Chapter V (1)

SPECIAL THERAPEUTICS AND CLINICAL RECORD.

I have thought it best for practical purposes, to accompany the consideration of the treatment of special diseases by the histories of illustrative cases, where I had such at command.

Before entering on the subject proper, I wish to offer some general considerations that may influence and guide us in determining when, where and why to employ electric baths as a remedy.

To realize thoroughly the indications in given cases for the employment of electric baths, we must first of all be more or less familiar with the effects and uses of the electric current as well as those of the ordinary warm bath. We must realize the fact that here we not only have these two forces united, but that the more important of the two, the electric current, here acts directly (locally) as well as indirectly (through the nervous centres) on every portion of the body—a circumstance of great importance in differentiating indications on the one hand for the baths, on the other for local electrization. In view of these circumstances we are fully justified in looking for results far more comprehensive than any that might be obtained singly from either of the two remedies that are here combined. There can be no doubt that in many cases the resisting power of a disease is sufficient to withstand two remedies brought singly and alternately to combat it, whereas the simultaneous combined action of these remedies may be fully adequate to overcome this resisting power.

Approaching in its effects more closely to the electric bath than any other remedy, is the process known as “general faradization,” to which I have already alluded (p. 36). In choosing between this and the bath, I state it as my conviction that, while there may be a small proportion of cases in which general faradization, so-called, is preferable, in almost all the cases where both these remedies are applicable, the faradic bath deserves the preference—it is a _more complete_ faradization.

We need never be afraid of ordering electric baths on the score of any imagined exertion or discomfort attaching to them. The most delicate, the aged and children alike, bear them with far more ease, comfort and impunity than any ordinary warm bath, or any but the mildest local electrization. The entire absence of shock or pain of any kind whatsoever, is always an agreeable surprise to those who, urged by their physicians, have with fear and trembling submitted themselves to a treatment, the mere name of which filled their minds with extravagant—and, it is useless to say, groundless—visions of painful shocks. Thanks to the tonic effects of the current, they are by the feeble and infirm borne much better than the ordinary warm bath. There is likewise much less liability to get cold after the electric bath. The stimulus which the current furnishes to the peripheral circulation is a powerful protection against cold, so that even in midwinter I see people daily take electric baths at an average temperature of 95°, and enjoy apparent immunity from colds.

Having once determined on the use of the baths in a given case, we have to observe certain points in their application.

In the first place, guided by what we know of the relative effects of galvanism and induced electricity, we must decide which of these two currents to use, and if both, in which order. We must determine on the direction and intensity of the currents, as well as on the duration of the baths.

Next we must use our judgment as physicians, in deciding whether a given case promises to get well under electro-balneological treatment alone, or whether auxiliary treatment may not be required to bring it to a favorable issue.

With respect to the frequency of the applications, I will say that while there are some cases where a bath twice a week is sufficient, and others where a bath every day is imperatively necessary, in far the greater majority of cases suitable for electro-balneological treatment, a bath every alternate day is _sufficient_, but a bath every day is _better_—it leads to more rapid as well as certain results.

In most of the cases, a daily bath for a few days or a week, followed by one every other day for a time, and, when the cure is about completed, a bath twice a week, to _consolidate_ and _confirm_ the good results obtained, has done me the best service.

I would dwell particularly on the necessity of _perseverance_ in this treatment. The majority of cases that have come under my observation in this connection, have been of a more or less chronic nature. In many of these, where medicinal and other treatment had been unavailingly gone through with for weeks, months and even years, I have found existing the most absurd expectations with regard to the effects of the baths. People who had made the tour of almost all the watering-places of Europe without obtaining the slightest benefit, have come to me imbued with the idea—whence derived I know not—that one or two baths should greatly improve, and two or three more cure them; and when these expectations were not realized, they would promptly discontinue treatment, fully satisfied that electric baths were no more capable of benefiting them than “all the other things.” I do not mean to be understood for a moment as intending to imply that ideas of this nature are shared by the profession; I mention them simply in order to show the necessity on the part of physicians to disabuse in this respect the minds of those patients whom they may send for electro-balneological treatment.

In appropriate cases, the use of the bath should not be too long deferred. I have had frequent occasion to become cognizant of the fact, that cases have been sent by physicians to take the baths only after prolonged ineffectual treatment of another nature had been gone through with, and where negative or at best tardy results took the place of the brilliant results that might have been obtained, had the cases been sent earlier. I do not mention this in a fault-finding spirit; to do so would be unjust. The remedy under consideration has up to the present time been too little known, the indications for its employment—in the absence of statistics—on too uncertain a basis, to expect from any but specialists the early realization in any case of its appropriateness. I trust however that in the future, from being a “dernier ressort,” it will come to take its proper place among other remedies, to be administered “when it will do the most good.” When this comes to pass, the results obtained, satisfactory as they are even now, will become as brilliant and well-authenticated as those of every other remedy from which experience has taught us how to reap the greatest advantage.

In the following “clinical record” I shall not omit to cite cases where the baths were unsuccessful, wherever it shall appear to me that the citation of such cases may be of assistance in arriving at a true estimation of the therapeutic value of the remedy.

In giving the histories of cases, it will scarcely be necessary to enter very minutely into details; the demands of the present work will be fully met if sufficient is said of a case to illustrate the effects of the baths in the class of cases that it represents.

