautery or knife. Two needles should be employed for the larger ones positive needle,at allevents, made of platinum ^the
"

by and the mole should be transfixed the two needles being taken that the needles do not care at opposite sides, touch. A current of 5 to 10 ma. should be used for fiveto fifteen seconds. The part must be previouslyanaesthetized
"

by

the degree of anaesthesiaobtainable by cataphoresis will not be sufficiently deep.

a

subcutaneous

injectioncocaine, as of

Superfluous hairs on
in front of the
women, ear,

the face, as

and may
a

may cause be conveniently removed

upper lip,chin, or in considerableunsightliness

on

by electrolysis.

It is,however, if the hairs are

prolonged and somewhat painful process Considerable practice is necesnumerous. sary

to perform the small operation of electrolysis the of

hair-follicles neatly and surely ; for, as Lewis Jones says, it really amounts to a catheterization the hair-follicles. of
The positivepole is attached to a flexible ened electrodeand fastround the patient'swrist or any other convenient exposed portion of the skin ; while the negative pole is attached to a needle-holder, using a very fineplatinum wire in the place of a needle. The wire, bluntended, is better than a pointed needle,for it is lesslikelyto penetrate elsewhere

The patient reclines than into the hair-follicle. with head thrown back, in a good light; three cellsof the the

248

ELECTRICAL
are

TREATMENT

sufficientto give a current of from IJ to 2 ma. when the wire is inserted. The hair is gently pulled with the left hand, and the platinum wire is passed as close to the root of the hair as possible so as to enter battery
turned
on,

distance of about one-eighth of an inch. It is held there for about five seconds, small bubbles of hydrogen gas escaping beside the root of the hair ; and for the hair-follicle
a

the hair should then be pulled out by using gentle traction. The pain is certainly sharp, but can be borne, and cocaine
cannot
ensues,

after a be attacked at

in most be applied. Very slight scarring cases and, if carefully done, it is practically invisible Several hairs close together should not week or two.
one

the whole area to be done being sitting,, done on each day depending gone over equally, the number on the endurance of the patient and varying from ^vq ten to three or four times that number. or
STRICTURES

destructive action of the negative pole has been made use of in the electrolysis of strictures of the urethra, structio nasal duct, and oesophagus, and lachrymal obstruction. Obor in the canaliculus leading to the at the punctum
The lachrymal
sac a

attached to

cured by using the negative pole fine platinum probe passed into the punctum

has been

and along the canaliculus, using a current of 2 to 3 ma. Traumatic stricture of the oesophagus, due to cicatricial contraction has also been said to be after swallowing corrosives, relieved by electrolysis with
a

small olive-shaped metal

or
ma.

the negative pole attached to flexible bougie covered with

rubber 3 or 4

Not more than celluloid nearly up to its end. should be employed, for ten minutes at a time on

alternate days.
FIBROSITIS
" A method of electrolysisor puncture electricneedle Davies for the treathas been elaborated by Dr. Naunton "

ELECTROLYSIS:
ment

FIBROSITIS-SCARS

249

affecting of chronic rheumatic and gouty fibrositis A needle, insulated by a the limbs or back muscles. rubber or shellac covering to within an eighth of an inch of its point, is inserted deeply into the site of the pain or tender point, the other end of the needle being connected by a holder to the negative pole of a galvanic battery.
The may

positive electrode should be moderately large, and be apphed to the limb that is being treated, or to the A
current

spine.

of 2 to 3

ma.

is turned

on

for

few

seconds, and the position of the needle then shifted to cover the whole area what of the fibrositis patch. It is a somepainful process, and several sittings may be required,

but excellent results have

been achieved.
SCARS

Large

tough

scars,

such

as

those resulting from

are after gunshot wounds, adhesions to the tissues underneath.

puration supoften painful from They may be rendered

freed from supple, smaller, and sometimes their adhesions by ionization. A thick pad of twelve to fourteen thicknesses of lint, cut to fit the scar, is soaked
more

in weak

copper electrode attached to the negative pole of the battery is firmly pressed on the outside of the lint. Since the negative solution, and pole is used A current
as over

iodide of potash

zinc

or

the

scar,

no

strong as 2 to even be used with these thick pads electrode may fifteen minutes at a sitting.
FIBROIDS

metallic ions will penetrate. 3 ma. per square inch of

for ten

to

Uterine fibro-myomata
and his followers by means The method is troublesome

have

been

treated by Apostoli

of intra-uterine galvanocausis.

tings sitand prolonged, numerous being necessary ; and in the of majority cases the be dealt with better by surgical operation. condition can Certain
cases,

however,

have

been

considerably improved

250

ELECTRICAL

TREATMENT

by

the intra-uterine galvanization, especially hsemorrhagic fibroids,the bleeding becoming arrested and the fibroids diminishing in size.
The

method is as follows : An intra-uterine sound, made of platinum, is passed into the uterus, under antiseptic precautions, and is protected by an insulation covering from

the vaginal walls and external parts. This, the active ent electrode, is attached to the positive pole, while the indifferelectrode, or kathode, is applied to the anterior abdominal formed by Apostoli of wall. The kathode was
The kathode china clay, but this is unnecessary. be of large surface, and should consist of a flexible must leaden plate 10 inches by 7 inches. The best way to apply this to the abdominal wall is over a sheet of wetted cottonwool.
moist

and

larger than the metal elecThis should be cut a little trode in dilute hot saline solution, and thoroughly wetted then applied uniformly over the lower part of the

it and the metal electrode carefully fitted over so as to be in complete apposition with the wet wool over its whole surface, but yet not touching the skin anywhere. Great care be taken before turning on the current must abdomen,
that all the screw connections of the wires to the battery quite tight, because with the and the electrodes are

tion heavy current used in this treatment any sudden interrupdue to a loose wire connection or any other cause A strong would give a serious shock to the patient. battery is necessary to provide the current, and when the electrodes in position the current must be turned on indicates 50 ma. This gradually until the galvanometer current is allowed to flow for six minutes, and is then
are

gradually turned off and the uterine sound withdrawn, a vaginal douche completing the operation. The process should be repeated on alternate days,

the intensity of current

to

60, 80,

or

even

being raised on subsequent occasions It is most 100 ma. important,

current,

during the passage of this heavy

that the patient

ELECTROLYSIS: should keep

ANEURYSM

251

and that neither the uterine absolutely still, sound nor any portion of the apparatus should be moved needlessly, on account of the danger of interrupting the current and thus giving the patient a severe and perhaps

After the completion of each application for half an hour the patient should rest on the couch before being allowed to walk about.
shock.
ANEURYSM

dangerous

Electrolysishas been used in the treatment of aneurysms of the larger arteries, as the subclavian, innominate, and Two even jthe thoracic aorta. needles are platinum
inserted, with antiseptic precautions, through the wall of the from 1 inch to 2 inches apart, attached to needlesac, holders and the two poles of the battery. A current of for ten minutes, then is gradually turned on tures gradually turned off and the needles withdrawn, the puncbeing sealed with collodion gauze. The objectof is to cause two treatment the clotting around the needles,
30
ma.

ate strengthen the wall of the sac and gradually obliterthe pathological dilatation of the vessel. The clot is, however, of loose consistence and of little value in an and
so

sac with a fierce current of blood constantly aneurysmal running through it. The method would have more chance

in an aneurysm of a smaller artery, such as the of success femoral, brachial, or radial. In this case the artery could be compressed on the distal side of the aneurysm while the being done, and also for two hours electrolysis was in order that the resultant clot might not be washed it was formed; as soon as after, away

CHAPTER
ELECTRIC
THE GALVANIC

IX
BATHS
ELECTEIC BATH

This treatment

is applied by immersing the patient in a bath, up to the neck and passing the current through warm the bath from end to end between two large metal electrodes.

The positive electrode is placed behind the patient's back,

and it must be covered with flannel or other material to prevent the metal from touching the skin. The negative electrode at the foot of the bath need not be so protected

lished of the thick skin on the sole of the foot. Pubof current calculations of the proportionate amount that passes through the patient's body, as compared with
on

account

is wasted by passing through the water only what between the electrodes,have taken as their basis the comparative of the water resistances of the volume and of the body, and it is asserted that only about onement less of the total current is available for treatown experiments, however, of the patient. My from the intensity of the sensations felt and the judging

eighth

or

degree of muscular contractions produced by reversals of the current, indicate that only two-thirds of the current on the average are wasted, one-third passing through the

patient's tissues,and that the higher the voltage used the greater is the proportion of current that passes through However, to pass a current of 50 ma. the body. through the patient's body in the bath, it will be necessary to employ

Now, it is practotal current of at least 150 ma. tically impossible to obtain currents of this strength from
a

252

GALVANIC
a

ELECTRIC

BATHS

253

and unless a battery primary battery of wet or dry cells, of thirty accumulator cells,giving 60 volts, is available, it curwill be necessary to employ the main electric -lighting rents for the purpose.

safest method is to use a battery of thirty accumulator cells. These will give a pressure of 60 volts,and the current can be conveniently of a shunt resistance or rheostat. applied by means
"

Method

of using

the

main

current.

The

of direct current, the ordinary enamelled full bath, with its water-taps and waste-pipe, can be used, as there is no rent possibilityof any danger from leakage of cur-

With

this

source

will there be any danger of the patient accidentally touching an electric-lightswitch or water-tap This method may be said to be " foolproof," while in the bath.
to earth ;
nor

and such

galvanic bath

may

with perfect safety

be manipulated by a nurse by or other attendant, or even the patient, after the way to use it has been thoroughly explained. If the house is wired in connection with the direct
current

mains, the accumulators electric-lighting be moved, and can be recharged through lamp

need

never

resistances

whenever necessary, when the bath is not being used, using lock switch to ensure a cutting off the main contact with the accumulators when the bath is being used. Another by an electric safe method is to drive a small DC dynamo be wound to produce half an The dynamo must motor. to drive it may be at 50 volts, while the motor ampere worked by either alternating or direct current from the
is very suitable for an institution or This method main. hospital. The earth-free multostat or pantostat apa paratus in an ordinary may be safely used in this manner enamelled bath, but before using it the circuit should be

tested in operation

to

really earth-froo, and the water and a neighbouring It is possible to make use

make that no

sure

that the apparatus is flow between can current

electric -light swdtch. of the direct current from

the main

for sivins;the galvanic bath without the rheostat

254

ELECTRICAL

TREATMENT

earth-free ; but special experience is necessary, be present during the whole time and the expert must that the bath is being given. The bath should be made being
of porcelain, and
wasteor

must

have

no

direct connections with

water-pipe. Moreover, no water-tap or electriclight switch must be within reach of the patient when in the bath, or a fatal shock might result. This may happen
in the following way : One of the poles is generally earthed at the power-house, as in the Marylebone supply, and therefore, when the bath is connected by wires through
a

resistance to a wall-plug or other electric -light if the pole that is connected to the zero or rightswitch, hand end of the shunt resistance is not the same as that diate which is earthed at the station, then there will be an imme-

shunt

rush of current between the waste- or water-pipe which is connected to earth and the wires of the apparatus, and the patient may, or may not, feelthe effectsof this powerful
according to his position in the bath with relation to the line of the current. Even if neither pole is earthed at the station, there is usually sufficientleakage to earth
current,

the cables to make such an earth current extremely dangerous. If, for instance, while immersed in the water he were to touch eitherthe cold- or the hot-water pipe, he
would
get
a

from

dangerous

always wall-plug
or

The operator should, therefore, test his apparatus after connecting it to the c other source of the electric-lightingurrent,

shock.

to ascertain whether

the pole connected to the zero end of his shunt resistance is the same as that which is earthed at the station. When that is so, there can be no danger of any accidental shock if the patient should touch a water
or even

pipe,

if the bath itself connected directly to earth is of testing will be for the operator, after his shunt rheostat to the wall-plug, to turn on
a

through the waste-pipe.

The

method

connecting the switch and

of both hands

then lightly to touch with the dry fingers binding-screw of his apparatus and a water-

I
tap.

GALVANIC

ELECTRIC

BATHS

255

Ifhe feels strong burning sensation, then the earthed a pole is not the one which is connected with the zero of his reverse and to put matters right he must now shunt rheostat,

the pole the two-pin wall-plug,so that he reverses connected to the zero of his rheostat. When this position of the wall-plug has been ascertained,it should be so
way. marked that it may always be inserted in the same he may now With the slidingcontact spring also at zero, touch with impunity, even with wet hands, a binding-

be no time ; there can and water-tap at the same danger of any shock to the patient from an earth current, trolled and the availablecurrent for the bath will be entirelyconby the sliding spring contact. With a properly
screw

enamelled bath, and the enamel not chipped anywhere to below the surface of the water when filled the desired height, the orifice the waste-pipe at the foot end of the of bath will be the only metallic contact with the water to
"earth," and it will be possible for an expert to make use of such an ordinary fullbath as a hydro-electric galvanic light mains as the bath, using the direct current electricsource of the supply. Under these conditions the orifice of the waste-pipe will act as the footplate, and only one

the wire and electrodejoining shunt rheostat to the bath is to be used. The method of using the main current in this case is as
ordinary platinoid wire shunt is used, with safety lamp, switch, galvanometer, rheostat in the circuit, the first point to ascerand current reverser tain is which pole is earthed at the station,as upon that

follows: Assuming

that

an

depends whether the footplate that is to say, the orifice be of the waste-pipe ^will positive or negative. First see that the two-pin wall-plug is inserted properly, so as to
"

"

avoid all danger of shock from the earth current, as above described ; then take a basin of water, attach one wire to eithert)fthe two binding-screws of the rheostat,and let the other end of the wire dip in the water. Take anotherwire,

256

ELECTRICAL

TREATMENT

water closebeside but not toucband let one end dip into tlie ing the otber wire, while itsother end is held in contact with a water- or gas- tap. The sliding contact spring is then pushed distance, and the two ends of the wires dipping along some

into the water are watched. Bubbles coming off one of them will indicate that to be the negative pole. If neither gives that is to say, if no current is passing then off bubbles
"

"

the current reverser start the will at once If the wire that is earthed is negative, then the current. bath electrode and its wire must be attached to the positive
switching
over

(N.B. The sign of the of the rheostat. rheostat binding-screws will vary according to the methcd mined of insertion of the two -pin wall-plug, and must be deter"

binding-screw

for the particular position of the wallplugs that are being used at the time.) Even now, although is passing, a current which increases in intensity a current

beforehand

the sliding spring contact is pushed further along, yet indicate no because the the galvanometer may current
as

galvanometer circuit is only connected with one of the poles. If this is the case, the wire to the bath electrode be taken out and attached to the other binding screw must

All of the rheostat, and the current reverser switched over. in order, and the galvanothe wire connections are now meter will indicate accurately the amount of current that
is perfectly safe, is being used in the bath. This method a-nd no shock from an earth current is possible, since the that which is connected to the as earthed pole is the same
to the same thing end of the rheostat, so that it comes nected whether the zero end of the rheostat or a water-pipe is conto the bath as one of the poles.
zero

As the description of the method given above will show, it will require some electricalknowledge to make use of an ordinary bath for giving a galvanic hydro-electricbath, when of the elecmains as the source tricity. using the eleotric-ligliting With that exception, the only point against it is be reversed, but that the direction of the current cannot

I
I

GALVANIC

ELECTRIC

BATHS

257

will depend entirelyon whether the earthed pole is positive or negative. The earthed pole will not necessarily for all the houses in the same district; be the same

neighbouring houses, or houses on the opposite sidesof the in same street, may differ the sign of the earthedpole,and be for it must, therefore, determined seps^rately each house. districtsre The difference a arises from the fact that some threee.g. Marylebone, wire system supplied on the of where the two outer wires have a difference potentialof from the middle 480 volts, while each outer wire differs
"

"

"

the middle wire will be wire by only 240 volts. Therefore, to positive one outer wire, and negative to the other. Some houses willreceivetheircurrent at 240 voltsfrom the middle
of the outer wires,while an equal number will supply from the middle wire and the receivetheirelectric other outer wire. Thus, if the middle wire is the pole
wire and
one

that is earthed at the station, the earthed pole willappear to be positivein some houses and negative ii;others. The stronger current at 480 volts is used for pow'er purposes for driving motors

With

of five-horse-power and upwards. insulated porcelain bath, the wasteproperly

to pipe does not connect directly the bath,but to a porcelain or earthenware gully into which the bath discharges. The

d water-taps are placed at a little istance from the bath and are covered with flexiblerubber hose-pipe,through which the bath is filled.Even with these safeguards against any accidentalleakage to earth, care should always be taken
to

that the two-pin wall-plug or other attachment of the shunt rheostatto the electric-lighting mains is so fixed as that the pole that is earthed at the stationis the same so that attached to the zero end of the rheostat, that when the current is switched on and the slidingspring contact is also at zero, no shock is feltwith wetted fingers, one
see

of the binding-screwsof the rheostatand the otheron a water-tap. If thisprecaution be taken, then there isno possible danger of an accidental connection of the bath placed on
one R

258

ELECTRICAL

TREATMENT
This, for in"

in to earth while the patient is still the bath.

stance,

discharging the bath water through the waste-pipe before the patient has got out of the bath, the column of water thereby establishing an earth
may

easily

occur

by

connection ;
water

or,

again, by

turning

on

some

more

hot

If patient has got into the bath. the rheostat has been arranged as described above, so that the zero end corresponds with the earthed pole, the liability

after

the

ous risk,though not of a dangernature in that case, cannot be entirely done away with, because the sudden earthing of one end of the bath by of the incoming or outgoing stream of water must interfere with the strength of the current passing between the two electrodes already in the bath, since an alternative
means

to shock will be lessened. The

path for the current is afforded, and thus the sudden diminution of current passing through the patient will be feltas a shock, which would be decidedly unpleasant when
20
ma.

being used. With an insulated porwere celain and .more bath it is a good plan to have a switchhydro- electric board arranged in connection with four pairs of electrodes
negaside and tive be concencan trated,

on along the sides of the bath (positive one so on the other), that more current

if necessary, through the legs body. This method whole body by

or

lower half of the

to the of applying general electrification means of the hydro-electric galvanic bath

will be found exceedingly useful in the treatment

bago, of lum-

chronic sciatica,and chronic muscular rheumatism ; and the effect of this form of application of the galvanic current is notably to diminish the pain of a neuritis. It
willalso be found of decided value in certain states of debility with anaemia, in palpitation and tachycardia, Graves's

disease,Raynaud's

disease, and multiple neuritis. In cases cular of local neuritis in which it is desirable to stimulate muscontractions, the hydro- electricgalvanic bath is less

desirable than local treatment

of the limb with galvanism

SCHN^E
by

BATH

259

When electric the labile method. administering the hydrogalvanic bath the temperature of the water should be about 100" F., and the patient should not be kept in than ten minutes, the firstoccasion for more though this may be increased with advantage on subsequent occasions to twenty minutes.

the bath

on

FOUK-CELL

OR

SCHNEE

BATH

It is often inconvenient for a patient to take a bath, and a fair substitute for the full bath treatment

full
in

Fig. 14.
"

Simple form of four-cell or Schnee bath.

many conditions, especially in neuritis affecting the limbs, bath, or Schnee bath. This is an arrangement isthe four-cell

of four small baths which is fitted with

wires to a rather than one of copper or zinc, is preferable because the former is not electrolytic, and does not give off ions.
of porcelain or earthenware, the foot-baths being sufficientlydeep to hold the leg up to
are

for each limb, each of sulated a carbon electrode connected by inA carbon electrode, central switchboard.
one (Fig. 14),

The

baths

made

the knee, while the arm-baths

are

about

6 inches deep

260

ELECTRICAL

TREATMENT

8 inches wide, and long enough to take the forearm from the elbow to the tips of the extended fingers ; that is to say, 20 inches inside measurement. The two arm-

by

fixed at a convenient height on the arms of a stout chair, so that the patient can sit in the chair with the forearm on each side immersed up to the elbow in

baths

are

in each of the the bath, and the feet and legs placed one foot-baths. The baths are filledwith hot water, in v hich may be dissolved certain salts for medicated baths, such
as

lithium

The

chloride for the treatment switchboard is fixed at the back

of gouty joints. of the chair, and

is connected to the battery, which may be either galvanic, faradic, single- or three-phase, sinusoidal, or Leduc alternating.
The

switchboard is

so

arranged

that

the

two

arm-baths are connected to the positive electrode, and This method the foot-baths to the negative, or vice versa. the of applying galvanism has certain advantages over full galvanic bath, besides the saving of trouble in the matter of the patient undressing, for only the boots and stockings need be taken off and the sleeves turned In this form of application of the up above the elbow. as current there is no wastage of electricity, all the current
that is used passes through the limbs and body of the patient. The strength of the current should, therefore, to a maximum range from a minimum of 7 or 8 ma. of 25 to 30 ma., though with this stronger current great care must

interrupt the current, and all the connections of the wires must be carefully attended to and screwed up tightly, as should one connection slip or break the patient will get a violent shock. With strong currents,

be taken not to break

or

the skin is apt to get sore at the water level. If only the legs require treating, the arm-baths need not be used, and one leg-bath can be made positive and the other ter a negative. With this arrangement mechanical interrupmoreover,

alternator can interrupt or reverse

or

be inserted into the circuit so

a

as

to

ci^rrent of 5 to 8

ma.

once

second

ARMor
or
so

AND

LEG-BATHS

261

for the treatment

causes.

of wasted

muscles due to neuritis

other

LOCAL

ARM-

OR

LEG-BATHS

Two,

three,

or

and a leg-bath by the sinusoidal arm rent current, or one and both legs by the three-phase curin the two arm- baths by galvanism for ; or both arms rheumatoid arthritisor for Raynaud's disease. If one limb
arm-

be made use of. hemiplegia in an

four of the cellsof the Schnee bath may Thus, one arm and leg may be treated for

by galvanism for only requires treatment, such as one arm writer's cramp or for neuritis,the two electrodes may both

dip into the water, one at each end of the arm-bath, or one flexibleelectrode may be fastened above the elbow to the If both electrodes dip arm above the level of the water.
into the water, the positive electrode should dip into the behind the patient's elbow, and the negative or water kathode near the fingers. The strength of the current

passed through the bath should be about 20 to 25 ma., though it is to be remembered that not the whole of this itself amount passes through the arm ^probably only about one-tliird. This point I have tested in the following manner, which,
"

if more

tical pracof inaccuracy, is certainly more as regards its application to the treatment of patients than the published calculations of the comparative resistances
open to
errors

of the body of the patient and of the water contained in the bath. These latter calculations seem to show that the body of the patient carries only one-tenth of the current passing between the electrodes in the bath. I partially filled an water arm-bath to a depth of 3 inches with warm at a temperature of 100" F., and placed the positive electrode, a flexiblemetal plate covered with chamois leather, The negative electrode, of the water. exactly similar to the other, after being thoroughly wetted, was applied tightlyto my arm above the elbow, and I then
at

the

bottom

262

ELECTRICAL

TREATMENT

hand in the water spread out over the positive the water just electrode, covering the hand entirely. The current was then turned on graduallyuntila definite strength placed my
experiencedin the hand, and the number of milliampereswas noted by my assistant. The two electrodes in were next placed vertically the water at the ends of the bath, the negative at the elbow end, and then I placed my
of sensation was

forearm in the bath

that the water covered it completely touching the positiveelecup to the elbow, the fingersjust trode. The current was then, as before,turned on gradually until I noted that the degree of the sensation in the
so

hand appeared to be the same as before, my assistant noting the reading of the galvanometer. The two readings were respectively. The experiment was repeated, with a stronger degree of sensation for comparison. The readings on this occasion were 12 and 35 ma. It is
6 and 18
ma.

thus clear that a larger proportion of the galvanic current arm the tissuesof the forepassing between the electrodes affects than the published calculations the comparative resistances of of the patient'sbody and of the bath water would

lead one

to expect, and I feelassured that the statement

that only one-tenth of the current used is received by the patient rests on insuffi.cient grounds and faulty deduction.

