Chapter V (2)

CASE XVII.* _Sub-hemiplegia from cerebral hemorrhage._ Mrs. S.,
aet. 30, married, from the practice of Dr. KREHBIEL, was sent by
Dr. K. to take baths, July 3d, 1874. It was a routine case,
differing in no respect from what is ordinarily witnessed as a
sequence of cerebral hemorrhage. Six baths, taken at intervals
of two and three days, restored almost entirely the muscular
power of the affected side. The patient subsequently made a
complete recovery without further treatment.

CASE XVIII. _Paralysis from insolation._ Mr. P., proof-reader
aet. about 40, had suffered for some time from sub-paraplegia,
the result of insolation. He was sent to take baths in May,
1874, by his physician, Dr. SCHIRMER. Electro-balneological
treatment in this case met with no success.

CASE XIX. _Lead paralysis._ Mr. M., aet. about 35, painter, was
referred to me for treatment May 15th, 1874, by Dr. MOHN. The
extensors of one (I believe it was the right) arm were
paralyzed. The characteristic blue line about the gums was
clearly defined. I ordered an electric bath daily. The
descending galvanic current was used for twenty minutes each
bath. From half to one ounce of iodide of potassium was added to
each bath. The blue line became less distinct from day to day,
until, after eleven baths, it had entirely disappeared. The
object for which I had ordered the baths having now been
accomplished, I treated the affected muscles with the faradic
current. A short course of this treatment sufficed to remove the
paralysis from all but one finger (it was either the middle or
ring finger), the extensors of which had probably undergone
fatty degeneration.

NEURALGIÆ.

The great variety of causes that may give rise to neuralgia, precludes the possibility of any specific for this symptom. In discussing its electro-balneological treatment, I would observe _a primo_ that I cannot, in the light of my personal experience, agree with those who claim for electrical treatment good results in a _majority_ of cases.[16] On the other hand it cannot be denied that, either as a palliative or curative measure, electricity, employed in an appropriate form and manner, is of inestimable value in many cases, and frequently succeeds where all other remedies are of no avail. Where we know the cause of a neuralgia, it is of course comparatively easy for us to determine whether or not electricity promises to avail anything. But even where the nature of the cases appeared to indicate its use, the failures, in my hands at least, have outnumbered the successes. The brilliant results—sometimes almost instantaneous—that we obtain now and then, should not lead us into overlooking our failures. Undoubtedly the circumstance that most of the cases that have come under my observation were of a very obstinate nature, referred to me by other physicians after varied unsuccessful treatment, has much to do with the formation of my views as expressed above, and future experience may perhaps lead me to modify them.

Speaking still from my own experience, I will state that the cases that have proven the most amenable to treatment were, _first_, those of rheumatic origin; _second_, hysterical neuralgiæ, and, _third_, cases where no assignable cause could be elicited. The most obstinate varieties were those of a malarial type (even when quinine in large doses or arsenic were employed in conjunction with galvanism) and those that depended on some form of chronic inflammation—_neuritis_, _periostitis_, etc. Of central neuralgiæ, I have had excellent results in the sympathetic variety and in the pains of posterior spinal sclerosis, while in the neuralgiæ of cerebral origin (diffuse cerebral sclerosis, tumors, etc.) I have never met with any appreciable success.

Where, then, we are able accurately to diagnose a case, there cannot be much doubt as to the appropriateness or not of electrical treatment, and in cases whose origin is obscure, which may be considered practically functional and therefore treated more or less empirically, electricity holds out as much or more hope than any other remedy. Whether electricity should be employed locally or in the form of baths, must depend on the features presented by each individual case. In neuralgia of the fifth pair—excepting those reflex cases where the _point d’origine_ is to be sought for somewhere in the trunk or extremities, and those that depend on cerebral hyperæmia or anæmia, where the equalizing effects of the baths on the circulation are frequently of great benefit—these are generally useless. Of other neuralgiæ, I have found the baths less successful in those of the superior than in those of the inferior spinal nerves. Lumbo-abdominal neuralgia and sciatica have yielded much more readily than brachial or dorso-intercostal neuralgia, etc., etc.

The mode of administering the baths in neuralgiæ does not possess enough of uniformity to render suggestion in this respect of any value. I will state however that, as a rule, the best results have been obtained from the descending galvanic current.

In chronic cases the baths should be administered daily, and should not be discarded as unavailing until at least a dozen have been successively taken.

CASE XX. _Sciatica._ Mr. R., a middle aged man, mechanic, was
sent by Dr. ARCULARIUS Nov. 9th, 1874. Had post-rheumatic
sciatica of some six weeks’ standing. There were no remarkable
features about the case, which however was sufficiently severe
to disable him from pursuing his avocation. He took his first
bath on the date above-mentioned. Another bath was administered
next day, and three more every alternate day. He was then almost
well. On Nov. 25th he returned, there remaining still some
traces of the affection. Four more baths, the last of which was
administered on Dec. 4th, sufficed to complete the cure.

