MODE OF ADMINISTRATION.

I shall describe under this head the modus operandi of administering a routine galvanic or faradic bath. As it will become necessary to describe special modes of administration when speaking of the electro-balneological treatment of special diseases, the describing them now would only lead to tautologies that I am desirous of avoiding.

Taking our cue from the indications to be met in each case, it becomes necessary, according to circumstances, to use either the galvanic current, the faradic, or both successively. As modifications of the application of the currents we have to consider 1) their intensity; 2) their direction, and 3) the duration of the application.

The intensity of the galvanic current corresponds directly to the number of cells from which it is derived. It were vain however to attempt to express this in figures, because the electro-motive force of different batteries varies to so great an extent, that a number of cells of some batteries of low intensity yield a current so feeble as to be barely appreciable in the bath, while the same number of cells of a battery of high intensity, furnish a current that few persons can bear without pain. In thus comparing the Hill cell with the StÖhrer cell, I have found the ratio to be about as 1 to 2½, i.e., as intense a current can be derived from twenty-four StÖhrer as from sixty Hill cells—and this is rather below than above the mark. Were all batteries alike in this respect, however, still no particular number of cells could be given as furnishing a current of suitable average intensity for the galvanic bath, because of the excessively great variations in the degree of electro-sensibility of different persons. This is so marked that I have seen persons in the bath tub who could bear no more than six Hill cells, diffused as was the current from these through the water and over the entire body; while on the other hand I have met with male patients on whom a current from thirty-two StÖhrer cells made not the slightest impression, and where I was compelled to supplement the current by that from a ten-cell quantity battery (zinc carbon elements 6 in. long by 4½ wide) in order to make them realize the presence of a current. These gentlemen had no cutaneous anÆsthesia.In view of the facts just stated, I have found it impracticable, when giving directions for the administration of a galvanic bath, to indicate any certain number of cells to be used. I am in the habit of ordering the administration of a “mild,” a “medium” or a “strong” current, as may be required in the respective cases; and in every instance it is the electro-sensibility of the patient that determines the number of cells requisite to obtain the desired result as represented by one of these terms. The same applies also to the faradic current.

To determine the direction of the current is sufficiently simple. Where a descending current is desired, the binding post which represents the electrode at the head of the tub must be connected to the positive pole of the battery, the other binding post to the negative pole; where an ascending current is desired, the reverse of this is done.

The duration of the bath varies with different cases. The average is about twenty minutes, though the time may range from ten minutes to an hour and a half.

Where it is desired to give the patient a galvanic shock, it is only necessary rapidly to reverse the current by means of the commutator. The simultaneous contraction of almost the ENTIRE muscular system that accompanies the reversal of a current of sufficient intensity in the bath, affords a striking illustration of the general effects of the galvanic bath. In cases where paralyzed muscles have lost their faradic irritability, galvanic interruptions are almost indispensable to successful treatment.

I have before (page14) described a “surface board,” which I have devised for the purpose of localizing the current from one of the poles in any portion of the body where required. This proceeding should by no means be looked upon as a “local” method of electrization; on the contrary, it is just as much “general” as the ordinary electric bath. Whereas in local applications the current runs from one point of the body to another, in this case, supposing the spot where the surface board is applied to be the centre, and the rest of the body the periphery, a current runs between every point of the periphery and the centre, its direction being centripetal when the surface board communicates with the negative, centrifugal when with the positive pole of the battery.

The current is felt more or less intensely in proportion to the proximity to the body of the surface board. With the galvanic this is less noticeable than with the faradic current. When, for example, a faradic current of medium strength being employed, the surface board is held about six inches from the abdominal surface, little or no current is felt. Let the surface board be now gradually approximated to the abdomen, and the current will be felt more and more sensibly, until, when about an inch away from the skin, or touching this, its influence becomes so strong as to cause more or less energetic contractions of the abdominal muscles. Where the galvanic current is employed, the skin beneath the surface board will be found more or less reddened after a few minutes’ application; the burning sensation ordinarily accompanying galvanic applications will also be experienced more or less intensely, in proportion to the strength of the current employed.

Where the current is to be concentrated in a manner still more energetic than that described, this can be effected by raising the objective part above the surface of the water, and then applying the surface board. In this way the entire strength of the current is concentrated in one spot, whereas, when the surface board is applied under water, a large portion of current is absorbed by this.

This appears to me the fittest place to say a few words in regard to the relative conductivity of the human body and water—the latter at the temperature ordinarily employed in baths, say from 90° to 95° Fahrenheit. Beard and Rockwell, in their work on Medical and Surgical Electricity,[2] state that “the human body is a better conductor of electricity than water at the same temperature.” Certain phenomena connected with the administration of electric baths having forced upon me some doubts in this respect, I made very careful experiments, both with and without the aid of the galvanometer (Bradley’s Tangent), to satisfy these. Without wearying the reader with details, I will state that the result of my experiments leaves no room for doubt that water at the temperatures stated—and still more so at 98½°—is superior to the human body as a conductor of electricity. I do not mean to be understood that water is a better conductor than every constituent of the human body; blood, for example, is a better conductor. But when I speak of the body in this connection, I take it as we find it practically, i.e., with the resistance of the skin, and especially the epidermis, superadded to internal resistances. I have no doubt that with a flayed individual it would be otherwise. I will add, that it will give me great pleasure to repeat these experiments, which are sufficiently simple, in the presence of any of my confreres who feel an interest in the subject.