Finally, I wish it understood that in a few of the conditions in which I shall advise the employment of the baths, I have had no personal experience in their use, but base my opinions on what I know of their effects, together with what is known of the results obtained in analogous conditions by local electrical methods.

SPECIAL DISEASES.

RHEUMATISM.

Its great frequency, the pain and discomfort which it occasions, and its many, often dangerous _sequelæ_, added to its frequent obstinacy under the most varied treatment, render rheumatism one of the most formidable diseases that we have to encounter. The long list of remedies that have from time to time been employed in its treatment, bear witness by their very number to the little reliance that can be placed in any one of them. A remedy then which can be _relied on_ to exercise a favorable influence in all the forms of rheumatism—acute, subacute and chronic—as well as on most of its sequelæ, should of right become a welcome addition to our armamentarium in the treatment of this disease; and such is the electric bath. The treatment of the sequelæ I shall speak of under separate heads. The disease itself I will divide into three classes, viz: _a_) acute, _b_) subacute and _c_) chronic rheumatism.

_a_) ACUTE RHEUMATISM.—A few years ago the use of electricity in acute inflammatory conditions was scouted by most of the profession, and had it not been for the quiet and patient labors of a few progressive spirits, we would at the present day be still deprived of the benefits which we reap from it in these conditions. Even to-day, the number of those who are satisfied of the utility of electricity in this respect is comparatively small. Only two years ago, I attended a gentleman who was suffering from a very severe attack of rheumatic gout. I had both a galvanic and a faradic battery at his house, which, in addition to appropriate medicinal treatment, I applied daily to the affected joints,—using mainly the faradic current. Being compelled at the time to go to the country, the case during my absence drifted into the hands of a gentleman, a professor at one of the medical colleges, of high standing in the profession and considered one of our leading medical men, who ridiculed and promptly discontinued the use of electricity in the case. He gave it as his opinion that it did more harm than good, and I have no doubt he did so conscientiously—however unprofessional his conduct may have been, in this as well as other respects. The contributions of others have since then vindicated my views in this respect. Among others, Dr. Drosdoff[10] of St. Petersburg has given a number of cases of acute articular rheumatism from the clinique of Professor Botkin, in which the faradic current was employed either alone or in conjunction with other treatment. From among the deductions which he makes from a series of careful experiments in this respect, I quote a few—such as bear directly on our subject, and to which I affix my own numbers.

1) “The sense of pain as the result of electric irritation is
considerably diminished, and sometimes entirely lost, in joints
attacked by acute articular rheumatism, so that the patient
experiences no pain, even when the distance between the coils
equals naught[11], and both closure and opening are accompanied
by the evolution of numerous sparks. At the same time the
slightest pressure of the affected parts gives rise to the most
intense pain.”

“The diminution of the electro-sensibility appears in the
majority of cases to be in inverse proportion to the severity of
the disease and the intensity of the pain produced by mechanical
irritation.”

2) “The enhanced tactile and thermic sensibility of the diseased
joints is diminished by a faradization lasting from 5 to 10
minutes.”

3) “From 5 to 10 minutes faradization causes a reduction of the
previously heightened temperature of the diseased joints to the
normal standard, or even below this.”

4) “The subjective rheumatic pains which are augmented by
pressure and motion, are diminished by faradization. This
diminution is sometimes so considerable, that the joint, which
prior to the faradization admitted of no movement, is able to
execute passive and active movements with tolerable facility.”

5) “The rheumatic pains as well as the temperature of the
affected joints remain diminished after the faradization for 3,
4 and even 5 hours; they then gradually return to the previous
height. At the same time the duration of the paroxysms of pain
becomes shortened, and the intensity of this diminished.”

6) “Although the rheumatic process takes a more rapid course
under the influence of faradization, and incommodes the patient
less, we have nevertheless made the observation in one case,
that the tendency to recurrence is not diminished. The attacks
however become more brief and milder.”

7) “From what has here been said it follows, that daily
faradizations, lasting 5-10 minutes, diminish the severity of
acute articular rheumatism, restore the perverted cutaneous
sensibility, and cause a reduction of the temperature of the
affected joints.”

8) “Several of those suffering from the pathological processes
mentioned, received no medication in addition to the
faradization, and yet made a tolerably rapid recovery.”

I might adduce further testimony of the value of electricity in recent cases of rheumatism, were it necessary to do so. The results in my own cases however have long since satisfied me of the utility in this respect of faradic not only, but also of mild constant currents. Accepting this as matter of fact, let us next inquire where and why we are to give _general_ electrization—in other words, the electric bath—the preference over local applications.

Where the manifestations of the disease are limited to a single joint, or at best a very few joints, or where we have to do with a case of muscular rheumatism—to one group of muscles, local electrization, as _symptomatic_ treatment, will answer. Where on the one hand however many joints, on the other the muscles of entire limbs, or even more, are involved, the advantages of a method by means of which we reach all the affected parts at once, thus effecting in, say ten minutes, that which where, for example, six joints are involved, would by the ordinary method require sixty minutes, are readily realized. There is, however, another reason why the baths are preferable in rheumatism to local applications. Rheumatism is a constitutional disease with local manifestations. The metastatic character of muscular rheumatism especially appears to indicate the greater importance of general as compared to local treatment. Pre-supposing, then, that electricity exercises the favorable influence on rheumatism which clinical results would appear to demonstrate, it follows that the electric bath, while it furnishes symptomatic (local) treatment equally well with local applications, does something more; it meets the _indicatio morbi_ likewise. The warm bath no doubt contributes its due share in bringing about the favorable results obtained.—Where the disease then does not confine the patient to bed, the electric bath will be found a most valuable remedy.

