jOo >JL^ ^ ELECTRICITY. ELECTEICITY MEDICINE AND SURGERY GEO. C. PITZER, M. D., • PROFESSOR OF THE THEORY AND PRACTICE OF MEDICINE IN THE ABIERICAN MEDICAL COLLEGE, ST. LOUIS; CLINICAL LECTURER AT THE CITY HOS- PITAL, ST. LOUIS ; EDITOR OF THE AMERICAN MEDICAL JOURNAL; AUTHOR OF "DIRECT medication;" AND "ALCOHOL ASA FOOD, A MEDICINE, A POISON AND AS A LUXURY." THIED EDITI0:N". ST. LOUIS, MO. 1884. COPYKIGIIT EMS Ub. PREFACE. The object of this work is to furnish the medical student with a book containing tlie principal practical facts embraced by the subject of electricity and electro-therapeutics. We have aimed to make everything as plain and simple as pos- sible, so that a mere novice may, with the aid of this book, commence the use of electricity in the treatment of disease. We hope it may supply a want expressed by country prac- titioners generally. GEO. C. PITZER. St. Louis, January, 1SS3. PREFACE TO SECOND EDITION. Although upon the market but a few weeks, the first edition of this work is ah-eady exhausted. This unexpected demand, together with the hearty appreciation and warm approval of this little book, as manifested and expressed by leading members of all branches of the medical profession, has encouraged us to immediately get out this second edition. It will be observed that the work has been thoroughly revised, and considerably enlarged, by the addition of several new chap- ters, embracing some of the most interesting subjects connected with electrical therapeutics. Of these we mention electro-diag- nosis ; how to detect feigned sickness or malingering; how to make tests for life or death in doubtful cases ; how to revive peo- ple suffering from asphyxia, or- from overdoses of chloroform taken by inhalation ; how to restore those who are suffernig from opium or morphia poison, and how to cauterize with elec- tricity. And static or Franklinic electricity is treated in detail, the best machines for its use fully explained and clearly illus- trated. Our own experience is given in all cases where we have actual knowledge of facts ; and the experience of other reliable men, such as Morton, Bartholow, Curtiss, Rockwell, etc., is added or appended in many instances, due credit being attached where it belongs. Speculative theories and reckless reports from doubt- ful sources are strenuously avoided. We have endeavored to furnish our readers with an honest, clear and comprehensive exposition of electro-therapeutics, that may enable them to apply this measure in practice in all cases where it may be avail- able. Hoping our efforts may prove satisfactory, and that the work may be studied with care and profit, and thanking our many readers and reviewers for their unsolicited expressions of praise in the favorable mention of our first effort, we now place before the profession this second edition. GEO. C. PITZER. St. Louis, May ist, 18S3. PREFACE TO THIRD EDITION. Within one year two editions of this work have been sold, and with the beginning of 18S4 another thousand is called for. We have carefully revised the work, and made such additions as have seemed most essential. New chapters on static elec- tricity, impotency, electrolysis in urethral stricture, and special instructions in the treatment of chorea, are added, with illus- trations of some valuable electrical machines and batteries. The work speaks for itself, and we hope it may give even better satisfaction than ever before. GEO. C. PITZER. St. Louis, IMarch, 1S84. Electricity in Medicine and Surgery. Electricity and Electrical Apparatus. Electricity is a force or mode of motion, which may be gener- ated by friction or by chemical action. No chemical change can take place without the evolution of more or less electricity. The application of this agent, in some form, to the relief and cure of disease dates back many years. At one time frictional or Franklinic electricity was very popular, a number of accidental cures resulting from its use. We say accidental cures because they resulted from the empirical use of electricity, no regard being paid to any law upon which the cures were wrought. An interesting treatise on Franklinic electricity, written by Rev. John Wesley in 1759, gives the reader a very good understanding of the position of electro-therapeutics more than a hundred years ago. Medical men at that time seemed to be inclined to turn away from this new agent ; this placed it in the hands of the laity, where it was resorted to for all kinds of ailments. This indiscrim- inate use of a potent agent, chiefly by men and women who knew but little about it, could but result in failure. Because electricity did not, in the hands of quacks, cure everything, it was denounced entirely by many, and rapidly fell into disrepute ; and to this day, while it has many able advocates, in and out of the profession, there are not a few who entertain strong prejudices against it. It is a fact that electricity will not cure everything, no matter in what form, how used, or by whom it is applied. While it is indicated in some form in a wide range of disorders, and while many distressing ail- ments are speedily relieved and others rapidly and radically cured, it fails in many instances. But where we have cases to which this agent is adapted and we rightly apply it, nothing equals it. Like everything else, electricity has its place and its power, and 4 Electricity and Electrical Apparatus. in its place it is prompt and positive in its effects. It is scarcely worth while to say that the principal reason of many failures in the use of electricity is to be found in tlie fact that many who try to use this agent do not understand the instruments they undertake to operate. They know but little about the principles of their workings, and they too frequently know even less about anatomy, physiology and pathology. It is folly to hope for good results from any ther- apeutic agent in the hands of an ignoramus, unless it be by acci- dent. A successful electrician must be an educated physician. He must understand physiology and pathology, then he may commence the study of electro-therapeutics and the use of electrical instru- ments. Taking it for granted, then, that our readers are all phy- sicians, we hope to make our lessons interesting, instructive and practical. Electricity, in the abstract, is always the same, no matter wh^e or how generated ; but its effects upon the human system are greatly varied, and wonderfully modified by the different modes of applica- tion and through the instruments used in generating and conduct- ing it to and into the body. For example: By the judicious use of Franklinic electricity a stimulating and tonic influence is imparted, the nutrition of the part is improved and the nervous system is in- vigorated. By the application of the Faradic, or induced current, we stimulate or excite with the negative pole, and soothe or relieve excitement and pain with the positive pole. With the simple gal- vanic current we excite or soothe, as in the case of the Faradic cur- rent; but we may do even more than this. We can, by using this, current properly, actually separate the constituents of the tissues, the acids and oxygen of the part going to the positive pole, while the alkalies and hydrogen go to the negative pole. This is called electrolysis, and in this way enlarged glands, indurated tumors and soft tumors are frequently dissolved and rapidly carried away. Again, if we close a galvanic current with a platinum wire, and apply the wire to a part, we may speedily burn it to a crisp. Or, by surrounding a part by this wire, we may remove it entire. This is called the galvanic cautery, by which we frequently remove tumors. The operation is bloodless, and the healing process rapid. But these are mere hints illustrating the different results of electricity, as applied in different forms and through different means. Electricity and Electrical Apparatus. 5 Before going further, we can best serve our purpose and that ot the reader by presenting a short description of the different forms of electricity and a few brief illustrations of some of the most practical batteries and instruments used in electro-therapeutics. As we be- come familiar with the different forms, and the instruments used in generating and conducting electricity, we are better qualified to un- derstand its therapeutic application. Electricity is manifested in three general forms : Magnetism, Franklinic electricity and Galvanism. Magnetism is that form of electricity found in loadstone. Load- stone is an iron ore, which, as above intimated, is permanently charged with electricity, and is called a natural magnet. Ordinary steel bars may be charged with electricity, when they become arti- ficial magnets. They may be charged or magnetized, as it is called, by bringing them in contact with a natural magnet, or they may be magnetized by the galvanic current, to be hereafter described. In either case these steel bars are only artificial magnets, and in time lose more or less of their electricity, or magnetic influence. But good, hard steel will retain its magnetic power for a long time. If pure soft iron bars are magnetized by a natural magnet, or by the galvanic current, while they remain in contact with the natural magnet or with the galvanic current, they are magnets themselves ; but when these bars thus made magnetic are removed from the natural magnet or the galvanic current, they at once lose their magnetic power. There is a property belonging to magnets called polarity. The ends of a magnetic rod of steel attract iron and iron filings, as il- lustrated by Fig. I. But this same iron, or iron filings, i)laced up- on the center of this magnet, immediately fall off, as above illustrat- ed. It is evident that two opposite kinds of magnetism are mani- fested in this rod ; one kind at the ends of the magnet and another Electricity and Electrical Apparatus. at its center. These points, manifesting opposite kinds of magnet- ism, are called poles. This property, polarity, belongs to other forms of electricity, and is a peculiarity of this 7node of ?noiion. More might be said here about magnetism, but this is quite enough to serve our purpose for the present. When we come to describe the Faradic current, this form of electricity will be referred to again. Franklinic or static electricity is obtained by friction, cleav- age and pressure. Quite a number of machines arc in use for the generation of this kind of electricity, and there are numerous cases in therapeutics where this form of this force is equal to others, even much better; then there are many cases where other forms are far superior. For good reasons Franklinic elec- tricity is being extensively used in therapeutics at the present day. Fig. 2. Galvanism, or electricity generated by chemical action, is the form in which this great force can be best utilized in therapeutics, and to this form does electricity owe its great popularity. For the evolution of electricity by chemical action, a galvanic battery is required, and we can make this part of our subject more intelli- gible by taking a battery in common use for illustration. Stohrer's famous galvanic battery, as made by the Galvano-Faradic Manufac- turing Company, of New York, will answer a fine purpose. Electricity and Electrical Apparatus. Fig. 2 represents Stohrer's galvanic battery. It consists, alto- gether, as we see it, of a number of elements and battery cells, as they are called, i6 or 32, as the maker may decide. A galvanic cuiTent may be produced with a single cell, but for therapeutic or surgical purposes, a number of cells are required. But for illus* tration of this, as well as other batteries to be described, we take it for granted that one cell only is used. Fig. 3 represents this single cell, made of glass or hard rubber, as may be desired, with a capacity suffi- cient to hold about two fluid ounces. For further illustration we now fill this cell about two-thirds full of a battery fluid, made as follows : To five pints of cold water add eight fluid ounces of commer- cial sulphuric acid, and, when perfectly cool, add thereto eight ounces of finely pulverized bi-chromate of potash. Wtien ^rr this is well dissolved, and before using, add one ounce of bi-sulphate of mercury, the required amount of this fluid in the cell. In this cell we also suspend one zinc and one carbon plate, as seen in illustration, Fig. 3. The zinc and carbon are called the elements of the battery; the solution, the battery or exciting fluid; and the container, the cell. The zinc is called the generating element ; the carbon, the conductor. Right here allow us to remark that electricity, when generated, may be transmitted by conduction or operate through induction. Conduction is the transmission through intervening metals, called conductors. Some metals are good conductors — copper is good ; platinum, poor. By induction we mean the operation of electricity through the inter- vening molecules of air. This principle will be fully explained when we reach the Faradic current. In the galvanic battery the electricity is transmitted through con- ductors, and, as above stated, the carbon in the battery cell is the conducting element, and to complete the circuit we connect the zinc and carbon, outside of the fluid, by intervening wires, as seen in Fig. 3. Now, here is represented, in this single cell, the principle and construction of a galvanic battery. When the electrically op- Fig. 3. Now, we put 8 Electricity and Electrical Apparatus. posed metals, zinc and carbon, are immersed in the battery fluid and united at their ends, either directly or by wires, chemical action immediately begins, and in proportion to the amount of zinc surface exposed to the exciting fluid will be the quantity of electricity gen- erated. The zinc attracts the oxygen of the fluid, is rapidly oxy- dized, and gradually destroyed. The hydrogen of the fluid is ap- propriated in another direction. The result of this chemical action \=, z. mode of motion, called a current of electricity. This current passes from the zinc or generating plate to the carbon or conduct- ing plate in the fluid, and outside of the fluid from the carbon, through the intervening wires, to the zinc. Now, let us, while this current is running, separate the ends of the wires connecting the zinc and carbon. Let us hold the two separated ends of the wires, one in each hand, and this same mode of motion, or current of elec- tricity, is passing through the body, from one hand to the other, entering at the hand holding the wire attached to the carbon, which, outside the fluid, is called \\\t positive pok. The current leaves the body at the hand holding the wire attached to the zinc plate, which, outside the fluid is called the negative pole. This illustrates the working of a single cell galvanic battery. But we frequently want more quantity of electricity than we can get from one cell of this size, and we more frequently require a more forcible current — a current of greater tension — than we can get from a single cell like this. Where the quantity of electricity is small, but more especially where the tension is low, the current passing slowly, but little change takes place in the tissues to which the electricity is applied, and the current is not felt or appreciated in any way. Where the tension is high^ the current strong and run- ning rapidly, then we observe redness of the skin, twitching of the muscles, and the patient complains of disagreeable sensations. In such a case the fluids of the tissues are rapidly separated, the acids and oxygen rushing to the positive pole of the battery, while the hydrogen and alkalies are attracted to the negative pole. A very small quantity of electricity may accomplish a great deal if the tension is high ; but for the purposes of galvano-cauteries, quantity is positively required. How are we to increase tension, and how arc we to get more quantity ? As already stated, the quantity of electricity generated in a galvanic cell is dependent upon the amount of sur- Electricity and Electrical Apparatus. face exposed to the exciting fluid by the generating plate; and when it is required to increase the quantity, the elements must be enlarged, or the generating plates of several cells must be connected directly, and the carbons must also be directly connected. Where we want an increase of force, or desire to increase the rapidity of the cur- rent — in other words, when we want more tension — we connect alter- nately the generating and conducting elements, the zincs and the carbons, of two or more cells, as illustrated by Fig. 4, where the Fig. 4. zincs and carbons are connected alternately, and the direction of the current plainly shown. Increasing the size of the elements always gives a proportionate increase of quantity, but it does not increase the tension or rapidity of the current. On the other hand, while a combination of two or more cells, as above described, the elements connected alternately, increases the tension in proportion to the number of cells thus connected, the quantity of electricity passing any one point at the same time is no more than when one cell is used. Enlarging the elements or directly connecting several gen- erating plates, and in like manner as many conducting plates, in- creases quantity. In the galvanic battery of Stohrer, used in this illustration, the combination of cellc; is for the purpose of increasing the tension, a property of the current particularly required in electrolysis. The instrument shown in the illustration has sixteen cells. Assuming Electricity and Electrical Apparatus. that they are all properly filled with fluid, and the elements sus- pended in them and alternately connected, as illustrated by Fig. 4, we may undertake to operate the battery. For the purpose of con- venience in conducting the electricity from the battery to and through the body, we use cords, called conductors, constructed of copper wire and covered with silk. The covering is called the in- sulator, because it is a non-conductor. The ends of the cords have exposed metallic tips, for the purpose of connecting them at one end with the commutator of the instrument, and to the handles of the electrodes at the other ends. Remember, the commutator is that part of this instrument which we slide along the beam of wood at the top of the apparatus. This commutator is so arranged as to connect with a zinc on one side and a carbon on the other, and a complete circuit is made through one cell by placing it at the right. To take in more cells, we simply move the commutator to the left till any desired number of cells are taken into the circuit. The electrodes are the parts of the instrument attached to the distal ends of the conducting cords, and are directly applied to the part of the body desired to be brought under the influence of electricity. These electrodes are metallic, and may be covered with chamois or sponge. More will be said about electrodes as we approach therapeutics. Other particulars, as well as the advantages of this particular battery, are given in detail in the illustrated circulars sent with the instrument. Another form of Stohrer's galvanic battery is represented below by Fig. 5. This is a very practical instrument, easy to operate and readily cleaned or repaired when necessary. Its arrangement is so simple that a mere novice may soon understand it, and any wrong in its workings can be detect- ed at once. It is manufactured by Aloe &: Hernstein, of St, Louis. It is a sixteen-cell battery, with large elements, zinc and Fig. 5. Electricity and Electrical Apparatus ii carbon, the same as those made by the Galvano-Faradic Manufac- turing Company. Aloe & Hernstein are making fourteen-cell batteries similar to this, with still larger elements, giving more quan- tity and, they claim, more power. The bottom of the box in these batteries is a movable tray in which the glass or hard rubber cells are placed. This movable tray is controlled by two hinged rods which are fastened to it, and these by two screw lifting rings. These rings, being screwed tightly down, hold the cells firmly against the cush- ioned board, which is pushed through a slot in the front of the Fig. 6. box, and covers the cells. This cushioned board is called the hydrostat, because it securely closes the cells and prevents spilling of the fluid in moving the battery from place to place. The rings referred to also serve as handles for lifting the tray of cells to which they are attached, and when raised to the proper place the rods are turned on their hinges and the tray of cells held in place, with the elements in them. When done using the battery, the rods are straightened, the tray of cells lowered, and the hydrostat, which Electricity and Electrical Apparatuo. was removed before lifting the tray of cells, is now replaced, the screw-rings turned a few times, and all is secured. The commutators, conductors, etc., are the same as in the first battery described. For all ordinary purposes, such as central gal- vanism, electroloysis, etc., these batteries are exceedingly well adapted. Fig. 6 represents the Bartlett galvanic battery, manufactured by the Galvano-Faradic Manufacturing Co., of New York. This is a thirty-six-cell battery, the elements zinc and carbon all arranged in very compact and neat style. The tray holding the cells is con- trolled by lifting rods, the same as the Stohrer battery. The com- mutator works with a lever or crank, and from one to thirty-six cells may be brought into the circuit at pleasure. This is a fine appear- ing instrument, and being provided with an automatic rheotome, current reverser, etc., it is a very desirable battery. The following cuts represent the galvanic and galvanic and Fig. 7. Fig. 8. faradic batteries combined, as manufactured by the MTntosh Gal- vanic Belt and Battery Company, of Chicago, 111. These batteries are constructed on an improved plan. The elements are zinc and carbon, and are arranged in couples, and securely clamped to hard rubber plates with thumb-screws. Any of the couples can be re- moved by simply loosening a screw. In this battery the plates are brought very near together, thus preventing the great internal re- sistance unavoidable in many other batteries. The cells are made in sections of six, composed of one solid piece of hard rubber. By Electricity and Electrical Apparatus. 13 this arrangement one section can be handled, emptied, and cleaned as easily and as quickly as one cell. A hard rubber drip-cup is placed by the side of each section of cells to receive the zinc and carbon plates when removed from the cells. Fig. 7 shows the hard rubber plates of a section of elements. Fig. 8 shows a section of six cells made of one piece of hard rubber, and a drip-cup of the same material to receive the zinc and carbon couples when not in use. The hard rubber on which the couples are clamped projects over on one side enough to cover the cells, when the zinc and carbon plates are reversed and placed in the drip-cups. The under side of this projection is covered with soft rubber. When the cells are not in use, this is clamped over them by means of thumb-screws and spring bolts. By this arrangement the cells are made water-tight, and the battery may be carried from place to place without danger of spilling the fluid. Fig. 9 represents a faradic battery of this make, which we will refer to again when we reach the construction and workings of fa- radic machines. In this illustration is shown the famous cable con- ducting cords used in these batteries. They are made with a spiral copper wire, insulated, inside of which is a bundle of small copper wires surrounding a strong cord. The tips are securely fas- 14 Electricity and Electrical Apparatus. tened to the spiral wire, which makes the connection perfect. In using any of the M'Intosh batteries, these cords are attached to the posts on the battery, the distal ends being fastened to the elec- trodes. One of these conducting cords is bifurcated, or forked, either division of which may be attached to the battery. This forked end is for the purpose of preventing a shock while changing to a less or greater number of cells while using the galvanic cur- rent. For example : Suppose you are using six cells. One of the bifurcated ends would be connected with cell No. 6, and the other end hanging loose. If you wish to use, say, twelve cells, you can take up the loose end of the bifurcated cord and connect it with No. 12, and then pull the other end out from No. 6. Thus all Fig. 10. shock is avoided. This arrangement takes the place of the com- mutator which was referred to in the Stohrer and Bartlett batteries. This is a simple arrangement, and could not be more satisfactory in any way. Fig. ID shows a twelve-cell combined galvanic and faradic bat- tery of the M'Intosh make. The case is polished black walnut, 8}4 inches long, 8 inches wide, 7^ inches high, metal work all nickel-plated, lock and handle, sponge electrodes, and cable con- ducting cords, as above described, all put up in the very best of workmanship style. Electricity and Electrical Apparatus. 15 Fig. II represents another form of a twelve-cell combined gal- vanic and faradic battery made by M'Intosh. This is a beautiful battery, too, same size and finish as Fig. 10. These are exceedingly fine instruments for a general practice Thev are safely carried Fig. n. about, and you always have with you a faradic and galvanic bat- tery at the same time. Fig, 12 represents a twenty-four cell combined galvanic and faradic battery of the same manufacture. Size, 15 inches long, 8j4 inches wide, 7 j^ inches high, with lock and handle; weighs less than eighteen pounds. This battery gives a galvanic current of great intensity, sufficient to treat almost any case coming in the range of a physician's practice. And the beauty of this instrument is, we can reverse one section of elements al a time when no more is needed, thus saving the elements of all other sections for future use. But where one section does not give us sufficient intensity, we re- verse another section, lifting it out of the drip-cup and placing it in the battery fluid in the cells. This arrangement is certainly a commendable feature. Special instructions, well illustrated, are sent out with all these instruments, so that a mere novice can operate them without a i6 Electricity and Elfctrical Apparatus. teacher. We have used these galvanic batteries and know them to be what they are represented to be — simple, efficient, and practical in every regard. When we reach therapeutics, these different instru- ments will be referred to again, and careful instructions regarding their use will ])e clearly set forth. Fig. 13 represents the Piffard galvano-cautery, as made by the Galvano-Faradic Manufacturing Company, of New York. For ihe purpose of cauterizing, gal- vanic batteries are constructed with reference to quantity. The elements are zinc and carbon, and the battery fluid the same as in ordinary galvanic batteries described in the first part of this monograph. This battery of the Piffard style is composed of large zinc-carbon elements, which are contained in cells of vulcanite, j,-j„ J.. and can be suspended on a mov- Electricity and Electrical Apparatus. 