CASE XXI. _Sciatica._ Mr. G., aet. about 35, saddler, was sent
by Dr. WAECHTER, March 6th, 1875. Had suffered from sciatica
without discoverable cause for several years. For one year prior
to his visit had been unable to work, and was confined to bed a
great portion of the time. There was slight atrophy of the
affected limb. He had had considerable medical (including local
electrical) treatment, without avail. The baths were faithfully
and persistently tried in this case, effecting however but
slight improvement. Subsequent hypodermic injections, first of
strychnia, then of atropia and finally of chloroform, the latter
in doses ranging from 30 to 60 minims, gave him only temporary
relief. The patient was finally discharged uncured.

CASE XXII. _Lumbo-abdominal neuralgia._ Mr. W., aet. about 40,
was brought by Dr. MARVIN S. BUTTLES in June, 1875. He had been
in poor health for a number of years, and was then in a very
cachectic condition. There was considerable gluteal atrophy on
the affected side. At Dr. B.’s suggestion he took a course of
electric baths, with the happiest result. He improved steadily,
and on the occasion of a late inquiry after I had not seen him
for some months, Dr. B. told me that the patient had entirely
recovered. His general condition as well as the neuralgia had
been very favorably modified by the baths, and he is now in far
better health than he has been for many years.

CASE XXIII.—_Lumbo-abdominal neuralgia._ Mr. G., aet. 40, came
to consult me in October, 1875. He had suffered from neuralgic
pains, more particularly in the renal region of both sides, but
also in the neighboring parts, for only one week. The case being
so recent, I entertained a very favorable prognosis, which
subsequently was amply verified. A bath on the 12th of October
and one on the 16th sufficed to effect a complete cure.

ARTICULAR EFFUSIONS.

It would appear at a first glance as though local galvanization of affected joints should be more directly and powerfully instrumental than electric baths in promoting the absorption of morbid deposits. To suppose so would however be a mistake—even where a single joint is concerned. Where many joints are involved, the advantages over local galvanization of the baths is sufficiently obvious. Where but a single joint is involved, the current can by means of the surface board be concentrated on the affected joint, while by the general galvanization a stimulus is furnished to the absorbents, that in itself is probably fully as important as any local treatment could be. In this manner absorption is made to progress much more certainly and rapidly, and this course is therefore to be given the preference in all cases where no special contra-indication exists.

The ascending general galvanic current should be employed for from 5 to 10 minutes. The surface board, connected with the negative pole, should then be applied for a few minutes successively to each of the affected joints. Iodine in some form should be added to the baths.

CASE XXIV.* _Specific synovitis of knee-joint, with considerable
articular and peri-articular effusion._ Mr. C., from the
practice of Dr. SHEPPARD, aet. about 35. First saw patient at
his house on Nov. 9th, 1873, in consultation with Dr. S. and Dr.
HUTCHINSON, of Providence, R. I. Had been on mercury and iodide
of potassium for a long time. When I first saw him, he had been
incapacitated from work for about a year. Had been unable to
leave the house for three months. The affected joint was very
much enlarged, with little or no mobility, the condition being
practically the same as true ankylosis. It was decided to
substitute tonics for the specific treatment, and to administer
galvanic baths. On Nov. 11th the first bath was administered,
another on the 15th, and a third on the 19th. Considerable
improvement in motility was then apparent. Two more baths, taken
respectively on the 22d and 29th, effected some reduction in the
size of the knee. The baths were continued to January 3d, 1874,
when the effusion had become almost entirely absorbed, and the
joint perfectly mobile. The patient then had been for some time
taking daily walks, unassisted. He now (Jany. 3d) walks without
any difficulty, has regained his normal vigor, and is perfectly
well.

IMPOTENCY.

The frequent obstinacy of this distressing condition under every variety of non-electrical treatment, is the cause of the frequency with which cases present themselves to the specialist. Unfortunately however but few of the referred cases are of recent origin. In almost all instances they have gone through a vast amount of medication and other treatment, and finally, either through their attending physicians or of their own accord, they come as a _dernier ressort_ to seek relief from electrical treatment. I have already (p. 47) spoken of the comparative merits in this disease of local and general electrization. A few years ago I was ignorant of the good effects of the baths in male impotency. I came to test and employ them here from two causes. In the first place, patients were sent me specially for electro-balneological treatment, ordered by their physicians; and, second, I began, when I became familiarized with the effects of the baths, to have recourse to them in cases where with local electrical and other treatment I had been unable to accomplish anything. My average results, without becoming uniformly successful, became so very much better, that after a brief but abundant experience with this treatment, I have come to consider it the most important we possess in this affection; one that will frequently succeed when everything else, including local electrization, has failed, and which, in cases where no incurable organic changes underlie the affection, will, if properly persisted in, either cure or improve to a great extent a large majority of the cases. I have even seen instances where, the sexual power having receded as the legitimate result of advancing age, it returned almost or quite perfectly and with seeming permanency under the influence of the baths. In the class of cases—and they are quite numerous—in which impotency (loss of the power of erection) occurs as a purely nervous symptom in comparatively young men; where its cause is sometimes purely imaginative, at others the result of early excesses, the baths are attended with the most gratifying average results. Where the cause is purely psychical, a very few baths are sometimes sufficient to dispel the morbid phenomena. Where masturbation or excessive venery are at the bottom of the trouble, there is always a probability of more or less organic change in the lower portion of the spinal cord, and frequently also a secondary enfeeblement of the digestive functions, which render requisite a long and steadily continued use of the baths. Patients whose sexual power was intact, who took the baths for other purposes, have time and again called my attention to their aphrodisiac effects.