The following directions will be found to answer best in the great majority of cases: The temperature of the water should range from 90° to 98° F; a mild constant current, descending, should be applied for ten minutes; this to be followed by a faradic current of as great an intensity as the patient can bear _without the slightest degree of discomfort_. In the application of the faradic current, the surface board (see p. 12) may advantageously be had recourse to for the purpose of more concentrated influence on affected parts, to each of which it may be applied for a few minutes; the entire faradization may last from ten to fifteen minutes. When coming from the bath, the patient should be received in a warm blanket, anything like a chill being carefully guarded against. In cases where the cutaneous secretion is of an abnormally acid character (which is often so marked as to become apparent through the sense of smell), bicarbonate of soda or potassa may be added to the bath. As appears from the foregoing, the entire duration of the bath is from twenty to twenty-five minutes. The baths should be taken daily until all urgent symptoms have disappeared; after this, every two or three days as required, until an entire cure is wrought.

As the results of this or similar treatment, conjoined with the requisite medicinal or other measures, I may state:

_a_) Considerable abridgment of the period of the disease;

_b_) Sequelæ are less constant;

_c_) The tendency to recurrence is very much diminished;

_d_) A relapse, if it does occur, is comparatively mild.

With regard to _b_ and _c_, let it be understood that I speak within the restrictions of a period of observation extending over two and a half years only.

_b_) SUBACUTE RHEUMATISM.

In the subacute variety, the electro-balneological treatment is similar to that in acute cases, with the difference however, that here not so much care is necessary with regard to the intensity of the currents. Muscular contractions, as induced by strong faradic currents, are to be dreaded in direct proportion to the acuteness of the inflammation, _resp._ the sensitiveness of the inflamed tissues.

It will be understood, I hope, that the electro-balneological treatment as laid down above, though it applies to the majority, does not apply to all cases. Special complications may make it expedient in individual cases to modify the treatment more or less. The course to be pursued in these instances may however be safely left to the judgment of the attending physician.

_c_) CHRONIC RHEUMATISM. In this affection the course to be pursued varies from that indicated in the acute and subacute varieties. We have here little or no constitutional disturbance, and need have no fear of doing any harm by strong currents. On the contrary, I have found that mild currents rarely do any good. By far the greater majority of the cases that have come under my observation were of the muscular type, the algic portion of the symptoms approaching those of neuralgia rather than subacute rheumatism. Of chronic articular rheumatism I have treated but very few cases. Although in some of the cases the treatment under consideration was attended with brilliant results, I freely admit that in some instances the results were imperfect, in others again entirely negative. This I found true more especially of cases that involved tendons. I must add, however, that in perhaps the greater majority of the unsuccessful cases the fault lay with the patients themselves, who, finding they were not benefited as rapidly as they had expected, discontinued treatment before this had had time to effect any thing.

In accordance with a theory which I have formed in regard to the pathology of chronic rheumatism, and which I am not yet prepared to promulgate (nor is it necessary here), I have of late been in the habit of administering in this disease, baths calculated to stimulate as much as possible the circulation of the blood. The best manner of applying the baths to this end will be found further on, under “Inequalities of the Circulation.” In addition to this I cause the galvanic (anode) as well as strong faradic currents to be applied to the affected parts by means of the surface board. Where there is any thickening, effusion or other similar concomitant of the disease, iodine may be added, as hereinbefore directed.

In chronic rheumatism it is not necessary to use the baths daily. Two or three times a week is quite sufficient. Indeed, the daily use of strong currents, as employed here, might in some instances be productive of evil rather than good. Although transient benefit may be experienced from a few baths—sometimes even from one bath, permanent progressive improvement need never be looked for from less than about a month’s treatment—more or less, according to the nature etc. of the case.

I regret that I have no cases of acute rheumatism to offer. As a rule, a person suffering from this disease is not in a condition to leave the house; and in the cases that have occurred to me in private practice, the difficulty of introducing an electric bath at the patient’s residence has been in every instance sufficiently great to induce me to forego this plan of treatment. While I have thus had frequent occasion here to employ local electrization, I have had but one case of acute rheumatism where I had the opportunity to employ the baths. The local symptoms in this case being limited to one arm and shoulder, the patient was enabled to locomote, and thus became an office-patient. At present the case is still under treatment; and although the results thus far have been eminently satisfactory, it would yet be premature to cite it before I shall be able to state the final result.[12]

CASE I.*[13]—SUBACUTE RHEUMATISM. Mr. F., from the _clientele_
of Dr. Alexander Murray, about 32 years of age, of robust
appearance, large, vigorous frame, had an attack of acute
inflammatory rheumatism in the spring of 1873, from which he
recovered in a short time. In the winter of 1874 he experienced
a second attack, for which he had had treatment for about two
months prior to coming under Dr. M.’s care. After treating him
by other methods, including local galvanic applications to the
affected parts (joints as well as muscles were involved) for two
weeks, Dr. M. sent patient to take electric baths. On May 25th
Mr. F. was brought in a carriage. He was unable to walk; had to
be assisted up the steps by two attendants. His arms were in a
scarcely better condition, the wrist joints especially being
exceedingly tender and painful. The first and second baths,
administered respectively on May 25th and 29th, did not effect
much change in his condition. The third bath was taken May 30th,
with the happiest results. On June 1st patient was able to come
for his fourth bath alone and on foot, and thenceforth his
recovery was very rapid. The seventh bath, taken June 7th, left
him perfectly cured, not a trace of the disease remaining. He
has been free from rheumatism since. In the first three baths
the galvanic current was employed exclusively, the muscles and
tendons being in too tender a condition to bear the
contractions induced by the faradic current. In the subsequent
baths both currents were used, according to indications.