If faradism be used instead of galvanism for the comparative test, it willbe found that a very small approximation of the secondary coilto the primary is needed to produce in the hand and the same degree the same sensation of muscular contraction of the forearm when the whole forearm is dipped in water between the two electrodes, as when the hand only is in the water and the other electrode is fastened above the elbow. Thus, in my own case, with

fastenedabove the the hand only in water and one electrode elbow, I noted the strength of sensationwhen the coilwas from the primary. With the whole forearm distant 75 mm. immersed, and both electrodes dipping in the water, one at the elbow and the other at the fingers,the same

THE
degree of sensation coil was distant 67 mm. of
an

LEDUC
was

CURRENT

263

inch

nearer

experienced when the secondarythat is to say, only about a quarter Using the primary faradic the primary.
"

current

instead of the secondary, the muscular

core

same

and soft iron

respectively ; that is to say, when the whole forearm and the two electrodes in the water the soft iron core of the primary had to were be pushed in only half an inch to strengthen the sensations
mm.

contraction was withdrawn 62 and 50

degree of sensation experienced with the

to the

same

degree

as

when
was

and the other electrode elbow.

THE

in the water only the hand was fastened to the arm above the
CURRENT

LEDUC

Professor Leduc by

of Nantes
an or

has

devised

an

of which to interrupt either

means

motor is made use electric to reverse the direction of

apparatus of in order
a

constant

galvanic current, at varying speeds. The current that is used to drive the motor is quite separate from that which

is used in the transforming portion of the instrument, and the latter current may be supplied either from a constantcurrent battery, or through proper resistances and a volt lightingmains. selectorfrom the direct current of the electricThe motor be driven by either alternating or direct may hand-power may current, according to its design, or even
be used to rotate the transformer by means of a wheel and suitable gearing. The effect of the interrupted or reversed tetanic contractions, somemuscle is to cause what to those produced by the faradic current, similar though the intensity and quality of the effect on sensory galvanism
on

and

the current is interrupted or reversed, and also according to the proportionate duration of the contacts and to the speed
motor
nerves

differs somewhat

according

as

is used to interrupt the galvanic current, the speed of the interruptions be graduated by resistances in the motor circuit from can about 10 to 160 per second, each revolution breaking the
of the motor

(Fig. 15). When

the motor

264

ELECTRICAL
By
means

TREATMENT

current four times.

the position the of altering of brushes the duration of contact can be lengthened collecting or so of shortenedat will, that foreach quarter-rev jlution the motor there may be obtained eithera momentary tion applicaof the current, and a long intervalin which no current is passing,or a long contact and a momentary break of the current, or any gradation between these two extremes, such as half contact and half interv^al. It is clear that when the motor is running and

producing interruptions

Fig. 15.

"

The Leduc motor, with interruptor.

in the galvanic current, the average current as indicated by the galvanometer will vary according to the relative durations of contact and interval. Thus, with the
at rest a current of machine tested,when the motor was 14 ma. was arranged to flow through a fixed resistance the ; was then started,and it was found that with the motor brushes arranged for the longest contact the current fell

t3 12

no

while with a contact of one-quarter the galvanometer indicatedonly 3.5 ma., the speed of the motor making difference.
ma.,

Motor
muscular

effects of interruptions.
contractions
are

"

The

produced

by

strongest arranging the

r
W^f

THE

LEDUC

CURRENT

265

nine-tenths interval with no current, and a slow speed of the motor, giving 30 to 40 interruptions per second,with a descending current

brushes brushei for one-tenth contact and

tested with wet electrodes along the limb. This was upon the muscles of the forearm, and using short contact ruptions and slow speed of the motor, giving about 1,800 intercurrent borne was per minute, the maximum I'D ma., being about equal in sensory effect to 18 ma. is without interruptions. The muscular effect much stronger at the kathode, and
was

the poriod of contact of the brushes increased,so the mus3ular and sensory effectdiminished, time the current increased from while at the same
as
ma.

This diminution of the effect with long contact is more noticeableat high speed than at low speed,when the diminution is only slight, and it is noticeableboth at
1 "5 to 12

the kathode and the anode.

With maximum

contact, and

l the muscular effect using a current of 1 ma. or a littleess, in the thenar eminence is only just perceptible at the lowest speed, and is diminished to the vanishing point there is fair at high speed. With a current of 2 J ma.,
tetanus of the thenar eminence at the lowest speed, which

does not disappear entirely at the highest speed of the 160 interruptions per second. With short conmotor tact, strong tetanus of the thenar muscles is produced by
"

the kathode with a current of only 1 ma. at low speed. With the high speed the contractions are less.

Sensory effects of interruptions." On placing one electrode on the eyeball in order to stimulate the retina, and the other on the wrist, using a weak current, it was
and anode the retinal effectwas stronger with very slow interruptionsand long contact than with short contact ; but with more rapid tions revolutionsof the motor, producing 1,800 to 2,000 interrupper minute, the retinalstimulationappeared stronger The totalsensory effect the retina, on with shortcontact. however, diminished as the speed of the motor increased,

found

that with both kathode

266
80

ELECTRICAL that with

8,000

TREATMENT

interruptions per minute a current which produced bright flashes of light in the eye with a slow speed
was

not

now

perceptible.

Reversals
used to produ3e
arrangement

of

current."

When
a

the Leduc

motor

is

reversals of current,

of the brush contacts are the interruptions. There are four brushes, and each revolution The proportionate gives two reversals of the current. duration

different wheel and used from those for

of contact, and of interval in which no current is passing, may be altered by moving the position of the brushes. The current is passed through a galvanometer before it is led to the
current
reverser,

so

as

to indicate the average

included in were passing. If the galvanometer the circuit between the reverser vanomete and the patient, the galneedle would remain
at
zero.

Motor
or
even

effects of
a

reversals." A

current

slow speed of the motor gives a tion duraof the muscles of the thenar eminence with maximum of the contacts, being a very much stronger contraction than that produced by the kathode when interruptions
contact, and of the
course,
same

less at

of 1 ma. fair tetanus

with maximum are used. Of

when reversals are be no differencein the action of the two electrodes,since each is alternately kathode and anode as the current is reversed.

strength of current, being used, there will

As the speed of the motor is increased,so the muscular effect with reversals is increased up to the fastest speed of the With apparatus motor about 80 reversals per second.
"

specially arranged for the production of very rapid reversals of the current, it has been shown that muscular excitation increases with the speed of the reversals up to 2,000 or second, and then diminishes until all signs of contraction disappear at a speed of 10,000 alternations per of high-frequency currents second, when the phenomena
3,000

per

commence

particular instrument to pass through a tested, I arranged a current of 14 ma. diminfixed resistance with the motor at rest : this was
to

appear.

With

the

I
%

THE
ma.

LEDUC

CURRENT

267

ished to 13.5

the motor was started at slow duration of contact, the current speed reversals and maximum falling 11 ma. when the motor was run at itshighest to

when

speed of 80 reversalsper second. With short periods of rent contact and long proportionate interval,the average curindicated by the galvanometer will fallconsiderably.
the period of contact is reduced to one-tenth of the interval between the contacts, the contractions,though powerful, are said to be much less painful than with a corresponding strength of faradism. If we compare the tetaniceffects upon the limb muscles of interruptionsof a galvanic current with those produced by reversals, find that interruptions of a descending we to the hand current from the anode on the upper arm placed on the kathode, using only one-tenth contact and
40 interruptions per second, gives far stronger contractions from reversals,using maximum than we obtain
contact, and the

When

strength of current shown on the galvanometer. Thus, placing the forearm in water in the arm-bath, with the anode behind the elbow and the kathode at the fingers,the current was turned on until 26 ma. was running steadily through the bath. Then
same

using interruptions with one-tenth contact, strong tetanus of the forearm muscles was produced, indicated on the were now though only 2J ma. degree galvanometer. Approximately, to obtain the same
starting the motor,

of

muscular

tetanus

contact, required a

reversals, using maximum current of 24 ma. shown on the galvanomet

with

contact, reversalsgive with maximum do, and with oneinterruptions stronger contractions than tenth contact, reversalsmay also prove the stronger. For general stimulation of the muscles and tissues,

Now,

and for muscle -testing, rapid interruptions or reversalsof a weak galvanic current by the Leduc motor ^with the brushes arranged for one-tenth contact and nine-tenths
"

interval with

no

current

"

may

prove exceedingly useful.

268

ELECTRICAL

TREATMENT

should supersede the faradic coil for all work where accuracy is desired. With the faradic coil the current is irregular, and its milliamperage unknown. curve and

Although

rapid

using interruptions, or preferably be used for mus3ular stimulation, reversals, may interruptions have no contraction effect in producing
motor,

the Leduc

in degenerating muscle in cases injury. of nerve Such degenerating muscle will give well-marked sluggish contractions to slowly interrupted or slowly reversed galvanic
currents, but when the frequency of the interruptions reversals exceeds two per second, the strength of the

or

muscular contractions diminishes to nil as the speed of the interruptions or reversals is increased.

Sensory
m same

the

same

effects of reversals." Testing the retina way as with the interruptions, and using the

strength of current, the brillianceof the effect on the tion duraretina is very much more powerful, with maximum of contact, than with the interruptions ; and whereas crease with the latter the sensory effect diminishes with the inof speed of the motor, with the reversals the effect speed of 30 per second, and then diminishes to the vanishing point at 80 per second, using a current which gave very great brilliance with 30
on a

the retina increases up to

reversals per second. On the whole, the sensory effects of the rapid reversals duration of current with the Leduc motor, with maximum

of contact, upon the skin and muscles are much than with a faradic current which produces the same

greater degree

of muscular contraction, the Leduc reversals of a galvanic current being distinctly more painful than a corresponding strength of faradism, especially when the motor is run at a

second, using maximum duration of contact ; but with very short durations of are the contractions, though efficient, contact said to be less painful than the corresponding strength of faradism. With very high speeds of alternation the sensory effects

high speed of 80 reversals per

DANGERS
on

FROM

MAIN

CURRENTS

269

skin and muscle both disappear, as is the case also with the motor effectswhen high-frequency phenomena
commence.

DANGERS
'

FROM

OTHER
,

HIGH-TENSION

MAIN ELECTRIC-LIGHT CURRENTS

AND

accidents from electricshock occur amongst the workers of the electriclighting companies, eitherfrom accidentalcontact with livewires when engaged
The of majority in repair work on the cables or in changing transformers, from accidental contact with parts of the switchor board in the power-house. It is impossible to get workmen to wear rubber gloves when doing work on the cables, " short and they may either receiveshocks by getting a
"

wires at differentpressures, or else,when standing on damp ground, contact with a Hve wire will " " sage earth for the pasafford a path through the body to be fatal. Inside a heavy current, which may easily of

between two

buildings the current is never at a higher pressure than 240 volts,except for the driving of motors of one or horse-power, when it may be as high as 480 volts. more
commonly circuits within houses, are by employed on electric-lighting no means should a good altogetherdevoid of danger to life,

Even low voltagesof 100 to 200 volts, such

as are

by the body to contact to earth be established

livewire.

voltage as 70 has been fatalin a chemical factoryin Germany to a workman who was standing with bare feetin an alkalinesolution, and thus affordedan ideal

Indeed, so low

"

contact with

earth." baths have already The special dangers with electric been alluded to {see 253), p. whether the current is direct or alternating. The bath should be of porcelain, and not

only should it be entirelyunconnected by water-pipes to but allwater-taps and pipes and electric-light earth, switches be quite out of reach of a patient in the bath; The should

bath should be filled with water through

rubber hose-pipe

270

ELECTRICAL

TREATMENT

the patient is in attached to the water-pipe ; but, once With the bath, no more water should be turned on. direct-current installations, in which one some of the poles is intentionally earthed at the power-house, it is
possible to arrange the apparatus so as to avoid the possibility of shock through an earth current (see. 253). Even p with the best and most perfect method of insulating the bath patient from earth currents, when using the direct current from the main for electricbaths there is always the possibilityof a sudden alteration in the voltage, which will and
cause

shock to the patient that might well be dangerous if large currents in the fullbath were being used. A sudden
a

fallin voltage in an electric-light supply will be indicated by the incandescent lights suddenly losing brilliancy and glowing a dull red ; while a raising of the voltage produces a
sudden increase in brightness of the lamp. Again, the supply for minutes may fail altogether for a few seconds, or even at- a time, all of which accidents have been unfortunately

district London. of Stillanother possibilityof shock when using the direct main is the liabilityof a sudden switchcurrent for treatment over
us

familiar to

who

livein the Marylebone

at the power-house

from

one

machine

to another,

or

from the dynamo

battery of accumulators. In alternating ent currents the position is quite differ; no dangerous shock will be produced by a sudden fall
to
a

in the voltage from one over

moreover,

or

cessation of the current, or by changing machine to another at the power-house ;

absolute safety with regard to earth currents is attainable by the simple means rent of passing the main curthrough a static transformer, which for treatment
purposes is most conveniently built as a sledge coil. The direct current from the main may, therefore, be for muscular used safely for all forms of labile treatment, wasting, etc., in which the strength of the current is not likely to exceed 15 ma. For stabile applications, such as for electrolysis of hairs, naevi, etc., for ionization, or

DANGERS

FROM

MAIN

CURRENTS

271

may neuralgia,the main current is less suitable,but still often be employed, the only danger being the possible one denly of a somewhat unpleasant shock if the current be sud-

interrupted.
burning with main to persons engaged in the work of cable currents occur repairing, transformer changing, or in other work about
or

Nearly all accidents from shock

the power-house or transmission lines. The large majority fatal accidents occur voltages of 1,000 and upof wards, with has given riseto the idea that the alternating which dangerous than the direct. It is not the current is more

in tjrpe of current that causes the difference the severity but in of injury, the difference voltage, the direct current seldom being met with at a higher voltage thatU 550. This latter strength of voltage will not give a shock through

ordinary dry clothing,and it has been demonstrated that a person may situpon the third railof the CentralLondon Railway, which is electrifiedith direct current at 550 w
volts,and rest his hands upon the outer rails, which carry the return circuit, without getting a shock. If the clothing
were

a shock might, perspiration, severe and probably would, be received. Unless the person remained in contact with both conductors, it is probable that a though itis to be shock at thisvoltage would not be fatal,

wet

with rain

or

remembered that at the comparatively high voltages of f the main supply, muscles behave differentlyrom what we findin the physiologicallaboratory with muscle-nerve preparatio
and weak constant currents. It has often been found that contact with the main direct current tetanizes the muscles; and if a person should unfortunately catch
hold of a livewire at a voltage of 200, when his feet were in good contact with earth, as when standing in water, he rent might be unable to leave go, and the sudden rush of cur-

would very quickly be fatal. In this way a man killedin the street by becoming entangled in some had fallendown wires which in a snowstorm

was

phone teleacross

272

ELECTRICAL
a

TREATMENT

the trolleywire of

tramway,
"

and having become trolley line at 300 volts. When a workman gets

the ends trailingin the street through contact with the alive
" " "

by simultaneous contact with two wires of a circuit at different voltages, the danger will differ according to the method of contact. If
a

short

one

hand

or

arm,

result is never isconcentrated between the two points of contact in the limb, and the man one gets offwith a bum, and nothing worse

leg has touched both the wires, the fatal if the shock is momentary, as the current
or one

than faintness and weakness, though this is often succeeded by hysterical symptoms of various intensity and duration.
form the contact, then the results may be much more
If both hands
or one

leg and

one

hand,

is not rare, the man heart being arrested in fibrillarycontraction. Some experiment Battelli, with on animals by Prevost and death alternating currents at different voltages, showed from heart failure with shocks at 120 volts pressure ; with high-tension currents at 1,200, 2,500, and 4,800 volts,
tetanus

grave, and a fatal result being killed, perhaps instantly, the

and convulsions were produced, and respiratory failure, but the animals could be saved by artificial tion. respiraIn America, where criminals are electrocuted for than once that the first murder, it has been found more
shock 'at 1,200 to 1,500 volts has not been fatal, though convulsions and burning of the skin were produced during A case has been recorded in America the period of contact.
of

receiving during several seconds a current at the standing close to the pressure of 20,000 volts. He was main switchboard of the power-house, when by some dent accihe was knocked against it and the current arc'd across
a man

shoulder, leaving his body by the foot on the same All side, which was also in contact with the switchboard. his muscles being tetanized, he was thus held immovable.
to
one

A but

second
was

caught hold of him to pull him away, instantly knocked down by the current, and the
man

TREATMENT first man

was

OF

ELECTRIC
man,

SHOCK

273

recognizing the danger of touching him with his bare hands, ran at him, jumpingin the air at the same time, and knocked him away
with his knee.
no

not released untila third

worse

Strange to say, the first man recovered, with resultthan two bad bums on his shoulder and foot.
arc

being formed limited the amount of current passing to him, and this explains his escape in voltage of the current. spite of the enormous Probably the fact of an

has electric shock, if the man escaped instant death, he will be found semi-conscious, gasping, pulse thready and small, pupils dilated and sluggish irresponsive to light. The skin is moist and cold, or
a

Usually, after

severe

and the limbs flaccid. There may be signs of burning at the points of contact, and the respiration may have entirely Artificial failed,or be on the point of doing so. respiration should be at once commenced, and persisted in until regular

breathing is re-established,and the usual remedies for shock brandy or salvolatile, diluted with administered ; some
should be given by the mouth, and, if necessary, injections ether and pituitrin hypodermically, while his of hands and feet are chafed, hot bottles applied, and the There is always a great fallof legs raised and bandaged.
water,

it is this, due to arrest or enfeeblement -pressure, and of the action of the heart, that is the chief danger. The failure of respiration will also kill,of course ; but this is
blood easily treated than. is the syncope from the direct action of the electric shock upon the heart. Hitherto, in this country, there has been practically no
more

danger the

to the public from

high-tension currents, owing

to

of such cables, and careful insulation underground formed their non-exposure before the current they carry is transinto a lower and safer voltage. In America and on
the

Continent there

are

numerous

long-line transmissions

of electric energy by the currents

50,000
to

110,000

bare wires carried on poles overground, being at various pressures from volts. Necessarily, these bare wires

274

ELECTRICAL

TREATMENT

must

increase the public danger, owing to the liability of the poles being overturned, or other accidental contact with the wire by telephone wires,etc. The near future seems to foreshadow an increasing development of high-tension
wires, of suburban railways, or even main line,such as the New Haven The London and Brighton suburban

by alternating-current electrification,

overhead trolley of longer lengths of Railway in America.

service is electrified and South-Western

on

this principle,while the London and the Underground Railways use the directcurrent, with third and fourth rails. Countries like Switzerland and

Sweden,

with

no
are

but coalfields,
sure soon

water-power,

to

practically unlimited electrifytheir railroads,

the transmission of electric and this will probably mean long distances at high pressures. Thus, in the power over future, the number of high-pressure overhead wires is
to multiply enormously, increasing especiallythe risks of the railwaymen, and, to a certain extent, of the

bound

public.