17 able arm screwed into the box. When lowered into the fluid, the top of the elements, which is made of hard rubber, contains two lat- eral bars supporting them, and which permits of a rocking motion to keep this exciting fluid agitated. This is a very efficient gal- vano-caustic battery, a complete and reliable instrument, powerful, portable, compact, and so free from complications and easy of man- agement that any physician can understand it and operate with it. It is adapted to meet all cases usually treated with this class of in- struments. In its construction each element is utilized to the full- est extent. The parts can be easily replaced, and the surgeon liv- ing at a distance can duplicate them and adjust them without diffi- culty. Size, 9 inches lonf, 6^ inches wide, and 10 inches high. Weight, 15 pounds. Fig. u. These cuts (Fig. 14) represent the instruments used in galvano- caustic operations. Universal handle ; handle for cutting loop when one hand only is at liberty; burners of various shapes. The use and application of this battery will be fully explained and clearly illustrated later in the work. So far as a description of galvanic batteries is concerned, we think we have shown a sufficient variety, and with what may be said about them incidentally in using them upon different patients and in dif- ferent cases, we think the reader should finally have a very good understanding of them. Faradic machines will next engage our attention. iH Electricity and Electrical Apparatus. FARADIC MACHINES. The chief object sought in the construction of faradic machines, is to obtain a current of electricity or mode of motion that will excite nen'ous and muscular functions. The simple galvanic cur- rent excites these functions to a limited degree, but its great merits depend more upon the changes wrought in the structures, fluids and solids of -the parts by the passing galvanic current. The faradic current influences, mainly, the nervous system. The galvanic cuiTent produces a change in al^ the tissues, but its direct influence upon the nen'ous system is comparatively limited ; but, indirectly, wonderful changes in the nen'ous system frequently result from the use of galvanism. All this will engage our atten- tion further on. What we particularly desire to place before the reader now is this : The faradic current or the current coming from electro-magnetic machines, is the great nei-ve stimulant and tonic : under its influence upon the neivous system the processes of waste and repair are increased, nutrition is improved; "the sti'engthened brain sends more nervous force to the stomach, by which the latter is enabled to send better blood to the brain." The galvanic current is a direct and continuous current, as fully described in the foregoing pages. The faradic current is an indirect or Induced current ; and it is an interrupted current. The electricity' producing the faradic cun^ent is the same as that of the galvanic cuiTent, and may come from the same battery, bu^ through intervening machinery the current or mode of motion is greatly modified before it reaches the patient. In the production of a galvanic current we may use a smgle cell, or we may unite the force and influence of many cells, which we find positively necessary in the successful use of galvanism. We may iise two or more cells, with the faradic current, but one cell with the pro- per eleinents and exciting fluid, is generally quite enough for all practical puiposes, and nearly all the faradic machines in the market are conshaicted with one cell. The elements may be zinc and carbon, and the exciting fluid the same as that used in the galvanic batteries heretofore described. Or the elements may 6e zinc and platinum, and the exciting fluid dilute sulphuric acid. Electricity axd Electrical Apparatus. 19 These are called Smee's elements. Or the elements maybe zinc and carbon, and an exciting fluid produced by the use of bi-sul- phate of mercury and water. Gaiffe's celebrated French pocket batteries are of this construction. The following illustrations will ser\-e to give the reader a -sery good idea of the battery cells and elements refen^ed to : Fig. 15. Shows a battery cell where zinc and carbon arc used as elements, and a solution of bichromate of potash, and sul- phuric acid as the exciting fluid. In principle this is the same as the cells of all zinc and carbon galvanic batteries ; the only difference is in the shape of the single cell, which is so con- stnicted as to adapt it to the accompany- ing: machiner\-. Fig. 16. Represents the Smee battery cell the elements being zinc and platinum, and the exciting fluid Fig. 15. sulphuric acid and water — one part acid to ten of water. The physician's improved electro-magnetic machine, manufactured bv Aloe & Hernstein, of St. Louis, is operated by this cell. And I'M- '''• the famous electro-magnetic machines of Kidder are constructed with this cell, onlv the shape of the cell, and management of the elements differ a little. Fig. 17. Shows Smee's elements and cell as manufactured by Kidder. The elements are suspended from rubber stopper in round jar. 3^ inches in diameter. In all these batteries, the zinc-carbon and zinc-platinum, the elements have to be re- moved from the fluid when the instruments are not in use, else the fluid would destroy the zincs. In the zinc-carbon cell the elements are raised by a hinged rod which is turned down when the elements are raised out of the fluiil. In the 20 Electricity and Electrical Apparatus. cell containing Smee's elements, a drip cup is provided, and the elements lifted out of the fluid and placed in the drip cup when the instrument is not in use. Yis. 18 Fig. 17. MiSSSSimMm Fig. 10. Figs. i8 and 19 show Kidder's improvement upon this plan. He has constructed a cell that when turned right end up keeps the elements immersed in the exciting fluid ; when it becomes neces- sary to stop the action of the instrument, a simple tip describing a quarter circle elevates the elements and lowers the fluid so that they are entirely separated. This is a great convenience, and all of Kidder's tip batteries, as he calls them, are furnished with this cell. Zinc and carbon elements with an exciting fluid made of bi- sulphide of mercury and water are used with various pocket elec- tro-magnetic machines in the market, and will be referred to under the description of these instruments. So far as cells, elements and exciting fluids are concerned the above should be quite sufficient, and we now introduce a variety of electro-magnetic machines complete. Fig. 30. Represents a fine instrument of this class, manufac- Electricity and Electrical Apparatus. tured by the Galvano-Faradic Manufacturing- Co., of New York. The elements are zinc and carbon, suspended by hinged rod, as heretofore described. The introchiction of this instrument calls for a descrip- tion of the machin- ery placed in the circuit of the gal- vanic current, which converts it into a faradic current. And now, let us keep in mind that we have before us a single cell, like that in the galvanic battei'ies already described ; that the battery fluid coming in contact with the zinc excites chemical action, Fio'. 20. which results in the (evolution of electricity ; that the carbon in the cell attracts and conducts this electricity out of the fluid as it is generated ; that if a wire is attached to the upper end of the carbon outside of the fluid, and connected with another wire attached to the upper end of the zinc outside of the fluid, we have a simple galvanic cur- rent — a continuous direct current. Now in the construction of a machine to produce a faradic or induced current, instead of attaching a short wire to the carbon, a longer wire is used, ten to twenty feet. This is insulated and wound upon a hollow spool, or bobbin, one round upon another. Then a still longer and smaller wire, perfectly insulated, is loose- ly wound upon this bobbin, and when all wound up we call this the faradic coil, or helix of the machine. The rounds of wire composing this helix or coil are parallel with each other. Now, if the current in the first wii'e is broken, a current is srenerated in 32 ' Electricity and Electrical Apparatus. the second wire by induction, the electricity passing through the intei-\-ening molecules of air. If the current in the first wire is again closed or caused to flow, another current is generated in the second wire, by induction, but in an opposite direction ; hence the current in the second w4re, which is an induced current, is not a continuous current, but a succession of currents, resulting from breaking and opening the main current. And this induced current is a to and fro current. For the purpose of breaking the main current, and producing the induced current, the wire con- ducting the current from the battery cell is so connected with an automatic hammer that the current is rapidly broken and renewed, which results in a rapid succession of to and fro currents in the second wire. The spool upon which the coils of wire are wovuid is hollow, and in this a bundle of soft iron wires, each carefully insulated is placed. The currents flowing through the wires sur- rounding this bundle of iron wires magnetize this bundle, and, while thus magnetized it reacts upon the coil and greatly strength- ens the current in the wire. In this way the faradic coil is greatly dependent upon magnetism for its force. Being wonderfully strengthened by the bundle of wires that become magnetic under the influence of the galvanic current, we say electro-magnetic when speaking of these instruments. From the above it will be seen that the simple galvanic current, in passing through different coils of wire parallel with each other, strengthened by a magnetic core, and rapidly broken, causing to and fro currents, must be greatly modified when it reaches the patient ; and so it is. While the to and fro character of these currents destroys, almost entirely, the electrolic force of the cur- rents, the power of exciting the nervous system and producing muscular contraction is wonderfully increased ; and this is further strengthened by the magnetic influence of the core or bundle of iron wires in the helix. Fig. 21. Represents the Physician's improved electro-mag- netic machine, as manufactured by Aloe & Hernstein, of St. Louis. It has two cells, (acting independent) ; in case one gets broken or exhausted, the other is in reserve ; the two cells can be united when extra power is required, as in case of suspended ajiimation. It has a three section coil, and is therefore well adapted for the Electricity and Electrical Apparatus. 33 medical profession, ns a tension and quantity can be obtained, which are very essential for the electric treatment. When the Fig. 21. pole cords are connected to Post i and 3, and the switch is turned on the No. i Switch Post, a mild current without quantity is ob- tained. By placing- the switch on the next post, (or Xo. 2), the current is stronger and some quantity is obtained. By placing the switch on the next or last post No. 3), a 2Dowerful cuiTcnt which contains quantity and tension combined is perceptible. Remove the switch entirely from all of the posts, place the pole cord which is in No. i into No. 3 post, and you will obtain a strict primary current. This battery is perfect!}' portable, as the elements are removed and placed in separate cups, while the cells wdiich hold the fluid are each closed with a well fitting rubber stopper. Switch 4 is for breaking the current bv removing it from the post on which it rests ; it stops the working of the 24 Electricity and Electrical Apparatus. battery. The helix, or coil, which is one of the main parts that constitute an electric machine, should be well guarded against dampness or impure atmosphere ; we have therefore taken the precaution in this battery (so that nothing of the kind can happen) to place a hard rubber jacket over the helix, which is the best insulator that can be had. Complete with Spoxge Handle Electrodes, Battery Nickel-Plated. Fig. 22. Represents Kidder's No. i. Physician's office elec- tro-medical apparatus, large size having four coils of wire in the the helix, and ten currents. There is some- times a demand for a large range of effect, and to meet this Dr. Kidder has furn- ished a four coil helix, developing ten cuiTents from the different com- binations prodi c- ed by ranging the two posts select- ed for the positive a n d negative. The fouith coil is conditioned t o pi'oduce electric- Fjo-. 22. ity in such a ratio of quantity and intensity, when used in combination with all the other coils as will go beyond the range of the greatest effect on the muscles, and into the range of soothing electricty, and with mild power, it will exercise the function of vision showing glim- ering light, without producing pain. The power of these currents is increased or diminished at pleasure. Full directions for use accompany the instrument. Fig. 23. Represents a four coil apparatus of Kidder's make, and intended for a physician's visiting machine. It produces ten Electricity and Electiiical Apparatus. 25 currents, the same as No. i. It is of compact form, constantly- ready for use many weeks without attention. The coil-box stands upright in one end of the case where it is hinged. By springs under- neath the hinges that fasten the coil-box to the case, the battery is connected to operate the coils w h e n turned Fio-. 23. down to a hori- zontal position, as seen in the figure. If ever desired, the coil- box can be detached and connected with any other battery by the two screw cups on the back part. This machine is about 6 inches long, 3^ wide, and six inches deep, and has a metallic handle on the lid for canying. Fig. 34. Shows Gaiffe's Pocket Electro-Medical Apparatus. This is a fine machine-, and is very popular with all electricians. Fig. 24. This battery is put in motion by putting a half a teaspoonful of bi-sulphate of mercury in each of the carbon vats or trays, and adding a little \vater, then unmersing in the vats the zincs belong- ing to the battery. This battery runs, without being recharged, during a sitting of 36 Electricity and Electrical Apparatus, an hour, or for two sittings of a half hour, and gives three cur- rents. 1st, The extra current. 3d, The inductive current. 3d, A combination of the two, in greater intensity. Though the re- sults of these currents may be the same physiologicall}', yet they present a series of increasing effects which may be varied at ^vill, beginning with a current so mild as scarcely to be perceptible, and being gradually increased to one of great intensity. When the battery is charged with the bi-sulphate of mercury and water, it gives rise to no odor. All its parts are perfectly adjusted, and do not readily get out of order. Extra troughs may be obtained at a small cost, thus enabling the physician to leave one with each patient whom he treats by electricity. This arrangement also diminishes the weight of the apparatus. The whole machine is in form of a case, y^ inches long, 4 inches wide and i^ inches thick, weighing only 24 oimces, including therein the electrodes, etc. , contained in the case. Nothing protrudes from the exterior. It is, in fact, a pocket instrument, combining with compactness and durability all the qualities of superior electro-medical appara- tuses. Fig. 25. Represents Kidder's pocket induction apparatus, which he claims to be superior to anything of the kind. Fig. 25. This apparatus has very expensive coils so as to get the desired ranges in the qualities of currents, in a very small space. It operates by means of a very little bi-sulphate of mercury, gives very strong power, and is very satisfactory in its operation. Two handles and sponge-clasps with conducting cords accompany each apparatus. Fig. 26. Represents Dr. Hathaway' s Electro-Magnetic Chair. Electricity and Electrical Apparatus. 27 The object of this invention is to provide a simple and convenient apparatus for the transmission of electrical currents through all parts of the human body and in different directions. It consists of a chair (or a bed, lounge or water bath may be used) provided with a suitable battery, wires and switches, by means of which currents of electricity may be passed through the body of the patient sitting therein, such currents being under the absolute control of the attendant, who can send them at will, first in one direction, and then in another, as desired. The special application of this powerful remedial agent to any particular portions of the person has, thus far, been at- tended with great inconven- ience. So far as known to me, it has never been done without the removal of the patient's clothing, and the passing of the current by means of a sponge or like substance over the sur- face of the body. In using this apparatus, it is Fig. 2G. only necessary that the hands and feet should be bared. The patient sits comfortably in a chair, and when the switches are yjlaced in a proper position, the current is made to enter the right foot, pass up the right leg, cross through the pelvis into the left leg, and down out of the body by the left foot. If now the switches be changed, the posi- tive current enters the left foot, makes the circuit, and goes out of the right. In this way I am enabled to pass the electricity through the pelvic portions of the body, which heretofore it has been almost impossible to reach. In a similar manner, the proper connections being made, the currents will enter the body by either hand, pass up the arm, cross the thorax to the other arm, and leave by the opposite hand. The switches may also be placed so that the electricity will enter both hands, pass through the entire system, and out by both feet. 28 Electricity and Electrical Apparatus. The management of this apparatus is easily learned, and as the changes are made at intervals of five minutes, one attendant can, without difficulty, attend to four chairs at the same time. I know this to be a convenient invention for the administration of this powerful therapeutic agent without giving the patient any trouble whatever. When in Chicago, at the National Conven- tion, I took the pains to call at Dr. Hathaway's office, and ex- amine this Chair, as he had it in operation. I wanted one immediately, for it is so convenient. Many people are benefited by electricity, but the use of it, as ordinarily applied, requires so much time and care that the busy practitioner can hardly afford to appropriate it. But this invention does away with the ob- jections. It is easily managed, pleasant to the patient, and in many cases where electro-magnetism is required, it is the thing. I am greatly pleased with it, and will freely give any information I can in regard to it ; or I will take pleasure in showing the chair to anybody who may take the trouble to call at my office where it may be seen in operation. Of course we do not pretend that everything in the way of faradization can be done through this chair, for we sometimes desire to localize the faradic current, and where this is the case we resort to a Sponge electrode. But in the scores of cases of nervous exhaustion that come to us, where general faradization is the thereapeutic agent, then this chair is a real luxury. I would not be without it and engage to treat diseases of the nervous system. Having described and illustrated a variety of galvanic batteries and faradic machines, we now present some important attach- ments used in connection with galvanic batteries for special and important purposes. Galvaitometers^ or Galvanoscopcs. — These are instruments used for ascertaining the presence and direction of a current, and for measuring the strength of the same. They are con- structed on this principle: A magnet is freely hung so as to be deflected by the passage of a current through a coil of msulated wire. Electricity and Electrical Apparatus. 39 Fig. 27 is an illustration of a very fine galvanoscope. It may- be readily attached to any battery ; and if a cuiTent is running, the needle will be deflected in the direction of the current. If the needle turns to the left, we know the negative pole is on that side ; if to the right, then we know the negative pole is to the risrht. Fig. 27. The number of degrees of deflection shown by the needle indi- cates the strength of the current. In this way, we can know ex- actly what we are doing ; know the direction of the current, its strength, etc. ; and this is very important in many cases of gal- vano-therapeutics. Other varieties of galvanoscopes are made, and in use, but this is a good one, and easily managed by any- body who can operate a battery. To use it, we simply attach the conducting cords of the battery to the posts of the galvanoscope and the electric current is closed. 30 Electricity and Electrical Apparatus. Rheotomes. — A rheotome is a contrivance for interrupting the electric current. Without something of this kind we could not have an induced current, for this is only present in the secondary coil, at the opening and closing of the primary current. By means of the rheotome, the primary current is broken and closed rapidly, so that the induced current seems almost like a continu- ous one. We also use the rheotome on galvanic batteries. By interrupting the galvanic current, we can frequently excite mus- cular contraction more perfectly and powerfully than can be done by applying the faradic current. But the interrupted galvanic cur- rent is not like the induced faradic current — a to-and-fro current — but a succession of straightforward currents. Fig. 28 is an illustration of Powell's rheotome. These in- Fiii". L>8. strniments — any of them in the market — may be attached to any battery ; and some galvanic batteries are provided with them as permanent attachments. See the illustration of Bartlett's gal- vanic battery, and it will be observed that the rheotome is per- Electricity and Electrical Apparatus. manently fixed on it. Their use is very simple. In all faradic machines, they are essentially a part of the instrument, and run whenever the battery is put in motion. In galvanic batteries, they have to be properly connected, placed in the circuit of the current every time we use the battery. This is readily done ; and all batteries are accompanied with specific instructions re- garding the manner of operating them and applying the attach- ments. Rheostats. — Rheostats are used for the purpose of modifying the current of electricity. They are placed in the circuit of the current, iu the course of the conducting wire leading from the carbon of the battery to the patient, in the positive pole, while the negative pole of the battery is continuous, nothing interven- ing between the battery and the patient but the negative pole of the battery. Fig. 29 is a form of rheostat called a hydro-rheostat. This is a very reliable rheostat, and is easily managed. The glass tube seen in this illustration is filled with water, and the con- struction is such that the current may be made to pass through the water in this tube from bottom to top, or but a limited portion of it may be traversed by the current. In this way we may greatly soften the current and produce exceed- ingly delicate shades or grades of sensation. Othe!*' forms of rheo- stats are used ; but this is as good as any, and is so easily managed. The general practitioner may not see the necessity of such in- struments as these ; but when we have nervous diseases of all varieties to handle, and sensitive or- gans like the eye, ear and brain to treat, it sometimes becomes positively necessary to resort to rheostats before we can employ Fis. 29. 32 Elkctricity and Electrical Apparatus. electricity at all. While rheotomes are used to increase the ex- citing power of the current, which is sometimes necessary, rheo- stats are used to soften the current, or produce delicate grades of sensation. This will be referred to again, when we reach thera- peutics. ELECTRO-THERAPEUTICS. Electricity is simply a force, and like all other therapeutic measures, must be rightly applied if we expect to accomplish much good with it. To be sure, a mere novice may relieve and cure people with electricity, knowing but little about what he is doing. But this is accidental, and such ignorant practitioners are liable to do as much harm as good. Before we undertake to apply this potent agent to the cure of disease, we should study its physiological effects, that we may be able to use it as we would any other therapeutic agent, for a direct and definite pur- pose. It is not sufficient for us to say our patient is nei-vous, and that electricity is a remedy for nervousness. No, this is not a satisfactory conclusion to rest and practice upon. We want to know hoxv our patient is nervous. Is the nervous system, or that part of the nervous system supplying the diseased organs in a state of hyperaesthetic excitement, accompanied with pain ? or is there a high state of irritability, giving rise to physical and men- tal distress, dependent upon exhaustion or mal-nutrition ? or is there a semi-paralytic condition, with diminished sensibility and loss of muscular motion? The condition of our patient must first be understood, then we may turn to our batteries for a possi- ble remedy. Well, what may we expect from batteries.? Our answer is this : It has been found that electricity may be em- ployed in medicine and surgery for the accomplishment of various ends. While its general effect is largely manifested upon the nervous system, its sphere of action is not limited to the nervous system alone. For its local effects, or for a general influence, electricity may be applied so as to act as a stimulant, a tonic, and as a sedative. Indeed, these three properties — stimulant, tonic and sedative are appropriately given to this agent. These Electricity and Electrical Apparatus. 