of electric baths, is a natural result of the enhanced tone and vigor of the physical system, and keeps pace with this. Mental buoyancy and even exhilaration are among the most common sequences of electric baths. Although indirect, these results are none the less decided.
It has been my aim in the foregoing remarks to give the reader, as concisely as possible and within the limits which I set for myself in the beginning of the present chapter, a summary of the more important physiological effects of electric baths. As the isolated results of observations made in a limited field by one unaided individual, I trust the shortcomings of this chapter will be viewed indulgently. If what I have said of the physiological effects of electric baths proves the means of stimulating to further investigation more competent observers than myself, my labor, whatever its imperfections, will not have been in vain.
Footnotes:[4]Dr. Franz Hartmann; “Der acute and chronische Gelenkrheumatismus,” Erlangen, 1874; pp. 194 et seq.[5]The Author here refers to mineral-water. Dr. S.[6]The Medical Use of Electricity, with special reference to general electrization as a tonic, etc. New York, 1867.[7]Beard and Rockwell; Medical and Surgical Electricity. N. Y. 1875.[8]Op. cit. pp. 253. et seq.
Footnotes:
[4]Dr. Franz Hartmann; “Der acute and chronische Gelenkrheumatismus,” Erlangen, 1874; pp. 194 et seq.
[4]Dr. Franz Hartmann; “Der acute and chronische Gelenkrheumatismus,” Erlangen, 1874; pp. 194 et seq.
[5]The Author here refers to mineral-water. Dr. S.
[5]The Author here refers to mineral-water. Dr. S.
[6]The Medical Use of Electricity, with special reference to general electrization as a tonic, etc. New York, 1867.
[6]The Medical Use of Electricity, with special reference to general electrization as a tonic, etc. New York, 1867.
[7]Beard and Rockwell; Medical and Surgical Electricity. N. Y. 1875.
[7]Beard and Rockwell; Medical and Surgical Electricity. N. Y. 1875.
[8]Op. cit. pp. 253. et seq.
[8]Op. cit. pp. 253. et seq.
GENERAL THERAPEUTIC EFFECTS AND USES.
Thetherapeutic uses of a remedy are based on what we know of its physiological effects. Many—or rather most—of the therapeutic effects of this as well as of most other remedies, correspond to certain physiological effects. Those therapeutic effects whereto we find none analogous among the physiological effects, are yet the results of the physiological tendencies of the remedy, and where these tendencies do not manifest themselves as results, it is because they find no field for action in the healthy organism. When they meet with the requisite pathological conditions, these tendencies make themselves manifest in the shape of definite results, commonly known as therapeutic effects.
Nothnagel, in his classical work,[9]recognizes this theory by excluding from his book the term “therapeutic effects” altogether. Where he finds it necessaryto say anything of the physiological effects of a remedy, in addition to those “on man in health,” he speaks—still under the head of “physiological effects”—of those “on man when sick.” When, setting aside its empirical employment, we come then to inquire what it is that furnishes us with the true indications for the use of a remedy, analysis of the question leads us invariably back to its physiological effects. If I have failed nevertheless to include the few effects which I am about to touch on, under the head of “physiological effects,” I have done so simply in compliance with universal usage, and as a matter of convenience for reference.
I will now, without further digression, proceed to the consideration of those effects of electric baths not yet enumerated.
As a fitting precursor to the enumeration of the therapeutic properties of the remedy under consideration, it may be well to dwell for a moment on what is among its most prominent characteristics; I have reference to its great value as a
In explanation of this, I will state that in a very large number of cases of disease of an obscure nature, and where, to be candid, the electric bath was employedempirically, or, if you please, tentatively, it has served to point out thelocus morbi. The number of cases in which I have made this observation, has been sufficiently large to establish beyond a doubt the fact, that as a rule the electric current makes itself more decidedly and often even painfully felt in any part where a morbid condition exists; whether this be of an inflammatory, neuralgic, rheumatic, traumatic, congestive or other nature, the result is the same. It appears to be somewhat analogous to the “tenderness on pressure” that we find present in many of these conditions. Inanæsthesiæeven the current makes itself conspicuous by theabsenceof its normal effects. The value of this will at once be recognized in connection with a method of electric application which at one and the same time acts on every portion of the body. Local electrization is accompanied by like phenomena,when we happen to strike the right spot. The superiority of the bath as a means of diagnosis is found in the circumstance that here wemusttouch it.
The great importance of this feature of the electric bath will at once be realized by every physician of much experience, for there can be none such who has not frequently met with subacute orchronic conditions the etiology of which was more or less obscure.
One of the most important effects in its therapeutic application of the electric bath, is its superior excellency as an
so far as I know, it is more potent, constant and comprehensive in this respect than any other agent. Where an imperfect circulation of the blood is due to irremovable organic causes, the results obtained will of course be transient only. In all other cases, however, favorable results, more or less perfect according to the nature of the case, may be reliably looked for. Both currents act very well in this respect, though on the whole I look upon the galvanic as superior to the faradic current.
As a theory of this effect of the currents I would offer the following, viz: That the galvanic current acts by stimulating the vasomotor centres and peripheral nerves, by giving tone to the mucular coats of blood vessels, and by counter-irritation. That thefaradiccurrent stimulates the vasomotor centres little, if at all, does not influence the coats of vessels, except such as are close to the skin, but tonicizes these latter more effectually than the galvaniccurrent; that it stimulates the peripheral nerves to some extent, though far inferior in this respect to the galvanic current; but that when employed of sufficient intensity it superadds to those mentioned a strictly mechanical action, which consists in forcing static blood from the capillary into the general circulation through the medium of muscular contractions.