CHAPTER
THE

X
CURRENT

SINUSOIDAL

sinusoidal current is a form of alternating current whose electromotive force regularly rises and fallsin two
The

being sometimes equal and opposite cycles, the curve ing We have already seen when dealknown as a sine curve. of the electromotive with the faradic current that the curve force of a faradic battery is an alternating current,
stronger in one direction than in the other, and are also far less regular and more jerky. For several years previously to 1831 it had

though the

waves

are

much

close association between netize and magnetism, and it was known how to magelectricity a piece of soft iron by passing an electriccurrent around it, bat it was reserved for Faraday in that year to
been recognized that there
was
a

demonstrate

the solution of the converse to produce an electric current by means If a coilof wire is wound on magnetism.
two

^how problem of the action of a bobbin and the

"

connected to a galvanometer, and then a fixed bar magnet is quickly pushed inside the coil,the galvanometer will indicate the passage of a current. If the magnet
ends
are

is quickly withdrawn a similar current will be generated in the coilof wire, but running in the opposite direction,as indicated by the needle of the galvanometer turning the
reverse

way.
case,

given

The direction of the induced currents in any and therefore of the electromotive forces giving

rise to them, can be readily determined by the simple law " " " first Lenz's law The : enunciated by Lenz, and known as direction of the induced currents is auch as to set up a
275

276

ELECTRICAL

TREATMENT

magnetic fieldwhich will tend to retard the change to which the induction is due."
in practice to move in and out of coils, to rotate in front of coils for the proor duction large scale, a of these alternating currents on
are

Now,

fixed magnets

too heavy

and the next step in the development of alternating current in 1835. Clarke's magneto machines was -electricmachine In this machine a heavy fixed steel magnet is used, and an armature consisting of two coils of fine wire with soft
bar of soft iron, is rotated by means of a wheel and gearing in front The coils are wound in of the poles of the fixed magnet. serieswith a continuous wire, reversing the direction of the
cores,

iron

and

together at joined

one

end by

winding in the two

coils,and the two ends of the wire are connected to spring contacts leading the currents developed in the coils to the terminals. These are alternating currents,
"

and
on

medical

this principle are

is provided with a iron, and this is attached to a the strength of the current can

" built magneto -electric machines frequently sold. The steel magnet still " keeper " or armature made of soft

the amount of contact and the poles of the magnet.

of which be graduated by altering the iron bar permitted between

These machines have been
treatment

lever, by

means

completely replaced in medical batteries driven by cells. In the

by

faradic

a wr.s commutator early Clarke's machines by means arranged on the axle of the rotating armature, direction of which the alternating current became a pulsating unicurrent, by altering the direction of the current

logical of each half-phase. This current had very slight physiothough it would decompose water, and had effects,
all the properties of
a a

galvanic current.

strong current and muscular device was 16): The axle added to the machine (Fig. is prolonged as a piece of ivory or of the commutator other insulating material, and on it are prolonged two

In order to produce ing contractions the follow-

SINUSOIDAL
narrow

CURRENTS

277

Against strips from the halves of the commutator. these presses a spring which is so connected as to shortso that as the circuit the current from the commutator,
commutator

revolves, whenever

the spring touches either of the two strips,no current

this will happen
with every wires from

passes to the terminals ; and

half-turn. The

the terminals leading to the patient are each led through two long coils before being

attached to the handles, and the efEect thisarrangement of

is that
rethe commutator volves a current is thrown in into the wires and coils the

as

Fig, 16.
"

Clarke's magneto

-electric machine,

with

commutator

and

coils.

patient'scircuit; but by the action of the spring contact on this current is not maintained constantly, the commutator being broken with every half ; and -turn of the commutator
with each break of this battery current there is a sudden induced extra current produced in the coils leading to the handles, which is quite strong enough to produce muscular
contractions and of muscles when the machine is from these current sufficiently rapidly. The worked magneto -electricmachines is therefore comparable to the primary current from a faradic coil.
tetanus

278

ELECTRICAL
The
next
was

TREATMENT
of magneto-electric instead of fixed steel
power,

step in the development

to
use

machines
magnets,

and the machine now A dynamo consists of heavy

or
more

to rotate

electro -magnets the moving parts by steam " becoming a dynamo."

electro-magnets with two

north and
a more

to form rotates

or

south pole pieces arranged alternately less circular magnetic field,in which
that is driven from
or an

an

armature
as
a

some

source

of

such to it. The

power

up of a in order to prevent the formation of eddy currents, which Around the iron ring is would overheat the armature. a coil of wire, and the rotation of the coils of wire wound through the lines of magnetic force generates induction currents in the coils. These currents are alternating currents,

electricmotor coupled armature consists of a soft iron ring built number of thin iron discs,insulated from each other
steam-engine

in any parthe change in sign of the voltage from + to ticular portion, A, of the coil taking place as A passes the net, middle line between the north and south poles of the mag-

line of commutation," it is called. This as line on the current curve. point corresponds to the zero If B is a point on the armature exactly opposite A, then
or

the

"

to that at A, both the current in B is exactly the reverse in direction and sign. Thus, for one whole rotation of the the EMF armature, of the current at any point passes half positive, through one complete cycle or period one
"

half negative dynamo.

one

"

for each pair of magnetic

poles in the

When

coil rotates with uniform field,as between the poles of an

a

velocity in

netic mag-

collected by the brushes intensity of the current is proportional to the sine of the mutation. angle between the plane of the coil and the line of comA similar current which does not change in
current
"

electro-magnet, the i.e. the is sinusoidal

direction is called an undulating {seep. 283)j current The periodicity of the current, or the number per second

I
on

SINUSOIDAL

CURRENTS

279

ot complete cycles of positiveand negative EMF

depends

of revolutions per second of the armature. The voltage of the current depends on the speed with which the rotating coilscut the magnetic linesof force,thus the number varying with the speed of rotation and the diameter of the intensity of the current may be The efficient armature. measured by a milliamperemeter, such as Lord Kelvin's, consistingof an index attached to a movable coilrotating inside a fixed coil. The direction of the deviation is thus

whatever the direction of the current, since the phase of the current changes simultaneously in intensity of the both coils. The maximum will _current bear the ratio to the efficient intensity of 1 ; that : ^^2 is to say, the efficient intensity will be 70 per cent, of the
always the
same

intensity. maximum In practice, sinusoidal currents are obtainable only installation. The alteris an electric where there nating -lighting by some these installations currents supplied of
very nearly a sine curve, and for medical purposes may be spoken of as sinusoidal currents. The number of complete cycles or periods per second depends on the type show

of machine employed in the power-house, and varies with differentinstallations from a periodicity of about 40 to high as 110 cycles per second when used for electric as

lighting while for purposes of traction for railways as ; low a periodicityas 15 per second is now thought to be As low the best with single-phase alternating currents.
by periodicity as 2 to 3 per second is recommended R. Morton for the treatment of muscular wastings, and a speciallyshunt-wound dynamo has been devised by him and
a

manufactured by Schall to run evenly at that slow speed. To obtain graphic curves of currents of rapid periodicity instrument called an an oscillograph is used, such as Blondel's,in which the current passes through two small
on coilsthat oscillate each side of the poles of a magnet. A mirror attached to a bar of soft iron oscillates between

260

ELECTRICAL

TREATMENT

the two
on

of light on to another at mirror oscillating right angles to the first, and thence
a coils, and reflects beam

photographic plate. The curve in Fig. 17 shows graphically one complete In it the time T is plotted horizontally, Cycle of such a curve. and the EMF of the current plotted vertically upwards (+) and downwards ( )from the centre line, which is also the zero line. The figures along 0 T are fractions
-

to

screen

or

Fig. 17.
"

Simple construction for

"

"

sine

curve.

of the periodictime which is represented by 0 T, the corresponding the functionbeing obtained in the way values of from the circle,the circumference by shown

projection

tional of which has been divided into the same number of fracparts as 0 T. The radius A D is to be regarded as
so clockwise direction, as to make a complete revolution in the time* T. At each instant the distance of A above or below the datum line A D B
a

revolving round D in

will give the corresponding ordinate or verticalheight of the sins curve. An armature winding may be tapped by two wires at diametrically opposite points, and the wires led to two metal slip rings mounted on the axle and properly insulated by from each other. The current collected brushes rubbing

these slipringswillbe a single-phase alternatingcurrent. If the armature windings are tapped at three equidistant points and wires similarly led to three slip rings on the axle, a three-phase current will be obtained from them. With four sliprings and four equidistantpoints of tapping
on

I
the armature,
can

COMMUTATORS

Ssi

current either a two-phase or a four-phase be obtained according to the method employed of connecting on for other varieties the wires,and so of polyphase

currents.

obtain a continuous unidirectionalcurrent from a dynamo, the alternatingcurrents which are induced in the
To

Fig. 18.
"

Diagram

___.JS
of
a

direct-current

(DC) dynamo,
means

and commutator.

armature

be collectedby The simplest form of commutator

mast

of

commutator.

consists of a splitmetal tube fixed on the axle, the two halves being insulatedfrom each other and connected by wires to two opposite points on the armature winding (Fig. 18). Brushes, usually made

of carbon blocks, are fixed so as to rub against the two halves of the commutator at exactly opposite points. As the armature revolves, and the two halves of the
commutator
or

split tube with it, although the currents

282

ELECTRICAL

TREATMENT

in the
are

yet

coils and in the two halves of the commutator in direction with changing each half-revolution, brushes will the current picked up by the two
one

necessarily be constant in direction, positive at and negative at the other. The current curve
have the form shown

brush

will then
a

in Fig. 19, and is known

as

pulsating

*S
"

90

135

180

225
or

Fig. 19.

Connected

alternate currents, current.

pulsating unidirectional

p. unidirectional current (see on modern dynamos are much

two

295). The
more

used instead of complex, and

commutators

halves of a split tube connected to two opposite points in the armature winding, the tube is split up into a large number of parts arranged in strips along the axle of the
all carefully insulated from each other. Each opposite pair of these strips is connected to two opposite points in the armature winding, and the resultant current
armature,

collectedat the brushes is a pulsating unidirectional current,

with the
as same are

there

of small waves divisions of the armature

number

of varying voltage winding and of the

current

commutator

20). (Fig.

Thus the constant

obtained

from

perfectly smooth Being a current, pulsating unidirectional current. electrolytic effects,and unidirectional, it has, of course, for practicalpurposes the dynamo constant current is nearly
but is
as

dynamo

is not, theoretically,a

smooth as a battery current. Such an armature described, wound as

on

soft iron

I
ring with
a

COMMUTATORS

283

numerous

continuous coil of wire, which is divided into sections, each of them connected to its correspond isknown as a Gramme part of the commutator,

If the axle is prolonged on the opposite side to sulate the commutator, and fitted with a pair of slip rings infrom each other and connected to two opposite points of the armature winding, the machine can be used Used in this way, constant cura rotary converter. as

Ring.

Fig. 20.
"

Diagram

of four pairs of coilsin series; of EMFs unidirectional current.

pulsating

brushes and rent from the main is fed to the commutator to the electro-magnets, thus driving the armature as a DC
motor,

and

an

alternating
on

taken ofi the slip rings

sinusoidal current can be the other side. Rheostats or

or

graduated resistancesmust be used to reduce the voltage of the main current to that for which the armature windings are adapted. If single-phasealternating current is taken
off the sliprings,its voltage will bear to that of the driving current as 1 :
a

proportionate ratio

about 70 per cent. If a three-phase current is arranged for,its voltage between any two terminals will be as : 2 ^2, or 61 per

J2, or

Further modicent, of the voltage of the exciting current. fications be applied to this machine, and by adding a can
the alternating current side the alternate phases of the current can be reversed, giving a pulsating unidirectional current (Fig.19). Moreover, if such a
commutator
on

^/S

and run as a dynamo, it will supply constant current through the commutator brushes on one side and alternating current on the other. be obtained from this An undulatory current can
a

machine is driven from

power

source

284

ELECTKICAL leading off brushes on

on a

TEEATMENT

macliine by
commutator

the slip rings

a

pair of wires from one of the the DC of side and from one ing formthe alternating current side, thus

combination

of constant

and sinusoidal currents,

or

current whose voltage varies rhythmisinusoidal constant cally but does not reverse itssign. This undulatory current has an electrolyticaction like the constant current ; but,

in addition, it has the stimulant action on muscle of the Dia grammatically, its curve variable current. would be

represented by line.

sine

curve

placed entirely above the base

transA rotary converter is often spoken of as a motor former, and it is usually arranged to be driven by direct current and to give out alternating ; but it may

be built to be driven by alternating current, and then will brushes current from the commutator give out constant
on

the other side. A

a

than
motor

coupled motor driving another dynamo

motor

rotary converter is and dynamo, which the

more

compact
an

is

shaft. The
combined

and
same

coupled to it on dynamo may, however,

electric the same

be

a as machine, when it is known This form has several advantages motor generator. In the latter the transformed over the rotary converter.

in the

circuit is in direct electricconnection through the armature windings with the current from the main which drives the motor, and therefore there is a danger of shock
current

through accidental contact with the earth current, through the patient or the operator touching a water-tap or electriclight switch. Therefore, when the machine is arranged to transform a direct into an alternating current, the current received by the brushes rubbing on the sUp rings

should be at once passed through a static transformer before being led off into the external circuitto cautery, lamp, or for in the full bath. Most modem treatment machines are
provided
with this safeguard, made,

and
the

if the

former static transwinding

is properly

with

secondary

DIRECT-CURRENT

MOTORS

285

thoroughly
no

insulated from

the

primary,

there

can
an

be
earth

possible danger

of any accidental shock from

current.

Another
dynamo,
or

advantage
motor

which the generator, has over

coupled
a

and rotary converter is

motor

the latter the voltage and periodicity of the alternating current is fixed, depending upon the voltage and speed of revolution of the DC motor, whereas with the that with

former type of machine the generator half of the machine be built to produce any required voltage or periodicity can
of alternating current.

Direct-current
"

motors

In the are shunt -wound." current in serieswith that which flows excited by the same into the armature the field motor coils; in a shunt-wound excited through a side circuit or shunt. The current should always be turned on gradually, using resistances, Heavy or the armature may become overheated.
magnets
are

may former

be

"

"

series -wound the field magnets

or

for traction purposes are always series-wound, but all motors for medical purposes should be shunt- wound, as a nonensures this arrangement variable supply of current
motors
to the fieldmagnets,

varying

although the load on the motor may be frequently and suddenly. Moreover, the motor

could not be run slowly and evenly unless shunt-wound. is reversible that is to A continuous -current dynamo say, if the direct current at a suitable voltage is fed to
"

the commutator
will revolve and

brushes and
run as
a

field magnets,
On
same

the armature

motor.

Alternating- current
such
a

motors."
run

dynamo

will not

in the

the other hand, way if fed with

through slip rings, for two main alternating current The alternating current will not excite the field reasons. if these are separately excited by a magnets ; and even the machine will continuous current from another motor,
not

but will require to be speeded start by itself,

the frequency of the induced

up until alternating current? in the

286

ELEGTBICAL

TREATMENT

coils gets into step with Once driving alternating current.

armature

the periodicity of the

running at that denly. overloaded, when it will drop out of step and stop sudnating-curr AlterThese are known as synchronous motors.
will continue

started, the machine invariable speed, unless

built specially for the voltage and periodicity of the driving current, and should the periodicity of the main current fluctuate, as it is liable
motors must

be

to do in

some

thrown

out

badly supplied districts, the motor will be Such alternating-cur of step, and will stop at once. are, therefore, on the whole much motors
motors,

less satisfactory than DC have produced

though

recent

ments develop-

very satisfactory single-phase for heavy traction purposes, alternating-current motors using a current with a low periodicity of 15 cycles per second. An alternating even recent of the most -current motor,

and

than efficienttype, weighs considerably more motor, and is about 20 per cent, less efficient.

DC

High-tension
currents

alternating

manufactured

usually made purposes are high voltage, in order to save the prime the transmission circuit. By thisismeant

The alternatcurrent." ing for electric lighting or power by machines giving a very
cost

of copper

in

that with currents of low voltage it will be necessary to send a very large along the wires in order to develop the same amperage
power
as

perage where the voltage is high and the amthat correspondingly low. It is to be remembered the power expressed in watts is the number of amperes of
a

in

case

multiplied by the voltage. Now, 746 watts is one electrical horse-power, and for a machine of low voltage to develop the same of high electricalhorse-power as one voltage it must produce a correspondingly larger number of
current

amperes

more,

copper cable will carry 1,000 amperes of current per square inch of its cross section, and no without danger of the cable heating, irrespectivelyof

of current.

the voltage of the current, and it is therefore clear that the

HIGH-TENSION

ALTERNATING

CURRENTS

287

higher the volta,ge which the current can be delivered to at the copper wire cables, the greater is the total amount of energy which those cables will carry. Now, with electric copper costing, as it did in February, 1907, and again

during the Great War, in the neighbourhood of "100 and mission more per ton, the necessity of saving copper in the transcircuit is obvious, especiallyif the districtover energy has to be deliveredis a large and which the electric
scattered one. as Private installations, for country houses, will always be built for direct current, owing to the facility storing of the electric energy in accumulators, and thus avoiding the necessityof running the dynamo continuously, as must be The voltage the case with an alternating -current supply. in such cases will vary from 25 to 200 volts,according to the sizeof the house and the area covered. dynamos to proIt is easy to build alternating duce -current be raised further by step-up transformers for deliveryto the transmission line, and as high a voltage as 110,000 isused at Niagara inAmerica,
current at high voltage,which
can

where the energy of the Falls is used to produce current for

a radius exceeding one and lightingpurposes over hundred miles. In Switzerland,Zurich is now supplied with three-phasealternating current, giving 22,000 horse-power

power

at

pressure of 45,000 volts, generated by water power at Thusis, eighty-fivemiles distant. In this country 11,000
a

is the highest voltage used, for the London Underground ElectricRailways, and 10,000 by the London ElectricSupply

Co. at Deptford.

of the alternating -current street mains are at a pressure of 1,000 volts,each house supplied safe with it having a static transformer fixed in some position in the basement, in order to transform the current
down to 200
100 volts,before it isled into the house. The 1,000 volt terminals of the street wires and the transformer
or

Most

should always be carefullyenclosed in stout wire cages, in by unauthorized persons, as order to prevent interference

288
an

ELECTRICAL

TREATMENT

accidental shock at that high voltage W9uld ability be immediately fatal.

in all prob

For the underground electricrailways the high-pressure alternating current is used to drive motor-generators at a few sub in which the current is transformed into -stations, a direct current at about 550 volts, at which pressure it is supplied to the locomotive from a third rail. Efficient be built^ however, now can, alternating-current motors and the question which is the more suitable type for traction purposes, alternating or direct current, is still being keenly debated by electrical engineers. A recent

development

in this direction is an enormously powerful locomotive of 4,000 horse-power, built by the Westelectric inghouse Company
in America

for the Pennsylvania

Railway.

This engine, weighing 125 tons, receives a single-phcse alternating current at 11,000 volts from an overhead trolley
wire, the current being transformed by static transformers on the engine down to 550 volts, of course alternating at the same periodicity of 15 cycles per second. The speed is

varied by changing the voltage delivered to the motors from the transformer, no rheostat being used in the control ; a speed of 75 miles per hour is easily obtained under load.

High- voltage
building dynamos

direct current."
to

produce mutators, voltage is on account of the excessive sparking at the comOn account of burnt out. which are thus soon it difficulties, has usually been the practhese commutator tice
to limit the voltage of DC

in The great difficulty direct current at a high

dynamos

650 volts. to produce

A laboratory dynamo direct current

maximum of has, however, been built volts.

to

at 11,000

practice the voltage of the direct current for long-line transmission of power by the Thury system in series. Lausanne, in of dynamos (ofcoupling a number Switzerland, is thus supplied by a direct current of 105 pressure of 23,000 volts, which is amperes, at a maximum

In commercial be raised may

generated thirty-five miles away

at St. Maurice by

5,000

F
HIGH-VOLTAGE DIRECT CURRENTS
289

horse-power turbines, driven by water In the power-station are river Rhone.

2,300 volts each, all of which may required. To render this safe,each dynamo

power from the ten dynamos of be coupled in series if

is bedded

on

tion. porcelain insulators, sunk in an asphalt concrete foundaThe copper cable which carriesthe 2,415 kilowatts
.

of electric of energy is only two -thirds an inch in thickness. In the Moutiers-Lyon plant, 6,300 horse-power is transmitted
by the Thury system more than one hundred miles, at a pressure exceeding 50,000 volts. It is,however, found that the loss by leakage islesswith

alternatingthan with direct current at high pressures, and the ease of transforming the alternatingcurrent to any required
voltage, especially with oil-ii sulrted wf ter-croled th'^Thur}static transformers, cannot be rivalledby even The system of direct current high-pr ssure tri nsm.ss.cn. likely entirely to replace alternating current is, therefore, the direct current in large power-houses where the output of current energy is heavy, and especiallyif it has to be

transmitted
but, as
a

long distance. The leakage is proportionately low-pressure currents ; greater with high than with than compensated by the saving rule,thisis more
over
a

in prime cost of copper cables. On the other hand, the danger to life from accidentalcontact with the high-tension currents is much greater than with the low -tension current,

alternating and thereforecircuits employing the high-tension to be especiallyprotected. current require To transform the voltage of a direct current a motor
generator must be used ; that is to say, the main direct motor, which current is used to drive a DC (direct

current)

is wound dynamo

for the main voltage. This motor

drives another

wound to produce the required voltage of direct The motor and dynamo are built on the same current. bedplate, and the apparatus is sometimes known as a rotary transformer. Alternating currents are much easier
to deal with

in changing'the voltage, a statictransformer

290

ELECTRICAL

TREATMENT

with, no

parts being all that is required. This, in its essentials,resembles the primary and secondary windings running through one of a faradic coil, the main current moving

coil,and an induced current is produced in the surrounding coil. The voltage of the induced current will vary with the proportionate number of turns of wire in the primary and secondary

coils,and to reduce the voltage of the street main at 1,000 volts to a voltage safe to use in houses, such have a com100 or 200 volts, the induced circuit must as parative of thick wire, while the primary main of turns of thinner wire. circuit consists of a large number On the other hand, in a step-up transformer, as is used in generating high-frequency currents from the alternating
consist of electric-lightcurrent, the inducing circuit must a large number of turns of thin wire. The voltage of the descent current used in any house will be indicated on the incanlamps

few turns

used
to

in it, though

the lamps
or

indication
current

whether the alternating is supplied to the house.

as

will give no the direct

CHAPTER
MEDICAL

XI
OF THE

APPLICATIONS
CURRENT

SINUSOIDAL

If the electric supply is by alternating current, a simple form of sledge transformer will suffice to reduce the voltage for all methods of applying the single-phase current Such a transformer closely resembles to patients. the sledge coil used for the faradic current, but the iron of the primary must be larger, and there is no interruptor. The thickness of the wire used in the primary and secondary coils,and the number of turns in the two
core

coils,will depend on the voltage of the current supplied to the house and the voltage that it is desired to obtain With a 200-volt main current, the from the secondary. thickness, primary windings should be of about the same turns than the secondary, as the but with many more
voltage of the current must of 12 or 20 volts were

be reduced ; but if an accumulator drive a motor to being used to

alternating current, the secondary winding of the sledge coilwould have to be made with much finerwire and with a far greater number of turns than the primary. produce
The
same

type

direct current (p. 27). It is known

of volt selector that is used for the will serve with the alternating current also
as
a

shunt rheostat, since the

patient's circuitand the coil circuit are alternative paths As soon for the current. as the current is turned on the

dull red, and current is being continually used, whether the shunt circuitto the patient is used or not. Since the current is thus continually passing through the
lamp

glows

to the wire of the rheostat, this is gradually heated owing 291

292

ELECTRICAL

TREATMENT

resistance offered by the wire ; and if the hand is placed round the slate bed the coil will feel upon the coil wound It never hot after it has been in use for a few minutes.
hot enough to bum the insulation of the neighbouring coils. If the metal bar is kept well polished, and the surface of the coil bright, the becomes
or

dangerously hot, however,

metal spring will slide smoothly on the coil,giving a regular and smooth increase of voltage and current without any sudden shocks to the patient. This form of volt selector will do equally well for the direct and the alternating current ; but if the latter current is required for use form of apparatus due
bath
"

in the electric bath, then a modified scribed will be necessary, since that justde-

will not protect the patient from the earth current if not immersed in a to leakage. Moreover, even only
one arm,
"

arm-bath

for example, being treated in an insulated the patient to touch a water- or ^were

his other hand, he would be gas-tap or electricswitch with liable to a severe pressure as the full shock at the same
voltage used in the house. is taken of inserting a new apparatus volt-selector

the precaution small transformer circuiton the 9 (Fig., p. 34), consisting of two coils
reason,

For that

the other, of wire, primary and secondary, one placed over like the primary but having no contact with each other, just faradic battery. The wires from and secondary coils of a the house main are connected with the primary coil,while the secondary coil is connected to the rheostat or volt selector.