33 properties, singly or in combination, are secured only by and through the proper manipulation of the instruments used in gen- erating and conducting electricity to the body. For example: if we desire to stimulate any part of the> nervous system, we may apply the negative pole of an electro-magnetic machine directly to that part. The negative pole of the induced current is a powerful stimulant, exciting muscular contractions, increas- ing sensibility, and when frequently applied for several minutes at a sitting, nutrition is improved, and lasting tonic effects result ; the parts are invigorated. Again: if it be desirable to produce sedation, or quiet nervous excitement in a part, or relieve nerv- ous irritability in weak and feeble people, we apply the positive pole of the faradic machine to the diseased, excited or irritable parts. Where there is great excitement a mild current applied with a large sponge electrode, attached to the positive pole, will give the desired results at once. Where there is more exhaustion, yet unnatural nei-tous irritability, a stronger current, through the positive i^ole, should be used, and soothing effects will result, while the parts are at the same time greatly invigorated. When the faradic or induced cun-ent is applied to any particu- lar part of the body, local faradization is the term used in expi'essing the measure employed. Where the whole body is brought under the influence of the induced current, general faradization is the term used to express it. As above instanced, local faradization may be had resoi't to where we desire to apply a direct stimulant ; in which case, we apply the negative pole to the diseased part, and allow the patient to hold the electrode attached to the positive pole in the hand ; or the positive pole may be placed over the course of a nerve, or over the site of its origin, while the negative pole is applied to the part to be stimu- lated. On the other hand, when a soothing, sedative influence is sought, we ap[)ly the electrode of the positive pole to the part, while the negative is held in the hand, or placed upon some vm- important part of the body. This is all local faradization, so called. Of course the current is not positively confined to the diseased parts, neither can it be. We may, however, by placing the electrodes of the positive and negative poles near each other on the body, confine the action to a comparatively small spot. 34 Electricity and Electrical Apparatus Th^ following examples may serve to illustrate local fara- dization, and local galvanization, and their uses: Mrs. K., about thirty-five years of age, married, and otherwise healthy, comes to me complaining of a partial loss of sensation, and a total loss of motion in the left side of the face. She is suffering from what we call facial paralysis, or Bell's palsy. She ' cannot close the left eye, in consequence of which she suffers from smarting sensations in it, and it looks red, while tears drop from the lower lid. She cannot purse up the mouth as in health, and saliva continually drips from the left side, greatly to her annoy- ance. No particular pain is suffered, but the inability to close the eye, or control the flow of saliva, with the distorted appear- ance of the countenance, together with fears of a worse and probable permanent indisposition, excite great apprehension, and lead her to seek counsel, and obtain relief if possible. The first question coming to my mind is this : I know that facial paralysis may be of a central origin, or it may be per- ipheral ; that is, the nei^ve supplying the face may be diseased at or near its origin, in which case we say the disease is intra- cranial ; or, it may be an impairment of that part of the nerve outside of the skull, in which case we say it is peripheral paraly- sis. To which class does our case belong ? Our decision or diagnosis in the case is of great importance ; for, if the disease is of a central origin, the prognosis must be guarded, but if it is simply a peripheral paralysis, the prognosis is favorable, and a positive and permanent cure may be promised. This is not our first case, no, indeed ; and from the experience and observation we have had we have learned to make successful and satisfactory examinations in this class of diseases. Well, how are we to know whether this is a case of central or per- ipheral disease ? Fii'st, there is no mental aberration, neither is there any signs of hemiplegia ; no sign of any paralysis except of the facial nerve, whereas, in cases of central origin, there are very apt to be signs of paralysis or weakness in other parts of the nervous system. But one of the most important and certain tests for central, or peripheral paralysis, is electricity; and I resorted to it in the case of Mrs. K. I have Kidder's electro-magnetic machine, Electricity and Electrical Apparatus. 35 and I tip the cup holding the fluid, attach the cords, upon the distal ends of which I attach sponge electrodes, wet with warm water. I place the electrode of the positive pole on the side of the face immediately in front of the ear, and apply the negative to the cheek, and move it about over the face. I commence with a mild current ; but as no muscular contraction results, I increase the strength by withdrawing the cylinder at the side of the ma- chine ; but still there is no muscular contraction. The muscles do not respond to the action of the faradic current ; and this is one of the best evidences we have that the case is one of peripheral origin, for if it was of central origin the response would be prompt, but little different from health. I am pretty well satis- fied. But I have a galvanic battery on my table, with a rheo- tome or current interrupter attached, and I change the cords and electrodes from the electro-magnetic machine to this, turning on twenty-four cells, and connecting the rheotome. I no\v place the electrode of the positive pole immediately in front of the ear, as in the case of the faradic curi'ent, and place the negative electrode on the cheek, between the ear and the mouth, and as I move it about over the cheek I observe a drawing of the face. The left corner of the mouth moves toward the ear, and as I move the sponge toward the temple, the eye closes. All this convnices me that we have a case of simple peripheral paralysis, and we so announce it, and commence treatment at once. While we value electricity highly as a therapeutic agent, it will be seen from the above that it is a valuable resort in the diagnosis of nervous diseases. This may be fully and clearly established in the ex- amination of various cases. Having made out our diagnosis, we next proceed to the treat- ment. In this case, local faradization is of but little use at first; at least, the improvement will be slow and the cure tedious if it be the sole dependence. But the interrupted galvanic current which takes a deeper effect than the faradic current, will, from the very first, improve the condition of the patient ; and with the addition of small doses of strychina, -^ of a grain three times daily, a speedy cure may be expected, as was really the result in the case of Mrs. K. In such cases, the galvanic battery should be used 36 Electricity axd Electricai, Apparatus. daily, at first, then every tvvo or three days, each sitting occupy- ino; from ten to fifteen minutes. As the case progresses, it will be found that the muscles will readily respond and contract under the influence of the faradic ctuTent, when it may be substituted for the galyanic : in fact, it is better now than the galvanic cuiTcnt. The above tests and treatment involve both local faradization and local galvanization ; and it should be obsen-ed that while the faradic current is a powerful stimulant, there are conditions where the interrupted galvanic current has more influence in producing muscular contraction than the faradic current. About the middle of September, 18S1, Mrs. A., about thirty years of age. and mamed. applied to me, complaining of a lame- ness in the right hip, and a numbness of the right arm. I diag- nosed the case as one of a rheumatic nature, and prescribed accordingly. On the fifth of October following, she came to me again, and upon careful inquiry and examination, I gained a coiTect history of the case, and found her in the following condi- tion : The remedies prescribed for the supposed rheumatic trouble had done her no good ; she had not been sick, neither had she been exactly well. A few days previous to her calling upon me, she had been attending the Fair, and while on the ground she experienced a peculiar sensation in the right side of the neck, as she expressed it. Upon examination, I found the location to which she referred as being the spot where the peculiar sensation was felt, to be just back of the petrous portion of the temporal bone, and extending to the foramen magnum. This was as nearly as she could point to the location. She said the sensation was likened unto the report of a pistol, and was immediately fol- lowed by a peculiar numbness on the left side of the face, and an inability to close the left eye, or draw up the left side of the mouth. As she gave me this history I obsem'cd that her speech was somewhat impaired, and that she did not wink the left eve She also walked lame ; could not handle her right leg and arm as well as she could the left. She was evidently suffering from a facial paralysis, and threatened with hemiplegia. She suffered from no pain ; there was no tenderness under pressure anywhere along the spine, or about the base of the brain. Her Electricity and Electrical Apparatus. 37 appetite was good, bowels regular, sleep undisturbed and re- freshing. Now, this is another case of facial paralysis. The same quest-on, is it peripheral, or is it of a central origin, presents itself. As hinted in the history of our first case, the accompany- ing symptoms of weakness in the other parts of the nen-ous system, especially the evidence of hemiplegia, lead us to suspect that this is a case of central origin. But we resort to electricity again. We apply the faradic current to the cheek, and we ob- serve that the muscles conti-act readily under its influence. As we move the electrode toward the eye the lid comes down, and the eye is closed. Here is another case where electricity aids us in confirming our diagnosis. But what can we do for the case, is the question. We know we have a serious case. We are guarded in our prognosis, and only promise to do what we can. We resort to local faradization, as in our first case. We give our patient strychnia and iodide of potassium, with other reme- dies having a tendency to counteract any rheumatic influence that may be present. We resort to local galvanization, alternated with local faradization. We use counter irritation over the right side of the cerebellum, and along the cervical portion of the spine. In the use of the electi-icity we always applied the nega- tive pole to the cheek, and the positive over the petrous portion of the temporal -bone, and over the cerebellum. Mild currents only could be borne. We treated this patient about six weeks without any improvement. But, upon the whole, she grew no worse. She got discouraged and went to another physician, and I have not learned the result. We report this case to show the value of electricity in confirm- ing our diagnosis and helping us to announce a correct prognosis. It also proves, to some extent, the comparative uselessness of electricity in the treatment of some cases. Early in the spring of 188 1, Mrs. G., a raan-ied lady, about twenty-five years of age, called upon me for what she called a swelling and stiffness of the right side of the face. Upon exam- ination, I found it to be a case of facial paralysis. The face was not swollen, as she thought, but the paralyzed condition of it 38 Electricity and Electrical Apparatus. made it appear so, and gave the feeling of stiffness. No other nervous symptom was apparent. The faradic current produced but little impression upon it ; but under the influence of local galvanization and the use of strychnia and phosphorous, she re- covered completely in about two weeks. In the early part of the year 1879. a young lady, about eighteen years of age, was suddenly stricken with facial paralysis. It came on in the night, she knowing nothing about its approach. When she got up in the morning she discovered her distorted countenance ; and, although she suffered from no bad or painful feelings, she was apprehensive. It was not so that I could treat the case at the time as seemed to be required, so she applied to another physician. He resorted to the faradic cuiTcnt — nothing else ; and for several weeks she remained about the same thing — no better. Finally, however, she began to improve, and made a complete recovery ; but the cure was very tedious. Had the galvanic current been used at the commencement, and strychnia administered daily, the cure would have been rapid. No disease co.ming under our obsei^vation is more satisfactorily and successfully treated by electricity than facial paralysis. But we need both currents, faradic and galvanic. It is true, we may suc- ceed occasionally with the faradic current alone, in w^iich case the pocket instruments of Gaiffe, or Kidder, illustrated in a previous chapter, will be found convenient and effective. But^when we know the galvanic current is required in so many cases, especially at the commencement, and in making out a diagnosis, it is advis- sable, and even •profitable and •practical to have at hand two instruments, a faradic and a galvanic. Or, what is more conven- ient still, an instrument combining both currents like that of the Mcintosh make, illustrated in the fore part of this work. These instruments are perfectly satisfactory in every regard. They are portable, easily managed, and in a few seconds' time we can change from, the faradic to the galvanic current, or from the gal- vanic to the faradic current. When a case of facial paralysis comes to us, our first business is to ascertain whether it is a case of central or peripheral paraly- sis. The manner of doing this has been described. The next thing is to apply the proper current. If the muscles contract Electricity and Electrical Apparatus. 39 under the faradic current, this is the one to use. If they do not respond, then we resort to the galvanic current. In both cases we place the electrode of the positive pole immediately in front of the ear, while that of the negative pole is moved about over the cheek of the affected side. The current should be as strong as the patient can well bear, and the sitting should last from ten to fifteen minutes, and be repeated for the first week every twenty- four to forty-eight hours, according to the severity of the case. After this, especially if improvement be inanifest, the applica- tion may be made twice a week till the cure is perfect. All this applies to cases supposed to be curable. In cases of a central origin, like that of Airs. A., previously described in this work, it will be found that electricity, no matter in what shape or form applied, will be of little avail. In fact, I think it may do harm in some cases. By referring to this case the reader will see that we commenced to treat Mrs. A. about the middle of September, iSSi, and that we continued the treatment for about six weeks, when she got discouraged and applied to another phy- sician. We heard no more from the case till December 19th, iSSi, when the husband again called me. I found the patient in bed. I learned that after leaving me she went to an electrician, a man who gives special attention to the treatment of diseases with electricity. She told me that he had bfeated her eight or nine times, and that he had applied the galvanic current so strong to her face that she suffered severely from it ; and that instead of any improvement, she had steadily grown worse from the time she went to him. She had quit him and was taking iodide of potassium and bromide of potassium under the instructions of one of the best physicians in the city. But with all of this she was growing worse. She suffered from a severe pain in the head, on the right side, immediately behind and a little below the ear. The left eye looked red and watery. The right arm and hand, : ,nd the right leg and foot, were motionless. She could not move them the least ; they were paralyzed. I put her upon strychina and bromide of potassium. Strychina -g^ of a grain every three hours, and bromide of potassium ten grains every four hours. Under this treatment the pain in the head ceased, and the eye improved in appearance — looked nearly 4© Electricity and Electrical Apparatus. natural in color; but up to this date, January loth, 18S3, there is no improvement in the paralysis. I certainly think the strong electric currents used by the elec- tric specialist aggravated the disease in this case, and would earnestly warn the novice against the reckless use of this potent measure in serious brain troubles. While it is the remedy in all cases of a peripheral origin, either in the form of faradization or galvanism, it will not cure, or even benefit many cases of a cen- tral origin. Happily, the great majority are of the curable kind. They result from extrinsic causes, cold, injuries, exposures, and not infrequently we meet with cases as complications of neural- gia. All these cases are readily benefited by the tise of elec- tricity. Where a paralysis results directly from a neuralgia, we should apply the electrode of the positive pole immediately over the nerve affected by the neuralgia, and that of the negative pole over the paralyzed part. Neuralgias are sometimes speedily relieved, and occasionally cured by the application of electricity. Aside from its use in curing paralysis resulting from neuralgia, electi'icity may be used to relieve the pain. In cases of long standing, and even in acute cases, and where the pain is localized, the part sore and tender under pressure, the application of a inild galvanic current, apply- ing the electrode of the positive pole to the affected part, while the negative is held in the hand of the patient, will sometimes do more toward restoring the parts to a physiological condition than any means to which we can resort. If the galvanic current fails to give the desired results, then, we try the faradic current. But we find that the galvanic current is most frequently useful ; it only occasionally happens that the faradic current is the best. "In morbid states involving 5(?;?5Z(5z7z'/)/ the faradic current is of little service. A very high tension current, with excessively rapid interruptions applied along the trajectory of a nerve, is sometimes serviceable in a neuralgia. The power to relieve pain is the property of the galvanic current. A descending stabile current is, theoretically, the best form of application to relieve the irritability of a sensory nerve ; but in practice, it is found that the direction of the current is of little moment, the relief being the same in what direction soever the electricity may be flowing. il-LECTRICITY AND ELECTRICAL APPARATUS. 41 It follows, then, of course, that the galvanic and not the faradic current is to be used in the treatment of neuralgia. The use of the faradic current in such cases is one of the medical delusions against which we must protest. The injunction, in systematic works, to add a little salt to the water with which the sponge electrodes are moistened, is propel" only in the case of galvanic applications to the face and head. In neuralgias of the extremities, especially of long standing, I am convinced that we should use powerful currents, and there- fore make the applications with large electrodes, moistened, but not with salt water. Not suthcient attention is paid to the dura- tion and number of the seances. In galvanic applications about the head the sittings should not exceed five minutes, but they may be repeated several — say three — times a day. In neuralgias the applications should be more prolonged, and should be re- peated at short interv^als. Much better results would be obtained in these affections, sciatica for example, if the applications for galvanism wei'e fifteen minutes long, and repeated every three or four hours. These statements are based on some experience with these frequent applications, and are not merely speculative theories." — [Bartholow.] These observations agree with my own previous experience, except that I think the application of the electrode of the positive pole to the tender part is always more agi^eeable, and in no case less effective than the negative pole. Referring to the use of the galvanic and faradic currents, we would make this observation : Heretofore medical practitioners desiring to test the virtues of electricity in medicine ha\'e almost invariably invested in faradic machines only. They probably get good instruments, and use them according to directions ; but, like all other therapeutic measures, the faradic current Will not meet all the indications, neither will it do all that can be done with electricity, and if we expect to succeed, we must use both currents. One current will be found best in a certain case, another in a second case, and in other cases both cuiTents may be required. As we proceed we shall aim to point out the special indications for the different currents. 42 Electricity and Electrical Apparatus. In a communication for the Peoria Medical Monthly for Nov iSSi, Dr. R. J. Curtiss, of Joliet, 111., very ably and instructively illustrates the value of the gaK^anic current in painful affections, and we gladly appropriate and reprint his observations, for they are in harmony with our own, and we know them to be faithful illustrations of galvano-tlierapeutics. He says : " There is no fact in therapeutics better verified than the power of a low tension galvanic current to relieve pain. A high tension current has less power in this direction, and still less if it is inter- rupted, while the high tension faradic current, most useful in anaesthesia, has very little power to relieve pain, and in some con- ditions will increase it. '■ Galvanism will relieve pain independently of its effect on the cause of pain. In fact most pain remedies operate independ- ently of the cause. It must be, however, that when pain, like sciatica, depends upon disease of the nerve itself that the galvanic current acts more or less by catalysis, upon the cause of the pain in the relief of the disease. " The method by which galvanism acts, or the changes of a phvsical, chemical, or so-called vital character which are pi'o- duced in the tissues in the relief of pain are probably better un- derstood than the same action of drugs. The first effect of the current is a phvsical one, and operates on the molecules of tissues. If the action is increased it becomes more complex and has a chemical effect. These effects of galvanism are termed catalytic, and it is by Ibis action that electricity can relieve pain. '■'■Case I. — Mr. , a bricklayer. This patient was obliged to stand in water at his work during one day. On the third day after he was unable to work on account of sciatica. The pain was intense, and the limb could not be moved without great increase of the pain. The extent of pain was from the point of emergence of the nei-ve from the pelvis to the heel. The foot was placed in warm v;ater, which contained the negative pole of the battery, — the positive was applied at different points over the nen'e. The applications were made twice daily, for three days, the direct current from twenty cells being used. Each applica- tion was followed by lessened pain and increased mobility of the Electricity and Electrical Apparatus. 43 extremity. No medicine was prescribed. After the sixth appli- cation the patient was free from pain, and complained only of stiffness of the limb when walking. " Case 3. — Mr. , a carpenter by trade, had had sciatica for ten years, more or less in relation to pain and time. Two years before I saw him he was subjected to the operation of nerve stretching. The wound became troublesome, and finally was attacked b^- erysipelas, and three months elapsed before he re- covered from the effects of the surgery and the accident. In this case a differential diagnosis was necessary between sciatica and locomotor ataxia. The pains in the legs at times resembled those of ataxia. The tendon reflex, however, was increased. There was no fault of co-ordination, or any other signs or symptoms of ataxia. He had been treated by a minister, he said, with elec- tricity derived from an electro-magnetic machine. The nerve stretching and ministerial therapeutics did not relieve him. He stated, however, that he was free from pain while in bed with his wound, following surgical operation, but pain returned when he had recovered and resumed work. "The electrical treatment of this patient was continued for three months and was successful. The applications were made daily as a rule, and variously applied in quality and tension as the effects justified. The treatment began with the use of twen- ty cells, which was increased by degrees to sixty, and finally to eighty — with the intensity diminished by the rheostat. The patient improved rapidly after the second month. As a rule each dose of galvanism was followed by relief of pain. If the intensity of the current, however, was great enough for him to sensibly feel it, it always appeared to increase the pain. I found that the quantity of electricity was what his case demanded with low intensity, which was a very different method from that employed by the minister. This patient was discharged over a year since, and has remained well with exception of stiffness of the muscles, and occasional ' storm pains.' " Ca5^ 3. — Mrs. E , a married lady, aged 40, is neuras- thenic, and says she had liad neuralgia in different nen'es and at different times, all her life. Among other trouble she had been subject to nervous headache — the pain being extreme in charac- 44 Electricity and Electrical Apparatus. ter. I noticed that the dark hair contained tufts of gray, proba- bly half a dozen in number, sharply defined, and which she , believed had been caused by excessive pain. Without doubt the loss of pigment had relations to her neurasthenic condition. I was called to visit this lady on account of an attack of sciatica. I learned that she had adopted the blue glass treatment for neu- ralgia, and while setting in the blue light her pains all settled into the sciatic nerve. The pain, of course, was intense, and patient helpless. I was obliged to use in this case a faradic cur- rent of rather high intensity, and used the same daily with good effect for about a week, when the patient was able to resume her avocations and daily routine of a confirmed neurasthenic life. I was anxious to try in her case the ' central galvanization ' and 'general faradization ' methods of Beard and Rockwell, but a diagnosis (;f tuberculosis was made by another physician, who took charge of the case, and I think must have cured his i)atient of tuberculosis, for after three years she is as well and as sick as ever. '' Case ^. — Was a robust, hearty person, who had sciatica for six weeks' duration, which he got by working in water which flowed from the savory Illinois and Michigan Canal. He said he came up to have me use my big battery on him, as he had tried a little one with no good effect. I applied the direct current from twenty cells, which was very unsatisfactory to the patient, who in- sisted that it was of no account because he couldn't feel it. By way of scientific experiment, therefore, I turned on sixty cells and interrupted the current. After the ' seance ' was over, in about five minutes, the patient complained of an increase of pain. He returned three times, in as many days, and I applied the cuirent in the same way with the same effect. He then staid away, and I met him on the street about ten days after, when he informed me that as soon as he stopped the electricity he began to get well, and recovered in a few days without treatment of any kind " Case 5. — Mrs. , married lady, aged 55, had schiiTus of the liver. The pain from this disease was unusual, and prevent- ed sleep, took away her appetite, and made her wish for the coming of the inevitable end. She had taken morphia and atropia, codeia, chloral, and even inhalations of chloroform. To Electricity and Electrical Apparatus. 