Having thus cursorily considered the manner of using the electric current in the administration of a “routine” bath, and there being no remarks required concerning the water employed, in addition to what has been said in the previous chapter, a few words are in place on the subject of chemicals. As has been previously stated (page13) these are added: a) to be absorbed, and thus act medicinally on the patient; b) to act on the skin; c) through chemical affinity to facilitate the elimination from the body of certain metallic substances, and d) to further the absorption of morbid deposits. Of the many drugs and medicines that no doubt may be made to answer these various purposes, I have had personal experience with but few, and of these I will mention the leading ones only. A requisite of all chemicals to be employed is their ready solubility in water. Of substances intended for absorption[3] I have used but three, viz: iron, iodine, and extract of malt. The first of these I have employed in anÆmic and enfeebled conditions generally, but especially in chlorosis and chlorotic hysteria, with marked success. It has the advantage, when administered in this manner, not only of sparing the alimentary canal the frequently injurious task of becoming the medium of its assimilation, but, in addition to this, I believe that it can in this way be introduced into the blood much more rapidly and in larger quantities than when given by the mouth. The preparation which I have found, all things considered, the most eligible for this purpose, is the “tartrate of iron and ammonia.” This is very readily soluble, leaving no deposit, is assimilable, and not too expensive for the purpose. As, in my experience at least, it leaves nothing to wish for, I would consider it superfluous to discuss in this connection any of the other ferruginous preparations.

Iodine I have employed with a view to its absorption in rheumatism and gout. I cannot speak favorably of it in this connection. I have not in a single instance found a bath charged with iodine, either in the form of the tincture or of iodide of potassium, followed by results in any way differing from those of the simple galvanic bath employed in the same cases.

Extract of malt I have employed as a roborant, either alone or in conjunction with iron, in cases of debility and malnutrition, and found it of service.

Where the absorption of substances is aimed at, the galvanic current must be employed.

Where we add substances to an electric bath with a view of producing some special action on the skin, we may be guided by the same principles that govern ordinary balneology. Thus to obtain counter-irritant effects, we may add mustard or common salt; to render the bath alkaline, bicarbonate of potassa or soda, etc., etc.

An important object to be furthered by the addition to the galvanic bath of chemicals, is the elimination from the system of certain metallic substances. It will be found here that in practice we have to deal chiefly with two substances, viz: mercury and lead. That the elimination of these bodies by means of the galvanic bath is feasible, I shall endeavor to demonstrate further on. At present I have simply to consider the chemicals adapted for the purpose, and the manner of using them.

To facilitate the extraction from the system of mercury, nitric-acid has been recommended by those who have heretofore instituted this treatment. While I cannot positively deny that this substance may aid in the elimination of the metal, I am compelled to state, after its trial in several cases, that I have obtained equally good results from the simple galvanic bath. In the light of my own limited experience, therefore, I cannot insist on the necessity of adding any chemical to a galvanic bath which is administered for the purpose of extracting mercury from the body.

Where the elimination of lead is the object aimed at, I am, on the other hand, satisfied of the utility of adding certain chemicals to the water of the bath. Sulphuric acid has been suggested and used for this purpose. I can say nothing respecting its usefulness, as I have never tried it. Indeed, the results with iodide of potassium added to the bath have been so satisfactory, that I have had no occasion to try any other chemical, although almost any other of the preparations of iodine would probably answer equally well. The chemical affinity of iodine for lead affords a ready explanation of its usefulness in this respect. One ounce of iodide of potassium to each bath appears to me a suitable quantity.

I have had no personal experience with any other cases of chronic metallic intoxication than those with lead and mercury.

The absorption of morbid deposits (plastic exudations, etc.) can be materially furthered by adding to a galvanic bath some resolvent—above all, iodine.

I have said above (page26) that I had found no perceptible benefit from the addition of this substance to the galvanic bath in cases of rheumatism or gout. The contrary holds good however with respect to the frequent sequence of these diseases—articular deposits. When the acute, and to a great extent the subacute symptoms have subsided—and in chronic cases especially, and the disease has left effusions in various joints, iodine, which when employed in this manner, appears to have little or no influence on the pain accompanying these complaints, is a powerful adjuvant in promoting the absorption of the deposits. In chronic synovitis and all other articular affections accompanied by exudation, the same holds good.

I have no doubt that future advances in this branch of science will develop the utility of numerous other drugs and chemicals as additions to the galvanic bath.—Before leaving this subject I must call attention to the influence which the addition to the bath of certain substances has on the conductivity of the water, resp. thus: the action of the current on the patient. I have found that when I caused salt or bicarbonate of soda to be added to the bath, the conductivity of the water became so much increased, so disproportionately greater than that of the body, as to render necessary the employment of very powerful currents in order to cause the patient to feel them.