While here the _general_ electric influence is the main remedial agency, there is no reason why the possible—or, I should say, probable—good to be obtained from its _local_ influence should not be realized—the less so that it is so facile to obtain this in the bath, by means of the surface board. While individual cases will undoubtedly call for modifications, I have found the following plan to answer best in certainly more than half the cases that have come under my observation: The first five minutes of the bath may be occupied by a general galvanic current of medium intensity, _descending_ where the patient is of an irritable, _ascending_ where of a phlegmatic temperament. The pole connected with the foot electrode should now be detached, and the surface board substituted. The second five or ten minutes may be consumed by running a galvanic current between the head electrode and the surface board, the latter applied alternately to the penis, scrotum, perineum and, where thought best, also to the lumbo-sacral region. Where, as is usual, the impotency is accompanied by a certain degree of cutaneous anæsthesia of the penis, but especially where the seminal secretion is scanty, the board should be positive (ascending current); where however nocturnal spermatorrhœa, premature discharges (before coition is possible) or other irritable phenomena characterize a case, the surface board should be negative (descending current). The head of the patient should rest on a sponge thoroughly saturated with water, and communicating with the water of the bath, so as to include the cerebellum in the direct circuit. The last five or ten minutes of the bath should be devoted to passing the faradic current between the head electrode and the surface board, this last applied about the genitals, but chiefly about the perineum, the current to be of sufficient intensity to contract the perineal muscles. With anæmic patients iron should be added to the baths. These should be taken at first daily, later on every other day, then three times a week, and so on until it becomes apparent that all the good that can be obtained from them has been obtained—whether this be a perfect cure or only a certain degree of improvement. Where it is thought requisite, internal medication and various hygienic measures may be advantageously resorted to as adjuvants. While these will do no good when employed alone, they may serve to enhance the effects of the baths.

In the following cases, I will include some where the impotency was not perfect, where the conditions were merely those of sexual debility. As there is here merely a difference in degree, it would be superfluous to separate the two conditions under distinct heads.

CASE XXV.* _Perfect impotency._—Mr. F., from the practice of
Dr. CARO, a robust gentleman, aet. thirty-six, full of muscular
vigor. Had had syphilis, the symptoms of which had disappeared
under Dr. C.’s treatment. For two years the power of erection as
well as sexual appetite had become extinct—if we except an
occasional imperfect spontaneous erection on waking up in the
morning, and even this was of rare occurrence. Ordinary
medication proving inadequate, Dr. C. sent patient to take
electric baths. From March 7th to July 16th, Mr. F. used the
baths, averaging about two weekly. He was then, and still
remains, perfectly restored.

CASE XXVI. _Perfect impotency._ A. E. K., aet. 23, commercial
traveler, applied to me for treatment in the spring of 1873. His
general health was very good. He had masturbated but little. Had
been in full possession of his sexual power until almost
twenty-two years of age, when he found that, without assignable
cause, he had lost the power of erection. His general condition
being, as far as discoverable, perfect in every respect, I
instituted a local electrical treatment. This was continued for
some time without avail. Strychnia was then administered with no
better result, and after some months’ treatment I told him that
I could do nothing for him. He remained without any treatment
whatever until the spring of 1874, when I advised him to try
electric baths. He took in all about half a dozen baths, which
resulted in his complete and thus far permanent restoration.

CASE XXVII. _Sexual debility._ Mr. W., aet. 32, married,
manufacturer, consulted me in February 1875. Had gradually for
about a year past lost sexual power. Was able to perform the
marital act at rare intervals only, and when he did, felt
exhausted the whole of the succeeding day. I ordered him
electric baths. He took the first on February 22d, 1875. Between
this date and March 22d, he took six baths. The sexual power had
then fully returned. I must not omit to state that during the
time he was under treatment he took, by my direction, gr. 1/25
phosphorus twice daily, which may have somewhat accelerated the
result.

CONSTIPATION.

Atony of the _muscularis_ of the intestine is admittedly the direct cause, in most instances, of constipation. It is the condition known as “torpor of the bowels.” It is ordinarily due to abnormal innervation of the parts. The inefficient innervation may be—and in females frequently is—reflex, or its cause may be sought for in the central nervous system. The condition of the voluntary abdominal muscles is likewise a factor in the alvine process. Sluggishness of the abdominal (portal) circulation is a not infrequent etiological concomitant of constipation, and, finally, the conditions grouped as “dyspepsia” may form the causative feature of a case. I have mentioned these different causes simply in order to account to some extent for the almost wonderful effects in this condition of electric baths. When we consider that in every one of the morbid conditions here enumerated, electricity is a very efficient remedy, and that for the resulting muscular atony it may be called a specific, it will not appear surprising that a mode of application which brings the electric influence to bear on both cause and effect—often on a combination of several of the causes enumerated, should be attended with such brilliant results. I have thus far met with no failure in the electro-balneological treatment of constipation.