This latter circuit is therefore completely insulated from the main current, as the patient's circuit is supplied by the current which is induced in the secondary
only

induction is similar to that of the larger coil. Its method of in the basement of the house, only stationary transformer it closely resembles a faradic primary of simpler design ; but without the interrupting hammer and secondary coil, No interrupter is necessary, because the of the latter. is already alternating ; whereas in the exciting current

F
absolutely no

SINUSOIDAL

CURRENTS

293

faradic apparatus the exciting current in the primaiy is a rupted constant current, and therefore it must he rapidly interin order to induce an interrupted current in the secondary. With this modified form of rheostat there is danger of any accidental shock from leakage of earth current, but the apparatus can only be used for supplied by the direct and not alternatingcurrent, the direct current can be made to yield the alternating type by means of a motor transformer. The direct current is used to drive a DC motor, wound
are

alternatingcurrent. In districts which

for the particularvoltage of the circuit and the armature ; of the motor is tapped at two exactly opposite points and the current led to a pair of slip rings insulatedfrom each

Thence the current can other on the axle of the motor. be collected by means of brushes rubbing on the rings This current is an and led to terminal binding screws. alternating current, and its voltage compares with that of the directcurrent driving the motor as 1 : J2. That is
to say, if the voltage of motor

the direct main current driving the is 240 volts, then the resultant alternating current

is produced at a pressure of about 170 volts, roughly or 70 per cent., about five of the voltage of the -sevenths, main driving current. It must be understood that this current is not perfectly to use for all purposes, because it is more or safe

less in contact through the motor with the main current, and there is therefore a danger of shock from an earth however, be made absolutely safe by current. It can, passing the alternatingcurrent obtained from the machine through a small transformer similar to that described above for using the alternatingmain current in the electric bath.

machines supplied by medical electricians now include such a transformer, and the always for or current that is used for application to patients, cautery and light,being taken from the induced current

The

best modern

294

ELECTEICAL
winding

TREATMENT

in the secondary

safe, with, no and the patient electric switch

current.

of the transformer, is absolutely possibilityof shock from an earth current,

or

operator water-tap

can

touch with impunity

an

or

while using this alternating described just

is sometimes

The simple alternating current

spoken of as single-phase, the positive and negative phases of its electromotive force succeeding each other with perfect regularity, so that if the curve of its EMF

is plotted out
curve

280). (p.

true sine a graphically it approximates Owing to the rapid oscillationsof its EMF

the action of the current on neuro -muscular tissue resembles that of faradism, the muscle being tetanized. Moreover,
since the positive and negative values of the current rapidly succeed one another, from 40 to 110 times per second, the

electrolyticaction. With special machines to increase the periodicity of the current, it has been found
current

has

no

muscular excitation increases with the frequency up to 2,000 or 3,000 alternations per second ; it then diminishes and disappears entirely above 10,000 alternations per second. At this point the phenomena of highthat

Sinusoidal currents begin to appear. at frequencies of 20 to 150 per second produce good motor To obtain results, especially upon non-striated muscle.
currents

frequency

alternating currents

with

lower

frequencies than

40 per

second,

motor

to produce

be used which is wound the slow speed of alternation that is required

generator must

(p.188).
If the sinusoidal current is obtained from the alternating current mains, its periodicity, or number of complete on per second, will be fixed, depending cycles of EMF of the alternations in the generators at the These usually vary in different districts power-house. from 40 to 110 per second, but the periodicity ought not frequencies to vary in the particular installation. Lower the frequency than
40

per

second

are

unsuitable for electric-lighting

MODIFIED

SINUSOIDAL

CURRENTS

295

circuits, that speed being the least that will maintain steady glow in an incandescent lamp. If the

sinusoidal current is obtained from a motor transformer, driven by the direct main current, the periodicity of the transformed current will depend on the speed
of revolution of the motor, and its voltage will be about three of the voltage of the driving current. -fifths If an alternating current is passed through a coilof wire

around a soft iron core, it has a certain magnetic action on the iron, and it is this property which is made use of in instrument called the " Neuron," which is a large alteran nating-curr
electro -magnet.

It will be described later

can

(p.307).
be tested by passing the current from a lamp resistance through the primary coil and interrupting hammer circuit of an ordinary cell-

This property of the current

driven faradic battery.

If the hammer

the spring tension is correctly adjusted, begins to vibrate gently, and this the interrupting hammer test is sometimes used by instrument-makers for a correctly
faradic adjusted apparatus;

is well hung and it will be found that

Modified
fixed

forms

of

sinusoidal
By

currents:
means

sating pul-

unidirectional
on

current."

the axle of the motor is possible to alter the form of the sinusoidal current so immediately that instead of obtaining negative waves of EMF following and
current

mutator of a comtransformer, it

equal

to

the positive

waves,

is, so

consists of a succession of positive waves. to speak, as if the negative waves of the sine turned
over

the It
curve

had

been

and

laid down

again

on

the upper

19, p. 282). side of the base line (Fig. A somewhat be produced with the similar effect can alternating current from the main by passing it through

called a electrolyticrectifier aluminium cells, of valve. These cells have the property of offering a very direction in one high resistance to the waves of EMF
an

Nodon

296

ELECTRICAL

TREATMENT
waves

but offer practically no resistance to the sign. Each cell will thus block the waves

in

one

of opposite direction

up to a pressure of 22 volts, and, therefore,to block out all in one direction for a current of 100 volts, it will the waves be necessary to use five of such cells in series,and twelve Using this arrangement, a is obtained, somewhat pulsating unidirectional current described, but with only half the number similar to that just being blocked. This Nodon the alternate waves of waves,
a

cellsfor

current

of 240 volts.

for working the X-ray coil and its interruptor, for it has the effect in direction though pulof producing a current constant sating, the speed of the interruptions being one half the

valve arrangement work for employing

is made use of sometimes the alternating-current main

in X-ray

periodicity of the particular alternating current used. A good form of aluminium electrolytic rectifierhas a large passive electrode of lead, and a smaller active electrode of
an

alloy of zinc and

of ammonium

aluminium, in Aluminium phosphate.

saturated solution has the property of

offering a great resistance to the passage of a current when it is the anode, so that a current of less than 22 volts cannot is the kathode no pass at all ; when the aluminium

This resistance is offered to the passage of the current. action is due to a polarizing effectof the current, so that a thin film of aluminium oxide is formed upon the anode. This electrolyticrectifiergets warm ing, with prolonged workthe valve effect falls off when the temperature exceeds 40" C. An economical way of using the alternating main current for X-ray coils is to charge accumulators through a and Nodon
valve, and work the coil and its interruptor off

have already spoken of the the form usually 21), single-phase alternating current (Fig. is supplied on main alternating-current circuits. This obtained by tapping the current induced in the rotating

the accumulators. Polyphase currents."

We

POLYPHASE
armature at two

CURRENTS

297

diametrically opposite points, and leading the current to a pair of insulated rings on the axle,whence ever, collectingbrushes deliver it to the external circuit. If,howbe arranged in three the windings of the armature groups at equal distances, and one end of the wire winding of each isled on to a collectingring on the axle, while the other

ends of the three groups

are

connected

together,

we

shall

Fig. 21.

"

Diagram

of single-phase and three-phase

currents.

then obtain what is called a three-phase current (Fig. are 21). Three separate waves generated, each of which is exactly like a single-phase wave, alternating, positive and
with three slip-rings, A, B, G, from which are led off three wires attached to three electrodes, there will be a flow of current between A and B, between B and C, and Similarly a C and A. also between negative,
so

that

two-,

four-,

or

five-phase current

might

dividing

of the armature winding five equal parts, leading one lated end on to separate insuthe axle, and joining together the slip rings on
other ends. A two-phase arranging the jn quadrature, four slip-rings windings of the armature The maximum and four wires being necessary. of the positive and negative values of the second phase occur

the

be produced by into four or

current

is produced

by

that the curve precisely at the moment of the firstphase line ; that is to say, the second phase crosses the zero is exactly one-quarter of a whole cycle later than the firet
voltage ratio of a three-phase current to that of the direct current driving the converter will be as

(Fig.22). The

298

ELECTRICAL
or

TREATMENT
A two

J'S: 2

sj2,

61 per cent.
a

per cent., and driving current

be 70 -phase current will four-phase current 50 per cent, of the

voltage.

Fig. 22.

"

Alternate

cun-euts

in quadrature,

or

"

two-phase

"

current.

Three-phase

sinusoidal currents
they

are

sometimes

employed

in medicine, and

form

very

smooth

and

//

///

Fig. 23.

of threephase alternating- cun-ent dynamo.

"

Diagram

easy

form

them
three

of obtaining of current to bear. The method is to drive a DC motor at and to tap the armature

equidistant points, leading the

currents

to

three

THREE-PHASE

SINUSOIDAL

CURRENTS

299

insulated slip-rings on tlie axle (Fig.23). The currents taken off from these rings by means of collectingbrushes are led through three primary coilsof a sledge transformer, the secondary coilswhich slide over the primaries being usually fixed together so that one movement wards pushes them all forbackwards or (Fig.

24).

The

induced

currents

developed in these secondary led by means coils are of three wires and electrodes to the patient or electric bath. tion Owing to the complete insulaof the patient from the of the main circuit by means

Fig. 24." Motor maiu currents.

transformer,

current,

producing

with three sledge or single-phase

coils, to utilize direct three-phase sinusoidal

sledge

transformer, there is absolutely accidental shock from an earth current.

These three-phase currents
are

no

risk of

any

of a special intragastric as electrode, described under Faradic Treatment (p.95). If b^ this instrument is not available a good substitute may made by passing a flexiblestomach-tube into the stomach,
means

of gastric atony and into the stomach by

useful in the treatment dilatation, one pole being passed

and after pouring

a

Uttle warm

water

down

the tube

pass

medium

copper wire down stiff

inside the stomach-tube

300

ELECTRICAL

TREATMENT

it slip down easily. after well lubricating the wire to make The necessary length to which the copper wire is to be passed must be first marked upon it by measuring it against

the stomach- tube, and it should be passed justa sufficient length for its lower end to rest against the lower orifice of be the stomach-tube.
use

Three-phase
of

currents

may

similarly made
or

for intrarectal treatment

also for Since

constipation,
atony

for

the

full bath

treatment.

and constipation so frequently accompany gastric atony and dilatation of the stomach, a good arrangement of the three electrodes when using threephase currents in the treatment of this condition is for one
of the

lower

bowel

into the electrode to be passed into the stomach and one rectum, while the third should be a pad electrode applied to the epigastrium.

With
it is not
only two
current.

machine

always
are

built for supplying three-phase currents necessary to use all three electrodes, as if

used the patient will then receive a single-phase

that a pulsating unidirectio mentioned be obtained from such a machine current may by the comparatively inexpensive device of fixing a commutator
already

We

have

the axle, so that the same machine may be made use of for three-phase, single-phase, or pulsating It is also possible to fit the axle unidirectional current.
upon

of these machines with the Leduc it into direct current, to convert

or a

transformer
a

for the

rapidly
may

machine
current,

reversed galvanic be fitted with galvanometer

rapidly interrupted Moreover, the current.

lamp resistance, volt application of direct

selector, and

for the

of the and a separate volt selector for the use for cautery and lamp. transformed alternating current The motor may also be used to work a dentist's or surgeon's

drill, or

flexibleapparatus for applying vibratory massageTo recapitulate : A motor transformer worked by the
a

direct main

current

can

be arranged

to supply

(1)direct

SINUSOID
current

AL-CUTIRENT

BATHS

301

for electro -therapeutic application, (2)single- or for electro three-phase sinusoidal currents -therapeutic (3)alternating current for cautery, (4)alternating purposes,

(5)pulsating unidirectiona current for electro-therapeuticpurposes, (6)Leduc currents or (interrupted rapidly reversed galvanism for application to (7) patients), vibratory massage, (8)motor power to
current

for surgical lamps,

work

dental
are

or

surgical drill, trephine, etc.

These

made remarkably compact, and standardized forms of them are sold as multostats, pantostats, etc., which should be made completely earth-free for allcurrents. Sinusoidal current is an extremely useful form of current
machines

for bath treatment,

the four-cell Schnee

baths, for or legeither for local armbath, or for a full electric bath. As

previously said, in its general effects it resembles faradism in its tetanizing effect on muscle, but the current is much less painful than faradism, owing to its smoothness and regularity of alternation. Faradism, moreover, truly an alternating current, the break currents is not being
so

so

powerful than the currents developed at make much more that the faradic current is, to all intents and purposes, Sinusoidal-current electric baths a unidirectional current.
are a

most

excellent method

of treating

cases

paralysis, whether hemiplegic or paraplegic ; useful for tabes dorsalis,peripheral neuritis,and muscular plegia atrophies. In spastic cases, as in the late rigidityof hemi-

of spastic it is also

and in spastic paraplegia from myelitis, disseminated etc., the current in the majority cases of appears sclerosis, to diminish the rigidity, so that the fingers and wrist or

the ankle

can

be moved

more

easily,and the patients feel

better and stronger. In the treatment

hemiplegia,
the

arm-bath forearm which the patient sits, so that the whole in it, the water be placed comfortably covering

late rigidity of of the commencing an arm-bath and a foot-bath should be used, being arranged by the side of a chair in
can

the

302

ELECTRICAL

TREATMENT-

A foot-bath is similarly placed for the foot of the If the Schnee bath is available,the armparalysed side. elbow.

foot-bath of one side only are to be used, one The current electrode dipping into the water of each bath. should be applied daily for about twenty minutes by means

bath and

of the shunt
about

rheostat

or

volt selector, using

10 volts. The strength of current sufficient to tetanize weakly the muscles of the forearm, in water, the supinator and, with the forearm immersed

pressure of should be just

to stand out in contraction as the will be seen pressure of the current approaches 10 volts. Massage to the paralysed arm and leg should be given daily also if possible.

longus

Spastic
to sclerosis,
a

paraplegia,

whether

due

to

disseminated

previous attack of acute transverse myelitis, lateral sclerosis, may to chronic combined or or often be advantageously treated by means of alternating -current baths, each foot placed in a foot-bath with warm water it up to the ankle. The effect of the current is to to cover diminish the spasticity,and thus the limb appears stronger

and

more

lifelike to

the patient.

usually provided with a graduated and an indicator attached to the sliding spring contact to mark the point reached on the scale. These scales are purely arbitrary in their divisions ; but when the "sliding
spring contact is pushed
as

volt selector is scale placed along it,

Each

far to the left as

voltage obtainable will be about maximum of the main current pressure supplied to the rheostat. In practice, the point on the scale at which the voltage is usually

possible, the 70 per cent,

come patient with good water contact will besufficientfor one familiar to the operator through constantly using ever, are the same paraplegic, howrheostat. Patients who
or

who

voltage and a for their treatment.

anaesthetic, usually require on correspondingly higher number

are

greater

the scale

Progressive

muscular

atrophy,

due

to

chronic

SINUSOIDAL-CURRENT

BATHS

303

anterior poliomyelitis, may be treated with sinusoidal electric current baths, either with the four-cell or the fullhydrobath ; but,
cases
arm-

as

with galvanism foot-baths, using the direct or

twice
a

rule, it will be better to treat these either in the full electricbath or in

a

or

constant
means

current,

slowly reversed about

such as mechanical reverser, described, fitted with a small Pohl's commutator

second by the metronome

of

previously

(p.144).

myopathies, may be treated and leg-baths, and I have with sinusoidal current armtype treated a case of the Landouzy-Dejerine at St. Mary's
or

Muscular

dystrophies,

Hospital regularly twice which period the patient

get any
worse,

though

for about six years, during was confident the weakness did not for the previous seven years he had
a

week

gradually become The muscular

extremely wasted and weak. dystrophies are usually divided into four

Pseudo : groups for clinicalclassification (1) -hypertrophic, or Duchenne's paralysis ; (2)Erb's juvenile progressive
muscular atrophy ; scapulo-humeral ;
type, or facio(3)Landouzy-Dejerine and (4)peroneal type, or type of Charcot-

dystrophies the electrical reactions will be diminished in proportion to the degree of muscular wasting. The reactions both to faradism and to galvanism
action will be sluggish, but there is nothing approaching the redegeneration. of

Marie-Tooth.' In all the muscular

The

pseudo-hypertrophic

type nearly always

commences

sex.

in childhood, and is almost limited to the male It is markedly hereditary, and is transmitted through

the female line, though the females themselves usually escape. The males rarely live long enough or retain sufficient for marriage. The muscles that are usually strength
hypertrophied
the gluteus, gastrocnemius, deltoid and infraspinatus, while the firstmuscles to atrophy are usually boundthe upper arm and thigh muscles, and the muscles ing
are

the axillaand shoulder girdle,the lower pectoral,latissi-

304
mus,

ELECTEICAL

TREATMENT

the whole of the trapezius, serratus magnus, and later the erector spinse. For the firstfew years there may be no atrophy of the forearm or leg muscles, though these, too,
to the weakness suffer later. Owing of the thigh muscles, including the extensors of the knee, walking, especially upstairs, isdifficult, and so too isrising from the ground.

may

Deformities ultimately cripple the patient, owing to contracture of other muscles, causing talipes of differentkinds, atrophy is usually remarkably symmetrical, and that point, together with the absence tremors, its heredity and distribution in several of fibrillary family, and the fact that the distribution members of the same scoliosis,etc.
muscular

The

of the muscular

atrophy

spinal segments, all combine from a chronic spinal atrophy.

does not correspond to in differentiatingthe disease

somewhat resembles the pseudohypertrophic in the distribution of the atrophy and its slow progress ; but differs from it in affecting both sexes later, about the age of about equally, in commencing

Erb's

form juvenile

puberty, and in the absence of any pseudo -hypertrophy. it tends to run in families. Like the pseudo -hypertrophic, The Landouzy-Dejerine type may be compared to of symmetrical facies is peculiar and myopathic easily recognized, the atrophy of the frontalis giving a very smooth appearance to the forehead ; and there is additional
facial atrophy. Erb's form, juvenile

with

the addition

This

atrophy of the sphincter muscles of the eyes and lips,the patient being unable to close the eyes or purse up the lips, while the eyes usually appear very prominent and the lips have a peculiar pouting appearance. The facialdiplegia
in this type of muscular dystrophy usually dates from birth, notice that the infant is unable to and the mother may suck or to close the eyes properly. In early childhood, and
up
to

the age of 9

or

10, there

may

be

no

further

atrophy of any other muscles noticeable, and the case may be misunderstood unless it is remembered that the facial

MUSCULAR

DYSTROPHIES

305

atrophy of this group of the myopathies may date from infancy.

is distinctive, and

type of Charcot-Marie-Tooth may be forms divided into two the progressive neuritic and The latter, like the other myopathies, is the myopathic. peroneal
"

The

strikingly hereditary, and probably affectsseveral members of the same generation. Its distinctive character is the
primary

wasting of the muscles below the knee, the calf and anterior tibial and intrinsic foot muscles all becoming atrophied. The atrophy then affects the lower portion of
muscles, the legs appearing peg-top shaped ; involved the intrinsic hand next muscles are muscles which rarely show much wasting in the other myopathies, and then only late in the disease, when the upper-arm and

the

thigh

"

shoulder -girdle muscles are extremely wasted. The progressive neuritic form is not really a myopathy dystrophy at all,but may resemble the or muscular

form
nerves

just described
are

in its muscular

distribution. The

prominent, such as the external popliteal and ulnar ; and there is often in be dissociated as extensive anaesthesia, which may syringomyelia ; or it may be reversed, with loss of tactile
sometimes
sense

much

enlarged and

ture. of pain and temperaand preservation of the sense be of the In some the pupils may of these cases Argyll-Robertson type, with loss of the reaction to light,

and autopsies upon them have in the posterior columns,

neuritis.

tion shown extensive degenerain addition to the hypertrophic Thomsen's

Myotonia

congenita,

or

disease, is

an

hereditary condition of muscular rigidity affecting especially the limb muscles, in which the rigidity appears while the muscles are at their commencement,
rest, thus

hampering
as

movements

at

though

the rigidity wears Many motion is continued. of chronic muscular

are conthe movements tinued off for the time, as long as the

exhibit a degree atrophy, especially of the hand and

of these
cases

306

ELECTRICAL
are

TREATMENT the
term to

forearm, and

distinguished by

atrophica. Electrical treatment service in these cases.

appears

myotonia be of no

Amyotonia

(or myotonia) congenita

of lack of muscular development which there is no particular group muscles trunk and upper-limb

is a curious form in young children, in

affected ; but all the cases the of the lower extremities, and in some

muscles also, are apparently equally wasted and atonic, though really they are undeveloped. They are extremely flaccid, and all the joint movements limp,
so

are

that the feet and legs

any The

by

any position without tonic muscular action.

be placed in practically resistance being offered

can
are knee-jerks

usually

There is little or no over voluntary power absent. these muscles, and the children usually lie or sit huddled be walk, but may up, and are unable to stand or
able to crawl about

the floor in

The condition is sometimes cases the child may appear to be normal for the firstyear or two, and the condition may then develop after some slight
very slightly to faradism, ard these children appear to tolerate surprisingly strong currents without any apparent pain. The prognosis is usually good,

squatting, frog-like posture. congenital, and in other

illness. The

muscles

react

though progress is slow.

is likely to

The diseases for which amyotonia

be

and

myopathy. faradic currents

are rickets, infantile paralysis, mistaken Persistent massage and treatment with should be employed.

type of spinal atrophy is a atrophy, due to a chronic chronic progressive muscular infants anterior poliomyelitis, in quite young children, even under a year old having suffered from it. In older children it may affect the facialand bulbar muscles, and it is always five years. Probably the full galvanic bath daily would be the best hydro -electric form of electrical for this rare disease. treatment
one

The

Werdnig-Hoffmann

fatal in from

to

four

or

Periodic paralysis.

"

This is

rare

form

of muscular

I
Every
now
"

PERIODIC

PARALYSIS

307

all tliemuscles of the limbs and trunk. paralysisaffecting It usually runs in families, vals and the attacks recur at interin early childhood. throughout life, commencing
may be once a week, or only every ^it few months patient,male or female,notices a rapidly ^the progressive languor and heaviness of the limbs, sometimes

and then
"

by slightpins-andthe commencement needles sensation. The limbs and trunk muscles become dition completely paralysed in a few hours, remaining in that confor several hours to a day, when the power gradually accompanied
at

time, respirationis slightly again. At the same hurried and difficult, though the diaphragm is never paralysed. Speech and the eye movements is are nor not lost,
returns

there sphincter paralysis, nor loss of sensation of any kind. Some dilatationof the heart has been noticed in
several cases. A very curious point in this form of paralysis,which has never been explained, is the lossof electrical irritability

in all the paralysed muscles, both to faradism and to galvanism, though the electricalreactions return with the ingly voluntary power. This condition, therefore,differsstrik-

from myasthenia gravis, in which, after the muscle has been exhausted to voluntary power, it willstill ontract c to faradism, and after it has been further exhausted to faradism it willstill over, contract normally to galvanism. Morer muscles paralysed by curare willstilleact to electrical
it is thought that the lesion stimuli,and for these reasons causing the temporary paralysis cannot be in the nerve fibres or any other part of the lower neurone such as the spinal ganglion cell or the end-plate in the muscle, but toxic condition in the muscle substance that there is some

itself which is absorbed and passes off with time. Neuralgia. An apparatus which has been called the
"

has been devised for the treatment of neuralgia and neuralgic headache. It consists of an alternatingis excited either by the current electro -magnet, which

"

Neuron

"

308

ELECTRICAL

TREATMENT

alternating current from the main, or, if tlie main supply is direct current, by means of a sinusoidal current from a This instrument transformer driven from the main. motor certainly has a powerful magnetic effect upon iron and steel, and if a bunch of keys is held close to the pole some of the keys will be powerfully attracted, and others repelled. If the forehead is held against the pole a curious sensation

is felt, rather unpleasant and productive of headache, and slightflashesof light may be noticed. These effectsare duced of alternating currents inprobably produced by means
in the tissues when the head is held close to the magnetic driven field. The magnetic fieldof an electro -magnet by means current is not rapidly varying, of a constant but steady, and therefore no currents will be induced in
a

at rest in its neighbourhood ; in fact, the of people are unable to perceive any sensation on or very powerful DC close to the poles of even

body

majority
contact

magnets. electro-

alternating currents, such as are portable apparatus, have been used supplied by Stirlings' in various forms of obstinate neuralgia. success with some

Three-phase

Electro-magnetism.
paragraph,

"

Although,
are

as

of no purposes, yet a powerful direct-current electro-magnet has been found of great service in ophthalmic surgery. Such electro-magnets magnets have been devised by Hirschberg, Schloesser, and Haab, varying in strength from a carrying power of one

in the last peutic service for theraseen

It is doubtful 300 lb. in weight. pounds up to over useful than whether the extra -large magnets are more for extracting steel particles from the medium-sized ones within the eye.
or

two

condensed form of oxygen, the containing three oxygen atoms instead molecule of ozone It has a somedf two, and it has a high oxidizing power. what unpleasant smell, and may always be recognized in
"

Ozone.