45 relieve her of pain I used the direct galvanic current from fifteen cells daily, about fifteen minutes, with the happiest effect. So long as she used this treatment she was comparatively free from pain, and availed herself of it until she ocnild no longer, from progress of the disease, come to the office. The tumor filled the epigastric region and extended into the iliac fossa. Her last days were painless, and Iwpeful of cure, under the ministra- tion of a ' cancer doctor ' from Chicago. " Case 6. — Mr. , aged 60, had pulmonary consumption (fibrous phthisis), of which he died after two years duration of the disease. His cough was excessive, and he suffered greatly during the last six months from this source and from intercostal neuralgia, and pain referred to the left shoulder. Various ano- dynes and Sequard's neuralgic pills were prescribed. As an experiment, galvanism was used. Galvanization of the cen'ical region and epigastric region — one pole beneath the ear and the other over the stomach — with a current from five cells used for ten minutes, would insure a good night's rest — comparatively free from cough and pain. He also found relief from night sweats by use of faradism lightly applied over the surface. From choice the patient used galvanism for pain and faradism for sweating, instead of dinjgs. This patient after he began the use of electricity had a remarkable increase of appetite and diges- tion. He could take and digest three ounces daily of cod liver oil, and took daily a large quantity of raw beef and brandy, this remedy having been prescribed for him as the latest therapeutical novelty from Paris. His life by this means was surprisingly pro- longed and his comfort greatly increased. " Case 7. — Mrs. , aged 53, had a cancer of the left breast, badly ulcerated. The pain in and about the tumor and through the chest, which at times ainounted to angina, she was in the habit of relieving as much as possible by hypodermic injections of morphia. Hearing about the effects of galvanism in rcliexing pain in similar cases, she reported for that purpose. In this case the treatment by galvanism was remarkable in procuring relief from distress. The galvanism was used every other day by applying the positive pole over the dorsal and cerxdcal spine, and the negative at various places over breast, side and arm. She 46 Electricity and Electrical Apparatus. stopped the use of morphine while being treated by galvanism, and was relieved of immense suffering by its use. She had used plasters, probably arsenic and zinc, for the cure of the cancer, and declined further treatment than what was calculated to relieve her distress." These are reports of seven cases where electricity was used to relieve pain. Galvanism was the principal resort, but in case " 5 " Dr. Curtiss says he " was obliged to use a faradic current of rather high intensity." But he does not say why he did this ; and we are frequently at a loss to know which current to use, the faradic or the galvanic. In painful affections we are guided by these symptoms : where firm pressure over a painful part in- creases the pain, the faradic current will aggravate, while the galvanic current will relieve. On the other hand, where pres- sure does not increase the pain, then the faradic current, the pos- itive pole over the painful part, will give relief. A little experience in the treatment of neuralgia will enable the practitioner to classify his cases properly. On the one hand he will have patients who manifest a fair share of vitality, and yet they suffer from acute neuralgia, about which they complain bit- terly. Touch these people and they are nervous ; and handling the diseased or painful parts cannot be tolerated. Galvanization is soothing to these patients and will cure. On the other hand we find a class of rather feeble people, suffering from impak- ment of nutrition, more or less anemia, hyperasthesia, exhaus- tion, &c. Holding the hands and rubbing the heads of these patients will give relief, and such measures ai'e enjoyed as real luxuries by this class. They even fall asleep under such treat- ment. Here is the place for the faradic current ; localized or general faradization. Mild currents should be used at first, then stronger, always being careful to avoid currents of high tension about the head and face. And large sponges should be used, that the current may be diffused as much as possible, for the con- centration of current about the head and face cannot be well borne, and may aggravate the pain, while a diffusion over a large surface affords quick and permanent relief. Nothing so speedily improves nutrition, relieves pain and hyperasthesia in such cases as faradization, local or general, as may be required. Electricity and Electrical Apparatus. 47 Other diseases associated with or dependent upon impairment or perversion of nutrition, besides those of a neuralgic character, are fi'equently met with and quickly and permanently cured with electricity. A case. — Lilly B., age fifteen, was brought to me about the middle of August, 18S1, for advice regarding a curvature of the spine. Upon inquiry I found that she had been under treatment for nearly a year without benefit. She had menstruated once or twice, when about fourteen, but never since. She was wonder- fully bent over in a forward direction. The difiiculty did not seem to be in the spinal column, but in the muscles of the back. The girl seemed to lack the power to hold herself up, and she could not straighten herself without some help. She could get up and walk about in a half bent attitude, but would get very tired in a short time. Even sitting up in a chair was a burden to her ; made her very tired. Her appetite was poor, face looked pale, pulse rather feeble, and all the functions of the body wei-e performed in a sluggish manner, and some of them, especially menstruation, were suspended. Our first advice was to have Mr. Schleifarth make and fit a suitable brace on the patient, which was done at once. This held her up temporarily, and with this on she could sit up and walk about without getting so tired. This brace was so con- structed that it could be removed in a second or two, and replaced as readily. In addition to this we had her come to the office three times a week for electrical treatment. Faradization was used thus : The back was bared the entire length of the spine, and we had the patient hold the sponge electrode of the positive pole of the faradic machine in the hand, first in one hand, then in the other, changing every minute, while we applied the sponge attached to the negative pole to the back, commencing at the neck, and moving down the spine to the lower extremity, then up one side, down the other, then up, then down the centre, using as strong a current as could be borne without discomfort, and continuing the seance for fifteen minutes. She always felt refreshed and invigorated after these. treatments. Small doses of strychnia and macrotys, occasionally alternated with arsenic, were given from the start. We continued this treatment about one 48 Electricity and Electrical Apparatus. month, when we observed a marked improvement in the appear- ance of the patient. The appetite was better, sleep more re- freshing, and she really felt stronger. Faradization was continued twice a week after this, for another month, when she had a slight show of the menses. She was still improving. Another month under the same treatment, and the menses appeared in a natural manner. She now looked red and fresh, had gained greatly in flesh, could sit up, and could walk and work with pleasure. We continued the faradization once a week till December 15, 18S1, when we stopped, and she is now taking nothing but macrotys and strychnia, and is growing and gaining in strength daily. She still wears the brace, but says she can do without it, and she can really straighten herself up nicely and get around like other girls. We shall soon take off the brace. Now, here is a case where faradization worked a wonderful cure. True, it may be said that strychnia, arsenic and macrotyg had something to do in the cure. So they had ; but they could not infuse new life and vigor into the muscles, and invigorate the nervous system so rapidly as actually resulted in this case. The very first seance was followed by immediate improvement, and the patient could even feel and realize that the electrical treatment was restoring her. And there is no doubt but that the indirect and constitutional influence of the faradization had more to do in re-establishing the menses in this case than anything else. Of course the faradization was comparatively local, and while we are sure the poorly nourished and feeble muscles of the back in- creased in size and gained in strength under the electrical influence, we are quite certain that the uterine and ovarian finictions were stimulated also. As evidence tending to establish the fact that snch things may result under similar circumstances, allow us to quote a paragraph or two from Prof. Rockwell : "Localized electrization of poorly nourished and atrophied mus- cles develops size and increases strength. Localized electricity of any organ, such as the uterus, the nutrition of which has be- come impaired, and its size diminished, tends to develop it and to increase its functional activity. In localized electrization, these results are, of course, of a local nature ; yet, owing to the fact that absolute localization is impossible, we not unfrequently ob- El^ECTRICITY AND ELECTRICAL APPARATUS. 49 serve effects extending far beyond the parts actually enclosed in the circviit. " By reflex action, also, we obtain remote effects, which are either desirable or undesirable, according to the demands of the case in hand. Galvanization of the spine, and even of the ex- tremities, may, in certain irritable conditions, excite the charac- teristic metallic taste. Galvanization, and even faradization of remote and limited areas, sometimes relieves pain, induces sleep, and increases the menstrual and other discharges through reflex influence alone." This was undoubtedly the case with ovu" patient ; and we have seen similar results in other cases, where the appetite increased, digestion and general nutrition improved under the influence of faradization, administered over very limited areas, through the electrical chair of Dr. Hathaway, of Chicago, when the hands and feet only of the patient are in contact with the elec- trodes. While localized faradization is certainly more potent in some cases, where it is practicable, we do know that special results actually follow general influences in many cases. One thing should always be obsei-ved in the application of electricity, no inatter whether we are using the electro-magnetic machine or a galvanic battery: the positive pole should always be applied to sensitive, painful or inflamed parts or organs, when such conditions are present. And while the positive pole is applied directly to or over these tender parts for the puipose of relieving pain and effecting cures, the negative pole should be placed upon some comparatively unimportant part of the body, and where the least excitement is produced. On the other hand, where it is the object to stimulate or invigorate an}' part or organ, the nega- tive pole should be applied to the weak part, while the positive pole is placed upon some part of the body not likely to suffer serious injury from the sedative influence of the positive pole. It will be observed that in case I., reported by Dr. Curtis, a severe case of sciatica was speedily relieved and permanently cured by the use of electricity; and that the positive pole was applied to the painful part, while the foot of the patient was held in warm water containing the negative pole of the battery. And in the case of Lilly B., reported by me, the negative pole was 50 Electricity and Electrical Apparatus. applied to the back, all along the spine and over the muscles of the back, while the positive pole Vvas held in the hand. A won- derful cure of spinal curvature and suppressed menses was the reward of this treatment. And we might cite the reader to numer- ous cases ilhistrating the truth of this law. Dr. A. \V. Tipton, in his new work on Electrical Medication, p. 56, illustrates the distinctive use of each pole very clearly. While the terms electro-vital fluid and electric fluid may be objectiona- ble, Dr. Tipton makes the reader know what he means, and his instructions are eminently practical. He says: "The reader will bear in mind that all acutely inflammatory or hypersthenic affections are electrically fositive in excess — having too much vital action — being overcharged with the electro-vital fluid ; and that all paralytic diseases, or those of sluggish, azoodynamic character, are electiically negative, having too little electro-vital fluid, too little vital action. It is a universal law of electricity that positives repel each other, and that negatives repel each other ; but that positives and negatives attract each other. This is a principle of electric action everywhere known where any thing is known on the subject. We appropriate it practically to therapeutic purposes. Therefore, when I wish to repress or re- pel inflammation, which is electrically positive in excess, I put the positive pole to it ; or, at least, I bring it under that half of the circuit with which the positive pole is connected, and as near to the pole or electrode as possible. And because two positives repel each other, and also because the direction of the current is always from the positive to the negative pole, carrying the elec- tro-vital fluid with it, either I must withdraw my positive elec- trode, or that excess of electro-vitality in the diseased part which makes it morbidly positive, and thus produces inflammation, must give way. I -vill 7iot withdraw my positive pole, and therefore the positive inflammation must retreat and be dispersed. In trciiting this case, I will place my negative electrode either on some health)' part, or, if there be percejDtible anywhere in the system a mor- bidly negative part, as is often the case, I will place my negative pole there. For example : if I am treating for nephritis — in- flammation of the kidneys — when I do not perceive any part to be abnormally negative, I manipulate with my positive electrode over Electricity and Electrical Apparatus. 51 the inflamed kidney, leaving the negative electrode placed at the cocc}Tc, the lowest part of the spine. My positive pole repels the positive inflammation from the kidney ; or, rather, repels from it that excess of electro-vital fluid which makes it morbidly positive and induces the inflammation, v^^hile the negative pole attracts the same towards the coccyx. On its way it becomes more or less diverted to adjacent nen-es ; or, if gathered in the healthy part, under the negative pole, it is immediately dispersed by the normal circulation as soon as the electrode is removed. But if I And a spinal irritation^ say in one or more of the cervical or dorsal vertebrae, and, at the same time, a stomach affected with chronic dyspepsia^ accompanied with constipation of the boxvels^ I will work over the inflamed or irritated spine with my positive pole, because I know from the irritation that there is an excess of electro-vital fluid in the part, making' it improperly positive ; and, with my negative electrode, I will, at the same time, treat over the stomach, bowels and liver ; because I know, from the inac- tion of these organs, that there is a lack of vital force, a defi- ciency of the electro- vital fluid, there, and that, consequently, they are too negative." Dr. Tipton is earnest and enthusiastic regarding these princi- ples, and whether we agree with him in all his theories and de- tails or not, the one idea advanced, and so fully illustrated in the above quotation, is one that cannot be treated with indifference if we expect to succeed with electricity. The distinctive use of the poles should be carefully observed under all circumstances. Where doubts arise as to the actual conditions of a part, then we may alternate, and finally use the pole that seems to give the best results. We have now defined electricity, explained the different meth- ods of generating it, described the leading and most practical electro-magnetic machines and galvanic batteries in the market, illu'sti'ated the difference between the electi'o-magnetic and gal- vanic currents, and have shown the marked difference in results from the application of the different poles, referring to specific conditions where each pole has a specific action in relieving pain or restoring vitality. The knowledge thus far gained from these pages should be sufficient to enable any intelligent physician, who 52 Electricity and Electrical Apparatus. has a practical knowledge of disease, to commence the use of electricity understandingly. CENTRAL GALVANIZATION. Central galvanization is a method of applying electricity that demands special attention. It consists essentially in bringing the brain, sympathetic, spinal cord, and pneumogastric, under the influence of the galvanic current. One pole of the battery is placed over the region of the stomach, while the other is applied to some part of the head or spine. In all cases of cerebral ex- citement, pain in the head, mental disturbances from sympathy, apply the negative pole of a galvanic battery over the stomach, and the positive pole to the top of the head. Great cautiori should be observed in applying the galvanic current to these parts. In all cases the head and face are more impressible than other parts of the body, and this is especially so with the galvanic current, for it passes directly through the scalp and skull, enters the brain and goes through every nerve and tissue it meets. In using this current in any case in the manner denominated central galvanization, the electrodes should be large, so as to diffuse the current as much as possible. iVnd we should commence with a very mild cuiTent, one or two cells, increasing gradually as the patient can bear it. And we should not depend upon the sug- gestions of the patient too much regarding the strength of the cuiTent, for bad results may be suffered before we are aware of any danger. vSuppose the patient is suffering from pain in the head, or there is cerebral excitement, and we desire to relit-ve it w^th electricity. Let the patient be seated, bare the stomach and make the top of the head quite wet with warm water. Now attach two large sponge electrodes, well moistened with warm water, to the cords of the battery, turn on two or three cells only, then apply the sponge of the negative electrode over the stomach, and carefully test the patient and the strength of the current in this manner : while the negative electrode is still over the stomach, we take up the positive sponge electrode, and with a tapping motion about the temple, or over the brow, we rapidly apply and remove the sponge. If the patient is quite sensitive, Electricity and Electrical Apparatus. 53 we may expect to hear remarks like these: " O, I see sparks! I see flashes of light when you hit my head with the sponge." If no such results as these follow this test, then connect two or three more cells, and repeat the experiment. If the battery is in any thing like good order, from four to six cells will certainly give the results above named — sensations expressed by the words sparks, flashes of light, etc. But some people are not very sensi- tive, and ten to twelve cells may be required to excite any un- usual manifestation. On the other hand, we frequently find people who are so sensitive that but two or three cells can be tolerated. Having carefully tested the strength of the current and the im- pressibility of the patient, while the negative electrode is still over the stomach, we carefully place the sponge of the positive pole on the top of the head and steadily hold it there for a time — from one to fifteen minutes, as may be determined by the immediate effect. The moment we place the sponge on the head the patient com- plains or speaks about a peculiar metallic taste in the mouth. If this is not mentioned voluntarily, it is called out in answer to questions. Occasionally it is complained of greatly, and seems to be quite disagreeable to some people. In other cases it is barely perceptible. Central galvanization with the negative pole to the stomach, and the positive pole to the head, is a potent measure, and if it does no good, it is likely to do harm. It lessens the quantity of arterial blood in the brain, and if used too strong, or continued too long, dizziness is experienced, and if still further continued the patient becomes unconscious and falls from the chair in a condition of sycope, and vigorous efforts, with the application of stimulants, may be required to bring about a reaction. From this it will be seen that great caution should be obsei"ved in the application of this measure. If the patient com- plains of dizziness, then the current should be lessened in ten- sion ; and if the dizziness is still suffered, a rheostat may be used. The rheostat is very convenient in applying elec- tricity to the head, eyes and ears. It is fully described and its use illustrated on previous pages. But with the greatest care and the use of the rheostat some patients cannot bear central gal- vanization long at a time. We observe the face growing pale, 54 Electricity and Electrical Apparatus. and the patient sighs a time or two, or expresses feelings of weak- ness or depression, and we are forced to desist. One or two minutes is as long as we can use it in such cases ; in others it will be well borne for ten or fifteen minutes. We use central galvanization in obscure nervous affections, such as hysteria, hysterical insanity, chorea, nervous headache, etc. Some of the most persistent cases of hysterical insanity are speedily relieved and permanently cured by this measure. Just how the cure is wrought we cannot always tell. But we do know that the galvanic current is capable of working wonderful changes. With it w^e can disturb nervous influences, divert the circulation, separate the constituents of the fluids of the body, and even dissolve the tissues. An agent capable of doing all this may be expected to do either good or harm whenever em- ployed. We may apply the faradic current to the extent of tol- eration, and rarely do injury with it, for it has no power to dis- organize the fluids or dissolve the tissues. In changing from the galvanic to the induced current the electrolic power is lost. Fara- dization influences nerves and muscles principally ; the galvanic current produces a change in everything coming under its influ- ence ; and the changes are not always simple excitements, con- tractions and relaxations, but are organic in character. The application of electricity to the head is opposed by some electricians, because they cannot explain just Iwiv central galvani- zation cures. And because bad results may come from reckless manipulators, they oppose and denounce it. We are not of this class, for we have cured some troublesome cases with central galvanization that had resisted various measures. Of course we should be cautious at the commencement, and if we find that the current is not well borne, and that the patient grows worse under the treatment, it need not be continued. Two or three sittings will be sufficient to test any case, for if the results are to be good a few seances will decide it. Central galvanization is sometimes applied by placing the posi- tive pole to the stomach and the negative to the head, or over different points along the spine. But the most satisfactory method is to apply the negative electrode over the stomach, and the positive pole to the top of the head, nape of the neck, or over Electricity and Electrical Apparatus. 