In the majority of cases the following method has proven the most efficient. The first ten minutes of the bath should be devoted to the administration of a galvanic current, as intense as can comfortably be borne by the patient. The one pole should be connected with the head-electrode, the other, by means of the surface board, applied alternately, to the epigastrium, chiefly, and to the hypogastric region. The current should a portion of the time be ascending, the rest descending. Occasionally the current should be rapidly reversed by means of the commutator, the intensity however having been previously reduced, in order to avoid too severe a shock; this will cause efficient contractions of the abdominal _parietes_, and probably also of the intestinal _muscularis_. The second ten minutes of the bath should be devoted to faradization, employed in the same manner as the previous galvanization, only that here the direction of the current is immaterial, and no reversals are requisite. The current should be of sufficient intensity to produce energetic but not painful contractions of the abdominal parietes.

CASE XXVIII. Mrs. * *, aet. 55, in average health, without
however being robust, had suffered from constipation for about
thirty years. She had had every possible medicinal treatment,
with no avail. Nothing had ever ameliorated her condition.
Without the aid of a cathartic, her bowels moved but once every
week or ten days. She was of course compelled frequently to
resort to laxatives. In the fall of 1873 I ordered her electric
baths. She was not very energetic in anything, and this lack of
energy caused her to take the baths less frequently than I
desired her to. Had she taken them regularly, she would probably
have been restored in as many weeks as it took months to effect
her restoration. As it was, she took some thirty baths in the
course of about fifteen months. For nearly a year past she has
had a passage every day with the utmost regularity. No adjuvant
treatment was employed in this case.

CASE XXIX.* Emil Miller, a bright child two years of age, was
brought for treatment July 7th, 1874. He had suffered from
obstinate constipation almost from his birth. Had been under the
care of several physicians, but had never received any benefit
from treatment. Even with the aid of powerful cathartics, given
in doses suitable for an adult rather than a child, defecation
took place only once every three or four days, and was so
exceedingly painful as to elicit cries of pain from the child.
The feces were always hard and lumpy, and of an abnormally light
color. A digital examination per rectum revealed considerable
flaccidity. My diagnosis was _paresis of the muscularis of the
intestine_. I ordered faradic baths. On July 12th the first bath
was administered, and I must confess that the result was a
perfect surprise to me. True, I had expected a cure to take
place; but I had looked for gradual improvement, and was not
prepared for a result such as was here obtained. _From the time
the first bath was taken, defecation took place regularly once a
day, without pain; the feces became perfectly normal both as to
color and consistency, and the boy continues to the present day
to defecate regularly and in every respect normally._ To insure
permanency, the baths were continued, at first twice, then once
a week. They have now been discontinued for upwards of a year,
there being no occasion for their further use. No other
therapeutic measures, internal or external, were resorted to in
this case, nor was any change made in the diet of the child.

HYDRARGYROSIS.

The etiology of this condition requires no comment. I will simply relate a case illustrative of the eliminative effects of galvanic baths.

CASE XXX.* _Mercurial Stomatitis._ Mr. S., about 35 years of
age, came to me for treatment in the fall of 1872. He then had
indurated chancre, two buboes and syphilitic sore throat. He had
had the chancre for six weeks before applying to me, but had
been, he said, ashamed to consult a physician. Before medication
had had time to make any impression on the disease, roseola
appeared. The syphilis was very obstinate in this patient,
compelling me to keep him under the influence of mercury for a
long time. In October 1873, the patient presented himself with a
very aggravated mercurial stomatitis. The customary remedies,
internal as well as external, made little or no impression on
the affection. On November 11th, I discontinued all other
treatment, and ordered a course of galvanic baths. He took his
first bath on the same day. This was repeated every alternate
day until six baths had been taken, when all symptoms of the
disease had disappeared. He has had no mercurial trouble since
then. The descending galvanic current from a zinc-carbon battery
was used throughout.

LOCOMOTOR ATAXIA.

Were it not for the remarkable results obtained in the following case, I should not have felt justified in devoting any space to an allusion to this formidable disease. I insert the case as it was published in No. 216 of the “Medical Record.” I have to add that the patient, some six months ago, suffered a relapse, which however is not nearly as aggravated as his former condition, nor are the symptoms so pathognomonic. I had a letter from him about a week previous to my writing this, in which he states that he intends soon to come to the city for the purpose of taking another course of treatment. Even if the treatment however has not had the effect of curing the disease—and this I do not claim for it, it has been of sufficient importance if it has resulted in arresting for a time its progress, giving the patient temporary comfort, and prolonging life. Further trial may possibly have better results—in more recent cases—with respect to permanency.