Ozone

is

the neighbourhood

working, such

as

of high potential electricmachines when large static machines or high-frequency

I
1^
I
than
a

OZONE

309

macliines, the brush discharge of the latter especially giving rise to its production. The lightning flash also
in its passage through the air ; but all generates ozone time produce oxides these electric agencies at the same of the atmospheric nitrogen, chiefly nitric oxide (N^OJ,

which is subsequently further oxidized into nitric acid. These oxides of nitrogen are very irritating and injurious to the respiratory tract, and it has been shown that more in the air is fatalto very small percentage of ozone small animals. Ozone has, however, a reputation amongst the public for revivifying properties, chieflybecause it is

found

air, due to the electricaleffects at produced by evaporation. The so-calledsmell of ozone certain seaside resorts is due entirely to decaying seaweed,
sea

in traces in

I
I

fish,and sewage. Machines are constantly being advertised for the production of ozone, the principleof construction being to drive a current of air through the space
between
two

being contained within glass cylinders, one the other. The inside of the inner cylinder is coated with tinfoil, which is connected to one pole of a strong induction

coil,while the outer cylinder is surrounded with

number

of metallic points which are connected to the other pole of the induction coil. This coil may be excited by dry cells like an ordinary faradic coil with an interruptor,
or

it may

When

be driven by alternating current from the main. in action a violetglow is seen in the space between the

glass cylinders,and air driven through this space by means fan, or the pressure of an oxygen of a hand bellows, electric cylinder will issue from the discharge tube highly charged

avoid the production of nitric oxides an oxygen, cylinder should be used, but in practice this is done. never
with
ozone.

To

CHAPTER
ELECTRIC
-LIGHT
are

XII
AND

BATHS

X-RAYS

used for two purposes : (1)to for the actinic effect of the promote free sweating ; (2) lighton the skin and subcutaneous tissues. For the former purpose incandescent lamps are used, and for the latter tween the arc and mercury- vapour lamps. The differencebeELECTRic-ligLt baths
classesof lamps is that the heat rays or rays at the red end of the spectrum, which are useful in moting raisingthe temperature of a cabinet bath and thus of pro-

these two

present in considerable quantity in the spectrum of incandescent lamps ; while the actinic rays which are present in the ultra-violet trum end of the specare very scanty in the light of incandescent lamps.

diaphoresis, are

On the other hand, the light of the arc lamp is richin ultraviolet the rays, which have a very special effect upon
skin and subcutaneous tissues. Sunlight is comparatively poor in ultra-violetrays, which are mainly absorbed by the upper layers of the atmosphere before reaching the

earth.
RADIANT HEAT

Radiant-heat baths have been especiallyrecommended for subacute and chronic rheumatic affections, infective g and other forms of polyarthritis,out, neuritis,sciatica, forms of toxaemic headache, and chronic nephritis some They are contra-indicated in cases with arterio-sclerosis. of myocardial weakness or aortic valvular disease of the heart. Radiant-heat baths may be applied in the form of cabinet baths, in which the patient,after undressing,sits
310

RADIANT
on a

HEAT"

FINSEN

LIGHT

311

chair covered with a blanket or Turkislitowelling, surrounded with incandescent electriclamps, which thus raise
to 150" F.
or even

All parts of the body being thus exposed to the radiant heat, except the head, which through a hole in the top of the projects bath, sweating usually commences within five minutes, and be varied in amount according to the number of lamps turned on and the duration of the bath. Fifteen to twenty
may

the temperature

300" F.

usually suffice. After the bath, the patient must be carefully rubbed down with soft towels, and allowed minutes
to rest and

cool down

for another twenty

are

minutes before

dressing.
Ordinary incandescent lamps
ultra-violet rays, and skin may be produced
a

not entirely free from

certain amount The by them.

of burning of the large incandescent

are

lamps

made

by the Bowsing

Company

stated by them

ultra-violetrays, and to be especially rich in heat rays from the red and yellow end of the spectrum. Intense radiant heat damages the eyes in course of Bottle up the lens and causing cataract. finishers are thus to subject cataract starting at the pos* terior pole of the lens. Their work necessitates frequent exposure of their eyes to the intense heat and glare of the time, drying glass furnaces.
FINSEN
LIGHT

to be entirely free from violet and

The Finsen light was

of the treatment Bunlight through water
Ventor to

first appHed
cure

by

the Danish in* of focusing

lupus, by
on

means

the skin to render it anaemic and thus allow the rays to penetrate. Partly because sunlight is less rich in ultra-violet rays than the
electric

lenses pressed

and* partly because of its inconstant devised by Finsen supply, large electric arc lamps were for the treatment, the light being focused on the part by telescopes through quartz lenses, requiring treatment
arc

lamp,

312

ELECTRICAL
by
a

TREATMENT
of cold
water.

cooled

stream

Quartz allows

free passage to ultra-violet rays, and is much almost better than glass. This light is, therefore, called the Finsen Hght, and the arc lamps originally used were 80 amperes as of of great power, requiring as much
current.

Smaller and

more

used, such as Strebel, and their modifications. These are brought close to the patient and can be used for only one person at a time, while the large Finsen arc lights are sometimes fitted
with four telescopes for the simultaneous treatment of four patients. is Of the small lamps the Finsen-Reyn This requires about 20 amperes. undoubtedly the best. The addition of iron to the carbon, or the substitution
to of iron for the carbon electrodes, has been shown increase largely the proportion of ultra-violet rays in the light given off, and to produce more readily a

commore monly convenient lamps are now the Finsen-Reyn, the Lortet-Genoud,

superficial reaction of for lupus.

the skin, but

it is less efficient

The

light treatment

used for the treatment of light required, the part being rendered anaemic by the pressure of the quartz lens on the skin, and the length ment and number of exposures required, the Finsen-light treatfor lupus has been, to
by X-rays.
The
a

has been, and is still, extensively Owing to the concentration of lupus.

light treatment

large extent, superseded is undoubtedly curative

besides the to of lupus ; but the great objection its use, length of time required, is the difficulty or impossibility of making the light penetrate sufficientlydeeply into the tissues. The subcutaneous tissues are rendered as anaemic as possible by pressure, because the light is with entirely arrested and absorbed by blood ; but even skin and this precaution the penetrative power of the Hght is not For this reason to be compared that of X-rays. ^with the Finsen light fails, as a rule, in the treatment of

FINSEN

LIGHT

313

epithelioma, rodent uloer, and other forms of malignant far disease of the superficial structures, and X-rays are
preferable.

ulcer has been already referred to as being treated with zinc ions, round button-shaped electrodes of
bare zinc being used with the positive pole and
current
a

Rodent

constant

of 5 to 10

ma.

Chronic

skin

affections, such

boils, etc., have gouty eczema, Certain wave-lengths of the ultrathe light treatment. violet rays have been foujad to be bactericidal, and this may
arc
on

varicose ulcers, been shown to benefit by

as

Strong be partly the reason for the improvement. lamps, with iron or carbon-iron electrodes, are mounted a portable frame which can be rotated in any direction
can or

and

be

brought

close to

the

patient.

After
a

three

minutes

more

the skin usually shows signs of

reaction,

the part becoming

so more

ful, and slightly swollen and painfarther off. The be removed fractory chronic skin diseases, such as an old-standing re-

reddened that the lamp must

of gouty eczema, will show no reaction, perhaps, for the firsthalf-dozen applications ; but once be borne only for there has been reaction, the light can a short time, and the eczematous patch rapidly begins
case

to heal up.

Lumbago,
sciatica may

chronic

muscular

rheumatism,

also be beneficially treated by means lamp and ultra-violet rays, in arc with the conjimction incandescent-lamp cabinet. These cabinet baths are usually made with a door specially fixed for the attachment oi

and of the

small arc lamp, or the rays of the larger and stronger arc lamps can be applied to the patient's back or thighs by opening the door through which he enters the cabinet. For
a

lumbago, bath
manner,

the best combination

with conjunction

in

is the incandescent cabinet lamp applied in this the arc

followed by

galvanic hydro -electricbath

and

massage.

314

ELECTRICAL

TREATMENT

MEECURY-

VAPOUR
as
a

LAMP

long glass tube, two to three feet in length, which is exhausted of air,but contains two or three ounces of mercury and mercury vapour. Platinum
wires fixed in carbon blocks form the terminals at the two of which the current is led to ends of the tubes by means They are driven by direct current, usually the mercury.

This is sometimes known Bastian light. It consists of

tlie Cooper- Hewitt

or

tlie

from the electric-lightains, using appropriate resistances. m The lamp is started by tilting it slightlywith the negative
below, so that the mercury makes momentary contact .pole between the two poles, when some ized, of it is instantly vaporthe vapour acting as a conductor for the current, the whole length of the tube to glow with which causes intensely bright light, slightly greenish-blue in colour. an

The spectrum
no

well as rays in the light,

as

tically of this light is remarkable in containing pracred rays ; but it is rich in green, blue, and violet, ultra-violet rays. Owing to the absence of red

c objectsoloured

appear black when viewed by a the hands and faces of people appear peculiarly corpse-like. Green-coloured

red in white light will mercury- vapour lamp, and

a

bluish livid hue,

s objects,uch

as

palms and ferns, will, however, appear quite natural in this light, owing to its richness in green rays.
In order to
overcome,

for lighting purposes, the tionable objecin the light, it is customary absence of red i:ays to surround a mercury- vapour lamp with a ring of three or four ordinary incandescent lamps, but this device is quite insufficient. It is, of couiBe, than useless to surworse round lamp with a red shade, as that would only result the in blocking out all the light, a red shade only appearing red in ordinary light because it absorbs all the other coloured rays, and reflectsor transmits only the red rays. Owing to
this

the objection,

into general use, although it is extremely cheap, cheaper than incandescent gas.
light has not
come

THE In places such

as

UVIOL and

LAMP

315'

railway jetties, for and it signalling and lighthouses, may, however, prove a success, when a convenient form of the lamp has been worked out.
It only two -thirds of a watt in energy for every candle in power, being thus nearly twice as efficient lamps, an as 16-candle lamp metal-filament ordinary
consumes
"

dockyards

requiring 20
per
or [unit,

with electricity costing 6d. kilowatt hour, a 100-candle-power mercurywatts.

Thus,

vapour
a

lamp

could be hghted for two

one

and

half hours at

cost of only Owing to

penny. for

the richness of this light in ultra-violetrays,

of
service

it is proving

purposes, as described above, and a special lamp, the Uviol lamp, has been devised with this in view. This lamp,

therapeutic

object

made

of

special glass, permits

of

are ultra-violet rays, which mostly ordinary glass lamps ; but spectacles are necessary to with it on account of the irritatingefiect of these rays

of passage by the arrested

use
on

the

the eyes.
such as the or
"

This is liable to produce intense conjunctivitis be caused by the light of a strong arc lamp, may
"

acquired by climbing in high snowfields. It has already been said that altitudes over are a large proportion of the ultra-violet rays of sunhght

snow-bUndness

Since, for arrested in the upper layers of the atmosphere. every 1,000 feet of altitude,the barometrical pressure falls
about

inch, and the air becomes proportionately more richer in ultra-violet rarefied, the sunlight is much time reflect rays on high snowfields, which at the same
an

the

the eyes so intensely. Goggles for the due protection of the eyes from conjunctivitis to exposure lamps, or mercury- vapour lamps, should to snow, arc
light into

therefore be made of the reddish-yellow non-actinic glass, instead of blue or smoked glass, as it is the rays in the tion blue and violet end of the spectrum that cause the irrita-

and chemical efEects. For therapeutic use, three Uviol lamps

are

mounted

316
on

ELECTRICAL
a

TREATMENT

reflector, rheostat, and meter. ampereeven than the.Uviol glass for allowing ultra-violetrays to pass is quartz, and now quartz lamps, for mercurywater-cooled, with quartz lenses, are made with
vapour lamps,
rays.

stand, Better

lamps. and

They

stand much

greater heat
more

than

.the

glass

generate lamp

powerful

ultra-violet

The
a

Nernst

gives

filament of yttria and This filament is not a conductor passage of the current. of electricitywhen cold, and therefore the lamp does not

intense white light, due to zirconia being heated by the

an

light up

at

once,

and

is provided

with

heater, automatic

cut-out,

and
arc

The flame
next

resistance. gives the most

intense form

spark. form of open arc light, and its the old efficiency is the highest of all electric lamps, being only 0 28 watts per pendicul candle. Instead of the carbons being perimprovement
on

to the Leyden

jarhigh-tension

of light, It is a great

to each

other at an out into a

an

other, they are inclined towards each angle pointing downwards, and the arc is blown flame by an electro-magnet below a reflector,

better. arrangement which distributes the light much The yellow flame arc is rich in red and yellow rays, due to the carbons being impregnated with calcium fluoride. Rays from these lamps penetrate water vapour much better than the shorter-vibration rays from the ordinary arc lamp, and better in foggy weather ; they are, are therefore much

accordingly, being largely used for street lighting. Barium salts make the flame arc white, while a pink light is produced by impregnation of the carbons with strontium exceedingly effective Hght for large areas. It consists of a long glass tube about If inches in diameter, of any shape and length up to 200 feet,partly
light is
an

salts. The

Moore

exhausted

of air, and iUuminated by the passage of a highThe lightsomewhat resembles voitage alternating current.

THE

MOORE

LIGHT

317

the glow inside the vacuum electrodes of a high-frequency An alternating current of 50 cycles and 100 to apparatus. 200 volts is sent through the primary of a high-tension transformer, the secondary yielding alternating current at a
pressure of several thousand volts. This is connected to tube by graphite cup electrodes,with an the glass vacuum automatic valve for admitting additional mercury-carbon small quantities of air to the tube, at intervals of about is raised by the passage of the one minute, as the vacuum The efficiencyof the light is 1"78 watts per candle, current.

about 12 candles of light being obtained from each foot be obtained from of tube. Different-coloured lights may it ; with ordinary air admitted by the valve, the tube glows
If the air is passed over phosphorus, the rose-pink. light is golden yellow ; if pure nitrogen only is admitted, the light is yellow ; with pure carbon-dioxide the light is white. Half-watt lamps

and

and

being largely used for streetgreater efficiency, shop-lighting, owing to their much for mainthey are largely replacing arc lamps, even
are

now

street

lighting. Though
than the flame
arc,

using

more

current

per candle-

power

maintenance as there are

as

yet the much cheaper cost and make the half-watt lamp cheaper in the end, no moving parts, and it requires no attention,

the

on

The principle of the lamp is founded the fact that the tungsten filament will bear a much
arc

lamp

does.

heavier

current,
an

and

therefore will glow very much

more

brightly, in

atmosphere

without gas than in vacuo, filled with nitrogen at are

other neutral volatilizing. The glass bulbs slightly less than the atmospheric

of nitrogen

or

pressure, and though there is dissipation of energy by increased conduction and convection of heat, yet this for by the much loss is more than compensated greater brilliance of the filament, and the consequent smaller

Such lamps of current per candle-power. consumption become very hot, and the intense brillianceof the light

318

ELECTRICAL
use

TREATMENT
some

necessitates for ordinary

other shading. is Appended

form

of opalescent

or

light, arranged
per candle-power

list of the principal sources of electric in the order of their efficiency in watts
a
:
"

COLOUKED

LIGHT

Red

light is said to prevent the suppuration permanent vesicles, and the consequent

of smallpox

This is ancient knowledge, have been treated for smallpox

scarring. for the Black Prince is said to

round

the bed.

by red curtains being drawn This belief is founded on truth, for red

curtains would exclude the rays from the blue end of the thus shutting out the ultra-violet actinic rays spectrum, which especially afiectthe skin. Cases have been published

ulcer and of gangrenous of chronic of improvement stomatitis by exposure to red lightfrom a IG-candle-power lamp, with a red globe and reflector. This is probably due
to the exclusion of the blue rays, for the red glass cannot add any red rays to a light which did not possess them

before ; it merely filtersoff the other coloured Blue light. Exposure light for to blue
"

rays.

several

minutes has been said to produce a curious sedative effect and ansesthesia, so that minor surgical operations may be

done

under its influence. Pain from

been

joint effusions or

in

arthritisis said to have insert a deep-blue glass

relieved, and it is usual to the window^into side of an electric-

I
effectupon

RONTGEN

RAYS

319

lightcabinet bath so that the lightfrom an arc lamp may be directedthrough itupon the joints a patient being treated of for rheumatism or other forms of arthritis.Its sedative mental states is also said to be pronounced, producing calm, followed by sleep.
RONTGEN
RAYS

nection of work has been done in conthese rays X-rays, as their discoverer with Rontgen named them. It was the work of Crookes on
enormous

An

amount

"

the phenomena

discharge in tubes highly exof electric hausted of air that led to Rontgen's discovery. If such a tube, having platinum terminals sealed into its ends, tenbe exhausted until the air-pressure is only one

thousandth part of an atmosphere, it is found that the resistance of the tube to the passage of high-pressure is currents of 50,000 to 100,000 volts or more electrical

changing. Before exhaustion, the current jumps across the air-spacebetween the terminals in a seriesof intensely bright sparks ; but when the exhaustion reaches the degree mentioned above, it is found that sparks are no longer
with a glow of light. passing, but that the tube is filled A beam of lightappears to issue from the kathode, which

is surrounded with a dark space, while a striatedcloud of light surrounds the anode or positivepole. When the exhaustio further, the dark space the tube is carriedstill of

around the kathode extends farther along the tube until tiful the glassat the other end, producing a beauat lastitstrikes phosphorescence green if the tube is made of soda glass,blue if the glass contains lead.
"

This phosphorescenceof the glassat the anode end of the tube is due to a stream of rays issuing from the kathode,
as
can

in be proved by shadows of solid objects front of the kathode being thrown on the phosphorescent glass. covered These rays were calledthe kathode rays by Lenard, who disin 1894 that they could pass out of the tube into

320

ELECTRICAL

TREATMENT

the outer air through an aluminium let into the window They consist of a beam glass bulb opposite the kathode. of infinitely tiny negatively electrifiedbodies called corpuscles,
known electrons. The smallest chemical atom is the hydrogen atom, the atomic weight of hydrogen being
or

taken

about 1 ; but the hydrogen electrons, though each electron, when

as

atom

contains 1,000 flying free, carries a

charge of negative electricity equal to the electrical charge Lenard discovered carried by a whole hydrogen atom.

that these rays of electrons penetrated substances in proportion to their density, thus differingfrom light rays, to
which many of low specific gravity (such as stances aluminium) are opaque, though heavier subsubstances

cork

and

are and glass) translucent. The Lenard rays, consisting of a beam of corpuscles, can be deflected by a magnet ; and by this means calculations have shown

(e.g.ater w

speed of 10,000 to 90,000 miles per second, or about half the speed of light, which is 186,000 miles per second. The rays, when they strike produce X-rays, which are very

that

these tiny

bodies

reach

the

enormous

objects,
a

different from
cannot

the rays that

give

be deflected by

of electrons or form of pulsating

magnet, corpuscles, but

X-rays rise to them. and they do not consist probably a peculiar the ether set up by

are

vibrations in the impact of corpuscles upon the of the beam which they strike. Thus the kathode rays or

object
beam

of corpuscles issuing from the kathode in the Crookes tube, by striking upon the glass at the other end cause the glass to phosphoresce, and so a new set of rays, the Xrays, is produced, possessing very different properties. The travel with the same velocity as light,but cannot be polarized like ordinary light ; they have enormously portion greater power of penetration through substances, in proX-rays
to

their density

or

atomic

weights ; and they

many
more are

can

affect photographic

plates through

inches of solid quickly arrested

wood

or

aluminium, though they

I
or

RONTGEN

RAYS

321

by the denser metals such as lead, gold, and platinum. X-rays are invisible the eye, and to Unlike ordinary light, cannot be deflectedby a prism or lens.

Various forms of Crookes tubes have been designedfor the o production of X-rays, but the essentialsfall are the same. isabout a foot long,made of soda glass The modern focustube window to allowof the escape of the Xsoda -glass rays,which are stopped by lead glass. The tube isblown into
with
a

bulb in the middle, which contains two anodes, one made of aluminium, the other of platinum. One of the anodes is placed directly opposite the kathode, and is therefore
a

called the anti-kathode,and it is made of copper coated with platinum, in order to withstand the intense discharge of the kathode rays upon it. Its face is inclined at half
"a

right angle to the perpendicularlinedrawn from the face pole is made of aluminium, and of the kathode. The latter its face is concave, so as to focus the discharge of kathode

rays which it gives off. If platinum were used for the kathode it would become gradually disintegrated,the

kathodal rays carrying offminute particles the metal, and of blackening the tube ; but this does not occur with aluminium to anything like the same extent. The distance
of the anti-kathode isso arranged that the kathode rays are cause almost exactly focused upon it ^not quite exactly, be"

the platinum would soon be melted and the tube rendered useless. The aluminium anode is sealed t into the bulb a littleo one side of the anti-kathode, and it is usual to connect the anode and anti-kathode together

in that

case

outside the tube by a wire, so that they both function as anodes, though this is not necessary, the main function of the anti-kathode being to serve as a target upon which the kathode rays are focused. The tube is then highly exhausted
of
an

of air,the pressure being reduced to one -millionth atmosphere. In order to excite this X-ray tube, a

unidirectionalcurrent through it so as to
V

of high potential must be driven its resistance and force overcome

"

322

ELECTRICAL

TREATMENT

through

or

volts, which : (1) a 10may be obtained from one of three sources by a direct current at 12-inch induction coil, worked
or
more

it a steady stream current of 50,000

of kathode to 150,000

rays.

Such

high potential is necessary,

times per second volts, interrupted 40 or more form of mechanical or electrolytical interruptor ; by some an (2)' alternating street current, transformed by a step -up transformer to a high voltage, and converted into a unidirectio
12
current

by

means

of

mechanical

or

valve tube

; rectifier (3) a large static machine. X-rays, being produced by the impact of the corpuscles of the kathode rays on any hard substance, such as the

platinum anti-kathode of the focus tube, do not consist, like the kathode rays, of material particles, but probably

somewhat

resemble
transverse

light

waves.

Light

waves

are

continuous

vibrations in the ether, the wave lengths differing with the colour of the light, being longest at the red end of the spectrum and shortest at the violet

end.