CASE II.*—SUBACUTE RHEUMATISM. Mr. B—y, aet. 22, came for
treatment on August 27th, 1874. Had subacute rheumatism, with
considerable swelling of ankle-joints. The acute attack dated
back six weeks. Locomotion was very painful, and could be
accomplished only with the aid of a cane. A galvanic bath on the
27th and one on the 28th of August were sufficient to remove
both swelling and pain, enabling the patient to resume his
avocation.

CASE III.—SUBACUTE RHEUMATISM. J. H. K., aet. 29. In the summer
of 1873 had a very severe attack of cephalalgia, which, judging
from his subsequent history, was probably of rheumatic origin.
The attack confined him to bed four days, after which it
troubled him continuously for three months. It then abruptly
left him, to make way, apparently metastatically, for enteralgia
coupled with diarrhœa. This clung to him for five months—until
May, 1874. He was then well for a time. Late in the summer of
1874 he began to experience pain in the soles of the feet, which
shortly culminated in a more pronounced rheumatic attack than
any to which he had previously been subject. It affected chiefly
the lower extremities. When he first came under my observation
(7th October, 1874) he had been confined to the house five
weeks. The left knee and both feet and ankle joints were much
swollen. The affected joints were exquisitely sensitive. Both
legs were very feeble, and coupled with this was great general
debility. Locomotion was rendered difficult to such an extent
that even the aid of two stout canes did not enable him to
dispense with additional help in mounting my doorsteps. The
first bath (Oct. 7th) was followed by no favorable results.
Indeed, the patient thought he felt worse, if anything. He
followed my directions, however, to take a bath every other day.
From the first three baths he received little or no benefit. The
fourth bath however had a very marked beneficial effect.
Immediately after it he was able to dispense with one of his
canes, and thenceforth improved steadily and rapidly. He took
his last bath Nov. 10th 1874, having taken in all fourteen
baths. He made a perfect recovery. At present (December 1875) he
has had no return of the disease, nor any other illness; says he
never felt better in his life.

CASE IV.—CHRONIC RHEUMATISM. Mr. K., from the _clientele_ of
Dr. Lusk, had been a sufferer from chronic rheumatism for a long
time. As far as I could gather, the disease originated in an
acute attack some two years ago. He came for his first bath on
June 21st, 1875. Between that date and July 16th following he
took twelve baths, which resulted in a complete cure.

CASE V.—CHRONIC RHEUMATISM. Mr. L., aet. 60, had been subject
to chronic rheumatism for many years. When he presented himself
for treatment (19th June, 1874) his health in other respects was
fair. The flexor tendons of the fingers of both hands were more
or less contracted, the result of previous rheumatic attacks. I
ordered him the baths, without any adjuvant treatment
whatsoever. His improvement was rapid. Between June 19th and
July 15th he took fifteen baths, a perfect and (thus far)
permanent cure resulting. Mr. L. has frequently taken baths
since then, solely however for the sake of their general tonic
effects.

CHOREA.

The utility in this disease of electricity has been for some time past almost universally conceded. While some vaunt the faradic, others prefer the galvanic current in its treatment. It appears that thus far the best results have been obtained on the one hand by galvanization of the spine, on the other by general faradization. It occurred to me, when I began to devote myself to electro-balneological treatment, that a method which combines the electrical procedures alluded to, must needs also combine their virtues. Accordingly, I discontinued my previous practice of spinal galvanization in this disease, and had recourse to the baths in almost every case that applied to me for treatment. I am happy to state that in no instance where the baths were employed was anything short of a perfect result obtained. I will state on the other hand, that in every case medicinal treatment was had recourse to at the same time. It is equally true however, that in all the cases medicinal treatment _without_ the baths had proved of no avail. The best method of employing the bath is as follows: For the first ten minutes a constant current of medium intensity should be passed, one pole communicating with the head-electrode, the other connected with the surface board, applied for five minutes to the epigastrium, five minutes to the sacral region. In anæmic persons the current should be descending, in all others, ascending. This concluded, a strong general[14] faradic current should be employed for five minutes. By this means all the muscles of the lower extremities will be very thoroughly contracted. The pole of the battery attached to the foot-electrode should now be transferred to the surface board, and the hands of the patient made to hold this, under water, an additional five minutes. In routine cases this method of administering the baths will be found very efficient. In special cases it may be modified as expedient in the judgment of the practitioner.