CASE XXXI.* Mr. W., aet. 48, came to consult me January 12th,
1874. He had then felt the symptoms of locomotor ataxia for
about six years. Had been unable for several years to walk
without the aid of a cane. When walking he dragged his right
leg along in a semicircle, and was able to accomplish very short
distances only. There were almost complete anæsthesia and great
paresis of the bladder. The same conditions were observable in
regard to the bowels. Anæsthesia of both lower extremities
existed, complete in every respect in the right leg, almost so
in the left. Dyspepsia and general debility and emaciation
accompanied the disease. Treatment was begun on January 15th. I
prescribed phosphorus and cod-liver oil, and passed a strong
galvanic current through the spine for probably ten minutes.
January 16th, a galvanic bath was administered. Towards the
close of the bath (which occupied twenty minutes), patient
thought he felt some sensation in his legs. The baths were taken
every two or three days, alternating with strong galvanizations
of the spine. While taking his second bath, patient remarked
that “his right leg felt warm for the first time in six years.”
The treatment as described was continued for about six weeks,
during the latter part of which the local applications were
gradually diminished in frequency, the baths being continued
regularly. Medication was discontinued about this time. About
the middle of March. Mr. W. was enabled to resume his occupation
(paymaster’s assistant on the Erie Railway). His improvement had
been rapid and steady. All the symptoms gradually disappeared,
and in the beginning of April the patient was, with the
exception of some feebleness, consequent on his protracted
illness, as well as ever. He continues so to the present
day.[17] He still takes two or three baths a month, but has had
no other treatment since May (1874). He walks freely without a
cane, and talks jocosely of running footraces. All functions are
performed normally.

Although in this case the baths were not employed exclusively,
yet they predominated in the treatment; and if the judgment of
the patient, a very intelligent gentleman, is to be relied on, a
large share of the success is due to the baths.

CACHEXIÆ.

After what has been said in a preceding chapter of the tonic effects of electric baths, it would scarcely appear necessary to introduce the subject of cachexiæ. If I do so nevertheless, it is only to be afforded the opportunity of relating the following case, which possesses sufficient interest to render its introduction here desirable. The first portion of it has already been published (Med. Record, No 216), but to this I have to add what occurred subsequently.

CASE XXXII.* _Mercurio-syphilitic Cachexia._—Mr. L., aet. 27,
had primary syphilis about four years ago. Subsequently had
inveterate constitutional symptoms, for which he was under
medical treatment both here and in Europe. When he had sojourned
in the latter country some time, he was pronounced cured by his
physicians. He married, and returned to this country in the fall
of 1872. A few weeks after his return he fell into a gradual
decline, which confined him to the house—and part of the time
to bed—for eight months, during the latter portion of which he
had discontinued all medical treatment. It was with difficulty
that, assisted by his wife, he managed to reach my office. I
found him terribly enfeebled; greatly emaciated; sallow
complexion. He was much annoyed by rheumatic pains, which I
considered specific. His condition was so exceedingly low, that
I decided to postpone all medication until he should be
stronger. I ordered galvano-faradic baths, i.e. the galvanic
current in the bath as an eliminative, the faradic as a tonic.
The first bath was taken on November 20th, 1873. For one month
he took the baths, and nothing else. He was then so much
stronger, that I felt justified in instituting a mild specific
course of treatment, the baths being continued as theretofore.
At the end of two months the patient was nearly as strong as
ever, was able to resume his occupation, and had gained
twenty-seven pounds in weight.

Thus far this case was published as above stated. For the sake
of the interest attaching to it, I will now proceed to give its
further history. Mr. L. remained to all appearances well until
July, 1874, when he commenced to suffer from headache and
constipation. On the 23d of August following, while I was absent
from the city, he presented himself to the gentleman who
attended to my practice during my absence, with paralysis of the
external rectus muscle of the left eye. He also consulted a
specialist, who pronounced the paralysis rheumatic. When I
returned from the country he presented himself for treatment. I
commenced a series of daily electric applications to the
affected muscle, which failed to respond to the faradic current,
but contracted very readily when the slowly interrupted galvanic
current was employed. As I had strong suspicions that syphilis
was at the bottom of the trouble, I also administered iodide of
potassium in gradually increasing doses—not however until
electrization and strychnia employed for some weeks had failed
to do any good. The administration of the iodide met with no
better success. The patient’s general health gradually declined.
On October 22d, he complained of numbness in the left leg, which
gradually increased, the leg at the same time becoming paretic,
so that the patient required the aid of a cane for ordinary
locomotion. His condition now became rapidly worse. His
movements became ataxic. Anæsthesia of the bladder, paresis of
this and the intestine, with obstinate constipation, loss of
appetite, emaciation, etc., rapidly supervened. I suspected the
development of _gummata_ on the meninges of the brain and cord,
and advised him to use the inunction cure, and to remain at home
until he should be well. This, on account of the business losses
which it involved, he was very much averse to doing. He
consequently proposed a consultation with an eminent physician,
which was had. This gentleman pronounced the case one of spinal
(either multiple or posterior) sclerosis, and discarded the
syphilitic theory. A consultation two days subsequently with
another physician had a like result. In deference to the opinion
of these gentlemen, I treated the patient in accordance with
their diagnosis. This was in the second week of November. The
patient became rapidly worse. He soon ceased to walk—he tumbled
about. After six days’ treatment, considering his life in
imminent danger, I reiterated my advice to institute the
inunction cure, and the patient then acquiesced. Nov. 24th I
ordered a drachm of Unguent Hydrarg. to be used every evening; I
could not however prevail on the patient to remain at home
during the treatment. He continued to grow worse. Nov. 26th he
had complete retention from vesical paralysis, and sent for me
at night to relieve him. Thenceforth until he got nearly well he
was obliged to use the catheter regularly. A few days after
this, fortunately for himself, he fell down as he was leaving a
horse car, and sprained his ankle. I say _fortunately_, for this
accident _compelled_ him to remain at home. From this time he
began to improve. December 2d I substituted for the ointment a
twenty per cent solution of the oleate of mercury, of which he
used a drachm morning and evening. The improvement from this day
was exceedingly rapid. On the 4th of December he had regained
control of the bladder. The constipation, which had been very
obstinate, also began to yield. From this date he used the
oleate only once daily, and discontinued it entirely on the
14th. On the 10th he had already resumed his avocation, and the
same month absolutely danced at a ball. He took iodide of
potassium for a time after his mercurial course. He has since
been and is now in perfect health.