As a
thegalvanicbath has few if any superiors. The degree of counter-irritation can be very nicely determined by regulating the intensity of the current. The characteristic tingling sensation of the galvanic current is felt over the entire surface, corresponding in degree of course to the intensity of the current; while the redness of the skin, bearing a like relation to the intensity of the current, is observable more especially near the electrodes, being particularly conspicuous over the entire back. Concentrated local counter-irritation can be obtained by the use of the surface board.
The counter-irritant effects of the galvanic bath, differ from those of ordinary counter-irritants in their freedom from pain, even the slight burningsensation accompanying strong currents ceasing with the application. The redness remains quite a while and the stimulus to the peripheral circulation causes the persistence for some time of a “glowing” sensation all over the body.
In the chapter on physiological effects enough has been stated to make it apparent that as a
the electric bath can have few if any superiors. In the healthy organism, however, the stimulant and tonic effects of the baths are much less marked than they are where the general condition is “below par.” In health there is little or no margin for improvement. The results obtained aretemporarystimulation, and a permanent invigoration which partakes more of artificial development than anything else. It is analogous to the development by gymnastic or other exercise of a previously healthy set of muscles. Where we meet with atonic conditions however, with debility, malnutrition, want of energy or general asthenia of an obscure nature, and amenable to electric influence, the tonic effects of the baths become striking and brilliant. I have observed cases where patients fairly bloomed up under their influence and acquired actually more physical strength andweighed more than before they became sick. When we consider how in such conditions as those mentioned, patients are made to swallow pills and mixtures for months or years, or, more appropriately, and if they can afford it, are sent abroad, we can realize the importance of an agent by means of which the desired end can be obtained more conveniently, certainly, economically and in a shorter time than by any other means. There is no rule without its exceptions, and I freely admit that in many instances where persons are, as the saying is, “run down,” a sojourn in some mountainous region or a course of sea-bathing, etc., would do them more good than anything else, electric baths included. The results obtained from these last are however sufficiently uniform to justify us in looking for very favorable results in every case.
In the preceding chapter I have already dwelt on the
of the baths. It is only necessary to state here that this influence manifests itself still more decidedly in corresponding morbid conditions than in health. The greater the degree of restlessness, irritability or wakefulness, the more strikingly does the soothingand hypnotic influence of the baths—appropriately administered, of course—become apparent.
as manifested by rapid increase of weight, and which I have likewise touched upon in the preceding chapter, is a reliable, constant effect of electric baths. Where previous loss of weight is due to an incurable organic disease, it is, if at all obtained, of course much less in degree, as well as transient. When due, however, as is frequently the case, to causes that are amenable to electrical influence, the increase in weight is marked, and has a tendency to be permanent.
It will be seen that the few therapeutic effects which I have here enumerated, are in reality nothing more than intensified physiological effects, there being about them nothing that might be termed specific. It may be asked in reply: why then did I devote any space to them at all? I will answer that I thought best to point out some general therapeutic USES for which electric baths may be made available, and the indications for which are furnished by so great a number of pathological conditions, that omitting special reference to them would have led to a great deal of tautology in the chapter on “special therapeutics.”
Before leaving the subject of “general uses” of the baths, I will dwell for a moment on their admirable adaptability as a
Every physician is fully aware of the fact that disturbances of the circulation constitute one of the most frequent causes of disease. There are, indeed, comparatively few pathological conditions that do not bring with them congestion of some more or less important organ. A remedy then which more than any other has a tendency to equalize the circulation, and thus counteract a condition which as cause or effect, or both, is an almost universal concomitant of disease, and which in addition to this is so admirable and physiological a stimulant and tonic, can hardly be surpassed as a prophylactic by any other uncombined remedy.
Footnotes:[9]Dr. Hermann Nothnagel: Handbuch der Arzneimittellehre. Berlin, 1870.
Footnotes:
[9]Dr. Hermann Nothnagel: Handbuch der Arzneimittellehre. Berlin, 1870.
[9]Dr. Hermann Nothnagel: Handbuch der Arzneimittellehre. Berlin, 1870.
SPECIAL THERAPEUTICS AND CLINICAL RECORD.
Ihavethought 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 handfor 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 amore completefaradization.
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 warmbath, 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 issufficient, but a bath every day isbetter—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, toconsolidateandconfirmthe good results obtained, has done me the best service.
I would dwell particularly on the necessity ofperseverancein 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 thetour 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 theconditions 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.
Its great frequency, the pain and discomfort which it occasions, and its many, often dangeroussequelæ, 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 berelied onto 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 diseaseitself I will divide into three classes, viz:a) acute,b) subacute andc) 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 asother 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 diseasedjoints 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.”
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 diseasedjoints 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 valueof 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 givegeneralelectrization—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, assymptomatictreatment, 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 localtreatment. 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 theindicatio morbilikewise. 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 bearwithout the slightest degree of discomfort. In the application of the faradic current, the surface board (seep. 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 caseswhere 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 tobandc, let it be understood that I speak within the restrictions of a period of observation extending over two and a half years only.
In the subacute variety, the electro-balneological treatment is similar to that in acute cases, with thedifference 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 ofthe 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, itwould 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 theclienteleof 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 tootender 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 withadditional 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 theclienteleof 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.
Case I.*[13]—Subacute Rheumatism.Mr. F., from theclienteleof 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 tootender 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 withadditional 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 theclienteleof 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.
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 treatmentwithoutthe 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 thehead-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 theclienteleof 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) permanentrecovery. 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.
Case VI.* Hugh O—l, aet. 12 years, from theclienteleof 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) permanentrecovery. 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.
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 toelectricity, 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 becauserecentstatistics, 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 assertingthat, 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.