55 the upper portion of the spine. Spinal irritation is sometimes instantly relieved by this measure. It is even astonishing how quickly harrassing pains and feelings of distress vanish under the influence of galvanism. And some cases of j^ersistent nausea, no doubt from spinal irritation, are immediately relieved by this measure. We meet with many patients where the symptoms are delu- sive. We find it impossible to make out what we call a positive diagnosis. We may be able to find a positive wrong here, and another there, and we may apply the appropriate remedy in ev- ery such case, but still there lingers a nervous distress, melan- choly, or wakefulness, and the patient may suffer from fits of sobbing — don't feel right at any time. With other appropriate measures we now resort to central galvanization. Of course we cannot always know, to a certainty, that they will relieve the pa- tient, but we frequently find that improvement commences at once. Just how the favorable change is wrought we do not pre- tend to explain, but we do know that with central galvanization we can frequently relieve, and many times speedily and perman- ently cure people who had lingered for months under different plans of treatment, medical and hygienic. ELECTROLYSIS. Electrolysis is a term applied to the process of decomposing compolind substances by electricity. For this purpose the gal- vanic current, not the faradic, must be used ; and that this direct current is capable of separating the elements that enter into the composition of fluids and solids is readily illustrated, as follows : Let us dissolve about thirty grains of iodide of potassium in two ounces of water. We put this solution in an open dish, on a suitable table, and obsei^ve that it is colorless. We now attach conducting cords to a galvanic battery, and on the distal ends of these cords we attach nietallic electrodes, iron, copper or plati- num. We now dip both of these electrodes into the iodide so- lution, at some distance from each other, and hold them there for a few minutes. Very soon we observe that the solution about the electrode attached to the positive pole of the battery changes color. It looks yellow at first, but rapidly grows darker, and 56 Electricitv and Electrical Apparatus. finally the whole solution presents the full color of iodine. In this case the iodine and oxygen go to the positive pole, while the hydrogen and alkali go to the negative pole. In all cases of electrolysis, or wherever the poles of a galvanic battery are ap- plied, the acids and oxygen present go to the positive pole, and the alkalies and hydrogen go to the negative pole. Now it is well known that the human body is largely made of water, holding salts of potash, soda, &c. , in solution. It is also a fact that the composition of the fluids and tissues of the body thus made up are readily decomposed in the living subject, by the application of the poles of a galvanic battery, the acids and oxygen rushing to the positive pole, while the alkalies and hydrogen as rapidly concentrate about the negative pole. In a given case, where metallic electrodes are applied directly to apart, the electrode attached to the positive pole is corroded ; and if a strong current from many cells is used, the accumulation of al- kalies at the negative pole may be so great as to produce a severe caustic effect. Such a result is rarely desirable, and unless we want it we are careful to avoid such violent action, by using a smaller number of cells. In either case, whether few or many cells are used, but especially where the current is strong, inorbid growths, swellings, tumors, and enlarged glands are frequently dissolved and carried away in a very short time by subjecting them to the process of electrolysis. Just how this disturbance of the elements in the tissues results in the removal of the diseased conditions referred to, we are not at present able to tell. Of course, in certain cases, where we use electrolysis to the extent of destroying the tissues, the effect is similar to the operation of an ordinary caustic, only the pain and subsequent inflammation are not so great, while the cure is more certain. A few cases in practice will serve to illustrate electrolysis, and the appropriate Instruments in making the applications. A young lady, aged 33, otherwise healthy, came to me last fall, Septem- ber, 18S1, asking advice about an enlargement of the parotid gland. She said the lump had been coming for several months, and that, notwithstanding she had consulted two doctors, and had used their medicines, the gland continued to enlarge. When she came to me it was large enough to make her appearance quite Electricity and Electrical Apparatus. 57 unsightly, and she was very anxious to have it reduced, or re- moved — anything to get rid of it. She suffered from no pain, neither v^as the gland tender under pressure ; no increased red- ness, but the tumor was very hard. Treattnent. — I attached conducting cords to a twenty-four cell zinc-carbon galvanic battery, Mcintosh's, and on the distal end of the positive pole I attached a large sponge electrode. On the distal end of the negative pole I attached a small sponge elec- trode. I moistened both electrodes with warm water, and placed the one attached to the positive pole in the patient's hand. The small electrode, attached to the negative pole, I placed firmly on the tumor, and held it there for fifteen minutes. After fixing the electrodes as above described, I connected six cells of the battery. This produced a sensation of warmth in the tumor, or in the skin covering it. I carefully connected more cells, one by one, till a distinct burning sensation was complained of, but I did not re- move the sponge from the tumor till the fifteen minutes were up, I did, however, move the sponge about over the tumor during the whole time of the operation, I did this to prevent a caustic ef- fect. When I removed the sponge at the end of the fifteen min- utes, the skin covering the tumor was very red, I had this pa- tient return twice a week for a month, and I could see a decided improvement. The decomposition of the fluids in this tumor, effected by the application of the negative pole externally, was resulting in a gradual dissipation of the enlargement. But the process seemed slow, and we determined to resort to a more di- rect method of application. Instead of using a small sponge electrode on the negative pole, I attached an electrolysis needle. This is a harpoon shaped needle made expressly for the purpose. About a half an inch of the pointed end is left exposed ; the re- mainder of the needle is carefully insulated with guttapercha. These needles are kept in stock by surgical instrument makers, and can be had of different sizes, styles and shapes, already in- sulated and ready for vise. One of these needles attached to the negative pole, as above stated, and the sponge attached to the positive electrode placed in the patient's hand, I thi'ust this elec- trolysis needle into the center of the tumor. This was readily done by picking up the tumor between the thumb and fingers, and 58 Electricity axd Electrical Apparatus. giving the needle a quick motion, as in introducing a hypoder- mic syringe. I now turned on six cells. The patient complained a little of a burning sensation, but she could hear it stronger, and we carefully connected other cells, one by one, till twelve were hicluded in the circuit. This was all done in a minute or two. By this time the needle seemed quite loose in the tissues, and I could turn it about in any direction. I took advantage of this and did turn the point in different ways, and by the time the fifteen minutes were up, the time usually occupied in electrolysis seances, the needle seemed to be in a free space. I now turned off the battery, withdrew the needle and dismissed the patient for a few days. But little inflammation resulted from this oper- ation, and scarcely any soreness was left after three days. The tumor had rapidly shrunken, and by the use of sponge electrodes applied externally after this twice a week, it speedly diminished in size, and finally disappeared entirely. It should be observed that in the introduction of electrolysis needles into deep tissues, they should always be introduced so that a part of the insulated portion of the needle goes beneath the skin. This protects the skin fi"om the electrolic effect of the current, and saves the patient from great pain. While tumors, swellings and enlargements of various kinds may be reduced in size, and finally removed by external electroly- sis, where it is practicable, the introduction of needles into the tissues will result in a more rapid dissipation of morbid growth. And, in some cases, it is required, to introduce these needles quite a number of times ; in others, one application is enough. Take a wart on the hand or face for instance. Let the patient take the sponge of the positive electrode in the hand, while we apply an electrolysis needle, attached to the negative pole, to th6 little tumor. The needle should be well fixed in the wart before the current is turned on, and then one or two cells at a time should be connected till the current is the required strength. The needle should not be taken away during the operation, for every time we take it off and reapply it we break the current, and this produces a shock which unnecessarily annoys the patient. We may move the needle about a little, so as to completely disor- ganize the whole tumor during the one operation ; but we should Electricity and Electrical Apparatus. 59 be careful in moving the needle that we do not, at any time, lift it from the tumor. When done, before removing the needle, and this should be obsei-ved in all cases, disconnect the cells, or turn them off. In all such cases as these the operator will be governed by the results in the number of cells used. First turn on two or- three, and if but little effect is produced, connect others, and continue to increase till a burning sensation is complained of, and the tis- sues at the needle turn white, and the needle loosens. Fifteen minutes is long enough for any operation in electrolysis. Some operators apply the sponge electrodes of both poles to the diseased parts, only at different points ; and they attach elec- trolysis needles to both poles of the battery, where needles are used, and they thrust both needles into the tissues, only at ex- treme points. This may be better than the plan we have prac- ticed and suggested, but we doubt it very much. We have tried it, and could never discover any advantage. And the needle of the positive pole, unless well covered with gold, is so corroded and the tissues so hardened about it that at the end of fifteen minutes it is removed with difficulty. A sponge on the positive pole, held in the hand, and a needle on the negative pole is all sufficient — the best. Electrolysis, applied in different ways, is a potent measure in such diseases as goitre, benign and malignant tumors, mother's marks, chronic rheumatic swellings, &c. In fact this is one of the most valuable therapeutic uses of electricity, if not really the most important of all. T.he current should be as strong as can be borne, and if necessary anassthetics, local or general, should be used. THE REMOVAL OF HAIRS BY ELECTROLYSIS. Electrolysis is successfully resorted to for the removal of hairs from the face, when it is desirable to have them permanently re- moved. Frequently the opinion and advice of the physician is sought by women respecting this abnormal and obnoxious growth. This growth of hair on the face of a lady is not always a trifling matter. It may not kill the patient, but it is almost certain to oc- casion great annoyance. It is very apt to affect her disposition, 6o Electricity and Electrical Apparatus. and to injure her prospects in life, especially if she be young and unmarried ; and it may eventually ruin both her health and her happiness by producing a mental disquietude which in many in- stances urges on melancholy. These observations, from a paper written by George Henry Fox, A. M., M. D., read before the Medical society of New York, with the following detailed procedure for the removal of this offensive growth, taken from the same paper, may interest a few, and it would leave our work incomplete to omit this use of electrolysis : " The operation for the permanent removal of hairs by elec- trolysis, has been described by several who have written on the subject, and the descriptions differ merely in a few non-essential points. The operation is a simple one, which any physician with a steady hand and keen eye can readily perform, although, as in many other simple operations, a peculiar dexterity is re- quired, and far more satisfactory results are obtained after a cer- tain amount of experience. An ordinary galvanic battery is re- quired and a fine needle, which is to be attached to the negative cord. The number of cells required for the operation depends upon the activity of the battery, the delicacy of the patient's skin, and the strength of the hairs to be removed, and should be de- termined in each case by the effect which is produced. I com- monly use from ten to sixteen cells of a zinc-carbon battery, or a corresponding number of a chloride of silver battery. " Upon the style of needle employed depends, in a large meas- ure, the success of the operation. A fine cambric needle, which has been recommended, may be successfully used, but on account of its stiffness it is more difficult to introduce it into the follicle without piercing the follicular wall than the hair-like flexible steel broach which I have recommended and invariably use. The cambric needle being larger is also productive of more inflamma- tory reaction, and more likely to leave permanent traces of the operation. Formerly I used a very fine platinum wire, pointed by means of a jeweler's file, but the delicate flexible broach, much finer than those commonly employed by dentists in extracting nerves, is far superior to any other needle which I have ever seen, and is almost a necessity in removing the hairs from the upper Electricity and Electrical Apparatus. 6i lip without the production of a scar. The needle can be readily attached to the end of the battery cord by a few turns of copper- wire protected by an inch or more of rubber tubing, or a special handle inay be made for the purpose. " Provided with battery and needle, the next thing is to get the patient in a proper chair and in a proper light. A high reclining chair and a southerly bay-window are desirable, but the main point is to secure sufficient light and to have the operator's eyes upon a level with the patient's chin. The needle is now intro- duced into the follicle by the side of the hair. If this is skillfully done, no pain whatever is felt by the patient. The sponge-cup or sponge-tipped positive electrode should now be used to com- plete the circuit. This may be applied to the skin in the imme- diate vicinity of the hair, if but a few cells are used, but it is usu- ally more convenient to allow the patient to hold the positive electrode in one hand, and when the needle has entered the folli- cle, to ask her to complete the circuit by applying the moistened sponge to the palm of either hand. The electrolytic action now manifests itself subjectively in the form of a sharp stinging sensation, and objectively in the form of slight hypersemia around the needle. In a few seconds the hyperaemia will give place to a blanching of the skin, and a little froth will appear at the mouth of the follicle. If the hair be now seized with a pair of forceps and the gentlest traction exerted, it will be found to be loose in the follicle in the coui^se of from ten to twenty seconds, provided the needle has been skillfully introduced. Before withdrawing the needle the patient should remove her hand from the sponge, in order to avoid the slight shock which would othenvise be felt. "In a paper on this subject which I read before the New York State Medical Society, three years ago, I recommended the ex- traction of the hair before introduction of the needle where the follicles were of large size. Under no circumstances, at the pres- ent time, do I ever remove the hair until it is loosened by means of the electi'olysis. " At that time I was in the habit of using a much coarser needle than I do at present. With the finest flexible needle it is extremely rare to produce wheals or pustulation. In many cases the effect of the operation is simply to leave red points, which soon disappear. 63 Electricity and Electrical Apparatus. " The operation is by no means u pleasant one, but rarely does a patient make any complaint of pain. The majority say it is not as unpleasant as having teeth filled in a dentist's chair, and with the fine needle the painful sensation is greatly reduced. At the first sitting the patient is often nervous, and suffers really more than in a dozen subsequent operations. When the sitting is prolonged, and especially in a poor light, the removal of the hair is very trying to the eyes of the operator. At certain times I know that I have suffered quite as much or eyen more than the patient. The use of a lens held in the hand or fixed before the eye has been suggested, but for my part I find one of no value. A delicacy of touch and steadiness of hand is more essential in this operation than an unusual keenness of vision. " As to the number of hairs which can be removed at one sit- ting, I would say that from thirty to fifty is the number which I usually expect to destroy in an operation lasting three-quarters of an hour. Upon the neck it takes much longer to destroy hairs than upon the chin or cheeks. I have removed over two hundred hairs at one sitting, when patients from a distance were anxious to leave the city ; but I deem it far better to spare one's eyes and to be more thorough, even if it involves a greater number of sit- tings. " If the operation is veiy skillfully performed, it ought not to leave scars, as a rule. In some cases it is impossible to prevent the production of minute punctate cicatrices, which, however, can only be seen on close inspection. I made a mistake in some of my earlier cases in operating upon two or more coarse hairs very close together, instead of taking one here and there at short distances apart. A little attention to this hint may serve to pre- vent the production of slight scarring by those who may attempt the operation. Here again I must refer to the fine needle, for its use greatly lessens the liability to the production of scars. " As regards the immediate success of the operation, it must be stated that, as a rule, a certain percentage of hairs will return and demand removal a second time. I used to expect a return of from thirty to fifty per cent of the hairs, while now I am surpris- ed if from five to ten per cent reappear. In one case in which I removed over fifty hairs with unusual care, not a single one has Electricity and Electrical Apparatus. 63 returned after an interval of three months. In some patients the growth of hair appears to have ceased, for some unknown cause, and when the hairs are destroyed the cure is effected. In other patients the fine hairs are constantly growing larger and darker, and after the most conspicuous have been removed a new growth will in time succeed, and appear, perhaps, like a return of those previously removed. ' ' In this operation for the permanent removal of hair the ques- tion arises as to how the electricity destroys the papilla from which the hair springs. Is it by thermic or by electro-chemical action ? A recent writer on the subject objects to the use of the term electrolysis as being a misnomer, claims- that the heat gener- ated in the needle by the passage of the electricity is the active agent in the destruction of the tissue, and suggests for the operation the name of akido-galvano-cauto'y . It cannot be denied that in this operation the temperature of the needle is slightly raised by its resistance to the galvanic current, but surely not to such a degree as to produce a caustic effect. On the other hand, it is evident, from the frothing seen at the mouth of the follicle and other ef- fects, that a decomposition of the water and salts contained in the cutaneous tissues is taking place around the needle and causing the escape of bubbles of hydrogen. This is certainly nothing more nor less than electrolysis. " In conclusion, I would like to refer to the cause of facial hir- suties in females, and I shall speak briefly on this point, for I know very little about it. I have wondered and pondered by the half-hour while operating on cases, and endeavored to find some characteristic common to all of my patients, but in vain. Some are in fine physical condition, while others are debilitated. Some are extremely nervous ; some are not so in the slightest degree. Some are stout and others thin. Some are of dark and others of light complexion. Some are maidens from twenty to fifty years of age ; while of others who are married, some have children and some have none. The somewhat common idea that the growth of a beard in the female is necessarily associated with masculine traits of character is certainly not founded upon fact, for most of my patients have presented the very highest type of feminine re- finement. That facial hirsuties is dependent upon a malforma- 64 Electricity and Electrical Apparatus. tion or imperfect development of the reproductive organs, as some liave claimed, is, in my opinion, doubtful. Certainly, an intimate relation betv^^een these two conditions has not been sat- isfactorily proven, save in a few exceptional cases. " The relation of facial hairiness in females to derangement of the nervous system is a subject which has already commanded attention, but has not as yet been sufficiently studied. I have al- ready "spoken of the depressed mental condition existing in many of my patients, and which I believe to be not merely a result of the disfiguring growth of hair, but a symptom of general nervous disease, upon w^hich the hirsuties in all probability depends. Ex- cessive growth of hair, whether in the male or female, is an aber- ration of nutrition, and not a sign of excessive vitality. The Samsons of the present day are clean-limbed, and usually short- haired specimens of the human race, and in our highest type of feminine health and beauty there is but a moderate growth of hair. The lady in the museum, whose luxuriant tresses trail upon the floor, is rarely, if ever, well-developed, and, like her bearded sister, furnishes unmistakable evidence of perverted nu- trition. " An abnormal growth of hair, whether it be m respect to length or location, indicates an abnormal condition of the nervous system. Precisely what this condition may be, and how it may be remedied, I must leave for others to determine. " In the following report of cases, I have selected twelve of those in which the growth of hair was inore or less abundant, and which will serve to illustrate some of the difficulties in the way of treatment, as well as its success. " Case I. — Mrs. , aged thirty-one, married at eighteen, and has one child. Is quite stout and in fair health. Is greatly worried by a growth of hair upon chin and neck. Seldom goes out for exercise, but prefers "to sit and mope." Her sleep is often disturbed by the thought of her " misfortune." The pa- tient IS almost a monomaniac on the subject of her beard, and most of the time is greatly depressed in mind. The growth of hair upon extremities is abnormal. The facial hirsuties appeared about two years ago, and pulling the hair out seemed to increase the growth. As a proof that pulling makes the hairs grow Electricity and Electrical Apparatus. 65 stronger, she cites the fact that the hairs on the right extremity of upper lip, which she could pull more readily than on the left side, are now much more developed in size. There is no ten- tency to hirsuties among her female relations. " Applied for treatment in March, 18S0. During the summer I removed over a thousand dark hairs, leaving an abundant growth of fine pigmentless hairs, which were scarceh" noticeable at the distance of a few feet. At her earnest request, I continued to operate ui)on these and removed a second thousand or more, most of which were so fine as to constitute no disfigurement whatever, but their removal produced a marked indirect effect upon her health and happiness. In this case about twenty-five hundred hairs were removed by count. How many of these re- appeared and were removed a second time it is diflicult to say. There was, evidently, a constant tendency for the fine downy hairs to develop in size and thickness, and at times I despaired of being able to effect their removal, but after eighteen months of intermittent treatment, success crowned my efforts, and her chin and neck appeared quite smooth and natural. In January, 1883, I saw the patient, at which time there were no conspicuous han's, and she stated that she considered the operations to have been perfectly successful and that the results had far exceeded her an- ticipations. "Case II. — Miss , aged twenty-four; a tall blonde, in good health. Applied for treatment in October, 1S79, on ac- count of a growth of light hairs on both sides of chin, about an inch in length. She had consulted the eminent dermatologist of London, Prof. Erasmus Wilson, and stated that she had been ad- vised by him not to touch the hairs, and informed that absolutely nothing could be done in her case. Her extremities were quite hairy, and the hair of the head was thick and long. The hair on her chin had mostly grown during the previous year, and after a severe fever. In this case I removed three hundred hairs, oper- ating upon the left side of chin by electrolysis, and upon tlie right side by the method suggested for the mechanical destruction of the follicle, consisting in the introduction and sudden twisting of a barbed needle. In April, iSSo, the patient returned to the city, and I found tliat nearly all of the hairs upon tlie right side 66 Elkctricity and Electrical Apparatus. had returned, while there was a perceptible diminution of the number upon the left side of chin, where the electrolysis had been employed. In April I removed one hundred and fifty, and in June one hundred hairs of a finer growth than those first op- erated upon, which left the face quite free. "Case III. — Miss , a young lady, aged twenty-six; tall and of fair complexion ; in good health, though delicate in ap- pearance and inheriting a tendency to pulmonary disease. Ap- plied for treatment in December, 1879, on account of hairs grow- ing on either side of chin, which had appeared within three months. There was a very light moustache on upper lip, though scarcely more than is commonly seen. In two operations I re- moved sixty hairs from right side, and thirty-five from left side of chin. " In May, 1S80, about ten of the dark long hairs, previously operated on, appeared to have returned. Removed twenty-five from either side of chin, most of them being fine and light- colored. " In October, the patient reported that she had been free from the capillary growth during the early part of the summer, but during the past two months a few fine hairs on either side of chin had rapidly increased in size. These were removed, and as I have recently been informed by a member of her fainily, there has been no subsequent appearance of the hairs. " Case IV. — Miss , aged thirty-two, tall, of blonde com- plexion, and lymphatic temperament ; health good. Applied for treatment in June, 1880, on account of long curling hairs on sides of chin and a mole on neck. She had been in the habit of pull- ing them every three weeks. There was no hirsuties on other portions of her body, nor were any female relatives affected sim- ilarly. Her hair, a lock of which turned gray at sixteen, ap- peared quite gray in front, while the back hair was of a natural brown hue. Upon her legs a singular condition had existed for two or three years. The hair upon the tibial region, instead of being normal or in excess, had almost entirely disappeared, and the existence of many follicles, either inflamed or distended by an accumulation of epidermic cells, showed plainly that the loss of hair was the result of the affection which is known as lichen Electricity and Electrical Apparatus. G^j pilaris. The hair upon her chin had been growing for five years or more. " In June and July I removed one hundred and sixty hairs. "In November I removed eighty, inuch finer than those first operated upon. " In June, iSSi, there were but seven to be removed. *' In January, 1SS2, I removed twenty-five, which were evidently of recent development, and not a return of those previously op- erated upon. "Case V. — Miss , a maiden lady, aged forty-six; tall, thin, and of dark complexion ; health poor. Applied for treat- ment in July, iSSo, on account of nuinerous fine dark hairs upon either side of chin. She had been in the habit of cutting them close or pulling them out, and at the time of her first visit they w^ere about half an inch in length. There was no excessive growth of hair on other portions of the body. The hairs on chin had begun to grow at eighteen years of age, and she stated that a sister and two paternal aunts suffered in very much the same vs^ay. During the week in which she remained in the city I removed five hundred of the largest hairs in six operations. " In September she returned to the city with apparently as lux- uriant a growth as before, and no indication, at first glance, of any having been removed. Close inspection, however, showed a few red points, especially on upper lip, where hairs had evi- dently been destroyed. I now removed six hundred in four op- erations, including many finer hairs, and used a stronger current and far more care in operating than I did at first. "In November the number of hairs was evidently decreased, and I removed less than a hundred. "In June, 18S1, there were but a few conspicuous hairs. I removed one hundred more, however, most of them being very fine. " In October there were but seven dark hairs, which I removed with twenty-five downy ones, which appeared as though they might develop and become conspicuous. A few ininute cicatrices were visible upon close inspection. The patient has since writ- ten to me as follows : ""• The result of the operation is very satisfactory. There are 68 Electricity axd Electrical Apparatus. no hairs perceptible on lip or chin, and the few scars are not no- ticeable.' "•Case VI. — Mrs. , a married lady, aged twenty-five; quite stout, of dark complexion, and in fair health. Applied for treatment, in August, iSSo, on account of long, dark, curling hairs upon either side of chin, for which she had been recently applying a depilatory. She had a luxuriant growth of hair upon the head, and said that no female relative was affected with hir- suties. The growth of hair upon her face was first noticed at eighteen years of age. She began to pull out the hairs three years ago at long intervals, but more frequently of late. She thinfe that the epilation increased the growth, but not so much as did the depilatory powder which she used. " In twelve sittings, extending through a year. I removed four hundred and fifty hairs, one-half of them being quite fine and evincing a marked tendency to develop in size. After a six months' intei-val, the patient writes that the operations have proved satisfactory, although the growth has not been entirely removed, and a little more must be done to make a complete cure. "Case VII. — Miss , a maiden lady of forty-six; small, thin and dark ; in fair health, although of delicate appearance. Applied for treatment in October, 1880, on account of dark, curling hairs on sides of chin, and dark hairs at either end of up- per lip. The growth first appeared on lip fifteen years ago. This had been treated by applications of sulphuric acid, which had lessened the growth of hair in the centre of the lip, and given it a wider appearance than the rest of the face. The hair first appeared on chin three years ago. Her mother had four or five hairy moles on her chin. " In October, I removed one hundred and twenty-five hairs. " In the following June, iSSi, the patient returned to the city, and I removed seventy-five hairs. It must not be inferred that over one-half of the hairs upon which I first operated had re- turned, as in this second operation I removed many fine hairs which had been left. " In November there were but one or two hairs at all csonpicu- ous. These I i-emoved, with a few more fine ones, and the pa- Electricity and Electrical Apparatus. 