DYSPEPSIA.

The remedies for this disease are unfortunately so numerous, there is so much temptation to try another where one remedy has failed, that it is seldom or never that an uncomplicated case of dyspepsia applies for electrical treatment. As a rule, the disease that furnishes cause for referring a case to the specialist, is some nervous trouble secondary to the dyspepsia.

In regard to the influence of electric baths on dyspeptic conditions, whether complicated or not, I can however speak unqualifiedly in their favor. I know of no one other remedy that can at all approach them in this respect. Whatever the secondary or other troubles of patients, any co-existing dyspepsia was in every instance either cured or greatly ameliorated. The improvement usually begins at once—after the first or second bath, and continues steadily. As I have not had occasion to treat by means of electric baths any uncomplicated cases of dyspepsia, I can adduce none. I may safely claim however for the baths a reliability and bespeak for them a confidence that I might claim or bespeak for no other remedy or plan of treatment whatsoever—assertions which would appear rash and venturesome, had I not at my command abundant clinical evidence to warrant my making them.

MELANCHOLIA.

A case of melancholia, highly illustrative of the effects in this condition of electric baths, came under my notice very recently. It may serve as a guide in the treatment of this and kindred conditions.

CASE XXXIII. Mr. F., aet. 22, single, butcher, consulted me Oct.
21st, 1875, for melancholia and loss of memory, from which he
had suffered for upwards of a year. He had frequently
entertained the idea of suicide. A thorough examination revealed
no trouble of any of the viscera. All functions appeared normal.
He had never masturbated. There were no collateral symptoms to
furnish any evidence of organic cerebral trouble. I prescribed
phosphorus and strychnia, and galvanized the brain twice a week.
Two weeks of this treatment had completely negative results. I
then ordered electric baths. Four baths resulted in a complete
cure.

INEQUALITIES OF THE CIRCULATION.

As a very fruitful source of morbid conditions of almost every nature, abnormities of the circulation of the blood are well worthy our attention. As is the case with dyspepsia, so here likewise patients seldom present themselves for treatment unless some definite secondary pathological condition has supervened. We find these patients complaining of cold hands and feet, irregular and disturbed sleep, occasional local congestions, with vague, usually slight pains here and there, etc., etc. Where organic cardiac disease is at the bottom of the trouble, we cannot of course expect much permanent improvement. Although even here considerable relief is often afforded while the baths are being used, their discontinuance will in all probability be soon followed by a return of the former condition. Where, however, cases are not complicated by organic disease, where we have a “sluggishness” of the circulation, due either to vasomotor inertia or atony of the muscular coats of vessels, the electric bath will be found reliably efficient. I have already (p. 55) alluded to this subject, and explained the probable “mode of action” here of the baths. I will now offer some suggestions as to the best method of administering them with a view to equalizing the circulation.

We must here seek to stimulate the vasomotor system, both central and peripheral; to give tone to the coats of vessels, both by direct and indirect electric influence; through counter-irritation to relieve internal congestions, by causing an afflux of blood to the skin. These objects are best attained by means of the galvanic current, which should be employed of sufficient intensity to produce a rubefacient effect. The faradic current acts in the same direction, but far less energetically, if we except the vessels near the surface, the muscular coats of which are probably more efficiently tonicised by this than by the constant current. The faradic current however is applicable here in another way, and for a very important object. I refer to the _mechanical_ counter-action of a sluggish circulation, through the agency of prolonged muscular contraction. This mechanical effect is not of course peculiar to the faradic current; it is shared by gymnastic and other exercises; but obtained in any other way whatsoever (with the exception, perhaps, of _massage_, which is however much more troublesome as well as inferior, and moreover not always admissible) it involves, in order to produce perfect results, a considerable amount of bodily exertion, often beyond the physical power of persons who are in ill health, and bringing with it the risk of positive injury, through over-exertion, which with the _passive_ contractions obtained by means of the faradic current, is entirely obviated. By administering the _general_ faradic current in the bath, of sufficient intensity to _maintain_ muscular contraction as long as the circuit remains closed, any stagnant blood in the lower extremities will be efficiently forced into the general circulation. After from three to five minutes of this faradization, the surface board may be successively applied for a minute or two each to the arms, abdomen, pectoral and dorsal muscles. I believe the _best_ results can be obtained by first going through the faradic process, then subjecting the patient to general galvanization, as above indicated, and concluding by another but brief faradization.