X-rays
in

are

probably

not

a very much ether, and length than light, being about 2,000 times shorter wave length of green light {see p. 335). shorter than the wave length the more Probably the shorter the wave penetrating

vibrations

the

continuous they have

but

pulsatile

ray

the higher the speed of the kathode the more rapid will be the ethereal oscillation produced by it at the anti-kathode ; that is to say, the

the ray, and

more

penetrating
rays

is the

X-ray
are

gamma

of radium,

which

Hence the produced. in reality X-rays, are

the most

penetrating of all rays.

p
The
"

CHAPTER
STATIC ELECTRICITY AND

XIII

HIGH-FREQUENCY

CURRENTS
STATIC ELECTRICITY

is derived from the Greek word electricity The fact has been known electron," signifying amber.

word

since ancient times that amber, when nibbed, attracts Dr. Gilbert, of Colchester,who light bodies ; but it was other bodies having extended this observation to numerous " a similar function, which he therefore named electrics."

beth, Dr. William Gilbert, who was physician to Queen Elizaand President of the Royal College of Physicians in the year 1600, published in that year, only three years
" De Magnete," * which before his death, his famous work, laid the foundations of the future science of electricity. The form of electricity produced by frictionof glass,

known as sulphur, or ebonite with silk,fur, etc., is now static electricity. The two substances rubbed together become oppositely electrified.Thus, a glass rod or plate, rubbed with a dry piece of silk,becomes positivelyelectrified,
the silk acquiring a negative charge. Similarly electrified bodies repel one another, while a positivelyelectrified This prinbody is attracted by one negatively electrified. ciple the two gold explains the action of the electroscope, leaves becoming similarly electrified,nd repelling one a

body is brought near it. another, when an electrified A charge of staticelectricity always at a much higher is
*
"

De Magnete

Magneticisque

Corporiljus, de Magno et

Magnate

Tellure,Physiol ogia Nova."

323

324

ELECTRICAL

TREATMENT

voltage than is usual with faradic or galvanic currents, and the charge is consequently quickly dissipated from points or rough surfaces into the air. The

projecting
method

of conduction of electricity at the high tension from the low of static electricity differssomewhat -tension batteries or of dynamos. currents of ordinary galvanic

the electricity flows along the whole of the cross-section of the wire, so that a solid galvanic current than a hollow wire wire will conduct more
the low -tension currents

With

of the

same

size, in proportion

to its weight.

When

the

voltage of the galvanic current or the alternating current is raised above 1,000 volts, it is found that of a dynamo on the surface of the conthe current tends to flow more ductor " in its centre, the so-called skin efiect." With than

the high-tension currents of static electricity,this effect is very much more pronounced, and the current flows
practically only ball a wooden with
same
as on

the

surface

coated

with

much

size. charge flows comparatively leather that are or wood

static electricityas Owing to the high tension of the current,

Thus of a conductor. be charged tinfoil can ball of the a solid metal

the

easily along substances such as fairly good insulators for low-

tension currents ; and it is exceedingly difficult properly to insulate bodies highly charged with static electricity,dry being among the best varnished glass, ebonite, and rubber insulating materials.

The original machines tional electricity produced

for manufacturing static or fricthe current by frictionof sulphur

balls,glass plates, or cylinders by the hand or by silk pads Ramsden's glass plate amalgam. covered with mercury its kind for more than a hundred the best of machine was
years. The positive electricity produced on the glass plate as it revolved was collected by metal points attached to a brass The Leyden jar was as prime conductor.

rod, which acted discovered by accident in 1745.

It

was

Franklin, Benjamin

THE in America, wKo

ELECTROPHORUS

325

first explained its action, and it was he also who, in 1752, invented the lightning conductor, and demonstrated the fact that the lightning flash and the jar or electrical machine were spark from the Leyden

identical. On account of Franklin's pioneer work on static by this form of current the medical treatment electricity,
is sometimes Following known the
"

as

franklinization."

producing of the electrophorus

friction machines came for apparatus electrificationby induction, and the invention
by

Volta in 1775.

This apparatus

consists of a cake of resin fixed on a metal stand, and another To use it metal disc of similar size,fixed to a glass handle. the resin is rubbed with silk,producing negative electrification its surface ; the metal disc is then lowered upon it, touched for a moment with the finger,and then liftedby the found to be positively glass handle. The metal disc is now
on

be repeated indefinitely, and this process can electrified, until the negative charge on the surface of the resin has slowly become dissipated in the air, and requires renewing
by

rubbing. Electrostatic influence machines, or continuous electrophori, were next invented, by Holtz in 1865, by Voss

In in this country. and others, and later by Wimshurst France and England the Wimshurst machine is almost exclusivel The latter used, and the Holtz in America. machine has the disadvantage of requiring an initial charge Wimshurst to be given it, usually by a smaller Voss or machine ; the last is self-exciting, if the plates have metallic sectors, though the later machines without sectors to be touched with the are not self -exciting, and require finger on the edge of the plate as it is revolving. consistsof two plates or more, in pairs, arranged on a central axle so that each pair of Fig. 10, p. 36). In plates revolves in opposite directions (see a machine with twelve plates, the second and third plates

The Wimshurst

machine

will be fixed

on

the

same

axle block and

rotate

tofiether,-

326

ELECTRICAL

TREATMENT

the fourth and fifthsimilarly coupled together and rotating in the opposite direction,and so on, the outer plates at the two opposite ends rotating in the same direction if
there is
an even

number

directions if the number of twelve plates will be driven by seven being crossed. In this country alternate ones
are

of pairs of plates, and in reverse Such an arrangeof pairs is odd. ment

bands, the

the plates

usually made of glass, being | inch apart, while 36 inches. Each pair their diameter is 24 to 30, or even of plates has two pairs of metallic brushes, whose tips
graze the surface of the edges of the plates. Each pair of brushes is carried on a curved metal rod attached to a prolongation of the fixed axle. They should be so placed

that,

on

facing the

plate, the

position of the hands of a five. Curved metal collectors, round with metallic points, surlevel of the horizontal each pair of plates, at the

rod occupies the clock pointing to five minutes to curved

diameter

of the plates. The collector rod on each side is for all the pairs of plates. common The voltage of the machine, that is to say, the length of the spark, depends on the diameter of the plates and the speed at which they are driven ; while the output of

the machine, that is to say, the frequency and the thickness and brilliancy of the sparks, depends on the number of plates and their speed of revolution. A machine has been
at South constructed for the Science and Art Department Kensington, with plates 7 feet in diameter, which is supposed Leyden jars to give sparks 30 inches long, but no

have been found to withstand the enormous electricstrain. bald built for Sir ArchiA large machine with eighty plates was Campbell,
account

On immense output. gives an which of the impossibility of rotating glass plates at high
to their liabilityto fracture, ebonite is often

speed, owing used, and

efficient machines, with twelve pairs of These ebonite plates, of 22 inches diameter, are made. be safely rotated at the high speed of 1,000 revolutions can very

THE
per minute
"

WIMSHURST

MACHINE
"

327

twice as fastas with glass plates and therefore the same voltage may be obtained with smaller plates. A dust-proof case is usually fittedto the larger glass-plate though it machines ; but it does not appear to be essential,

cleaning. Owing to the destructiveeffect of ozone upon ebonite, it is better not to enclose machines with ebonite plates in cases.
certainlysaves

Machines for physical laboratories are fitted with Leyden jars, as to increasethe power of the spark, though so the sparks will be lessfrequent. If the machine is being used to produce X-rays for photographic purposes, the

Leyden

connect used, though they should be disfrom the machine for most therapeutic applications. The largermachines, which are the only ones of use

jarshould also be s

for treatment, with four or more pairs of plates,are best driven by an electricmotor, of J to J horse-power. In Pidgeon's influence machine there are nine revolving plates, consistingof three groups of three plates each. The three central plates, 2, 5, and 8, are driven by the 1, whilst the outer plates, 3, 4, centralaxle in one direction, C, 7, 9, are carried on suitablesleeves and driven by bands
in the opposite direction. The platesare made of volenite, with sunk metallic sectors, but a full descriptionof the

machine is unnecessary here. Like the Wimshurst machine but with sectors, it is self-exciting, itsoutput is said to be about four times as great as that of the older form of Wimshurst.

machine, with eight plates of 30inches diameter, when working well will give sparks of 6 to 10 inches in length. After it has been running for
A

large Wimshurst

few seconds, a glow of violet light appears upon the collectingbrushes and points, and the speed of rotation of the plates becomes sensibly decreased, owing to the

of greater resistancefrom the self-induction the machine. The current received from the collectingbrushes by the fixed conductors is led to two brass knobs outside the

328

ELECTRICAL

TREATMENT

of tlie machine, which, are separated by a distance of about 12 inches. The two poles of the machine should have sliding rods attached to them, ending in
case

adjustable

brass knobs,

while midway

vertically an ebonite rod knob. The upper knob is attached to

poles is fixed carrying at each end a brass

between

the

nected metal chain conwith a gas- or water-pipe, while the lower knob is connected with a similar chain to connect it to the patient's circuit. The sliding rods attached to the discharging poles
a

with either the upper or lower knobs of the vertical rod between them, so that either pole may be quickly connected with the patient or
can
"

be

to adjusted

be in contact

with earth." The current be

supplied by a Wimshurst direction machine is uniand therefore one of the discharging knobs will" In order to distinguish positive and the other negative. lowing the two poles for the purposes of treatment, the fol-

given by Lewis Jones, is useful. The method, machine is set in action, with neither of the poles connected to earth. A pointed electrode, connected by a light,

metal chain to earth, is then gradually brought near one of the two poles. If this is positive,a star of light will appear at a distance of several inches, and upon the point, even this star of light will remain without much alteration until the point is brought up almost into contact with the knob, when small sparks pass. If approached to the negative
pole in the
same

way,

the discharge takes the form of

a

visible brush or spark, when the point is stillat of 2 or 3 inches from the knob.

distance

a strong insulated of treatment, stool is necessary, and four or five different electrodes. The stool should be stoutly made, and should be fully

For

the purposes

It should have a raised curved 3 feet long by 2 feet wide. rim, to prevent the patient's chair slipping off the edge, and it should stand on four stout glass legs, 10 to 12 inches
in length, and

varnished.

On the top of the stool should

I
be fixed
a

STATIC zinc
or

ELECTRICITY

329'

brass plate, about 12 inches square, which is connected by a light metal rod with one pole, usually the positive. The patient sitswith the feet placed
upon the metal plate,and is thus brought in contact the positive pole.

with

The electrodes that are necessary are four in number : (1)a metal ball or large knob on holder; (2)a metal
roller, similarlymounted
;

(3)a multiple point electrode;

a and (4) metal cap with multiple points, attached to a metal arm which can be swung out from the top of the case of the machine to hang over the patient'shead. If the machine has no case, this electrode must be mounted on a

tallstand, and connected to earth.

*

METHODS

OF

TREATMENT

There are four methods of treatment: (1)By sparks, (2)friction,(3)the breeze or effluve,(4)static charging. With the ball or knob electrode, sparks are administered form of treatment which must be used a severe
"

than one spark at a time is to be with caution. Not more given, the electrode being rapidly approached and withdrawn before there is time for a second spark to leap The result of the spark is to cause a sudden spas^ across.
modic muscular contraction at the point of its application, and this mode of treatment may be used for muscular stimulation. A better method for this purpose is to use Morton's " are then connected to static induction," Leyden jars the two poles of the machine, and their outer coatings

attached to connecting cords and ordinary pad electrodes, which are applied to the skin and muscles in the same way as with faradism. To control the intensity of the shocks, the sliding knobs attached to the two poles
are

at of the machine may be adjusted variable distances; the nearer they are brought together the weaker will be the This shocks from the outer coatings of the Leyden jars.

330
same

ELECTRICAL

TREATMENT

method of adjustment the sliding knobs is used to of graduate the intensity of the sparks applied to the patient by the ball electrode, or instead, the operator may weaken them by putting his foot on to the stool, so as to cause
some

of the static charge to leak away. Another method of applying the static sparks for muscular is to avoid sparking the skin entirely,and treatment

electrode to a small metal electrode held over the motor point on the skin by an insulated glass handle. In this way the skin escapes the powerful stimulating action of the spark, which often

to allow

the spark to

jump

from

the knob

caria, of large wheals, resembling urtiof when strong sparks are taken from a small area for several seconds together. The muscular contracskin tions be from the stimulation of the spark can resulting

results in the appearance

injury produced in cases of nerve and degeneration, even after the muscles have lost their reaction to faradism. In
the progress of the reaction of degeneration, the reactions
to the static sparks disappear before the vanism excitabilityto gal-

is lost.

The sensory stimulation by spark treatment

and may be of considerable functional paralysis.
use

is powerful,

in hysterical anaesthesia and of obtaining the

same

A milder, and in most cases better, way form of sensory stimulation is to use

friction. This

is done

with the metal roller electrode, which is rapidly the limbs, and rolled outside the patient's clothing, over
"

especially along the spine. The thicker the clothing and it must be dry ^the stronger are the sparks which shower through on to the skin underneath, so that the additional thickness of a blanket, or other woollen garment, may be
"

added

when

it is necessary that the treatment

should be
by

specially stimulating.

The
point
or,

breeze
better,

or a

effluve is administered

multiple-point electrode, which to earth by a chain, while the patient sits

single is connected
on

the

STATIC

ELECTRICITY

331

insulated stool and the footplate connected to the tive posi329). The point elecpole of the machine in action (p. trode is directed towards the patient, being gradually approached
to the
areas

that require treatment.

a

It produces

cool breeze on the exposed parts, or as a hot pricking upon the parts covered with administered in this way, the treatment clothing. When " is called the negative breeze," because the patient is

wind,

or

souffle, which is feltas

positively charged. The point electrode circumstances, be approached much nearer without
a

can,

under these to the patient

spark passing than when the footplate is attached to the negative pole and the positive pole is earthed. The is very sedative, if given properly, and is a usetreatment ful

headache, and neuralgia of treating neurasthenic of different forms, and the pains of neuritis. This form in of static brush discharge is said to be very efficacious the treatment of chronic indolent ulcers.
means

Static charging,
placing the patient in a the footplate to one

the static bath, is applied bying chair on the insulated stool,connector

setting it in motion. machine is kept running, the potential of the patient on the stool is raised to that of the prime conductors ; he

of the poles of the machine, and No electrodes are used. As the

is thus placed in an electrostatic field, and the charge, being at a high potential, leaks away from his hair, limbs, neighbourand all prominences, to the surrounding air and ing As he loses his charge, in objects contact with earth. so is it replaced by the continued working of the machine ; his hair stands on end, his skin feels pricking and the face Usually the patient is charged positively, the cobwebby.

sedative of pain and exhilarating than effects being more when he is charged negatively. is by static electricity said favourably to This treatment

The respiratory exchange. metabolism and depression of spirits appetitp improves, sleep returns, and tends to disappear. An efEect that has been observed is
influence

332:

ELECTEICAL

TREATMENT

raising oi the blood-pressure, and this method of treatment is to be avoided in arterio disease, and the a -sclerosis nd renal form of headache associated with high blood -pressure. Many perspire subjects
profusely from the forehead and hands during the treatment. The treatment be combined may with the douche, by swinging the cap with metal points the patient's head at a distance of 6 inches. When this is done, the positive charge rushes mainly to the head
over

and leaves the scalp by the hair, which stands on end, as the current passes off in the effluve to the metal cap, which by being earthed is connected to the negative pole. This is the most of useful kind of static treatment
"

for various forms

to

headache

more

particularly

the

neuralgic.

Insomnia

especiallyseems
or

neurasthenic and be relieved by

friction with the roller will be indicated in cases of hysterical paraplegia and anaesthesia, most and other functional, paralyses, and it is sometimes

positive charging. Treatment by sparks

useful in lumbago and other forms of muscular rheumatism; The treatment should not, as a rule, be given strong enough
or

long enough

to produce

pain ; but the aim should be to

administer a strong moral stimulus with a minimum of painful impression. The patient should, on no account, be allowed to play with the machine or to remain in the room ment. when it is being used for any other purpose than his treatThis is important, because
case

the beneficial effect of

the treatment
an

in this class of

efiectupon

the mental

is obtained by producing condition, whereby the condition

hibitio of auto-hypnosis or semi-voluntary, semi-involuntary inof the motor and sensory centres by the highest centres of the brain, which constitutes hysteria, is relaxed.
with due formality and impressiveness in cases of hysteria ; for respect should the patient by undue familiarity acquire a dis-

The

treatment

must,

therefore, be

applied

always

for the treatment,

no

it will be certain to have little or

good result.

HIGH-FREQUENCY
In

CURRENTS

333

addition to the various medical applications of static the Wimshurst machine may be used to excite electricity,
an

X-ray

tube.

powerful

machine

is necessary, having

less than four pairs of plates, and good pictures on the screen may be obtained, the light being absolutely steady.
not

does not compare, however, with in the secondary a galvanometer circuit will indicate only a small fraction of a milliampere or passing through the tube. Hence, for photography therapeutic

The output of the machine that of a good coil, and

applications, much

longer exposures
be obtained from

are

required.

High-frequency

static machine outer coats through

effects also may by using Leyden

a

good

jarsand

connecting the
wire.

stout

coil of copper
CURRENTS

HIGH-FREQUENCY

the development of the especially we owe D'Arsonrnedical applications of high-frequency currents.

To
two
men

val, in 1890, had

repeated

and

extended

"Ward's experiments,

proved that with rapidly alternating electric stimuli, muscular excitation increases until the speed of the alternations reaches about 3,000 per second ; as which further increased, the amount the speed is still of muscular in the early contraction progressively diminishes. Tesla
at high nineties, experimenting with oscillatory currents rents voltages, produced by Hertz's apparatus, found that curlamps produced powerful enough to light up incandescent ment body. Treatno appreciable effect upon the human by these currents is often called D' Arson valization; An oscillatory discharge, or high-frequency current, is Leyden jar. produced by the discharge from the coats of a The smaller the capacity of such a condenser, and the less the resistance of the circuit through which the discharge If the takes place, the more rapid will be the oscillations. discharging circuit has a high resistance, or high selfinduction, the oscillationsare less rapid, or the discharge

334

ELECTRICAL
a

TREATMENT

becomes

compared yoir. If two below by

a

continuous to the sudden

one.

This phenomenon

is usually

slow emptying of a water reserlevel, are connected glass vessels, at the same wide tube, having a cross-section large in proportion

or

to that of

the glass vessels,then if one

and the tap
one

of the vessels

is filledwith
water

water,

to rush from
a

is turned, allowing the to the other, the water will reach its

series of oscillations,whereas if the tube connecting together is small the water will slowly the vessels as that rise in the second vessel until its height is the same in the firstvessel,without any oscillations.

level by

If the spark of

Leyden

jardischarge

piece of paper held between it will be found that the edges of the hole in the both sides, which on are turned up paper suggests did not that the the sparks pass through paper

through

be made to pass the two terminals,

in

definite direction, but

was
an

that

the

disruptive

discharge

is extremely hundred-millionth part of a second. develops the greatest heat known,

The duration of the spark oscillatory one. brief, being calculated as less than the one

The high-tension spark higher than that of the

electric arc furnace, and comparable to that of the hottest known stars, such as those in the constellation of Argo. The spectrum of the spark resembles that of these stars in Its duration is so the lines of the proto-metals.

showing brief that

gun, may usual frequency

flying riflebullet, as it leaves the muzzle of the be sharply photographed by its illumination. The
a

of the oscillation in a high-frequency apparatus is said to be about 100,000 per second, though Hertz produced them at a speed of 50,000 with his apparatus These discharges set up oscillations in million per second.

Hertzian waves, as the ether which are known and are made use of by the various systems of wireless telegraphy, waves up to several miles in length being produced with

the powerful coils employed. It is instructive to compare

the length of these

waves

HIGH-FREQUENCY

CURRENTS

335

with that of X-rays, which are produced by the action of a similarlargeinduction coilin a Crookes tube. These latter lengths, which one hundred million rays are due to wave of 1 inch, being 2,000 times occupy the space of only shorter
may vary from one ten-thousandth of a millimetre to 12,000 feet in length,or even more, and their discoveryhas gone far to prove Clerk Maxwell's hypothesis
waves,

than the wave or Hertzian

lengthof green light.Electro-magneticwaves,

of the electro -magnetic propertiesof light. The number of oscillations each Leyden jar discharge at varies from ten to twenty, dying rapidly away ; and it is steady supply of high potential source high-frequency currents. of be employed for this purpose, such as a m electricityay staticmachine, or a large induction coilsuch as is used for the manufacture of X-rays ; or the alternatingmain current
Any be used, after passing it through a step-up transformer to raisethe voltage of the current to 10,000 volts or more. The simplest apparatus is that described by D' Arson val, in
may
or which the outer coatings of two Leyden jars condensers Fig. 11, are t joinedogether by a helix of thick wire (see p. 37). The terminals of the spark coilor staticmachine
are

thereforenecessary to keep the Leyden continuallyrecharged,in order to obtain

or jars a

condensers

attached by wires to the inner coatings of the two jars, a spark gap is arranged between them inside a and for the otherwisedeafening glassbox, which acts as a silencer noise of the spark. The wire of the primary coilor helix sulate should be thick, and may be hollow, and need not be infurther than by the air between the neighbouring by itsself-induction, acts like the primary coils. This coil,
coilof a faradic battery, though no iron core is required. So great is the resistanceof this coilthrough itsself-induction, to two turns of the coil that if the fingerbe held close when the machine is in action,sparks willjump across the the current thus airgap from each turn of wire to the finger,

the preferring

enormous

resistanceof this alternative path

336

ELECTRICAL

TREATMENT

rather than traverse the coil of wire.

two

Wires led off from the

terminals of this primary helix, or solenoid, will carry high-frequency currents, which can be used for application to the patient, who is thus placed in a shunt circuit with

the condensers. The form of the oscillatory currents which traverse the patient's body is not known. Instead of this form of primary solenoid, a more powerful be used to produce high-frequency apparatus may
for spark of higher voltage for the effluve,or even treatment. The current from the outer coatings of the condensers is sent, instead, into a solenoid known as Oudin's
currents

be used. Oudin's resonator consists of a helix of wire wound verticallyon a wooden frame, ending at the top in a metallic knob (see Fig. 12, p. 41). The wires from the condensers are attached, one to the bottom of the helix, and the other
resonator,
or

Tesla's transformer may

through

of the coils of the helix, usually about one- quarter of the height of the helix from The position of this clip has to be varied the bottom.
a

movable

clip to

one

according to the use to which the resonator is put, in order to get the best effect, with the most powerful effluve ; this is known The part of the as the tuning of the resonator. solenoid between

the attachments of the wires from the condensers acts like the primary coil already described ; while the upper portion of the solenoid acts as the resonator
to the primary

helix, increasing immensely

its power.