CASE VI.* Hugh O—l, aet. 12 years, from the _clientele_ of Dr.
J. O. FARRINGTON, came for treatment February 5th, 1874. This
was one of the most severe and obstinate cases of chorea that I
have ever met with. Internal medication, ether spray, change of
air etc. had been of no avail. Between the date above mentioned
and March 23d the boy had seventeen baths, steadily improving.
He made a complete and (thus far) permanent recovery. His
intellect, which had been somewhat impaired, was considerably
improved.

CASE VII. J. G., aet. 9 years, was sent for electrical treatment
on September 22d, 1874, by Dr. KREHBIEL. He had been under
medicinal treatment for a long time, the choreic manifestations
dating back upwards of a year. When I first saw him, the choreic
movements were so continuous and violent as to preclude the
possibility of administering electric baths. The attempt was
indeed made; but no sooner had we managed to place the boy in
the tub, than he splashed the water freely about, and by the
violence of his movements bid fair to injure himself. I
therefore deferred for a time the electro-balneological
treatment, and had course to ordinary spinal galvanizations.
These, together with internal medication—which Dr. K. attended
to—had by the 8th of October diminished sufficiently the
violence of the movements to admit of the administration of the
baths. Accordingly the local applications were discontinued, and
from Oct. 8th to Nov. 27th the boy had seventeen baths, when,
all traces of the disease having disappeared, treatment was
discontinued.

HYSTERICAL AFFECTIONS.

If there is any one disease that more frequently than any other tempts the physician to have recourse to empirical treatment, it surely is hysteria. The obscurity, in many cases, of its etiology, as well as its frequent obstinacy under the most diverse methods of treatment, successively employed, are alone sufficient to warrant us in having recourse to electricity, where this has not already been employed. Where we can establish the etiology of a given case, we cannot of course be in doubt as to the remedy; and in many instances of this kind we find in electricity our most potent curative agent. But even where we are in doubt or positively ignorant as to the origin of the symptoms, we are justified in giving preference empirically to electricity, not only because, the disease being essentially of a nervous character, we find in electricity the most powerful of neurotics, but also because _recent_ statistics, those that embrace a period when electricity has been permitted to participate, if not duly, at least more largely than heretofore, in the treatment of disease, go to show that by means of this remedy better average results have been obtained than with any other. Again, where there are no positive indications to employ any special method of electrization, either central or local, it appears rational to give the preference to a method that is at the same time central and peripheral, that admits of the application of either current with the utmost facility, and is susceptible of so many modifications that, with at best two or three tentative applications, it can be suitably adapted to almost any given case. The results I have thus far obtained justify me in asserting that, of the cases that are merely functional in their nature, by far the greater majority will yield completely to judicious electro-balneological treatment.

As to the mode of administration in this affection, I can suggest nothing. There is so little uniformity in the manifestations of hysteria, that it were idle to even attempt to establish anything like a routine electro-balneological treatment. Each case must make its own laws.

CASE VIII.* Mrs. A., aet. 28, married, sterile, from the
_clientele_ of Dr. KREMER, was referred to me on June 12th,
1874. She had been a sufferer from hysteria for a number of
years. Among the more prominent symptoms were intense
_pruritus_, transient flushing and heat of the entire surface,
with pricking sensations and headache. Six baths, in each of
which both currents were employed, sufficed to effect a complete
and permanent cure.

CASE IX.* Mrs. E., from the _clientele_ of Dr. KREHBIEL, aet.
28, married, of an exceedingly nervous temperament, had suffered
from excessive nervous irritability and prostration since her
last confinement (about a year previous to my seeing her). There
was no organic trouble, the symptoms pointing to pure functional
hysteria. She was sent for electro-balneological treatment April
21st, 1874. Six baths, in which both currents were employed,
restored her to perfect health.

NEURASTHENIA.

(NERVOUS EXHAUSTION.)

Those who are familiar with the pre-eminent qualities as a neurotic of electricity, will not be surprised to be told of the beneficial effects in the condition under consideration of electric baths. It is not only in _general_ nervous exhaustion, however, that electric baths exercise this salutary influence, but in the condition known as _cerebral exhaustion_ likewise. Judging from my own experience, their efficacy in this latter condition is far greater than that of local applications, whilst they are unattended with any of the irritant and other disagreeable effects that even with the greatest care and caution we cannot always disassociate from galvanization of the brain. They no doubt act here in two ways, i.e., first and chiefly, through reflex influence from the entire periphery; second, by derived currents on the brain directly. Whatever their mode of action, the results obtained are of the most gratifying kind. The pitiable condition in which some patients of this class present themselves, is familiar enough to every physician; but it appears that the greater the degree of exhaustion and the more prostrate the various functions, the more striking are the effects of the baths. The patients seem to live up anew under their influence. While in many if not most other complaints that come under electro-balneological treatment, a certain number of baths are requisite in order to get discernible effects, in the disease under consideration each bath, except perhaps the first, is followed by more or less immediate improvement, which, if the treatment is persevered in, remains permanent.

