NEURASTHENIA.
(Nervous Exhaustion.)

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

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

AGRYPNIA.
(INSOMNIA; SLEEPLESSNESS).

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

ANÆMIA.

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

PARALYSES AND PARESES.

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

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

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.

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.

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 spermatorrhoea, 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.

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.

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.