When

to tage, clip is adjusted the best advanstreams of violet light, or the effluve, issue from the To this knob is attached knob on the top of the resonator.

in

use,

and the movable

the wire leading to the multiple point or other electrode used for administering the effluve, and a wire from the bottom of the solenoid is attached to a gas- or water-pipe, to ensure
an

earth connection.

primary coil or helix of four turns of wire, which carries the current from the condensers, surrounding a secondary helix of a much larger
consists of
a

Tesla's transformer

HIGH-FREQUENCY
number

CURRENTS

337

of turns of finerwire, wound on an ebonite cylinder, and separated from the primary helix by an air space of IJ to 2 inches. The secondary helix can be pushed in or of the primary, in order to vary the strength of the induced current. like the primary This machine acts just and secondary coilsof a faradic battery, with the difference
out

that in the transformer the secondary is insidethe primary, instead of outside, and there is no iron core. To one of the terminals of the secondary coil is attached the wire to the multiple point or other electrode used for treatment,

the remaining terminal being connected to earth, or to the metallic plate at the back of the condenser couch. The condenser couch." This is a long ordinary
of bentwood covered with insulating and cane, cushions, and to the back is fastened a large metal plate, couch
end of the primary This couch is used for treatment solenoid or resonator. by auto-condensation. The patient lies on the couch, and holds in on^ hand a metal handle, which is attached by
a one

which is attached by

wire to

wire to the other extremity of the solenoid. A good plan is to earth the end which is attached to the back plate of the couch, as is done with the Oudin resonator and

another

the

Care should be taken that all metallic substances are removed from the patient before on treatment the couch is begun, or quite painful sparking
Tesla transformer.
severe

of produced by means sparking from a trimming of metallic braid on the edge of though not in contact with the ground. Such a skirt,even in healing, and after electricburns are indolent and slow about ten days of slow ulceration the skin around may become violently inflamed and cedematous, to be followed by general urticaria. Large cage solenoid. ^This is a large wire helix
on

be may burns

induced.

I have
were

seen

case

in which

the legs

"

in the form when

w

of

sittingon

cage big enough to enclose the patient by down chair. It is raised up and

338

ELECTRICAL
of
a

TREATMENT

pulley and counterpoise. The wire solenoid, like the primary coil,has very littleohmic resistance, but is called of treatment great self-induction. This method
means

avJto-conduction. The large solenoid takes the place of the primary helix, and currents are induced as a secondary To demonstrate the production circuitin the patient's body.
of these induced currents, the patient should hold in hand a Geissler vacuum tube (p.42). If, instead of one this, he holds an incandescent electric lamp, with one of its attached wires in each hand, the arms being held parallel In to the wires of the solenoid, the lamp will light up. spite of the passage through the patient's tissues of such

powerful currents as are evidenced by the lighting up of the lamp, the patient himself is conscious of no sensation. Various electrodes are made use of in high-frequency
treatment.

The

multiple-point

electrode, for administering the

effluve from the secondary solenoid or Oudin's resonator, is built on the same plan as that used with the static An excellent form of this electrode is sold by machine. Messrs. Gaiffe for use with their high-power alternating-

high-frequency apparatus. in being burr-shaped.

current

It differs from

others

Metallic
in
a

electrodes shaped Hke

cone

and

ending

blunt point are used occasionally for administering strong sparks from the resonator or secondary coil. These
sparks will be white sparks, not blue like those from the effluve,and they are painful and strongly stimulating. They are comparable to those from the metallic rolleror metal

point used with the staticmachine, and must not be directed continuously at any one point, or blisterswill be raised. Bare metal electrodes may be used in direct contact by the condenser couch, when the patient holds a metal electrode in one hand, which is connected to one end of the primary coil. A metallic blunt-pointed cone-shaped electrode is also used in the

with the skin,

as

in the treatment

HIGH-FREQUENCY
treatment
anus.

CURRENTS

339

of hsemorrlioidsand

painful fissure of the

Variously shaped glass vacuum electrodes are useful for the application of the current by administering blue surfaces. An insulating sparks to the skin or mucous handle with a binding screw attachment is fixed on to a
hollow glasselectrodeof various shapes,usually more or less disc-shaped at the end. The hollow glass electrode is into the partiallyexhausted of air, and a wire

projects

and is connected through the binding-screw attachment to the primary or secondary solenoid. When the machine is in action,the interior the glass electrode of
vacuum,

fine crackling blue glows with violet light,and numerous skin to the outer surface sparks will pass from the patient's of the glass,when this is rubbed over the surface. These

induced by the flow of electricity inside the to the inner surfaceof the glass. Sometimes conducting vacuum the glass becomes perforated by a spark, rendering the electrode useless. These blue sparks are not painful,
currents
are

like the white sparks from the single-point metal electrode, upon the skin and a and they produce a stimulatingeffect prickling sensation accompanied by a feeling of warmth, v with dilatationof the superficial essels. A milliamperemeter should be used in the circuitwhen ment the patient is treated on the condenser couch, the instrubetween the solenoid and being placed in the circuit the patient. The instruments register on the hot-wire much and currents of 100 to 500 ma., or even principle, more, may be used. With auto -conduction, when the patient is enclosed in the large cage solenoid, there is no method at the current passing through him. present for registering
MEDICAL
OF APPLICATIONS CURRENTS

HIGH-FREQUENCY

The general effectof treatment

by high-frequency currents,
con-

whether applied by auto -conduction, by the

340

ELECTRICAL

TREATMENT

denser couch., or by local applications of the effluve or dilatation of the superficial blooda vessels, sparks, is to cause with an increased volume of the capillary pulse,
and fall in the general blood-pressure, and The fall in the blood raising of the surface temperature. to pressure may be quite considerable (according Moutier,
a

consequent

My of mercury at each sitting). own observations with the Riva-Rocci sphygmomanometer before and after the brachial artery, immediately upon treatment for twenty with the condenser couch method
as

much

as

30 to 40

mm.

minutes, using the full strength of the primary coil of twenty turns of wire, of a powerful machine driven from 10-inch coil, have frequently shown a drop of 10 to 12 a
of mercury, when ranged from 140 to 150 become permanent,
mm.

the pressure before the treatment The fallin pressure tends to mm.

when the original pressure is greatly treatments above the normal, though six or more will be be required. Moutier claims that the blood -pressure can in cases reduced to normal limits, even of permanently he asserts that the effects in this and arterio -sclerosis, direction are much more powerful with the method of auto-conduction, using the large cage solenoid to enclose the
patient, than with the condenser couch. Most observers to be much the report the effects of the two methods
same.

ment extended trialin the treatand chronic renal disease, in which of arterio-sclerosis ment, the blood-pressure, as tested with the Riva-Rocci instrufrequently registers as much as 250 mm. of mercury,

This method

deserves

more

more. and even the headache,

The bad effectsof this high blood-pressure, the tendency to cerebral haemorrhage, etc,,

are

serious and so difficultto control with drugs and that the highordinary hygienic and therapeutic measures,
so

frequency

treatment

deserves to be thoroughly

tested.

Cases with abnormally low blood-pressure have also been recorded as being improved, with raising of the blood

HIGH-FREQUENCY

CURRENTS

341

It is pressure to normal, by condenser-couch treatment. difficult to explain this apparent paradoxical result on

physiological grounds.

Metabolic
treatment

effects have
in gout,

been

claimed

for

quency high-fre-

diabetes, and but I am not

obesity, chronic rheumatism, other conditions of disordered metabolism ;

aware

of any convincing records or experiments It is true that the exto prove these assertions. periment D'Arsonval and others have shown that highof
treatment

leads to accelerated respiratory exchange, of the carbonic acid with increase in the amount I expired, and increased diaphoresis and diuresis ; but increase in the know of no definite proof of any marked
frequency
ment. nitrogenous excretion as a result of high-frequency treatIndeed, on reflection,we should scarcely expect to find chemical effects from treatment with high-frequency

and their effects would probably be confined to stimulation of the tissues, On is the case with sinusoidal currents and faradism. as
currents,
as

they

are

alternating currents,

the other hand, the unidirectional currents

"

"

galvanism

and

static electricity are capable of producing chemical effects with the transference of ions. benefit by high-frequency Certain neuralgic states may especially neuralgic headache by the brush discharge, or by using the condenser-couch method, light massage with the time employing and at the same
treatment,

tips of the fingers to the forehead and scalp. This method fine blue sparks to play from the scalp to the masseur's causes fingers,producing a sensation of tingling and warmth, which has a marked anodyne effect. Occasionally, sometimes the condenser couch, marked hysterical are evoked, the patient complaining of inability phenomena to stand, giddiness, and faintness. Haemorrhoids may be and painful fissure of the anus after treatment
on

beneficially treated by
cone

means

of

blunt-pointed
vacuum

metallic

electrode,

or

similarly shaped

glass elec-

342

ELECTRICAL
The

TREATMENT

trode. be

introduction of the instrument, wliich must

vaselined, will probably cause considerable tenesmus as the current is turned on, the muscular at first. As soon spasm is said to relax, and a sensation of warmth and slight
pricking is produced. be necessary. Numerous applications will probably

Falling out

of the hair and alopecia has been observed to benefit by high-frequency applications, either

by the effluve from the multiple point and resonator to the scalp, or by means of friction with the vacuum glass electrode used with the primary coil. The growth of the hair
is probably stimulated by by the treatment.

duced the superficial vascularity in-

Certain chronic skin diseases may benefit considerably by high-frequency treatment with the brush discharge
from the resonator, notably lupus, acne, In the treatment of lupus and chronic

and chronic eczema. eczema the best form

of application is by means of a vacuum glass electrode with disc-shaped end, attached to the resonator or secondary coil, and held close to the diseased skin so as to rain a steady

shower of sparks upon it for some inflammatory reaction is produced,

As a result, minutes. followed by cicatrization.

Chilbains, dead
are
on.

fingers, and
means

Raynaud's
vacuum

disease

best treated by

of the glass

the condenser couch, administering a sparks to the affected parts. Usually the full strength of the primary coil should be used, and the disc-shaped end

electrode shower of blue

face of the glass electrode should be moved slowly over the surof the fingers and hand, or the foot, so as to rain the blue sparks upoii the skin from a distance of about one-

should be given for eighth of an inch. This treatment fifteen minutes daily. Chilblains usually clear up rapidly
under any it.
part

If the of the
a

painful and

sense

electrode is rested too long upon rather skin, the application becomes of burning is produced, and a patchy

HIGH-FREQUENCY
redness of the skin may
scorching.

CURRENTS
a

343

persist for

day

or

two,

due to

Rheumatoid
same more

treatment,

arthritis may also be benefited by the less painful and the jointsbecoming
after
are

freely
results

movable

These

the vaso -dilatation resulting the extremities from the general efEects of the high-frequency currents and Similar improvement the local irritant effect of the sparking. be seen a as result of the passive hyperaemia may
produced by the routine applications of to the limb.
a

probably by produced

days' treatment. several due to the hypersemia of

Bier's bandage

In all applications of the effluve from the resonator, or of blue sparks from the vacuum electrode to the hands or head or neck, it is necessary that all metallic contacts with

pins the parts should be removed, such as rings, hairpins, hat; or, if the scalp is to be treated, the hat should be as may removed, with ladies the wire in the hatband
sparks forehead.
attract

and

cause

shock

to

be

felt

across

the

has already been referred to (p. as useful 8) in the treatment and chronic of sciatica, chronic fibrositis It may also be used for its cautery by one effect, as fulguration, making of the electrodes a metallic point, and used for the destruction of superficial cutaneous growths and blemishes. inflammations. joint

Diathermy

INDEX
Ankle-jerk. 68 Anorexia, 71 Anti-kathode, 321 Antrum 82 of Highmore, Anuria, 72 Anus, fissure of, 342 122, 125, 126 AOC, Aphasia, 215 hysterical, 71, 215 Aphonia. 88 hysterical. 71. 212 Apostoli's 249 galvanocausis. Arc lamp. 311 light. 172. 316 Argyll-Robertson pupil. 208 Arm-bath. 197. 227. 2 5 9, 261 Armatures. 30. 276, 2 78 221 Arsenical neuritis, Arterio-sclerosis, 82, 310. 340 5, 81 Arthritis, rheumatoid, 82 Asthma. 87 Ataxic paraplegia. 6 Athetosis, ftmctional 67 Atony, muscular, bowel, 300 of lower 136 Atrophies, muscular, chronic 52, 136, 140, Atrophy, arthritic,
-

bdoniinal reflex, 68 Abductor 214 paralysis. Abscess, 82 alveolar, 122, 126 ACC, 269 Accidental shock, Accumulator 114 charging, Accumulators, 29, 106, 111, 113 Acids. 169, 242 Acne. 342 Acupuncture, 171 Adaptor plug, 28 71 Adductor paralysis, Adhesions, gall-stone, 99 99 gastric-ulcer, 151, 197 periarticular, 99 pericolitis, pleuritic, 82 63 Agoraphobia, Alcohol injections, 83, 162. 211 Alcoholic neuritis, 202, 2 21 104 poisoning, 63 Alcoholism, 169, 242 Alkalis, 239 Alkaloids, 342 Alopecia. Alternating (see Current) current dynamo, 188 , 295, 307 electro-magnet,
~

motors,

285

of, 188 periodicity Aluminium cells, 295 Amaurosis, 70 60. 70, 7 6 Amblyopia. 206 tobacco, toxic, 206 Ampere, 109 109 Ampere-hour, 74 Amputation stump. 306 Amyotonia, lateral sclerosis, 219 Amyotrophic 3, 7, 55. 258 Anaemia, 69. 332 Ansesthesia, 87 cerebral, 5 cocaine. 57. 69, 74. 707 hysterical 70 stocking-and-glove," 193 ulnar, 104 AnsBsthetic, 90 Analgesia, 124 Anelectrotonus, 251 Aneurysm, Angina pectoris. 82. 173 2 37, 241 Anions. Ankle clonus. 68. 87
" ^

148 179 of hand. 136 idiopathic muscular, interossei, 145 50, 140, 301 muscular, optic, 89, 205 303, 305 peroneal.

progressive
136,

muscular.

130.

140, 146, 218, 219. 223. 302 neurit ic, 305 216. 218 trapezius.

306 Wei-dnig-Hoffmann, 73 Attitudinizing, 40. 337 Auto-condensation. 42. 338 Auto-conduction, 75 Auto-inhibition,

"

hysteria, 69 on Babinski, 8. 342 Baldness, Bandaging, tight. 132 diseape Basedow's {see Oravea's disease) 261 197. 227, 2 59, arm-. Baths, 310. 313 cabinet. electric-light, 310

\v*

345

346
faradic, Baths, foot-. 227,
43, 56, 64, 301 28. 29. 121, galvanic. 227. 2 5 2, 258, 269, hydro-electric, 227, 2 313 257 porcelain.
2 59,

INDEX
75

Cells, storage, 114 Cerebral 86 anaesthesia, 222, 223, Cerebral 205 tvxmour, Cervical 270, 306 rib. 179 5 2, 270. Chilblains, 5. 226, 2 2 8, 342 Chlorosis, 55 Chorea, hysterical, 66 re77 current ceived Choroiditis. proportion of 252, 2 61 by patient, Chronic 97 constipation. 171, 310 313, 342 eczema, radiant-heat, 32. 172. 227, 2 5 9, 302 Schnee, 81, muscular rheumatism, 292, 299, 300, 3 01, 258, 313 sinusoidal, 310 303, 306 nephritis, Batteries. Ill 89 paraplegia, 2 3, 25, 127, 229 disease, 82, 340 renal combined, 9 faradic, 258, 310. 313 sciatica, 163, 15. 106. 112. 169 galvanic, skin diseases, 313, 342 Leclanche. 16, 106 318. 331 ulcers. 15, Chvostek's 170 patients, sign. 136 106. 11 4-, 253 Clarke's m a g n e t o e 1e c t r i c secondary, Dr., on 56 Beard, 276 neurasthenia, machine. break, Claustrophobia, Beclere's 63 mercury coal-gas Clavus 42 hystericus. 63. 70. 91 Bell's palsy, 83, 134, 152 Cocaine ionization, 5, 239, 2 45 Beri-beri. 152, 221 habit, 63 75 hysteria, Bernheim, Coils, induction (see Induction) on by Black Bristow, 149 positive caused marks Lewis Jones's, 244 12 needle, 48 44, Bladder 292, 337 stimulation, secondary, 84 Blepharospasm, 299 sledge, 12, 31, 270, 291, 77, 2 06 Spaiiier's, 12 hysterical, Blindness, Colour onset of. 88 sudden vision. 70, 76 7, 332, 3 4-0 Coma, Blood-pressure, 3. 104 23, Blue light, 318 Combined batteries. 25. 127, 339 229 sparks, Bowel, faradism faradism 25, of. 99 galvanism. and 172, 202. 203 12 7, 146. 151, 186, Brachial 229 neuritis. lesions, 17 7, 189, 195, plexus sclerosis, 87 Commutator for direct 203 current, Brain, laceration 31. 276, 2 81 of. 58 0 Breeze, de Watteville, 24, 127, 187, static electric, 38"33 disease, 81 229 Bright's Bristow Concussion. 57 coil, 149 Bronchitis. 39. 109, 335 82 Condenser. 212. 219 Bulbar 337 palsy, couch, Burn, 118 Conjunctival reflex, 68 galvanic, Conjunctivitis. 85. 315 3. 97, 98, 300 Constipation. Constriction fields. 60, of visual
"

"

"

"

"

"

"

"

"

77.

206

Cage 337 solenoid, Carbon pole, 117 313 Carbon-iron electrode, Carcinoma, gastric, 94 Cardiac failure, 104 Caries of spine, 81 Catalepsy, 67, 74, 105 Cataphoresis (sec Ionization) Cataract, posterior polar, 311 113, 114 Cautery. battery, 253 Cells, accumulator 113 in parallel, arranged 113 chromic-acid, Daniell. 108 dry, 108 Cells, Hellesen dry. 9, 16, 113 Leclamhe. 107 wet. dry, 108 Obach
" " "

Contact-breaker (see Interruptor) Continuous (see Current) current Contraction, tonic, 156 hysterical. 61, 66 Contracture, late, 158, 222, 301 132, 199 primary. 70, 73, 74, hysterical, Convulsions,
" "

105

86. 224 Convulsive tic, 78, lamp, 314 Cooper-Hewitt inner, Cord, plexus, of brachial 189, 191 192 posterior, lesion transverse of. 5 0, 52, 140 (.*ee Electrons) Corpuscles 71 Cough, spasmodic, Coulomb, 109

INDEX
Degeneration,

347
reaction of {see Reaction) Dental 82 neuralgia. Depression, 7. 531 De Watteville switch, 24, 128 Diabetes, 7, 81 Diabetic neuritis, 221 8 Diathermy, Dilated stomach. 3, 93, 101
venules, 245 Diphtheria, facial palsy in, 159 Diphtheritic neuritis, 212, 221 Diplopia, 85, 88 Direct Current (.feeCurrent) 308 electro-magnet, 30. 283, 2 86 motor, Discharge, oscillatory. 39, 333 Dislocation of spine, 150 Disseminated sclerosis, 6, 88" 227 Double 73 consciousness. 77 hemianopia, Dry cells, 9. 16, 108 188 Dynamo, alternating-current. 2 7 8, 298 direct-current. 2 81, 288 Dyspnoea, hysterical, 72

Cranial nerves, 205 Crooke8 tube, and X-rays, 319. 321 Crutch palsy, 130. 183 29, 33, 45, Current, alternating, 188, 270, 2 75, 307 power of copper -carrying cable, 286 collector. 17 106 continuous, 14. 279 curves, density of. 12 0, 167 derived. 40. 44 diffusion of, 125 direct. 106 26. 25 3 main. 254, dangers of,
"

-^

269

earth, 30. 35, 254, 269, 292, 299 faradic, 9, 43 galvanic, 106 7, 37. 39, 266, high-frequency, 294. 333 high-tension alternating. 33, 272, 2 86, 316. 324 direct, 288 induced, 39, 43, 46, 292. 329, 337 Leduc, 263 oscillatory, 39. 333 6, pulsating unidirectional, 283, 295 31. 276. 282, reveriser. 19 55, 292, 337 secondary, sinusoidal. 5, 29, 151, 188, 275 2 7 8, 294 31. 284 constant. 281. 2 98 four-phase, periodicity of, 2 7 8, 294 33, 2 80, single-phase, 283 294 32. 98. 280, three-phase. 283, 287. 297. 298 two-phase. 281. 2 97 278. 2 83 undulatory. diseases, chronic. 342 Cutaneous ionization, 240 Cyanide Cyanotic reaction. 52, 137 hebetis, 71 Cynobex Cystoscope, 114
-

"

"

"

Dancing Dangers

72 mania. 30. 34, currents. of main 253. 2 69, 292 Daniell cell, 10ft 20 28 D'Arsonval galvanometer, 3 7, 40, 42. 335 transformer, 333 D'Arsonvalization. 20 Dead-beat galvanometer. fingers, 5, 2 2 6, 342 Dead in, 211 Deafness, galvanism hysterical. 211 159 nerve. Debility. 55 Decomposition of water, 241 Deep sensibility. 193

269, 30. 35. 254. Earth current. 292 299 Earthed poles. 25 4, 257 58 Ecchymosis, meningeal, Echolalia. 225 Eczema, 313. 342 Efficient intensity of alternating279 current, Effluve, 3 30, 332. 336 Electric baths (see Baths) burn. 272 needle, 248 shock, 269. 273 110 Electrical horse-power, units. 108 Electricity, conduction of. 236, 286, 324 negative. 320. 331 positive, 323. 324. 328. 331 static, 6. 35. 323 Electrification, general. 55. 64. 252, 301, 331. 337 of railways. 274. 287. 288 Electrodes. 22. 52. 53. 118 brass-roller. 38. 329, 330 313 carbon-iron. destructive action of, 242 facial, 22 flat-pad, 22. 53, 166 indifferent. 53. 126 intragastric. 95. 98. 101, 299 laryngeal, 213 multiple-point. 38. 329. 33 8 rectal, 99 Electrodes, roller. 68. 98. 99. 202 testing. 53. 123. 214 53 treatment,
.
"

:U8
Electrodes,

INDEX
Fracture-dislocation of spine. 150, 180 Frankel's 90 exercises, Franklin. 324 Benjamin, 325 Franklinization, Fraud in hysteria, 75, 2 07 8 Fulguration, FuQctional 67 muscular atony, 51, 65 paralysis, 78 epasm, 65 symptoms,
"

339 vacuum, 64, 68. 74. 90 wire-brush, Electrolysis, 28, 120, 2 3 6, 243, 245, 247, 248 of skin, 118 Electrolytes, 108, 2 3 6, 241 Electrolytic rectifier, 295 Electro-magnets (AC), 35, 307 (DC) 278, 308 Electromotive force, 108 Electro-negative 117 element, Electi'ons, 320 Electrophorus, 1, 325 Electro-positive 117 element, Electroscope, 323 Electro tonus, 124 Epicritic 193 sensation, 4, 247 Epilation, Epilepsy. 75 laryngeal, 215 303, 304 Erb"s myopathy. 177 paralysis, Erythromelalgia, 226, 228 Exophthalmic goitre (see Graves's
-

batteries, 17 106 hydro-electric bath, 313 4, 15, 106 Galvanism, faradism, combined and

Galvanic
"

current,

{see

Faradism)
effects of. on on skin, for deafness, muscle, 118 211

"

122

disease)
Extension, Extensors

passive,

181

{see Muscles)

"

162 Facial massage, 82 neuralgia, 17. 50. 83, 133, 135, paralysis, 152, 158, 160, 162 double, 159 in, 160 galvanism infranuclear, 163 154 middle-ear, 216, nerve-anastomosis, 218 159, 163 nuclear. 153, 163 supranuclear, 7 8, 162 spasm. in, 162 nerve-stretching Fallopian 153. 158 canal, Farad, 109 induction Faraday coil, 43, 275 bath Faradic {see Bath)
"

:"