It is almost unnecessary to say, that in the more advanced cases great care is requisite in the administration of the baths. By over-stimulation at first, much harm may be done, and the patient, instead of getting better, get worse. In such cases very mild currents should be employed in the beginning. As recuperation advances, stronger currents may be gradually introduced. The intensity of the currents should be carefully regulated to keep pace with the gradually increasing capacity of the various organs to respond to the electric stimulus without detriment. Both currents may be used from the first. The galvanic current should precede the faradic, and be employed for not more than ten minutes. Where irritability is a feature of the case, the current should be descending; otherwise ascending. This may be followed by the faradic current, not of sufficient intensity for the first few baths, however, to cause any but _slight_ muscular contractions. In most of these cases iron may be advantageously added to the bath. The duration of the baths should at first not exceed fifteen minutes; in some cases this even is too long, the patient complaining of being fatigued perhaps after the lapse of ten minutes. When this is the case, the bath should be at once terminated. It is in these instances not the electric current, but the warm water bath, that gives rise to the sense of fatigue. Later on in the treatment, the duration of the baths may be from twenty to twenty five minutes, according to indications.

CASE X. _Cerebral Exhaustion._—K. S., aet. 42, lawyer. First
consulted me on June 2d, 1874. The salient points in the history
of this most interesting case are as follows: Ten years prior to
his calling on me he was engaged in some very heavy law cases
and other duties requiring intense mental application. At that
time he began to manifest occasional symptoms of cerebral
exhaustion; was unable to endure mental exertion with same force
as theretofore. These attacks, commencing in 1864, supervened at
various times until 1868, sometimes incapacitating him for
business for a few days at a time, and accompanied by intestinal
catarrh, flatulence and gastric disturbances—probably the
results of loss of nerve-power. In 1868, having been subject for
a time to extra heavy mental strain, he was completely
prostrated, and compelled to retire from the pursuit of his
profession. By the advice of his physician he went to the
country. There, without any premonitory symptom whatsoever, he
suffered an attack of (left) hemiplegia. I quote from his
recital as follows: “While standing in the office of the hotel
registering my name in the book, I suddenly dropped down,
retaining full consciousness. I lost the power of speech for
some hours. After twenty-four hours the paralysis began to
recede, and in a few days I had made a spontaneous recovery. I
then went further into the interior. Two weeks subsequently I
had a similar, but milder attack; retained full consciousness
and mental control. Returned to city (New York) two weeks after
this, in a very debilitated condition. On the third day after my
return, I had a more violent attack than either of the
preceding—again on the left side. I felt as if a line were
drawn perpendicularly through my body, dividing it in halves. My
stools were clay-colored. With this attack for the first time I
became unconscious, and passed into a delirious state. So far as
I know, no diagnosis of my condition was made. I was confined to
bed for a month, at the end of which I was in a very feeble
state. I then went to Europe, where I spent some years. While
there I consulted the first physicians of London and Paris, with
but little benefit, however. Both mind and body remained feeble.
My normal weight is upwards of 120 pounds, but has for a long
time past been in the neighborhood of 90 pounds.”

When Mr. S. came to consult me, he had but lately returned from
Europe, whence, he stated, his physicians had sent him home to
die. His complexion was sallow, sickly; skin of face plentifully
wrinkled; features wearing the air of suffering and anxiety that
so frequently accompanies painful chronic conditions. He had for
some time past suffered from excessive cerebro-spinal
irritability, for the relief of which cantharidal collodion had
been employed in the cervico-spinal region (the same had also
been used in the hepatic region, to meet the diagnostic views of
some one of his medical attendants). He had a remittent chronic
intestinal catarrh, with—noticeably during the periods of
exacerbation—abundant discharge of a glairy mucus. The appetite
was very capricious—not to say poor, and he was obliged to be
exceedingly careful in his diet. He was not capable of any
continued mental application. The muscular system was weak and
flabby. All the vegetative functions were more or less impaired.

On June 3d, 1874, Mr. S., by my directions, took an electric
bath. He continued the baths daily for some weeks; then every
two or three days, all the time steadily improving. He had some
adjuvant medicinal treatment, probably similar to what he had
already had in Europe. He states, however, that his improvement
commenced with the first bath he took; and the baths certainly
constituted the main treatment throughout. He gained daily in
every respect. Mind and body were invigorated; his muscles
increased in size and hardness; color gradually returned to his
cheeks, etc. He continued the baths with more or less regularity
until the close of the year, taking in all sixty-one baths. He
was then in a better condition than he had been for many years.
Thinking a trip to Europe would benefit him, I advised him to go
there and remain a few months. He left early in January and
returned in the beginning of April, 1875. He had been very well
during his absence, until within a few weeks prior to his
departure from Europe, when he experienced a severe attack of
cerebro-spinal congestion, which caused him much suffering. On
his return he resumed the baths, and continued them throughout
the spring, continually gaining in strength and weight. At the
beginning of last summer he was practically well. He has
regained his normal weight (120 pounds). As a criterion of his
bodily vigor, I will simply state that I have seen him lift,
with ease, 350 pounds, which, for a person of his weight, is not
bad. His mental force is as good as it has ever been. The
digestive disturbances have disappeared; he can eat things which
for years he had been compelled to eschew. To use his own words:
“I am well.” In view of the fact that he had already received,
at the hands of competent men, all sorts of internal as well as
external treatment, I believe I am justified in attributing his
cure almost entirely if not solely to the baths.