69 tient returned to her home well pleased with the results of treat- ment. "Case VIII. — Miss , aged about thirty; tall, dark, and of extremely nervous temperament ; health good. Applied for treatment, in January, 188 1, for a slight growth of hair mostly on right side of chin, which had appeared during the preceding year. She had always noticed a tendency to a slight excess of hair upon extremities, although upon the scalp her hair was rather thin. " At two ojDerations, in January and February, I removed thirty-two hairs from chin and left cheek. " In June there were but five hairs to remove. '"In Februaiy, 1S82, I removed twenty-seven fine hairs, which were evidently a recent development and not a return of those previously operated upon. " Case IX. — Mrs. , a married lady, of about forty-five, with no children; tall, thin, and of dark complexion; health poor; applied for treatment in March, 188 1, on account of a few fine and long hairs on chin, and a fibrous mole on right cheek, from which a few hairs sprung. She had first noticed the growth of hair about three years before and had resorted to depilatories and epilation. In March I removed forty-five haii^s from the chin and inserted the needle at several points around the base of the mole, which was of the size of a split pea. In June, there was scarcely a trace of the mole and no hair on chin, save a very few fine ones which I removed. I have heard through friends of the patient since that the growth of hair was permanently removed. " Case X. — Mrs. , a young married lady of twenty-eight; of rather weak constitution, but in fair health. Applied for treatment in April, 1880, with an abundant growth of fine, soft hair on cheeks, chin, and neck, which, if allowed to grow, would undoubtedly have produced a fine, thick, soft beard. The upper lip was free from an excess of hair, and there was no ten- dency to hirsuties on other parts of the body. The growth of hair began at the age of fourteen, and there had been no percepti- ble increase during the past three or four years. For nine years she had been in the habit of pulling out the hairs at intei-vals of three days, and necessarily devoting a liberal amount of her yo Electricity and Electrical Apparatus. time to this procedure. Attempts had been made to destroy the hairs by liypodermic injections of carboHc acid, but with no re- sult save the production of a few disfiguring scars. The patient stated that her mother had a remarkably fair complexion, and that no female relative suffered from hirsuties. " During the months of ISIay and June I operated daily, and sometimes twice a day upon the patient's face, and removed up- ward of five thousand hairs. I operated rapidly — too rapidly, as the sequel proved — and removed from one to two hundred hairs at a sitting. " In October, iSSi, the patient came again to New York, and at first glance I could not see that very much had been accom- plished. She expressed her opinion, nevertheless, that the op- erations of the previous year had proven quite satisfactory, inas- much as they had lessened the growth of hair decidedly. I ac- cordingly resumed the treatment, and with the assistance of Dr. W. S. Conover removed about one thousand hairs. This left the face much smoother and more free from hair than after the first series of operations. "Case XL — Miss , aged thirty-five ; of dark complexion, and in fair health ; a teacher by occupation. Applied for treat- ment in December, 1879, with a thick and strong growth of black hairs on cheeks, lip, chin, and neck. Indeed, she would have had as perfect a beard as almost any of the women on exhibition if she had allowed the hair to grow, but for over fifteen years she had been using both a depilatory and the tweezers. Four hours at a time she was in the habit of devoting to the painful opera- tion of removing the hair. Neither her mother nor any one of four sisters manifested any tendency to hirsuties, and the patient herself did not, except on face. " During the first six months of tr-eatment I removed, with the assistance of Dr. Conover, over twenty-seven hundred hairs. During the following year about twenty-three hundred were re- moved by Dr. Conover and myself, making five thousand hairs in all. The patient is still under occasional treatment for the gi^owth of hair upon the upper lip, from which would grow a strong moustache. The removal of this is very tedious, since with a Electricity and Electrical Apparatus. 71 view to the prevention of ev^en minute scars, she only allowc ■' dozen or more isolated hairs to grow at one time upon the lip. The left side of her face, exclusive of the upper lip, is, and has been for the past eight montt^s, perfectly free from the objec- tionable growth. Upon the right side the hairs were removed v/ith less care at first, and some fine ones have been lately re- moved. There have been many minute cicatrices left by the needle, but they are of little account, and the result of the pro- longed treatment has been most satisfactory both to myself and to the patient. " Case XII. — Mrs. , a large, handsome lady, aged twenty- five, and apparently in perfect health ; married four years and no children. Her skin was unusually fine and delicate, and with the exception of fifty-seven hairs growing upon her neck and a single mole upon right side of chin, there was no tendency to an ab- normal growth of hair upon face or other portion of body. " This patient's skin seemed unusually sensitive, and as an ex- ception to the rule she complained of the pain produced by the operation. Small wheals, like inosquito-bites, were produced at the points where the needle was inserted. "These fifty-seven hairs were removed in November, 1S81. Two months later she wrote nie in accordance with my request, and stated that the red marks caused by the needle still lingered, ' but so surely did the instrument do its work that the objectiona- ble hairs seem to be permanently eradicated, not one having re- appeared. The mole on the chin has entirely gone.' " MISCELLANEOUS DISEASES TREATED BY ELEC- TRICITY. As examples of the great utility of electricity in the treatment of many stubborn diseases, we reprint the following observations from the experience of Romaine J. Curtis, M. D., of Jolliet, 111., and published in the Peoria Medical Monthly^ for June, 1882: Skin Diseases — Chromophytosis. — Mr. , aged about 23, on his travels got inoculated with the materies morbi of chromophytosis. He had carried the picture about a year whea 72 Electricity and Electrical Apparatus. I saw him. The disease completely covered the anterior half of the trunk, and there were patches of it on his back. He was directed to use a solution of chloral, an ointment of zinc, and to bathe twice a day with use of green soap, thoroughly washing away the loosened cuticle. This treatment was of no avail, and afterwards chrysophanic acid and mercurial preparations were used. Various other medicines were prescribed, and he contin- ued medication for about four months locally, and I gave him" cod's oil and Fowler's solution. The disease would clear up in places at times, or its products with cuticle be washed off by aid of green soap, and the surface of patches look clear for a time, but would soon be covered by a fresh plant. During part of this time he wore a special covering for the diseased surface, using a new one every day, my opinion being that the cloth- ing presei*ved the germs of the disease with obvious results. I began to use galvanism in this case as a sort of dernier res- sort, and because I did not know what else to do. The applica- tions were made daily, a large sponge being applied to the dis- eased surface and the positive pole at different places on the healthy skin. The disease began to disappear immediately. The skin along the median line became healthy first and extended outwards until the disease disappeared. Herpes — Shingles. — Mr. , aged 48 years, had com- plained of heart disease (intercostal neuralgia) for several years. Latterly he had an eruption of herpes zoster, covenng the greater portion of left chest. He had taken iron, arsenic, cod's oil and quinine with some benefit, and was using a lotion of cologne, glycerine and lead. The continuous galvanic current was used every other day in this case for some time without benefit. I then interrupted the current, using varieties of tension and number of cells, but the disease refused to yield until the faradic current was used, which made short work of his shingles, greatly to patient's relief, for he was impressed that should the disease extend to the right side of his spine his life would soon terminate. Eczema. — Miss , aged iS years, had eczema, covering left side of nose and portion of cheek, of four years' duration. She had been through the regular course of zinc, arsenic, iron, Electricity and Electrical Apparatus. 73 quinine, cod's oil, etc., etc., and had "tried Homoeopathy," which was found wanting. No medicine was used in the treat- ment of this case, but the galvanic current effected a cure in four months. The poles were applied indifferently, one being over the eruption, and the other sometimes behind the ear and sometimes on the cervical spine. After each seance there would be for a few hours some swelling and increased redness of the eczematous skin. Acne. — Mr. , aged 20 years, had been disfigured by acne of the face since his fifteenth year. He had a long history of mortification of spirit, sulphur baths, zinc ointment and Fow- ler's solution. The treatment of galvanism was continued at irregular intervals for six months. Each application had the effect of so reddening the surface where the sponge was ap- plied to the face, that the patient would take his dose only late in the evening — a sample of pride under great difficul- ties. He was cured, however, without lotion, ointment or medi- cine. Amaurosis. — R. M. , aged 33 years, worked in the rail mills, and was subject to extreme degrees of temperature during the " heats." He gradually became blind — could see the larg- est test type with indistinctness only at a few inches. He had naso-pharyngeal catarrh and sequent vomiting, steel scales, and carbonaceous matter was always present in the nasal and pharyngeal cavities, where they could be seen by the laryngo- scope. The patient was obliged to stop work, and was treated for his catai'rh by sprays, and his amaurosis by galvanism for six months, when he was discharged cured. The current from five or six cells was generally used, and the positive pole applied over the eye and the other over the mastoid. The current was tempered by the rheostat, so that during its passage faint flashes could be seen. In this case the retina of the eve was anaemic. Amenorrhcea. — Miss , aged 36 3'ears, had been a teacher in public schools for eight years. During past two years she had suspension of the menstrual function and occasional attacks of asthma. She was plethoric ; of good appearance physi- 74 Elfxtricity and Electrical Apparatus. cally, and complained of no local pain or other sensory disturb- ance. I suppose, in the light of modern pathology, her dis- ease would be called neurasthenia, of some set of motor or gland nerves. She declined a pelvic examination, and I recom- mended galvanism for the amenorrhoea. The current was passed from the lumbar region through to ovaries. The seances were held twice a week, and during the sixth week of treatment the menses were restored, which had the effect of stopping the asthma. Lead Poisoning. — Mrs. , aged 33, married four years, no children ; was a fashionable person of most intense jDcrsonal vanity. She was a perfect specimen of neurasthenia ; the an- tecedents and sequences of this disease wei^e all there. She was even subject to hay fever. She had uterine disease, and had been subject to the silver treatment for a year or two by an eminent gynecologist of Buffalo. She had "wrist drop," which was very noticeable when I made my first visit, and I suspected the cause of her abdominal pains ; which suspi- cion was confirmed by an inquiry in this direction and the exhibition by her husband of her large collection of hair washes and cosmetics, all of which contained lead. The patient had been bed-ridden for several months. Her cosmetics were disposed of; iodide of potash was given, and general farad- ism employed daily for a month, when she recovered from her neurasthenia, and resumed her social standing without the aid of lead. Lumbago. — Mr. , a carpenter, strained his back by work- ing on a cornice, and was placed liors de combat by pain in his back when he attempted to move. His appearance and move- ments were such as are always exhibited by the lame back. He came to the office three times, and a current of sixty cells was passed through the painful part, about fifteen minutes each time. The relief was marked at each dose of the remedy and the cure prompt. Mr. , aged about 40 yeai's, a rheumatic subject, was brought to my office and carried in groaning from pain, which was referred to the lumbar region. This case illustrated the exception which proves all rules. I applied the galvanic current. Electricity and Electrical Apparatus. 75 with very large quantity, with greatly lessened intensity, fully ex- pecting to stop his pain and groaning in a few minutes. To my surprise he complained of an increase of the pain, and in a few minutes fainted. When he recovered he refused to allow further galvanization and would not take medicine. He was taken home and a physician sent for, who gave him morphia, and sympathized with him by remarking that " electricity was a humbug anyhow" —an opinion to which the patient gave his free assent, and I sup- pose they are both of the same opinion still, and that each of them knows as much about it as both, and both of them as much as either. Rheumatism. — Mr. , aged about 30 years, a laborer, native of England, had muscular rheumatism of the right leg. The muscles were tender, swollen and paretic, and he went and came on crutches. There was no evidence of venereal disease. The patient had a gouty ancesti"y, and the exciting cause of his own disease was working in a wet ditch. He had suffered from this disorder for sevei'al months, had taken several inedicines, and received some benefit from iodide and colchicum. He was sent to me by a physician who was somewhat undecided about the hum- bug of electricity, and was disposed to investigate. The patient's foot and leg and the negative pole were put into a vessel of warm water, the positive pole being applied to the leg higher up. This treatment was continued daily for two weeks, when patient was discharged cured. Indurations. — Mr. , aged about 60 years, had acute rheu- matism, which lasted two months. He was treated by salicylate of soda, which failed, as he could not take it without insanity, and he was brought through by the alkaline treatment. On sub- sidence of the acute symptoms the tendons of various muscles in upper and lower extremities were subject to indurations, which showed no disposition to absorb. He was given iodide and col- chicum without much benefit, the enlargement of the hamstring tendons and tendons of ankle joints and wrists being thick and painful. He remained without much improvement for two months, when he was brought daily to the office for galvanic treatment. The different indurations were treated separately by passing the galvanic current through them. The treatment was continued ij6 Electricity and Electrical Apparatus. daily and every third day for three months, when the indura- tions of the tendons were absorbed and the normal functions restored. Mr. , aged 37 years, a merchant, sprained his ankle se- verely, which injury was followed by an induration of the tendo Achilles. The tendon in lower half of its length was more than double its natural thickness. This deformity was treated every other day for a month with the negative pole attached to a roller electrode, thus combining the electrolytic effects with massage, a very convenient and efficient method. The tendon was restored to its morphological and physiological integrity. N^EVi Materni. — Miss , aged 13, had a port wine mark on her left cheek about the size of a dime. The natural beauty of the anatomical deformity was somewhat deteriorated by sev- eral applications of some sort of caustic, which had, however, not removed it. Three fine needles were inserted through the nsevus, carrying the negative pole, and the positive was placed near by on the sound skin. The current from the cells was used ahout five minutes. In a week the operation was repeated, and the ncevus disappeared. Miss , aged 16, had a prominent, raised, purple najvus on the left cheek ; a physician had attempted its removal with a fara- dic machine, and afterwards applied caustic, and then suggested cutting it out. In this case four electrolytic apjDlications of galvanism were used, which removed the mark. Mrs. , by some slip of the embryonic tissues, had a spot on her left upper lip about half an inch in diameter, from which sprang a vigorous growth of hair. I undertook to destroy the hair follicles in this case, and succeeded after the following inethod : A small needle (negative pole) was pushed into the fol- licle beside the hair and held in position about five minutes, the lady holding the other electrode in her hand. Five or six hairs were thus abused at each seance until the whole crop was removed. This is an operation which is tedious and very use- less, unless there is considerable beauty behind the unnatural growth. It is, however, a very satisfactory operation for the patient. Local Atr JPHV. — Mr. received an injury to the shoul- Electricity and Electrical Apparatus. 77 der in a railroad accident. There was nothing of dislocation or fracture, but the injury was followed by ati'ophy of the del- toid muscle. There was no antecedent paralysis; but the muscle, what ^vas left of it, would contract by volitional stimulus, though there was not force enough to raise the arm from the body to a level with tlie shoulder. The faradic current was used in this case witli the roller electrode for three months, the applications being made two or three times a week, when tlie muscle was re- stored in form and function. Mr. , about a year before I saw him, was thrown from his horse, striking on the back of his right shoulder. The arm was useless for several months from pain and paresis. On exami- nation the spine of the scapula was his most prominent morpho- logical feature, by reason of the atrophy of the inuscles above and below. Electricity, faradic and interrupted galvanic, with massage, were used for this deformity for a year with the result of making restoration, which, though not complete, was serviceable. Mr. , aged 23 years, had typhoid fever, the duration of which was six weeks. During convalescence he over-fed and was relapsed for nearly two months. He finally recovered from this illness, and rapidly gained his average weight of 170 pounds; but three months afterwards his gait was ataxic, for the reason that he had lost sensation of his legs and feet. There were no pains in legs, nor other evidence of tabes, except diminished sen- sation. The faradic current was used in this case, and fully re- stored the sensation of legs in a month's time. The applications were made daily by placing the feet in a bath containing one pole, while the other was applied on the extremities above — to the spine or held in the hands. THE WRONG CURRENT. From the proceedings of the New York Medical Society, and published in the Medical Record^ we glean the following im- portant items, which entirely agreed with our own observations. Dr. Rockwell thought that the mistake could be best pointed out by repoi'ting a few illustrative cases, from a score or more that might be narrated : 78 Electricity and Electrical Apparatus. Mrs. — , an opera singer thirty years of age, was sent to him by Dr. J. B. Read. Several months before, while singing in public, she was suddenly attacked with left /acza/ paralysis. The eye refused to close ; she subsequently suffered from severe ceph- alagia and marked vertigo. The physician to whom the patient first applied prescribed electricity, used it a few times, and then directed her to buy a small faradic apparatus, and apply the cur- rent along the course of the affected nerve. This was done faithfully for many weeks, but with negative results. On exain- ination, no response, as might have been expected, could be ob- tained by the use of the faradic current. Galvanism, however, at once produced faint contractiojis, and three weeks after the proper treatment was begun, farado-muscular contractility re- turned, and recovery to a good extent had taken place. Case II. — A boy, four years of age, suffered from cerebro- spinal meningitis, which was followed by complete paralysis oj the right leg.- The patient was sent to Dr. Rockwell by Dr. Chauveau. Before Dr. Chauveau saw him a physician had re- commended the faradic current, and it had been used faithfully, but without benefit. On examination there was no response to faradism, and only slight reaction to galvanism. Under the sys- tematic use of the galvanic current, however, improvement be- gan, and farado-muscular contractility was finally restored. The improvement in the power of locomotion was coincident with that of the electro-muscular contractility. Dr. Rockwell thought there could be no doubt that in both these cases the fail- ure to correctly differentiate in the selection of the method of treatment not only interfered with the rapidity of recovery, but in one instance, at least, might be the cause of some permanent disability. Electrical Conditions of the Muscles in Facial Paral- ysis. — In facial paralysis the farado-muscular contractility is ei- ther normal or decreased, but the galvano-muscular contractility may in addition, in certain cases, be increased^ while the reac- tion to the faradic current in the same cases is either wanting or very much diminished. In these cases the galvanic current must be used with increasing strength, at each sitting, in order to keep up the vigor of the muscular contractions when galvano-muscu- Electricity and Electrical Apparatus. 