{see Current) current 55 {see also ti^eatment,

Farad
Faradic; Faradism) 95, ism, intragastric,

Baths,
102

24, and galvanism, combined. 82. 96. 12 7, 146, 151. 186, 201. 229 254, 271. 273 Fatal shocks. Fibroids. ele"'trolysis in, 249 81, 2 48 Fibrositis. rheumatic, nerve. Fifth 177 cervical 209 nerve, cranial Fillet. 87 Finsen light, 311 lamp, 312 Fineen-Reyn First dorsal root, 191, 192 342 Fissure of aniis, 316. 318 Flame arc. Focus tube, 321

hyperexcitability to, 129, 132, 134 in facial paralysis, 160 in optic atrophy, 205 in sciatica. 166 262 interruptions, rapid 266 reversals, (see FaraGalvano-faradization dism and Galvanism) Galvanometer. 20, 28 d'Arsonval, 322 Gamma rays, Gastrectasis, 93 93. Gastric dilatation, atony and 299 94 carcinoma, 97 Gastroptosis. General elec-trification, 53. 64 faradization, 55, 64 208 paralysis of the insane. Geniculate 154, 159 ganglion, 70 hystericus, Globus Glove-extension 181 apparatus, Gout, 7. 82. 152. 310 238 rheumatic. 313 Gouty eczema, 201 neuritis. 79 facial spasm. Gowers. on Gramme ring, 282 Graves's disease, 73, 23 0, 258 in, resistance electrical 234 208 Gummatous meningitis, Gunshot as cause of wounds 200 sciatic paralysis,
"

Habit 224 spasm, false, 72 Hsematemesis, Haemorrhoids. 342 lamps. 111, 317 Half-watt Hand, of. 179 atroohy Head injuries, 57

INDEX
Headache,
7, 70, 91 functional, 91, 332, 341 neuralgic, 7, 62, 91 1 332 neurasthenic, Heart failure, 272 Helix, 39, 335 Hellesen dry cell, 108 60, Hemiansesthesia, hysterical, 69. 207 87, 160 organic, Hemianopia, 77, 207 double. 77 Hemiplegia, 6. 50, 86, 137, 140, 15 0, 160. 301 hysterical, 60, 66 infantile, 223 in, 150 muscular wasting Herpes 235 zoster, Hertzian 334 waves, Hiccough, 72 High blood-pressure, 332, 340 rents, High-frequency {see Curcurrents

349
slow,
25, 103, 187,

Interruptions,
211

9, 43, 187, 292 spring, Intestines, ballooning of, 72 Intragastric faradism {see Para-

dism)
Intrinsic hand 179, 190, muscles, 305 Iodine, in ionization, 238. 241 Ionization. 2 38* 168, 176, 203, 241. 249 5, 239, 245 with cocaine, 270 current, with main with salicylate of soda, 168 Ions, salicyl, 169 theory of, 236 zinc, 239 Iron core. 11, 46, 291, 295 lechaemic 131, 140, 190, myositis, 199

high-frequency)
High-tension
currents

(see

rents, CurJoint, hysterical. 66. 70 149 tuberculous. Joint-lesions. 149 in hemiplegia. 151 in neuritis, 174, 197

high-tension)
272 shocks. Hip. hysterical. 71 Holtz 325 machine. static Hot-wire milliamperemeter. 42, 339 Hydrocephalus, 205 Hyperacusis. 153 auditory, 69, 70 Hyperfesthesia, Hyperpyrexia, 73 Hypertrophic neuritis, 305 Hypnotic 75 state. 216, 218 Hypoglossal nerve. Hypothenar 190 muscles, 306 Hypotonia, 65, 88. 225 Hysteria. nature of. 332 of, 75 pathology 211 Hysterical deafness, joint. 66, 70 fields, 70, 77 visual 70 HjTStero-genetic zone,
"
"

31,

Katelectrotonus. 25, 124, Kathode 319 rays, 2 37, Rations. 241 12 2, 125, 126, 130 KCC, 110 Kelvin, Kilowatt. 110 Klumpke 179 paralysis, Knee-jerk. 68. 306 12 2, 125, 126, 136 KOC.

126

"

4 Labile method, Lachrymal obstruction.

248 myopathy,

Landouzy-Dejerine
lamp, Incandescent 110, 114, 290, 294, 310, 318 60. 88 Incontinence, Inco-ordination of arms, .88 309. 335 Induction coils, 43, 223 hemiplegia. Infantile 5, 51. 130, 133, 140. paralysis. 141, 223 Infranuclear lesion, 159. 163 178, 303 Infraspinatus. Inner (of brachial cord plexus) lesions. 189. 191 73. 74 Insanity. Insomnia. 7. 6 2, 97. 332 ated Insular (see Disseminsclerosis

sclerosis)
16, 111, Internal resistance. Interossei. 53. 145, 189 Interruptions, speed of, 25

116

303. 304 Laryngeal crisis. 216 215 epilepsy, 212 paralysis. 215 vertigo. Late rigidity, 50. 87. 301 Lateral sclerosis. 87. 137 Lead 135. 144. 183, 221 neuritis. 144 poisoning, Leclanch6 cells {see Cells) ionization Leduc, of, experiment 240 263 current, 263. 300 motor, 319 Ivenard rays. Lenz's law. 275 235 Leucocytosie. I^eukaemia, 234 Lewis Jones battery, 12 Leyden jar, 39, 109

350
Wght,
Finsen, 311

INDEX
Muscle, pollicis, 190 adductor biceps, 178, 181 brachialis anticus, 178 ciliary, 208 deltoid, 149, 178, 181 digastric, 209 indicis, 192 extensor longus digitorum, 201 hallucis, 201 digiti, 192 minimi ossis metacarpi pollicis, 183 internodii primi cis, polli183 radial of wrist, 145, 178 internodii secundi pollicis, 192 ulnar of wrist, 145 finger extensors of and 144, 192 thumb. flexor brevis pollicis, 190 carpi radialis, 195 189 ulnaris, longus pollicis, 195 digitorum, profundus 189. 195 digitorum, 195 sublimis 303 gastrocnemius, 149, 303 gluteus, hypothenar, 190 inferior 208 oblique, infraspinatus, 178, 303 interossei. 53, l45. 189 intrinsic hand, 145, 179, 305 latissimus, 303 levator anguli scapulse, 182 208 palpebrae. lumbricals. 190, 195 209 masseter, 209 mylo-hyoid, 218 of tongue, opponens pollicis, 190 oris, 153. 220 orbicularis 153, 160 palpebrarum, longus. 195 palmaris 191, 303 pectoral, 181 clavicular, 201 peronei, teres, 178, pronator radii 195 129 of degeneration, reaction recti, of eye, 208 182 rhomboids. scalene, 177, 182 182, 304 serratus magnus, 225 splenius, 153 stapedius, 216. 225 sterno-mastoid. longus. 178, 183 supinator 178, 182 supraspinatus, 209 temporal, 209 tensor tympani, 201 tibialis anticus, 225 trachelo-mastoid, 216, 225, 304 trapezius. triceps, 183 161, 162 zygomatici, Muscular functional, 67 atony,
"
"
" " " "

Lightning pains, 90, 164 Lines of force, 46, 124 Lithium salts, 238 Live blood." 78, 162 Live wires, 269, 272 Long-line 273, 287 transmissions, Low blood-pressure, 341 269 currents, main voltage 82, Lumbago, 148, 164. 258, 313 Lumbrical 190, 195 muscles, Lupus, 7, 312, 342 Lymphadenoma, 238
"

"

Magnetic field. 43, 276, 278, 308 Magnetism, 275, 308 Magneto-therapy, 35. 307 Main {see Current) current Malingering. 59, 75 Malnutrition, 55 Manganese 108 peroxide, Massage, 170, 177, 202 facial, 162 Swedish, 80, 177, 202
"

151, movements, with passive 170 Mastoid, on, 154, 157 operation Maximum 113 effect of battery. Median inner head, nerve, 191, 195 head, 195 outer Meningeal 58 ecchymoses, Meningitis, 158, 205. 212 148, 152, 208 gummatous, basic, 158 posterior 314, Mercury-vapour lamp, 318 Metabolism, 56, 64, 341 Metal-filament lamps, 110. 318 143, Metronome 147, reverser, 187, 303 Microfarad, 109 Middle-ear disease, 157 Migratory neuritis, 203 Milliampere, 109 31, Milliamperemeter, hot-wire, 42, 339 Mimicry, 78 Moles, 247 hysterical, Monoplegia, 66 Moore light, 316, 318 Morphia habit. 63, 166 Morton's current, static induced 39, 329 285 Motor, alternating-current, 285 30. 2 83, direct-current. 288, 289 106, 2 84, generator, points, 52, 122 power, return of. 194 293, 30, 2 84, transformer, 300 Multiple neuritis. 130, 202, 2 21 Multostat. 33, 253 laryngeal, 214 Muscle, abductor pollicis, 190 laryngeal, 212 adductor
"

"

"

"

INDEX
Muscular
"

351
Nerve,

dystrophy, 136, 303 3, 81, 258 rheumatism, Musculo-spiral 183 paralysis, Mutism, hysterical, 71, 215 Myalgia, 82 Myasthenia 86, 13 7, 209, gravis, 214. 219 Myasthenic 137 reaction, Myatonia (sec Amyotonia) Myelitis. 6. 87, 137, 151, 216 Myopathy, 131, 137, 140, 303 Myositis, ischaemic, 131, 132, 140, 197, 199 Myotonia 306 atrophica, 305 congeuita,

sixth cervical, 177 160 nucleus,

accessory,

spinal 216

163,

212.

"

4. 243, 245 Naevus, 244 Needle-holder, 244 insulated, Needle, 243. 244 negative, 251 platinum, 244, 247 positive, steel, 244 Negative breeze, 331 electricity, 320, 323 107, 117 element, 29, 294, 295 phase, 316. 318 Nernst lamp, 216, 218 Nerve-anastomosis, 211 Nerve, auditory, 83, 154, 159 tympani, chorda 178 circumflex, compression of, 196

cranial, divided,

205 179

"

"

"

cervical, 179. 191 eighth external popliteal, 200 facial, 153 177 fifth cervical, 209 cranial, first dorsal, 179, 192 207 fourth cranial, 212 glosso-pharyngeal, 81 great occipital, 49, 84, 131 hyperexcitability, hypoglossal, 163, 216, 218 injuries. 177, 183, 188, 195, 200 brachial (of inner cord plexus), 189. 191 thoracic, internal anterior 191 182 long thoracic, 195 median, 183 musculo-spiral, optic, 205 pelvic. 99 104 phrenic, 182 scapular, posterior radial, 184 of. 49. 84, 131 reaction of, 84, of degeneration 129 214 laryngeal, recurrent of, 197 regenaimtion

162, 171 -stretching, 178 suprascapular, third cranial, 208 trigeminal, 81, 2 09 188 -^ ulnar, 212 vagus, Neuralgia, 80, 177, 239, 307, 331 dental, 82 facial, 82, 210 sciatic, 81, 163 trigeminal, 5, 210 Neurasthenia, 7, 56 traumatic, 57 Neurasthenic headache. 7. 91, 331 Neuritis, 81, 83, 145, 151, 310 159, 202 alcoholic, 221 arsenical, brachial, 5, 17 2, 202. 203 degenerative, 153 diabetic, 221 diphtheritic, 212 of feet, 203 173. 200 gouty, 148 gummatous, hypertrophic, 305 inflammatory. 158 influenzal, 172 interstitial, 153 in, 174 joint-changes lead, 135, 144, 183, 221 local, 152 203 migratory, 130. 152, 158. 202, multiple. 2 21, 258, 301 optic, 205
"
-

"

"

peripheral

{see

Neuritis,

multiple)
201 peroneal, 221 post-diphtheritic, 182 scapular, posterior 206 retrobulbar, 201, 238 rheumatic, sciatic, 80. 163 178 traumatic, in, 174 trophic changes 202 tuberculous, 190 ulnar, Neuroma, 74 295, 307 "Neuron." Neurone, lower 132. 140 motor, 140. 150 upper motor, 75 Neurosis, 63 war. 73 Neurotic tachycardia. terrors. 62 Night Nodon valve. 2, 6, 2 95 Nuclear lesion, facial. 163 212 Nucleus ambiguus, 88 Nystagmus,
-

"

Obach

dry

cell, 108

352
Obstetrical 177 paralysis, 222 Occupation neuroses, 88, 2 07 Ocular paralysis, 168 Ohm, 16. 108, Law, 111 Ohm's Open 318 arc, 104 Opium poisoning, 89, 209 Optic atrophy. neuritis, 205 39, 333 Oscillatory currents, 279 Oscillograph, 149 Osteo-arthritis, 40, 41, 33 6 Oudin's resonator. 69 Ovarian tenderness, 308 Ozone,

INDEX
Polyphase 296 currents, Positive-electricity. 323, 324 29. 2 94 phase. Post-diphtheritic 221 neuritis, Post-influenzal debility, 56 Posterior cord, 192 14 8. 204 spinal roots, iodide. 238, 2 41 Potassium Pressure 193 sensations, Primary faradic current. 44 39, 335 solenoid, Progressive muscular atrophy, 219, 223, 30 2, 305, 306 Prolapse, rectal. 4, 102 4, 102 uterine, in bath, Proportion of current 252, 261 Protopathic 193 sensation, Pruritus, 8 Pseudo hypertrophic muscular 303 atrophy, Pseudo-tabes. 221 Pseudo-writer's 224 cramp, Psychical in hysteria, symptoms 73 Ptosis. 85. 139 208 Pupil. Argyll-Robertson, dilatation of. 85 paralytic Pupil-dilator fibres, 192 93 Pyloric obstruction, Pyrexia, 73 Pyrolusite. 108
,-

164, 216 Pachymeningitis, Palate, soft, 21Z Palpffation, 73 Pantostat, 33, 253 hot, 230 baths, Paraffin wax 214 Paralysis, abductor, 171 adductor, 184 alcoholic, 192 of cervical sympathetic. movements of of conjugate 160 eyes, 159 nuclear. 306 periodic, 183. 188. 200 post-ansBSthetic. spastic. 137. 302 183 Sunday, 343 hypersemia, Passive battery, 15 Patient's Peptic ulcer, 93 155, 164 Perineuritis, 306 Periodic paralysis, 294 Periodicity, Peripheral neuritis, (see Neuritis.

lamp, 316 Quartz Quinine in neuralgia,

83

multiple)
93 Peristalsis. 70 hysterical. Peritonitis, 303 Peroneal atrophy, 125 PflUger. on electrotonus, 70 tumour, Phantom 319, 320 Phosphorescence, 85 Photophobia, 327 Pidgeon's static machine, fields, 206 Pin-point Plantar reflex, 68 I 68. 88, 89 extensor. flexor. 68 Platinoid wire, 27 135 Platysma, 3, 82 Pleurisy, 144 Pohl's commutator. 38, 116. 328 Polarity. 107. 113 Polarization, 116, Poles, positive negative, and 127. 128 117 Pole-testing paper, 160 Polioencephalitis, 60, 140, 141 Poliomyelitis, acute, 136. 140 chronic, 140. 144 subacute, 310 Polyarthritis,
"

"

heat, 90, 172, 310 Radiant 324 Ramsden's static machine, 5, 2 2 6, 258, disease, Raynaud's 342 52, 137 Reaction, cyanotic, 49, 83, 12 9, of degeneration, 134. 184 in nerve. 49, 84. 131 135, 83, 134, partial. 154, 196 137 myasthenic, light. 318 Red 68 Reflexes. 88. 89, 150 extensor plantar. 68 flexor plantar, pupil. 73. 192. 208 superficial. 68 197 Regeneration of nerve, disease, 332, 340 Renal failure, 104, 272 Respiratory 252, 261 Resistance of bath, Resistances. 13, 27. 253, 300 168 internal, 16. 112, 168. 234 of skin. 16. 112, 206, 265, 268 Retinal stimulation. 225 Retrocollic spasm. flbrositis, 81, 164 Rheumatic

INDEX
238 Bheumatic gout, 201, 238 neuritis, Rheumatism, 7, 152

333

Slip tube. 12. 14 Snow-blindness, 85, 315 Solenoid, 20, 39, 46, 336. 337 81, 341 large cage, 337 chronic, 3, 82, 258 39, 336 primary. muscular, Rheumatoid Spamer's faradic arthritis. 5, 81, 343 coil, 12 Rickets, 3, 55. 135 Spark coil. 335 Rigidity 66 in hysteria, 37 gap, late, 50. 87, 151 Sparks, 39, 75, 3 2 9. 342 Rings, blue, 339 slip, 30, 31, 280, 284, 297 Rodent high-tension, 334 ulcer, 239, 313 Rontgen (see X-rays) rays white, 339 Rotary 284 Spasm, 87 converter, adductor. 289 87 transformer, extensor, facial, 7 8, 162 hysterical. 66, 78 78 orbicularis, 225 retrocollic, Salicyl ions, 169 Spasmodic 71 cough. Salicylate torticollis, 5, 66, 79, 217, 2 24, of soda, 168, 241 Salicylic acid ions, 238 230 90, 210 Spastic Salvarsan, 50, 67. 137, paraplegia, SW^3/i*s 249 301. 302 32, 172, 222, 227, Schn^e bath, 150 rigidity, 259, 302 Spasticity, 87 28, 80, 163, Sciatica, 258, 310, 313 88 Speech, scanning. in, 8 diathermy incontinence Sphincters, of, 60, in, 80 faradism 88 in, 166 Spider galvanism naevi, 245 80 Spinal neuralgic, syphilis, 148 lateral, 219 Sclerosis, amyotrophic tumour. 81 87, 302 234 Spleen, combined, enlarged, 6, 88, disseminated, 301 234 Splenic anremic, insular, 89 from. 132 Splint, pressure lateral, 87, 137, 302 218 Sprengel shoulder, Secondary batteries 27, 255, 302 teries) Spring (see Batcontact, 4 Stabile galvanism, Secondary 331 Static charging, coil (see Coils) 44. Ill, 333, 335 Self-induction, induction, 39, 329 Sensation, forms 35. 324 of, 193 machines, 86 Sense, output of, 327, 333 stereognostic, 33, 270. 287. 290 Senses, transformer, special, 60, 70 42, 287. 87 Step-up Sensory transformer, crossway, 69 290 in hysteria, symptoms 221 Septicsemic Steppage neuritis, gait, 201 57, 206 hysterical, Series-wound 285 Stigmata, motor, dilated. 3, 93, 63, 211, 213 101, 136 Shell-shock, Stomach, 343 85, 208 28, 169, 254, 2 69, Shocks, Strabismus, 25, 53, 127 248 Strictures. single faradic, ions, 240 20 Strychnine Shunt. by, 76. 77, treatment Suggestion, circuit, 27 2 7, 253, 291 92, 211 rheostat. hairs. 247 114 Superfluous Sigmoidoscope, lesion, 163 29. 275. 278 Sine Supranuclear curve, 193 Suture, Single-phase (see Current) secondary. 25. 272 82 Sinus, frontal, Switchboard, Syncope. 3. 104. 273 (see Current) Sinusoidal current 286 342 diseases, chronic, Synchronous Skin motors. Syphilis. 90. 148. 159, 200. 205. 208. effect, 39. 111. 324 210 glossy, 174. 197, 203 168, 212, 219. 223 Syringomyelia, of, 16. 112, resistance 254 Sledge coils (see Coils) 30. 31. 33, 2 91, transformer, 299 205. 208. 81. 89, 130, 183, dorsalis. 191, 195 Tabes Sleep paralysis. 227 74 walking, Tabetic pains. 90, 164 Slip rings (sec Rings)
"

354

INDEX

"

73, 230, 234, 258 Tachycardia, 318 lamp, Tantalum loss of, 154, 157, 159 Taste, 85 Teeth, carious, Telephone wires, live, 271 40, 336 Tesla transformer, Tetanus and anodal of muscles, 129 kathodal, 124 DC from main, 135 Tetany, Third rail. 123, 2 71, 288 305 disease, Thomson's (see Current) Three-phase current 257 Three-wire system, 288 Thury system, 230 Thyroid gland. 7 8, 86, 224 Tic, convulsive, 78, 83 douloureux, 211 Tinnitus, 206 Tobacco amblyopia, Torticollis (see Spasmodic) headache, 310 Toxaemic 206 Toxic amblyopia, Transformers (see D'Arsonval, Static, StepSledge, Motor,
up,

2, 6, 295 Valye. Nodon, Vaso-motor paralysis, 61, 68, 226 dilated, 245 Venules, 215 Vertigo, laryngeal, in hysteria, Visceral symptoms 71 97 Visceroptosis, Vision, yellow, 206 60, 70, 77 Visual fields, contracted, 199 Volkman's contracture, Volt, 108 2 3, 34, 291, 302 Volt regulator, selector (see Shunt rheostat) Volta, 106 Voltaic pile, 106 108 Voltameter. 71 Vomiting,
"

Tesla)

lesion of cord, 50. 52, Transverse 140 57 Traumatic neurasthenia, 89 intention, Tremors, 5, 81, 210 Trigeminal neuralgia, 123, 272 Trolley wire, 197 Trophic changes, Trousseau's sign, 136 Tuberculous joint, 149 neuritis, 202 158 Tumours, cerebellar, 159 cerebral. 219 of medulla, pelvic, 164 70 phantom, 158, 159 pontine, spinal, 81
" ""

63 War neurosis, 141 "Wasting, general, 140, 148, 149 muscular, Watt. 109, 317 110 Watt-hour, 149 Wave current, lengths, 335 Wave 64. 89 Weir-Mitchell treatment, 306 Werdnig-Hoflmann atrophy, 35, Wimshurst machine, static
" "

3 2 5

61, 64, 68, 74, 90, 105 Wire brush, 22 Wire connections, 27 Wire, platinoid, Wounds, granulating, unhealthy 239 183 Wrist, dropped, 222 Writer's cramp, 224 Wry-neck,

Ulcers, 8, 119 318, 331 chronic, 85 corneal,

peptio,
"

312, 319 X-rays, disease, 232 in Graves's 235 in leukaemia, 85 from, ophthalmia sources of, 322 lengths, 335 wave

93

239 rodent, 194 Ulnar anaesthesia, 188. 192 paralysis, -nerve 191 neuritis, 310, 318 Ultra-violet rays, 244 Unipolar method, 110 Unit, Board of Trade, 109 of capacity, 109 of current, 108 of EMF, 109 of energy, 109 of quantity, 109 of resistance. Urate of soda. 239 lamj), 315 Uviol
" "

Yellow Yttria,

vision, 206 316

"

116 element, 239 316 Zirconia, Zone, hysterogenetfc, 125 peripolar. 125 polar, 235 Zoster, herpes, Zinc
Ions,

70

Printed

by

Cassell

"

Company,

Limited, 2"3.ioig

La

Belle

Sauvage,

London,

E.C-4

UniversityToronto of Library

DO

NOT

REMOVE

THE
CO 00

CARD

FROM THIS
O

u
o

POCKET

"

cd

35
Acme
o

Library
Pat. "Ref.

Card
Index

Pocket
File"

Under

Made

by

LIBRARY

BUREAU

"-