CASE XI. Mr. * * *, aet. about 50, lawyer, of large, vigorous
frame, came to consult me January 4th, 1875. He complained of
symptoms that are the frequent results of prolonged mental
over-taxation. His intellect was as good as ever, but he lacked
his wonted mental endurance and power of application. His mind
was perfectly clear, but unable to work. It was a case of
“_limited_ cerebral exhaustion.” Physical nutrition was pretty
good; yet his color was not normal, being rather paler than it
had been and has since become again. His flesh was flabby. There
were vague neurotic disturbances, etc., etc. He had until
recently occupied a leading public position, and the onerous
duties that devolved on him in connection with this, evidently
stood in direct etiological relation to his trouble. I ordered
an electric bath every other day. This was complied with until
the end of February, when the patient had apparently entirely
recovered his health, mentally as well as physically. I saw him
not very long ago; he looked the picture of health, and told me
that he was and had been since I saw him, perfectly well in
every respect.

CASE XII. Mr. L., aet. 23, presented himself for treatment in
October, 1874. He had at various times made the attempt to study
some profession, but had never been able to concentrate his mind
sufficiently on any object to enable him to persevere in its
pursuit. He was fretful, irritable and vacillating; would desire
one thing to-day, another to-morrow; never long of the same
mind. Melancholia, digestive disturbances and hypochondriacal
phenomena accompanied this condition. No organic disease was
discoverable. On October 1st he took his first bath. Very
shortly after this he commenced the study of medicine. He
improved rapidly in every respect. During the month of October
he had six baths, which resulted in complete and permanent
relief of all the symptoms. He progressed satisfactorily in his
studies, and is at the present time taking his second course in
one of our city medical colleges.

AGRYPNIA.

(INSOMNIA; SLEEPLESSNESS).

Although, as a rule, but the symptom of some definite pathological condition, agrypnia is of such frequent occurrence, and so detrimental to the general health, that it appears to me to merit special consideration. This holds good especially in this connection, because, even where electric baths fail to influence the disease giving rise to the insomnia, they almost invariably remove this, irrespective of its cause. Even where, the disease itself remaining uncured, the insomnia must return sooner or later, the sleep is very much improved while the baths are being had recourse to. We must of course endeavor in all cases to relieve the original disease, and, where the baths are not adapted to this purpose, resort to other and appropriate means. It will be found of no small service to us in the therapeutical management of every case, to be enabled to procure for the patient, without the aid of medicinal hypnotics, sufficient of sleep during treatment.

CASE XIII. Mr. A., from the _clientele_ of Dr. LEONARD WEBER,
was sent by Dr. W. to take electric baths. He suffered from
chronic spinal congestion. Among the most prominent and annoying
symptoms was _agrypnia_. It was for the relief of this symptom
chiefly that Dr. W. ordered him the baths. He began to improve
in this respect from the time he took his first bath, and
although the disease itself remained uncured, he enjoyed good
sound sleep while he was under treatment, his general health
improved, and he frequently spoke of the notable benefits that
he received from the baths. He continued them until his
departure for Europe, where, by direction of his physician, he
went last spring. I have not seen him since, but Dr. W. tells me
that he is doing well.

CASE XIV. Mr. D. was brought on Sept. 30th, 1874, by his
physician, Dr. HOGAN. He was in the incipient stage of _delirium
tremens_. Had not slept for some nights. Dr. H. had administered
successively opiates, chloral and bromides in full doses,
without effect. On the evening of above date the patient had a
bath, in which the descending galvanic current was used. As a
result, he slept well that night. The baths were repeated on the
two succeeding days, with like effect. As the disease developed
however it became necessary to send the patient to an asylum,
whence he returned cured in a short time. The effect of the
baths in this case, where full doses of the most powerful
hypnotics of the materia medica had failed, was remarkably
illustrative of their hypnotic power.

ANÆMIA.

As is well known to the profession, anæmia forms the basis of a great number of morbid conditions. Hysteria, general debility, emaciation, sterility, various nervous affections, phthisis, in short, a perversion of almost any of the various physiological functions may be the direct result of anæmia. On the other hand, anæmia may be only a symptom or sequel of some other morbid condition—but of such cases I do not now speak. I have to do here only with those cases where anæmia is the primary and etiological of a group of symptoms, and where therefore it is to this that the treatment must be mainly directed. Now let us see what this treatment is. Dr. FLINT[15] suggests the following therapeutic measures: “_first_, a nutritious alimentation, into which meat should enter largely; _second_, the use of tonics and stimulants to render the digestive functions more active; _third_, iron as a special remedy—the effect of which is often remarkable; and, _fourth_, a regimen calculated to increase the energy of the assimilative functions, consisting of exercise in the open air, recreation, etc.” This agrees mainly with the views of other writers. It may conveniently be condensed under two heads, instead of four, namely: _first_, to secure for the patient appropriate food and adopt the best means to insure its assimilation; _second_, the administration of iron. As to the ingestion of appropriate food, open air exercise, etc., patients are of course to receive the necessary directions. The remainder of the therapeutic indications, as given above, are admirably met by electric baths. As we have seen in a preceding chapter (p. 43 et seq.), they are a tonic and stimulant of the first order, and as nearly as possible a specific for the furtherance of the digestive and assimilative processes. When impregnated with iron, they constitute a treatment for anæmia which, in conjunction with the requisite diet and other hygienic measures, is inferior to no other. It will moreover be found very efficacious in counteracting secondary anæmia, and thus, by maintaining the general strength of the patient, often enable nature and appropriate treatment to cope successfully with the original disease.