79 lar contractility is reduced to normal, or sometimes before farado- muscular contractility becomes manifest, and a rapid recovery usually follows. Dr. E. C. Seguin said, with 'regard to the use of the actual cautery^ that his experience was veiy much in accord with that given by Dr. Rockwell, Occasionally remarkable results were obtained from one or two applications. He had found it very sei"viceable in exceedingly painful cases, as well as those of the character described. "With regard to the simplicity and painlessness of the applica- tion, he entirely agreed with Dr. R. Sometimes considerable argument was necessary to induce a patient to submit ♦^o the first ai^plication, but he had not had any ti^ouble whatever concerning the second operation ; indeed most patients returned of their own accord and asked for the use of the cautery. The question of the utility of the tivo elcctj-ic currents he regarded as a very im- portant one. But he thought it possible that in one of Dr. Rock- well's cases at least, if it had been left to nature, the patient might have recovered withoiit electricity. It was probably a case of jDaralysis from lesion of the nerve, whether from super- ficial pressure or from reflex action upon the nucleus of the nerve was uncertain, but there were good reasons, from clinical history and from electrical reactions, to assimilate it with cases of ordin- ary nerve injury. In such cases he thought there was a fatality in the degeneration and regeneration of the nerve, and he doubted very much whether measures commonly used had greatly to do with recovery. The process of regeneration is much slower than that of degeneration, but it takes place with a great deal of cer- tainty, and in a majority of cases of facial paralysis the recovery was through the process of repair of the nen^e, and the conse- quent repair of the muscular tissue. He agreed entirely with Dr. Rockwell that the faradic current was next to useless for several weeks or months, and he also doubted whether galvanic applications had much to do Avith recovery. The changes in the electrical and nutritive state of the muscular fibres produced bv the application might do something toward keeping up the nu- trition of the muscle, and presen'c it in a condition fit for action when the nerve had improved. He did not, however, believe that electrical currents could hasten cell Apparatus. These illustrations are from electro-plates furnished by James W. Queen & Co., Phila. We have a full supply of all these instruments, and take great pleasure in exhibiting them to physi- No. 1. No. 2. Nos. and 3. cians who are sufficiently interested in electro-physics and elec- tro-therapeutics to give us a call. While handling these instru- ments actually furnishes us with first class amusement, this entertaining feature of electricity is the ver}^ smallest part to be considered. In point of real therapeutic value, no agent in exist- ence can take the place of electricity in thousands of cases. What is required is careful observation, study and practice, an<^ Electricity and Electrical Apparatus. 135 Ho. 5. No. 8. No. 9. No. 10. No. U- we may afford relief and actually cure many stubborn cases of disease that have heretofbre baffled the skill of the wisest physi- cians of all ages. These observations and clinical experiences should be suffi- cient to enable any intelligent physician to ap^oly static electricity when it needed. STATIC ELECTRICITY AND OZONE. When a static electric machine is in action and sparks are pro- duced, a peculiar odor is perceived in the room ; this results from the conversion of a portion of the oxygen of the atmos- phere into ozone, just what takes place in the heavens during a thunder storm. No uneasiness need be suffered on account of any bad i^esults that might come from this peculiar odor, for its tendency is to purify the surrounding atmosphere, drive away infection, brace up and really invigorate those who inhale it. If used for no other purpose, a static electric machine in a house, where it is operated more or less daily, is worth all it costs for the generation of ozone as a sanitary measure. 136 Electricity ax.o Electrical Apparatus. THE ELECTRO-MAGNET IN EYE SURGERY For the pui'pose of removing small particles of iron or steel from the eye, where they are on tlie conjunctiva or imbedded in it, or even where they penetrate the coats of the eyeball, the electro-magnet is of inestimable sendee. Such cases really be- long to eye surgery, but general practitioners are frequently called upon by men who work in foundries, manufactories, nail and chain shops, to have "motes" taken from their eyes, and it is very convenient for both parties if we happen to be pre- pared to render the sei'vice required. Some of these cases are very simple, and the foreign substances may be removed readiJii Fig. 32. wi5"h common forceps, or wiped off with any blunt instrument. Other cases, however, may give us much trouble. The iron or steel scales may adhere so tenaciously to the tissues, and be so situated, that their removal with ordinary instruments inay be impossible ; at least we may be unable to remove them without doing great violence to the eye. It is in such cases as these that the electro-magnet serves a better purpose than anything else. The prniciple upon which this operating instrument is con- sti'ucted is this : A piece of soft iron is conveniently shaped into an electrode, and before we operate with it, and zvhile ivc are operating^ this instrument is included in a galvanic circuit, and thus converted into a temporary but powerful magnet. While in a magnetic condition thi<; electrode is placed upon the Electricity and Electrical Apparatus. ^37 offending scale of iron or steel, which adheres to the magnet, is readily dislodged, and easily removed from the eye by simply withdrawing the magnetic electrode. Fig. 33 represents a practical instrument for the purposes named. It was designed and put into operation by Prof. J. O. Stillson, M. D., of Evansville, Ind., who has used it very suc- cessfully in many instances. We have had our instrment-maker make us one of these electro. magnets for our own use, and its capacity for lifting metals is simply wonderful. Small metalic objects are drawn from quite a distance by it. This electrode, or operating instrument proper, as seen in the above illustration, consists of a rod of soft iron one-half inch in diameter and three inches long, terminating in a screw-head or socket, to which may be joined at pleasure either a straight or curved point; and for convenience of manipulation, several of different sizes and styles of point applicable to the various emer- gencies likely to arise may be used with this instrument. Two are shown in our illustration. For small particles upon the coi'nea, unless deeply imbedded, a blunt point, having a flattened bulbous termination, will be found most suitable. When contact is effected between the foreign body and the point of the magnet, a distinct tone or metallic noise is heard, faint, to be sure, but readily perceptible, t.id generally the larger the body the more distinctly the sound. Cases Reported by Prof. y. O. Stillson. — "I. — R. N., aged 26, smith. While working at his anvil in attempting to cut a piece of cold iron, received a wound in the right eye, caused by a sliver of steel from the chisel. " When I first saw the patient there was a corneal wound in the upper portion of the low and outer quadrant. The wound was of a linear character, about one-sixteenth iiich long, and from without and downwards, upwards and inwards. " Anterior chamber full, and by oblique illumination a slender piece of metal was observed occupying the lower and outer por- tion of the bottom of the anterior chamber. " Patient said that piece had stuck in the eye, and some fel- low workmen had attempted to remove it with a silk handker- chief, thereby pushing it into the eye. " My first impulse was to make an irridectomy, as the foreign body was visible and as the corneal wound was scarcely per- vious, but as the accident was so recent, I felt justifiable in 138 Electricity and Electrical Apparatus. attempting removal ^vithout harming the iris, and therefore selected the magnet as the best means. " Having chlorofoimed the patient, who was extremely ner- vous and unruly, I enlarged the wound somewhat with the point of a Graefe's knife, permittmg the aqueous to escape. I next nitroduced the curved point of the magnet barely within the chamber and towards the sharp end of the sliver, which was lying downwards. ''Presentlv the point of the sliver approached and attached itself to the magnet, the contact being plainly felt, but no sound heard. The instrument was slowly withdrawn, and when the point of the foreign body was well through the cornea, it was seized with a pair of forceps and withdrawn. " The subsequent treatment consisted of atropine, etc.; and with slight iritis and very little corneal trouble, the patient made a good recovery, leaving a slight cicatrix in the cornea at the site of the wound, but no prolapsus of iris. " Case II. — March 15, 1S81, J. B., aged 22, file-maker, pre- sented himself for treatment twenty-four days after accident. "Upon examination found corneal wound one-eighth inch long, slightly above pupil. Aqueous cloudy ; iris adhered to capsule in upper outer quadrant; remainder of pupil dilatable with atropine, showing lens in state of swelling and nearly opaque, translucent, with body visible at lower margin of uppei edge of pupil ; iris apparently transfixed, but point of foreign body, to which iris adheres, not perceptible from above. Upon widely dilating the pupil the iris adheres by a mere thread. Ansesthetic, ether : tension of eyeball greatly exalted ; puncture in cornea made with a lance-shaped knife ; aqueous ejected from chamber with great force. Oblique illumination reveals situa- tion of foreign body. Introduction of magnetic needle no effect upon the foreign body until magnet was made to touch it, where- upon a slight sound perceptible. Upon attempting to withdraw magnet, contact broken, body remains. " Second attempt also unsuccessful; but upon making third attempt the adhesion gave way, and the removal was effected as in the preceding case, the last part being facilitated with the use of the forceps." .Other interesting cases of a similar character are reported by Prof. Stillson, but these are sufficient for illustration. That this is a practical device may be seen at a glance, and it w^ill be found exceedingly useful to the general practitioner, especially if he happens to be located near manufactories or foundries. Where simply upon the conjunctiva metallic substances are removed almost instantaneously with this instrument. * Electrici'^y and Elkctrical x\pparatus. 1.39 Any style of galvanic battery may be used with this instru-- ment, so it gives a current strong enough to magnetize the soft lion rod of the electrode. One Bunsen cell is amply sufficient. But if we have a Stohrer, Mcintosh, Bartlett, or any of the gal- vanic batteries in common use, we can attach this electrode to any of them, and from four to six cells will be sufficient to operate this electro-magnetic electrode with entire satisfaction. ELECTRICITY IN SEXUAL WEAKNESS AND IMPOTENCY. Slight sexual disturbances, and conditions bordering upon a total loss of sexual power, are frequently met with, and we occasionally see a case of complete impotency. Patients suffering from sexual weaknesses behave quite differ- ently ; in fact, the conditions are very unlike in most cases, and a description of one cannot be relied upon as a true history of another. For these reasons it is not safe to prescribe for new cases at a distance. We should see each patient, make a careful examination, and obtain a correct histoi'y, if possible, before we prescribe. And in the majority of instances we want our patients of this class under cxir immediate, daily observation. At least this is the best for a while — till we are certain a cure is in progress, and that the treatment can be carried on at a distance, at their homes, as well as with us. Men, young and old, married and single, come to us com- plaining of peculiar troubles, and we frequently find them sr.l- ering from a sexual weakness of some kind. They sometimes know the nature of their trouble ; occasionally they do not. Some have not the same keen desire for sexual intercourse en- joyed in former days. They sometimes fail in executing or com- pleting the act of sexual congress ; or they are over-sensitive, and barely come in sexual contact with the opposite sex when suddenly an imperfect, unsatisfactory orgasm quickly terminates the intercourse, the virile organ at once becoming flaccid and totally incapacitated for further efforts at copulation. In some cases an erection is impossible. Some of these joatients complain of dull headache, suffer from 140 Electricity and Electrical Apparatus. forgetfulness, pain in the back, palpitation o£ the heart, dyspep- sia, weak or dizzy spells, cold hands and feet at certain intervals, and horrible feelings of impending danger are sometimes suf- fered. Under such circumstances, the countenance wears an anxious expression, mixed with an appearance of distress and melancholy. Tired feelings, loss of ambition, drowsiness, and yet an inability to sleep, are not infrequent symptoms of sexual disturbances. Now, the treatment of these cases should engage our serious consideration. Men value the sexual function highly, and an impairment of this kind, especially a condition approaching a total loss of power — impotency — not infrequently leads good men to ruin. They are apt to lose all interest in business, fam- ily and friends ; are likely to dissipate, and sometimes are tempted to commit suicide. For these reasons, and knowing that we can, in so many cases, completely restore these patients, and greatly relieve others, we urge prompt, radical and per- sistent treatment in every case of this kind we meet. So far as relates to the moral and medical treatment of this class of cases, our literature is abundant. Rest, abstinence, temperance in all things, and the judicious use of coca, strych- nia, phosphorus, and sometimes the bromides, are the princi- pal means recommended. But in the judicious use of electricity, in the proper form, and rightly adapted to each case, we have one of the most important, if not the very best therapeutic measure now available, in all cases of sexual weakness and im- potency in the male. But it must be used with judgment, and applied with a skilled hand. Accidental cures may be wrought by the empirical use of electricity, but, while this may be the case, we should remember that great harm may result in other cases by its unskillful application. Where its judicious em- ployment does not radically cure., it frequently helps materially, and by the aid of other remedies many excellent cures are made. The proper use of electricity, the particular form and current to employ in each case of sexual weakness, and how to apply them as material and radical means of cure in this class of diseases are the principal ahns of this chapter. Electricity and Electrical Apparatus. 141 Upon this subject, Wm. F. Hutchinson, M. D., of Provi- dence, R. I., in the New England Medical Monthly^ gives us some practical suggestions, as follows: " Electricity has been employed for a long time in these cases, until quite lately by charlatans alone, and even in their hands has yielded good results. It is to call attention to a few points, which are perhaps novel in the application of the currents to the generative organs, that this article is written, although the long preamble might easily have led to another opinion. Early hi my special study of electro-therapeutics, in 1S74, the idea occurred to me that faradisra could be applied to the male generative organs in a better way than by manipulation with rheophores or the electric brush. I therefore devised a special electrode, in the shape of a cylinder of metal, within which plays a piston, the rod of which is surrounded by a weak spiral spring, bearing upon the inside of the closed end of the cylinder. Resting upon the piston is a pad of surgeon's sponge. The tubes are made of different diameters, varying from | to 2 inches — and from 3J to five inches in length, and during the operation surround the penis, the sponge pad, moistened with salt water, pressing against the glans. The current should be exceedingly fine faradism, i. e., of rapid interruption, of high tension, and fair quantity. In other words, it should be as strong as the pa- tient can bear without pain and without shocks. Applied in this way, with a large negative sponge electrode at the back, under the lumbar vertebrae, the patient comfortably recumbent, the re- sult is a strong stimulation of those branches of the sacral plexus composing the genito-urinary tract, and a corresponding increase in muscle nutrition. The penis becomes turgid, the dartos con- tracted, and a close watch must be kept upon the patient, lest, by continuing the application too long, an emission be produced. By discontinumg the current after five minutes, or by increasing the electro-motive force until it becomes painful, this result may be avoided. By a steady persistence for several months in this form of treatment, I have succeeded in rescuing several patients from that worse than death to a sensitive man — a life of lost manhood. The applications should be made daily. "In cases of nocturnal emissions, a directly contrary course must be pursued, since the conditions are opposite, at least in a certain sense. There is as yet no loss of virile power — there is an intense hyperaesthesia of the genito-urinary tract, which re- quires no stimulus, which is directly injured by it. No tonics, beyond the general ones of out-door exercise and plentiful food, can be depended upon ; for they tend to aggrayate the irriration of the excited nerve centers. For this reason, faradism is inad- 142 Electricity and Electrical Apparatus. missible. I think that far more injury than good has followed its use, and abandoned it wholly in my own practice in these cases several years since. In its place I use galvanism, derived from a battery of low tension — some modification of Daniell's element. It is applied by a Newman's urethral electrode, with olive tip large enough to gently distend the urethra. This is passed into the bladder, and the circuit completed through a hand electrode, when it is slowly withdrawn, the whole opera- tion lasting about one minute. If the slightest pain is expe- rienced, the current is too strong, and should be modified until only a sensation of warmth is perceived. This operation should be repeated daily for several weeks, and has been, in my practice, productive of the happiest results. One case, now under treat- ment, in the eighth week, reports emissions reduced from three or four weekly to one in eight or ten days." Dr. C. L. Dana, one of the leading neurologists and electricians of New York City, in the Medical Record furnishes us with the following pi'actical points : " We have, I think, in electricity, an agent by which direct se- dation of the over-irritrdole nerve-centers can be obtained. In a case of irritable sexual weakness with premature emissions, the patient after a few applications of my spinal electrode was greatly improved, though electricity had been tried before for a long time in vain. " I have here a special appliance for the treatment of sexual nerve-weakness. It was devised by Clemens, of Frankford, and was used upon a most obstinate case of impotence, a case which had been in the hands of many prominent neurologists of New York. The patient rapidly recovered, and is now a new man. This, which I know to be a fact, is my excuse for showing the apparatus, which apparently has a good deal of hocus-pocus about it. ''It consists of a zinc cylinder, made to enclose the penis, with a funnel attached, so that it can be filled with Rhine wine or weak alcohol. The positive pole is connected with it, and the negative pole, which is attached to a very large electrode, is placed over the spine. It is to be used three times a day for five or six minutes, a current of five to eight cells being employed. It is supplemented with a set of magnetic apparatus which seems to be of subsidiary importance. There is no doubt that the patient gets the sedative effects of the galvanic current very thoroughly. I am at present treating a case with it. The pa- tient, who is a very intelligent man, in fact a doctor himself, was very decidedly improved, and is indeed now almost well." Electricitv and Electrical Apparatus. i'43 These appliances, as described and used by Drs. Hutchinson and Dana, are certainly effective. We have not used their exact pattern, but have a similar device that, in some respects, we pre- fer to then-s. We like the results of its use very much There IS something-yes, I will say there is a great deal, in properly localizing electrical treatment. ' i ^ ^ Prof. Wm. A. Hammond, M. D., in his very excellent work, Sexual Impotence in the Male," makes some very practical observations regarding the use of electricity, and we take pleas- ure in making some verbatim quotations from his work A young man, the first morning after marriage, called upon him, in utter despair, with the information that he was impotent : "Continual questioning led to the information that his desire had been moderately great, but that his sexual powei lad been utterly vvanting. There had been no erection, or ^ approach to one, and the result was that after manv attemnf. ?f- '^1'^'°'^'^'' ^^ in the expectation that success woulc "i;tt'i:^r he effonf 1^^ desisted, had gone to sleep, and during the night had had two .•::^f:^-\i^:^i^- s^ v;z:tz^:^-^-z sexual mtercourse should be made and thnt In ! '^\ ,"'I'^' P^ 144 Electricity and Electrical Apparatus. enjoined the use, morning and night, of cold baths, with friction of the whole body after each with coarse towels. He was also to walk at least five miles every day, and to go to some place of amusement of a cheerful character every evening. Internally his food was to be of a highly nutritious character, of which fat in some form or other, preferably cream, was to constitute a large proportion. His dinner was to be taken not later than two o'clock, and a couple of glasses of Burgundy were to be drunk with it. For medicine I prescribed the following: B. Sodii bromidi, s'l. ; pepsin (Fairchild's), pancreatin (Fairchild's), aa 3 iss ; glycerine, aqute, aa 5 ii. M. Dose, a teaspoonful in a little sugar and water three times a day after meals. "My objects in giving this mixture were to lessen the reflex and automatic excitability of the genei'ative system, to relieve the cerebral hyperaemia, and to promote the digestion of food. " At bed-time he took a capsule of five grains of the mono- bromide of camphor. " Every morning I applied statical electricity to the penis and testicles, and to the whole length of the spinal cord, drawing inch sparks from the former organs, and from three to four inch sparks from the spine. This was continued for about fifteen minutes. Though painful the effect was all that could be de- sired : the blood-vessels of the penis became visibly distended, and the whole organ assumed a deeper red color than it had possessed, as he said, within his recollection. For several hours afterwards a warm pleasant glow was felt in the penis and scrotum. " Tw'ice a week I applied by means of a urethral electrode a galvanic current from eight cells to the membranous and pro- static portions of the urethra, with the object of diminishing the morbid excitability. which evidently existed in those parts. I may say that examination with the sound had previously demonstrated the hypergesthectic condition of the parts in question. I had at first thought of cauterizing them with Lallemand's instrument, but decided upon the galvanism as being the less painful and equally or inore efficacious. In very severe cases, however, Lallemand's procedure is preferable. "Under this system of treatment the general health of the patient began to improve from the first. The nocturnal emis- sions ceased entirely on the fifth night. On the first night he had one, but without a dream ; on the second, two ; on the third, none ; on the fourth, one ; on the fifth, none, and there were no more while he was under iny observation. "On every night after the second he slept from six to eight hours, and in the morning he awoke refreshed and cheerful. On the morning of the eleventh day he had an erection, which, how- Electricity and Electrical Apparatus. 145 ever, was due to a distended bladder, but which nevertheless was the first of the kind he had experienced for several years. " On the fifteenth night he had a lascivious dream in which the usual images did not appear, or, if they did — and upon re- flection he was a little doubtful on the point — they were much less distinct than they had been. They were not accompanied by an emission. The next inorning he had another erection accom- panied by a slight desire, and every morning thereafter while he remained under my care he had an erection, sometimes with and sometimes without sexual desire. "• He had now been two weeks under treatment, and the gen- eral results may be summed up as follows: " Sound sleep every night. " Freedom from pain or other uncomfortable feeling in the head. " A strong, hearty appetite, with good gastric and intestinal digestion. "Cessation of the nocturnal emissions and of the lascivious dreams. "A return of the matutinal erections, and of normal desire in connection with them, " Frequently during the day desire with erections. These, however, were not as yet strong, and I continued my prohibition in regard to attempts at intercourse. " On the fifteenth I suspended the administration of the bro- mide of sodium, continuing, however, the mixture with the other ingredients unchanged ; and in addition I prescribed the follow- ing solution : R. Strychnine sulph., gr. j ; acidi hypophos, dil., § j ; M. ft. sol. Dose, ten drops three times a day before meals in a teaspoonful of the fluid extract of coca. " I gave this mixture for the reason that I know of no better tonic for the sexual organs, after the abnormal state of erethism into which they gej: by abuse has been relieved, than strychnia, hypophosphorous acid and coca. It is necessary, however, not to give it iminediately before going to bed, as without this pre- caution it may produce seminal emissions. " From this time on his condition continued to improve. He had gained over ten pounds in weight, was getting stronger every day and more cheerful, and altogether more normal in his mind. His erections were occasionally tolerably strong, but, as a rule, though he had several every day as a consequence of the very vivid desires which he experienced, they were not yet by any means of natural strength. He was very desirous of going home, being convinced that he could carry on all the treatment but tlic electric as well there as in New York. This was probably true, but as I attached a great deal of importance to this part of the man- 146 Electricity and Electrical Apparatus. agement of the case, I declined to give my consent. He had now been under my charge twenty days, and I felt confident that a week or two longer would complete the cure. On the night of the twenty- first day his wife left her bed and got into his, and he, in disregard of his pledge, attempted intercourse, and with a measurable degree of success. I judged, however, that the emission was premature. The next morning he was filled with remorse, and not only re- newed his pledge, but promised, in addition, that his wife should go home and prepare the house for his return. This, however, was not what I wanted. I desired her presence, under restraint, as a constant stimulus to him, but I did not want things to be carried to extremes again till he was strong enough to act his part in a physiological manner. There were, I have reason to believe, no further infractions of discipline. On the night of the thirty-second day he attempted intercourse with my partial con- sent. I knew he would do better if I allowed him to make the attempt with seeming reluctance than if I gave him full liberty to do as he pleased. In sexual matters, as in many others, the desire and the power are stronger with forbidden fruit than with that which can be had for the asking. The end fully justified the means, for he informed me the next morning, with great satisfaction, that I was over careful with him, and that he be- lieved he had done all that could have been reasonably expected of him. "I then allowed him to go home, but continued all the treat- ment, excepting the electricity and the nightly dose of the mono- bromide of camphor. I thought he ought to continue the whole system, with the exceptions mentioned, for three or four months. "And I warned him in the most solemn manner that, under no circumstances, was he to have sexual intercourse more fre- quently than once a week for at least a year, and ])erhaps even longer. Alore than a year has now elapsed, and I have every reason to believe that he has strictly followed my injunction. Rewrites that he is determined not to go beyond the limit fixed, that his happiness is complete, and that neither he nor his wife are willing to exceed those moral and physiological bonds which nature has imposed; that she is pregnant, and that they both look forward to the birth of the child as a sign that God has for- given him the sins and indiscretions of his youth." Regarding the use of electricity in cases where there is ab- sence of the power of erection, under the heading of " external remedies," we quote from Dr. Hnmmond as follows: '■'■ External remedies. — First among these, and ranking high in the list of remedies, is electricity. " This agent is employed under three forms — Galvanism, Far> Electricity axd Electricai, Apparatus. 