AFFECTIONS OF THE SYMPATHETIC.

Last, but not least, I have some remarks to offer on the treatment by the electric bath of certain affections of the sympathetic nerve. While I do not in any such cases accord to the baths the rank of an exclusive remedy or even a specific, their importance as an adjuvant is sufficient to entitle them to special consideration in this connection. In those neuroses of the sympathetic where electricity (galvanism) is indicated, the _greatest_ benefit can be obtained from local applications. On the other hand the baths, employed in addition to local applications, will be found a very important factor in the treatment, possessing, as they do, two advantages, viz: _first_, by their means, the electric influence is brought to bear—in a much less concentrated form it is true—on the entire sympathetic system, from the _ganglion impar_ to the _ganglion cervicale supremum_, and, by derived currents, on the cephalic ganglia also, at one and the same time; _second_, the rest of the body participates in the general nutrient and tonic effects of the bath equally with the sympathetic, the latter thus receiving a reflex benefit which local applications fail to furnish. There are, moreover, cases where hyperæsthetic conditions of the nerve do not admit of local applications, and where yet electricity is urgently called for. Thus I have at present under treatment a lad sixteen years of age, in whom both supreme cervical sympathetic ganglia as well as the ganglion impar were until recently so susceptible that the mere adjustment of the electrodes caused him great pain, while on the other hand he bore the baths exceedingly well. In such cases, electric baths, suitably administered, frequently constitute in conjunction with proper medication, the most useful treatment.

As to the mode of administration in sympathetic neuroses of the baths, the most direct manner in which to influence the diseased nerve, is by connecting one pole of a _galvanic_ battery (I consider the faradic current next to useless here) to the head electrode, the other to the surface board, the latter applied portion of the time to the epigastrium (solar plexus), the balance to the coccyx (_ganglion impar_). This will include in the direct circuit the main portion of the sympathetic, the position in the tub of the bather bringing the cilio-spinal centre very close to the head-electrode. The direction of the current must be determined by the individual features presented by each case, as also the duration of the bath.

CASE XXXIV. Mr. S., aet. 31, merchant, was referred to me April
3d 1874, by Dr. KREHBIEL. In January, 1874, Mr. S., until then
in the enjoyment of good health, woke up one morning to find, as
he expressed it, “everything dark before his eyes.” He groped
his way to the window, in order to open the blinds. When at the
window, he felt as though about to fall out—probably vertigo.
He soon returned to an apparently normal condition, and went
about his business as usual. A week after, he had a much more
serious attack, which he describes as follows: “I had been
playing whist during the evening (several hours), when suddenly,
without premonition, I felt as though a champagne cork popped
against the top of my head, inside. Accompanying this was an
indefinable sensation about the heart as though the blood all
rushed thence down to the feet. I did not lose consciousness;
did not fall. I trembled all over, and a great fear came over
me. Felt very weak all night; my pulse was very slow.” About two
months subsequently, patient was referred to me, as above
stated. He then had an uneasy look; an indefinable continual
sense of fear; was excessively nervous in the forepart of the
day; had brief attacks of tremor—usually every alternate
morning, but not typical as to time of occurrence. The history
exhibited neither syphilis, malaria nor intemperance. Had never
had headache. Sleep good; appetite likewise. The most
pathognomonic symptom, however, related to his pulse. This was
abnormally slow, ranging from 44 to 54 (the latter only when
standing or after walking) per minute. It was full and regular.
There was no organic heart trouble. In the absence of any other
symptom whatsoever pointing to irritation of the pneumogastric
or spinal accessory, I was justified in excluding this as the
possible cause of the cardiac infrequency. On the other hand,
the pathogenetic manifestations appeared all to point to
“asthenia of the sympathetic”—at any rate the portion of this
whence the cardiac nerves take their origin, and I formed my
diagnosis accordingly. In the beginning, the treatment consisted
of bilateral ascending (from cilio-spinal centre to both mastoid
fossæ) galvanizations of the sympathetic, and galvanic baths
(head electrode negative, surface board positive, to
epigastrium) on alternate days. Improvement in every respect was
steady, though not rapid. At the end of three weeks, I
supplemented this treatment by the administration of ergotin and
nux vomica. At the expiration of two more weeks, the patient
being nearly recovered, I discontinued these medicaments,
substituting the valerianates of zinc and iron, and steadily
maintaining meanwhile the electrical treatment as above
indicated. After a short time recovery appeared complete, and
patient was discharged from treatment. He returned however a few
months subsequently, complaining of “faint spells” in the
mornings, accompanied with excessive nervousness, and a renewed
though moderate cardiac infrequency. Electrical treatment,
similar to that above described, soon restored him. One or two
more slight relapses occurred during the next six months. For
over a year past however Mr. S. has been in the enjoyment of
perfect and undisturbed health. His normal pulse ranges from 72
to 80.