CASE XV. Mrs. S., aet. 22, four years married. I was called to
see her on October 2d, 1874. She then had a spontaneous
miscarriage, the fifth since her marriage. She asked me whether
nothing could be done to enable her to carry a child to full
term, as both she and her husband were very desirous to have
offspring. In pursuance of my directions, she presented herself
at my office about ten days after I first saw her. On
examination I found no organic trouble, no uterine displacement,
nor any other local trouble to account for her premature
confinements. Involution had progressed normally. The only
deviation from the normal that I could discover about the uterus
was undue paleness of the cervical portion. Her appearance was
very decidedly anæmic; features pale, flabby; lips whitish blue;
physical energy much depressed. She had had but very slight loss
of blood on the occasion of her recent miscarriage; certainly
not enough to account for her anæmic appearance. Viewing her
case as one of idiopathic anæmia, I ordered her electric baths
strongly impregnated with iron. In addition to this, the regimen
usual in such cases, and also strychnia and phosphorus
internally. She took her first bath on Oct. 14th; then one bath
weekly until she had taken six baths, the last of which was
administered on the 24th of November. During all this time she
kept steadily improving. The anæmic appearance and symptoms
gradually receded, and, soon after she had taken her last bath,
I discharged her, as far as the anæmia was concerned—cured.
While she was under treatment she had, by my advice, refrained
entirely from sexual intercourse. Early in the spring of 1875
she called to tell that she was again pregnant, and in November,
1875, I delivered her of a healthy male child, at full term.

PARALYSES AND PARESES.

I include these under one head, because not only is their origin frequently identical, but, chiefly, because the therapeutic indications are almost always the same in both. Whatever the cause in any given case, whether cerebral, spinal or peripheral, organic or functional; whatever the treatment that may be indicated—and this should never be neglected—for the primary trouble, the direct electrical treatment of the paralysis, sub-paralysis or paresis, being purely _symptomatic_ treatment, remains in the great majority of cases essentially the same. The objects to be aimed at are two, viz: _first_, a normal state of nutrition of the affected muscles; _second_, their normal contractility. In other words, we are to endeavor to prevent atrophy of the affected muscles, or, where this has already taken place to some extent, to restore their normal bulk; and, _second_, we must strive to restore the more or less impaired contractility of the paralytic or paretic muscles. Even where symptomatic treatment for these purposes is the _only_ treatment employed in a case, we frequently meet to a great extent the _indicatio morbi_, by favorably influencing, either in a reflex or direct manner, the primary disease. This is true of _local_ electrizations of the affected parts; it holds good much more strongly however of _electric baths_, because here, in addition to the reflex influence that we get from local applications, we have also the direct influence of the electric current on the spinal cord and posterior portion of the brain not only, but on the sympathetic system and all the important organs contained in the thoracic and abdominal cavities. The great importance of this is apparent, when we reflect that in very many if not most cases of disease of the nervous system, central or peripheral, electricity in an appropriate form is a useful therapeutic agent, and that moreover the great majority of functional paralytic disorders respond favorably to its influence. As for any harm being done by it in those rare cases where its use may be contra-indicated, I admit that such may accrue from the administration of electric baths without medical supervision; it is entirely obviated however where the baths are under the supervision of a physician, who does not, like a layman, indiscriminately admit to their use any and everybody who is willing to pay for their administration, but will carefully discriminate, and conscientiously exclude those cases in which general electrization might result injuriously. In such cases a tolerably accurate diagnosis is as a rule readily made, and will enable the physician to separate the suitable from the unsuitable cases.

As to the mode of administration of the baths in cases of the class under consideration, the use of both currents is requisite; the galvanic as a nutrient, the faradic as an excito-motor agent. Where, as is sometimes the case, faradic irritability is extinct, or so slight as to be practically unavailable, the (slowly) interrupted galvanic current must take the place of the faradic, until faradic irritability has become re-established. As to the intensity, direction, etc., of the currents, each individual case has its own laws, which must be recognized by the supervising physician.

CASE XVI.—_Infantile paralysis._ Albert Pichl, aet. 22 months,
was sent me by Dr. LILIENTHAL, October 3d, 1874. Had complete
paralysis of right leg (of four weeks standing), with
considerable atrophy of the entire leg as well as the gluteal
region of the corresponding side. The temperature of the leg was
much lower than that of the healthy limb. _Faradic irritability
was entirely extinct._ The treatment was begun by galvanizations
of the lower (lumbar and sacral) portion of the spinal cord, and
the use of the interrupted galvanic current on the affected
muscles. This was at first done daily. The contractility of the
muscles gradually but slowly improved, but neither the atrophy
nor temperature of the limb appeared visibly affected by the
treatment. With a view to favorably influencing these
conditions, I ordered him galvanic baths. He had a bath every
alternate day. The result was favorable and rapid. The leg
became sensibly and permanently warmer after each bath, and
commenced steadily to increase in bulk. Faradic irritability
soon returned. The local applications were continued several
times a week for some time, and then gradually abandoned, the
baths being meantime continued regularly. The boy very soon
began to walk, and in December active treatment was
discontinued. At that time, faradic irritability having long
since become completely re-established, I caused the child’s
father to purchase a faradic battery to use at home. The limb
was eventually entirely restored in every respect, with the
exception of a slight abduction of the foot, for which I
referred the patient to Dr. GIBNEY. I saw the child recently; he
remains well.