A PAPER BEAD BEFORE THE Academy of Medicine, JUXK 15th, 1882, By y JAMES KNIGHT, M.D., SlROEON-IN-ClIIEF OK TIIK HOSPITAL OF THK N«W YORK SOCIETY FOR THE Relief of the Ruptured and Crippled; Member of the Medi- co-Chiruruical Faculty of Maryland; of the District Medical Society of Ohio; of the County Medical Society and the Academy of Medicine £Utv \torh: E. WELLS SACKKTT A RANKIN, PRINTERS ANI) STATIONERS, 56 ractitioner, a reactive power. According to Matteucci, thq nervous system responds to electricity after all other stimu- lants have ceased to act. ELECTRICAL INFLUENCE. Alterative Action. An influence frequently exerted by electricity is that of chang- ing the action of an organ, or the general tone of the system, thereby arresting a diseased condition. PROMOTION OF NUTRITION. In deficient nutrition, electricity may co-operate in the vital transformation and organization of the nutrient matter, by means of the nervous system or by direct action on the tissues of a part. To produce increased action in the latter case, static or galvanic electricity may be used. This will be done wherever a part needs 9 to be nourished, or the waste of any organ to be replaced. As a general rule, the current should be feeble, and the application long continued and frequent. For this purpose static electricity is much more efficient than dynamic. PROMOTION OF ABSORPTION. In effusions of scrum, or lymph, in some forms of hypertrophy, in bony deposits, rheumatic enlargements and every undue organic development, with the exception, perhaps, of some ma- lignant growths, the power of the absorbents needs to be quick- ened, and this may often be effected by electrical action. In this case, the application is usually made directly to the organ, though the rule still prevails, in acting through the nervous system, that the vital stimulus artificially supplied directs itself to, or principally perceived in, that function whose efficiency is suspended. In other words, the tendency of the nervous influ- ence seems to be, to harmonize the various vital functions, dis- proportionate action appearing thus to proceed from causes acting originally on the life of tissues. In serous effusions accompanied with inflammation, cautious and gentle application of static electricity will be effectual. RESULTS OF STATIC ELECTRICITY. This condition of the patient and the favorable results from the use of static electricity was of my earliest experience. Col. I., of Great Barrington, Mass., was most seriously afflicted, hav- ing synovitis affecting nearly every joint in his formation. The cause was exposure to a running stream of cold water for a con- siderable duration of time, in repairing a mill-dam in the month of April, 183(5. The first indication of the invasion, was an inability to rotate the neck and then the back and thigh joints ; then the knee and ankle joints, and finally the arms and wrists, to such a degree as to leave him in an entirely helpless condition. Then followed a chronic diarrhoea, that necessitated the taking of large doses of opium to retain any nutriment. His complexion was sallow, his joints enlarged and painful, but with no appearance of super- ficial inflammation. This had {ill intervened from April to November, when treatment by static electricity was commenced and applied daily with light shocks, from the cervical region to the extremities—the patient being placed upon the insulating 10 table. After three months’ treatment, varying the mode of appli- cation to and from the patient, the diarrhoea ceased and the appetite increased ; but an intolerable irascibility ensued, with apparent congestion about the head. Venesection was resorted to, and much relief and comfort afforded the patient. It was then observed that he could again use his hands and had some power to move the elbow and shoulder joints. After ten days a similar condition of distress ensued, and relief again afforded by vene- section of about sixteen ounces. After this he was able to push a chair before him and thus walk. The joints were much less- ened in size and comparatively soft from that of almost cartila- ginous hardness. From this time his physical condition gradu- ally improved, and locomotion became more and more tolerable, so that in the following month of May he was able to mount a horse and ride, although his back and neck remained partially fixed. At this time electricity was applied twice a week until August, he being then quite active, and prepared to leave home for the South to spend the winter. He returned home the follow- ing spring and became president of the Housatonic Bank. This was in 1837 or ’8, and ever since that time I have used static electricity as a therapeutic agent when possible to obtain it, which at that time could only be had in a dry atmosphere. Now, through the improved Holtz induction machine, static electricity can be obtained, in all probability, ten months in the year, and in such profuse quantity that it can be made available to the most satisfactory degree. And recent improvements made by Mr. Berge, of our city, may tend to better results. In the London Lancet of June, 1846, a statement appears of Dr. Golding Bird’s experience in the use of static electricity in Guy’s Hospital, London, which agrees most closely with my own. Dr. Bird, from his large experience, classifies the following forms of paralysis that are relieved by the judicious application of static electricity. The favorable results, as stated by Dr. Bird, of cases carefully noted, and his highly appreciated professional standing, places his statements beyond controversy, and induces me to present them again to the medical profession as an evidence of my own experience from the long continued use of static electricity. 1st. Partial paralysis from organic congestion, or effusion, which has been removed. 2d. Paralysis of the portea dura, of the seventh pair, from exposure to cold. 3d. Paralysis of a limb from the same cause. 