Whoever is familiar with the physiological effects of electric baths, will readily concede their great utility in a variety of conditions that I have not thus far specially alluded to. Of such I would mention ASTHENIÆ, ATONIC AND DEBILITATED CONDITIONS GENERALLY, including the state of CONVALESCENCE FROM ACUTE DISEASES and the DECLINE OF ADVANCING AGE; many cases of CHRONIC HEADACHE; some INCLASSIFIABLE CONDITIONS OF MARASMUS and MALNUTRITION, etc., etc. In all such cases, when purely functional and uncomplicated by incurable organic disease, good results may be confidently looked for.

* * * * *

With these remarks I conclude my subject. Whichever the errors that a too limited experience may have engendered—and I doubt not there are many, I cannot on reviewing my work accuse myself of lack of candor nor yet of undue enthusiasm. I have cited but a small proportion of the successful cases whereof I possess records; still I believe that I have adduced amply sufficient clinical proof of the great value as a remedial agent of electric baths, and of the desirability of their more general adoption. I would more especially call attention to the inappropriateness of deferring their employment until almost all other remedies have been exhausted; and when I reflect that pretty much all those cases that had been referred to me by other physicians had already had the doubtful benefit of almost every other conceivable treatment, while many of those who came of their own accord, had in addition made the rounds of all the quacks, and exhausted nearly all the nostrums that are to be found advertised in the columns of our daily papers, the wonder seems that the results obtained were as good as they have been. I sincerely trust that in the future physicians will avail themselves more frequently than heretofore of a remedy that is certainly capable of accomplishing much good; and I hope that in addition to myself there will be found others, more competent, to devote themselves to the study of the subject. To these, and perhaps to myself at a future time, I relegate the task of correcting my errors and promulgating hitherto undiscovered truths.

Footnotes:

[Footnote 10: Centralblatt für die medicinischen Wissenschaften,
No. 17, 1875.]

[Footnote 11: The apparatus used in these experiments was that
of Du Bois-Reymond, with a Grove’s element.]

[Footnote 12: Since writing the above, this case has had an
entirely favorable termination.]

[Footnote 13: The cases distinguished by an asterisk were
published in No. 216 of the “Medical Record.”]

[Footnote 14: Wherever I use the word “general” as descriptive
of an electric current used in the bath, it is not as a
characteristic, but merely to distinguish it from the instances
where the surface board is employed.]

[Footnote 15: Austin Flint, M.D. A Treatise on the Principles
and Practice of Medicine. Philadelphia, 1873. 4th ed. pp. 63 and
64.]

[Footnote 16: See Beard and Rockwell, op. cit., 2d ed. p. 472.]

[Footnote 17: This was written a year ago. See remarks preceding
the case.]

INDEX.

A.
PAGE
Agrypnia 92
Anæmia 93
Apparatus for baths 7
Articular effusions 105

B.

Bath-tub 8
Batteries 16

C.

Cachexiæ 118
Chemicals in baths 15
Chorea 80
Circulation, effects on 55
" inequalities of 123
Clinical Record 61
Conductivity of water, etc. 13
Constipation 112
Counter-irritant effects 56

D.

Debility, general 129-130
Diagnostic uses 53
Digestive apparatus, effects on 44
Dyspepsia 121

E.

Electric Bath compared with other
electrical methods 32
Electrodes 10

G.

General Therapeutics 52

H.

Hydrargyrosis 115
Hypnotic effects 38-58
Hysterical affections 82

I.

Impotency 106
Insomnia 92
Invigorant properties 57

L.

Locomotor Ataxia 116

M.

Melancholia 122
Mind, effects on 51
Miscellaneous disorders 129-130
Mode of administration 19
Muscular contractions 50

N.

Nervous Exhaustion 84
Neuralgiæ 100
Neurasthenia 84
Nutrition, effects on 59

P.

Paralyses 96
Pareses 96
Physiological effects 31
Prophylactic influence 60
Pulse, effects on 41

R.

Rheumatism 67
" acute 68
" chronic 74
" subacute 73
" cases of 77

S.

Sedative effects 48-58
Sexual apparatus, effects on 46
Sexual debility 106
Sleep, effects on 38
Special therapeutics 61
Stimulant effects 43
Surface board 14
Sympathetic, affections of 126

T.

Temperature, effects on 41
Tonic properties 43-57

[Transcriber’s Notes: The table below lists all corrections applied to the original text.

p. 029: [normalized] the sub-acute symptoms -> subacute p. 056: GENERAL COUNTER IRRITANT -> COUNTER-IRRITANT p. 056: [normalized] the use of the surface-board -> surface board p. 059: does ... became apparent -> become apparent p. 067: [normalized] acute, sub-acute and chronic -> subacute p. 073: [normalized] bi-carbonate of soda or potassa -> bicarbonate p. 107: ordered by their physicians: -> physicians; ]