4th. Paralysis of one side of the body or a 11 winkle limb, from exhaustion—as from lactation and flooding. 5th. Paraplegia from rheumatism, paraplegia from enervation. He found the use of electricity most successful in recent cases, and contends against its use in many of the established organic lesions; stating that he has known fatal apoplexy to follow its application in cases of ramolissement of the brain, or where indurated arteries existed. I would here state that venesection is essential in the treatment of these cases with static electricity, and dangerous if omitted. And, moreover, he remarks that he has never known electricity to do any good in rigid flexion of the thumb or lingers. Under various modes of electrical application we find, however, that paralytic contraction has been successfully controlled in cases of diminished tone in certain sets of muscles impaired by long continued extension, that impairment of the balancing muscuW force having even tended to contortion. Dr. Bird remarks: “From tin* want of exercise, the muscles of the affected limb become atrophied. The power of electricity in this respect is very remarkable, frequently restoring power to the paralyzed muscles in a very short time.” I)r. Todd, in a paper in the Medico-Chirurgical Transactions of 1H47, from a large number of observations, arrives at the following conclusions: 1st. That irritability of paralyzed muscles is in direct relation to their state of nutrition. 2d. It varies with the condition of nerves more than with that of the muscles themselves. 8d. In a majority of cases of cerebral palsy, the contractility of the paralyzed muscles is less than that of the muscles of the sound side, on account of diminished nutrition. 4th. No diagnostic mark to distinguish cerebral from spinal paralysis can be based on any difference in the irritability of the muscles. 5th. The irritability of paralyzed muscles under the intluence of galvanism is an index to the state of their nerves. This applies equally to static electricity. These are indications to be carefully considered in the use of electricity as a thera- peutic agent. In regard to the efficiency of static electricity, Dr. Golding Bird expresses his favorable opinion of its use in the treatment of nervous diseases, of which I will give a synopsis. His mode of applying electricity is by insulating the patient. In regard to the drawing off of electricity, silently in connection with the earth, he remarks: “During the discharge, heat is 12 evolved, the circulation becomes quickened, the secretions generally become more active, and perspiration breaks out. A person thus situated is said to be in an electrical bath-, and it is by no means improbable that this might be frequently employed with advantage in certain affections in which the functions of the skin and nervous membranes are deficient.” Dr. Bird presents a common mode of applying the static electricity by insulating the patient and drawing off sparks, which method is subject to much modification by drawing heavy or light sparks, and from various parts of the body and limbs, but more especially from the spinal column. Paralysis of the extensors of the hands from lead poison, known as dropped hands, are mentioned by Dr. Bird in his reports, in which he refers to eleven of these cases treated by static electricity. Five, he says, were cured, three relieved, and one improved; two received no benefit whatever. Sparks were generally drawn in these cases from the upper part of the spine while the patient was seated on the insulating stool, in order to influence the axillary plexus. Four of these cases are most worthy of note: 1st. A compositor, aged nineteen. Paralysis of the extensors of both hands, with amaurosis, preceded by an attack of lead colic. After four months of interrupted treatment the paralysis was cured, but the amaurosis remained, though the pupils, previously nearly insensible, contracted and dilated readily. I have treated many cases of these ailments, arising from lead poisoning, successfully, with static electricity alone. In obstinate cases I have given the patients, in divided doses, twenty grains daily of antim. sulph. aur., or the hydro-sulpliuret of antimony, which we believe, from the relief afforded patients thus affected, to be of great benefit. In fact, patients were perfectly cured by this medicine, and without the assistance of electricity, but not in so brief a period as when electricity was made a part of the treatment. As we have before stated, dropped hands are often the result of long continued position of the hands in a state of tension, as occurs in some occupations when closely applied to labor; shoemakers, clerks, and persons engaged on fine needle-work, or any similar employment requiring the fingers to be fixed and long retained in a state of tension. Of this class of patients, nearly every one is perfectly curable with static electricity, and often after dynamic electricity has failed. 13 In the treatment of this variety of partial paralysis of the fore-arm and hand, we but seldom insulate the patient, and simply pass light shocks from the elbow to the extremities of the fingers, having an elastic spring support applied, to keep the hand extended by such support. From this treatment of patients under fifty years of age laboring under this ailment, we know of no failures to improve the condition of the arm and hand, although a great number present for treatment, every year, at the Hospital for the Relief of the Ruptured and Crippled. Ordinary splints to keep the hand extended serve a tolerable purpose, and should be made available where elastic support cannot be obtained. Dr. Bird speaks of the most remarkable influence from static electricity in rheumatic paralysis before the wasting of the muscles. Out of ten of these cases, only two failed to be relieved and cured. This, by far, exceeds any other treatment in its curative tendency. Twelve cases of paralysis from various causes treated by Dr. Bird in Guy’s Hospital resulted as follows : 1st. A man, aged thirty, with hemiplegia of right side, of nine months’ standing, induced by a fall in which he struck his head ; cured in four months. 2d. A woman, aged fifty-two, with partial paralysis of motion and of feeling of right arm ; cured in five months. ltd. A waiter, aged forty-six, with paralysis of motion of right half of the body, with some loss of sensation, of three months’ standing ; cured in three months. 4th. A smith, aged twenty-two, with recent complete paralysis of motion of right arm ; cured in one month. 5th. A boy, eleven years old, with complete paralysis of motion on the right side, of seven weeks’ standing. Sparks were drawn from spine and limbs. After first apjfiication, walked back into the ward with the aid of a stick. In a few days completely cured. 6th. A coal porter, with paralysis of right arm and face. No- vember 29th : sparks from spine, face and arm. Cured in one month. These cases, with others, are more fully stated in my book on orthopiodia, p. 131. We have treated many similar cases with static electricity, dif- fering somewhat in the application, but with quite equal success. Dr. Bird’s experience fully confirms my own, which is of many 14 years’ practice in the use of electricity in its various modifica- tions ; and we have been most favorably impressed with static electricity as a curative means, though requiring great care in its application We have seen patients irrecoverably injured by injudicious treatment with both static and dynamic electricity. Matteucci has pointed out the entire exhaustion of nervous power, similar to paralysis, resulting from an excessive use of electricity. If the improvement ceases under the use of elec- tricity, I would recommend the discontinuance of the agent for a week or two. The progress in treatment by electricity is by this interim of rest rendered again susceptible to improvement, and more especially after a strengthening regimen, with tonics and friction, carefully guarding the patient from exposure to cold. M. Bermond, of Bordeaux, relates a case of hemiplegia, fol- lowing apoplexy, in a lady, aged twenty-six, in which the Leyden jar was successfully employed. After three months’ medical treatment the hemiplegia remained nearly complete. The mem- ory was slightly impaired, and there was unusual nervous irrita- bility. At the first sitting, shocks from the jar were passed from the hand to the foot of the affected side. After fifty more mod- erate shocks considerable improvement manifested itself. After the fourth sitting, four days later, the patient took some steps. At the tenth sitting, seven weeks from the commencement, the patient walked to the office of Mr. Bermond. After the eleventh application, a week later, the cure might be considered as almost complete. The shocks were increased in number toward the close, and directed, at times, to a single limb, or to the tongue. This was a case of unusual discouragement. This gentleman relates another case, even more discouraging as to affording relief to a lady, aged fifty-six, who, when in full health, was attacked with apoplexy, resulting in hemiplegia, and which remained after relief from the apoplectic seizure. Speech was difficult, the saliva constantly flowing from the corners of the mouth. Taste and hearing were both affected, deglutition diffi- cult, the bladder distended constipation at first obstinate, and cramps in the paralyzed limbs frequent for the first fifteen days. (Edema at length appeared throughout the left side. After a month a slight improvement had taken place in other respects, when electricity was applied. After the first application the patient was able to stand, and even to stoop slightly and recover the erect position. On the following day, the features had be- 15 come more regular, the hearing improved, the oedema dimin- ished, and an abundant perspiration had ensued upon the limbs of the left side. The application was then repeated. The circu- lation increased in force, and on the third application, which took place two (lavs later, the pulse was greatly increased and plethoric symptoms induced, which yielded readily to treatment. After twenty applications, the patient had essentially recovered.* I have related this case as a representative condition of a number of cases that we have treated, where the patients were of full habit and laboring under paralytic seizures. The electric treatment invariably increased the circulation of the blood to a plethoric condition, that in many instances hydragogue cathartics afforded no relief, but required for their relief venesection. This plethoric disposition is a most favorable indication of recovery, indicative of an obscure internal congestion relieved by the dif- fusive effect of electricity and developed in the superficial circu- lation. Such cases advance to recovery upon the reduction of their plethoric condition. In a majority of these cases, hydra- gogue cathartics are all-sufficient as derivatives that afford relief. Our treatment is the application of light shocks passed from the upper cervical vertebrae to the extremities of the limbs—the patient being insulated—and at the same time drawing off the electricity from the extremities with metallic points, carefully observing the influence upon the patient, as we have observed in some patients a decided indication of prostration whilst under the direct influence of the electricity. The veins become greatly dilated in the feet and hands, apparently lessening the circulation about the vital organs—an effect not producible by dynamic electricity, to the same extent. This equalization of the vascular circulation by diversion from congested tissues in delicate, patients supersedes depletion, and thus avoids an expenditure of vital force, such as made in blood-letting, evacuants, and starving the patient. * Bui. Med. de Bordeaux.