147 adism, and Franklinism. In using galvanism the only rule in regard to the strength of the current is to bring into action as many cells as will produce a decided sense of discomfort to the patient. The electrodes should ordinarily consist of wet spono-es, and the application should be made to the spine, the perineum, the testicles through the scrotum, and the penis. '' In applying the current to the spine, the whole of the verte- bral column may be embraced within the circuit, though greater attention should be given to the lower dorsal, the lumbar and the sacral regions. I usually first apply one electrode — it makes no difference which — to the nape of the neck, and then stroke the back over the spinous processes with the other for three or four minutes, using a current strong enough to cause a considerable sensation of warmth and to produce redness of the skin. Then the upper electrode is placed over the middle of the dorsal re- gion, and the other moved slowly down over the parts below^ a dozen times. The effect of the application is rather unpleasant, than otherwise, and the back continues to feel a sensation of warmth for an hour or more afterwards. ''Then one electrode is placed over the sacrum and the other on ihe perineum, and both are kept in their position for about a minute. A current of somewhat less strength will be advisable for this application, as the patient will not generally endure one so strong as that used for the spine. "la making the application to the penis externally, one elec- trode may be placed on the perineum, and the other on the glans, the latter being removed every five or ten seconds, or the current broken by the arrangement for that purpose on one of the electrodes. Two or three minutes are sufficient for this purpose. "It is sometimes the case that the impotence depends in a great measure on an ansesthetic condition not only of the glans but of the whole penis. In such a case the electrode should be passed over the w hole organ, and the strength of the current should be such as to cause considerable discomfort if not actual pain. " In those cases in which nocturnal emissions are frequent and the erethism is so great that emissions take place without erec- tion or on slight provocation, it is sometimes necessary, to apply the electricity to the interior of the organ. A special electrode is necessary for the purpose. It is made of some non-conduct- ing material, except at the very extremity, which is metallic and is in connection with a wire running through the instrument and attached to one of the conductors leading from the battery. This electrode is introduced into the urethra, and the metallic point brought into contact with the orifices of the seminal ducts or to 148 Electricity and Electrical Apparatus. the prostatic portion of the uretlira, as the case may seem to re- quire. As a remedy for nocturnal emissions or analogous conditions it is far superior to the cauterization recommended by Lallemand, and far less painful. " The application of galvanism in this manner is also ex- tremely useful in cases of nervous exhaustion, or in paralysis of the erector muscles of the penis, the accelerator urinae, etc. In this internal use, the other pole — the sponge electrode — should be applied to the perineum, the sacrum or the pubis, or alter- nately to each of these regions, so as to send a current through the penis in all directions. The strength of the current need rarely exceed that from four or six Leclanche cells, and it re- quires to be frequently interrupted to avoid too great a degree of irritation. " In applying galvanism to the testicles, care should be taken to provide that the current be not too strong, that from four or six cells being generally amply sufficient. Very intense currents cause a good deal of pain and may induce syncope, an accident which has occurred in my own experience. But the beneficial effects of this use of the agent are often very decided, even after the organs have begun to become soft and to enter upon a state of atrophy. The nutrition is improved and a condition of greater firmness induced. With these changes a return to sexual health is often initiated. '•'■ Faradisjn is also of great value in the form of impotence under consideration. Its mode of use is not essentially different from that of galvanism, except in certain respects to be noted. " In applying the current to the spine, one of the electrodes should consist of the wire brush ; the other, a wet sponge is placed high up on the neck, and the wire brush is carried down the spine slowly, the action being repeated a dozen or more times. The operation is a very painful one, but the reflex stim- ulating action is very decided. The nutrition of the cord is im- proved, its normal degree of activity I'estored and the cui'e of the impotence materially facilitated. " For the relief of the anaesthetic condition of the glans, which sometimes is a cause of the non-excitability of the penis, one pole, the wet sponge, is placed over the lumbar or sacral region, while the other, the wire brush, is placed on the glans. A mild current is used at first, and this is gradually increased as the patient becomes more used to it, till one of considerable inten- sity and causing decided pain is reached. The object is to make a marked inpression on the terminal extremities of the nerves of the part, and this cannot be done without exciting more or less pain. Two or three minutes are enough for this application, which, however, ought to be repeated, sometimes daily, and at others every alternate day. Electricity and Electrical Apparatus, '49 "For application to the interior of the urethra the faradaic current is useful, though in general not as desirable a means of employing electricity as the galvanic current. An electrode of the same kind as that previously mentioned is introduced and being attached to the induction machine a current is passed as in the other instance. " Faradaic currents employed in the ways referred to should be frequently interrupted. Slowly interrupted currents are of httle sei-vice, and cause fully as much pain as those in which the interruptions are rapid. '\Frankli7zic or Statical Electricity, though not of such varied uses as the forms mentioned, is still capable of beino- em- ployed with great advantage, and is, in some respects, the prefer- able kind to administer. The manner in which I generally employ it when I have decided that it is the variety of electricitv most suitable to the case is as follows: 1 ''T^e patient being seated on the insulated platform, the clothing being unremoved, sparks are drawn by means of a lar-e brass ball from along the whole length of the spine. The effe1:t of this is toprocuce a counter-irritant action and a degree of reflex excitation which no other form of electricity so safely and effectually affords. Each spark leaves a slight elevation of the skin, find the whole surface is reddened. The penis frequently enlarges under the influence, and if the sparks be drawn from the sacral region, erections will often be produced, even in cases in which they have not taken place for several months under the influence of venereal excitement. By means of a brass electrode enclosed within a glass cylinder perforated at one end, devised by Dr. W. J. Morton, the action can be directed with o-reat exactness. ^ " This electrode is also admirably adapted for application to the penneum. Indeed it would be difficult to conduct sparks trom this region without some such anpliance. ". I*})!- the relief of anaesthesia of th^ glans the statical electric- ity is fully as effectual as galvanism, perhaps even more so. For this purpose I use an electrode, also invented by Dr. Morton so arranged that, while the sponge extremity is on the body, 'the spark can be made to pass between two balls capable of beincr brought close together or separated as may be necessary. In ai- plying It to the glans penis the dry sponge disk is brouo-ht into close contact with the organ, and the brass balls being separated a half inch or more, a powerful effect is produced. In several cases I have succeeded, by means of this apparatus and statical electricity, on restoring sensibility to the glans and adiacent tis- sues when galvanism and faradism had failed " On the whole I am quite satisfied that in the several forms of i:^o Electricity and Electrical Apparatus. electricity which I have mentioned, the physician has the most important of all means for the treatment of enfeebled conditions of the o^enerative system. There are other useful adjuncts to be presently mentioned, but they can none of them, or all of them combined, take the place of electricity." From the above quotations we may learn a great deal about the use of electricity in tiiese cases, what current to use, how to apply it, etc. These authors are all ripe in age and experience, and trustworthy in eveiy regard. We would call special attention to the last clause from Prof. Hammond. This is one of the most positive and wholesale statements regarding the use of a therapeutic measure that can be made ; and we should remember that it is wi'itten by an ex- perienced, competent specialist, acknowledged as authority everywhere. And there is much truth in this statement. Elec- tricity has almost unlimited power in working physiological changes, and we are just beginning to learn about its value as a therapeutic measure. When we commenced the study of elec- tricity, we had no idea of the vast amount of good there was to be derived from its judicious, scientific emplo3'^ment. We are more than satisfied, and earnestly commend it to others. And especially do we urge its regular and persistent application, in conjunction with appropriate medication, in all cases of sexual weakness or impotency, for we can accomplish a great deal more in such cases by this combined treatment than we can with drugs alone. Indeed, we can actually restore some men in this way where drugs alone scarceU help. Of course, coca, strych- nia, phosphorus, etc., properly used, help us greath% and, certainly, we have succeeded in making some excellent cm"es with these and other drugs in combination, without electricity. A preparation known as Cclerhia^ composed of equal parts of coca, celery and viburnum, we regard as one of the most effi- cient, if not the very best prescription we can use, in certain cases of sexual weakness. But, after all, we have in electricity the must potent remedy, and in no case of this kind should it be neglected or omitted, for in some cases it will be found the main reliance. It will help in every case, and always hasten the cure. Electricity and Electrical Apparatus. 151 STRICTURE OF THE URETHRA, IMPOTENCE, AND ELECTROLYSIS. Stricture of the urethra is a surgical disease. It may be spas- modic or organic. The contraction may be found in any, or in different parts of the canal. It may be so limited as to attract but little attention, or it may greatly, even completely, obstruct the flow of urine, necessitating surgical interference for imme- diate relief. It is generally caused by inflammation of the mucous membrane lining the canal, which may come from gonor- rhea, masturbation, or sexual excesses. Strictures are some- times very troublesome, and may be followed by serious results. In this connection, we would obsei^ve that one of the most lamentable consequences of stricture of the urethra is sexual weakness. Even in cases where the disease is limited, the pa- tient not being aware that he has a stricture, impotency, or a condition bordering upon total loss of sexual desire and power, may be suffered. And in severe and protracted cases of strict- m"e it is not uncommon for the patient to suffer from sexual weakness, if he does not become totally impotent. Any irrita- tation in the urethra, about the prostate gland, in the testes, or eveii about the anus, continuing for any length of time, has a tendency to weaken the generative function. The reflex action upon the lower portion of the spinal cord results in exhaustion, or a condition called anaesthesia. Regarding the frequency of urethral stricture, in connection with sexual weakness ana impotency, Prof. S. \V. Gross, in his great work, "Disorders of the Male Sexual Organs," holds that the most frequent variety of impotence, what he calls "atonic impotence," is generally induced by subacute or chronic in- flammation and morbid sensibility of the i^rostatic urethra, which is frequently associated with stricture ; and that these strictures frequently result from masturbation and sexual ex- cesses, as well as from gonorrhea. Of the one hundred and seventy-one cases of impotency coming under Prof. Gross's ob- servation, one hundred and fifty-nine depended upon urethral disease — inflammation, hyperassthesia, or stricture. Prof. Gross calls special attention to the fact " that inflamma- 153 Electricity and Electrical Apparatus. tion of the prostatic urethra bears the same relation to the spinal reflexes of the male that the inflammation of the uterus bears to allied disorders in the female, and that it is a constant source of irritation of the genital nerves which tei-minate in that local- ity. An enfeebled state of the lumbar division of the cord and ex- haustion of the cells that minister to its reflex functions are thus finally brought about." Some of the cases examined had been masturbators, others had indulged in sexual excesses, while not a few had had gonorrhea. Prof. Gross holds, and this agrees with our own observations, that confirmed masturbation is just as sure to result in urethritis and the formation of a stricture as is gleet. And we are sure that the same thing may result from sexual excesses. Of eighty-two masturbators who suffered from atonic impotence, and of ninety-one who had seminal incon- tinence — of one hundred and seventy-three in all — examined by Prof. Gross, only twenty-two were free from stricture. This shows the frequency of stricture in connection with and as a cause of impotency. In some cases two or three strictures existed, in others there was only one. In many cases the con- traction was near the meatus, but the majoritv will be found in the prostatic portion of the urethra. The fact is well established that impotence, in its various de*- grees — from a slight weakness to complete incapacity — is fre- quently associated with and dependent upon disease of the ure- thra. And where this is the case, especially where stricture exists, all ordinary plans of treatment for impotency fail to give permanent relief. We may prescribe coca, strychnia, phospho- rus, etc., and apply electricity to the spine and glans penis, and may help the case materially, and but for the urethral disease we might restore the patient, but until the urethral disease is cured we need not expect lasting results. These patients notice a ropy mucus following the discharge of urine. They may suffer from difficult or painful micturition. Nocturnal emissions, or daily incontmence of seminal fluid, are not uncommon. Sexual intercourse is impossible, or it is un- satisfactory on account of premature emission and sudden relax- ation of the virile organ. This urethral disease must be cured. It is a fact that some men suffer from urethral disease, and Electricity and Electrical Apparatus. 153 even from stricture, and never think about impotency ; indeed, they may not be very much weakened, except temporarily from pain. But a sexual weakness is liable to obtain at any time, under such circumstances, and all this makes the treatment of urethral disease, especially stricture, of great importance. Prof. Gross is an old surgeon, and he treats stricture, as nearly all surgeons do, by the application of medicaments through appropriate instruments, by the judicious use of sounds, and sometimes resorts to the knife. But we are electricians, and prefer electricity in overcoming and curing urethral strictures. Of course, where the parts are very tender, and a high state of inflammation is present, suppositories containing iodoform, or sugar of lead an*l tannin, or hamamelis, may be placed in the urethra once or twice a day for a while ; and occasionally an opium suppository may be placed in the rectum to relieve pain, lessen sensibility and give rest. But for the radical cure of stricture, electricity^ is the remedy. No treatment yet devised is so successful in the treatment of stricture — spasmodic or organic — as electrolysis. In spasmodic stricture the faradic current cures by its relaxing power ; but the great majority of strictures we are called upon to treat are of an organic character, and require the constant galvanic current — not the faradic* From original papers furnished by Robert Newman, M. D., of New York, we glean the important facts regarding the treat- ment of stricture by electrolysis, as quoted in the following pages. Dr. Newman is reliable authority everywhere, and we take great pleasure in reproducing his reports, putting his meth- ods in permanent form, for they are of inestimable worth. We are applying his treatment successfully, and cannot better present the subject than quote him verbatim : Dr. Newman defines the specific action produced by electrol- ysis in the treatment of strictures as follows : " My experience of its action, after observing it minutely in all its known relations, leads me to name this electrolytic action galvanic chemical absorption, and I depend mainly on the chem- ical decomposition caused by electrolysis. "Next, I must define my term 'absorption,' as some may *See page 55. 154 Electricity and Electrical Apparatus. object to it as not definite enough, or understanding that it per- tains only to the action of lacteals. But I believe I am justified in using the term, as Webster's definition of absorption is as fol- lows: ' The process or act of being made passively to disappear in some other substance, through molecular or other invisible means, as the absorption of light, heat, electricity, etc' And such is the action exactly, as we will see hereafter. " The negative pole acts as a caustic alkali. If increased ten- sion is used, it will destroy tissue, but mildly applied it acts as a chemical absorbent on the altered tissue, and restores the part to its normal condition. " The theory on which my first experiments were made, has been corroborated by an experience of some years, and proved to me that electrolysis in curing stricture of the urethra is of the most substantial value." , In all electrolytic operations, galvanic batteries with zinc and carbon elements, and an exciting fluid made of bichromate of potash, sulphuric acid and water, are greatly to be preferred; and the elements should be very small, or the arrangement should be such that the elements can be immersed in the excit- ing fluid to a limited extent — one fourth, or their whole length, at pleasure. Tension, and not quantity, is what we want in electrolysis. The catheter or instrument used in the treatment of urethral strictures should always be attached to the negative pole, while a carbon electrode, covered with a wet sponge, chamois or flan- nel, may be held in the hand by the patient. The catheter or operating instrument employed by Dr. Newman consists of a metal rod, over which a flexible catheter is fixed, and (jut off at its extremity for the attachment of a metal bulb, which is securely fastened by means of a screw point on the end of the rod. The bulb is egg shaped, about half an inch long, its length propor- tioned to its diameter. Tbe flexible catheter acts as a perfect insulator, and at the upper or free end the instrument is con- nected with the wire from the negative pole of the battery.* These are nearly the words used by Dr. Newman. Regarding the physiological and therapeutical effects of elec- trolysis on mucous lining, Dr. Newman says: * These instruments are now kept in stoe^, ready made, of different sizes, by nearly all electrical supply dealers, and are called electrotlu bougies. Electricity and Electrical Apparatus. 155 " In describing the different degrees of quantity and tension of the current, the result of actual observation and experience, the salient points will be perhaps more intelligible if subdivisions be made, '' The contact of the positive pole with the inucous linmg by a metal, bulb-shaped catheter, causes great pain. The electrol- ysis thus applied feels and acts similar to a strong vegetable acid, destroys tissue, and is not easily borne. '' But if the negative pole is used with the same electrode, no pain follows the application, provided the current is not too strong; it thus produces only a sensation of pricking and burning. "a. If a limited electrolytic power be selected and applied by the usual method, the current is gradual and slow in its action, and we observe — '•''First. — The mucous lining of the urethra is often covered with an alkaline secretion. The electrolytic action coagulates it in a semi-solid mass. The same result may bo observed if the albumen of an &^^ be submitted to the action of both jooles. ''''Second. — In the absence of this secretion, moistui'e only being present, a general stimulation takes place. ''''Third. — Agitation. '"''JPourth. — Lifting and loosenmg of epithelium. '"'Fifth. — Attraction and disintegration. '•'•Sixth. — Coagulation of alkalies. '•'•Seventh. — Tne epithelium shrivels up. '•'• Eis^hth. — Detached and lost. '•'•Ninth. — Mucous lining dries, and gradually changes color from a pinkish red to white. " Tenth. — At the commencement of the caustic action, absorp- tion slowly takes place, tissue is absorbed and disappears. '•'• Illeventh. — The metallic extremity of the bougie insinuates itself in the deeper tissue, producing a depression; an aperture is made wdiich forms a new passage. ''''Twelfth. — The electrolytic action having made a passage, the albuminous secretions on the walls of the urethra are acted upon by the negative pole coagulating it, and bearing resemblance to boiling froth. ''''Thirteenth. — By degrees a scab is formed. "(3. Electrolysis may become caustic in its action if too strong currents are used, destroying the tissue, leaving a denuded sur- face behind, which in the healing process throws out plastic lymph, fills up the cavity, and forms solid and adherent walls. "c. If electrolysis of great power is used, it rapidly opens a passage. The perforation thus made forms a scab upon the walls of the urethra. " My experience has proven conclusively that the means of 1^6 Electricity and Electrical Apparatus. curing- stricture consists mainly in using weak currents; and mischief m:iy be clone by strong currents, which destroy tissue rapidly, instead of causing chemical decomposition. " As seen by the foregoing, the two poles differ in their action, and therefore give different results. It further appears that the poles vary in their action with the material used. For example, by a general application with sponge electrodes, a certain result is obtained ; the same current, similar in every way, will, by the use of a metallic electrode, become electrolytic. The faradic or mduced current, as a general application, with the sponge elec- trode, is mainly used (and even preferred) to ascertain muscular contractility. Hence it is employed in paralysis, because it vitalizes, and stimulates the muscles into activity, sustains the action of the heart, impresses the circulation, and exerts a pow- erful influence over the motor nerves. "If the faradic current is emplioyed with metal electrodes, or a sponge electrode as positive, and the bougie with metal bulb as the negative pole in the urethra, it prevents, or cures spas- modic action ; hence, is a cure for spasmodic strictures. " It appears that the two poles are identical in their action, and manifest no significant difference, at least it is not so mai'ked as in galvanization. "The galvanic, or constant current, as a general application, may be used with more or less advantage or benefit in all cases (although the faradic is preferred as a general tonic and stimu- lant), and acts as such principally on the sympathetic, motor, and sensory nerves, and its effects to equalize the circulation ai"e very significant. But if galvanization is used with metal elec- trode to obtain electrolytic action, the result obtained will be widely different. " The positive pole will coagulate the blood, attract acid and oxygen : in fact, by a pecular action the battery has yielded an acid product, which acts as actively and produces as painful and sloughing a sore as will the most powerful mineral acid, and leaves behind a hard and retractile cicatrix on the tissue with which it has been in contact; while the negative pole will dis- solve blood, augments its fluidity, attracting hydrogen, coagulates albumen, attracts alkalies, and acts as a caustic alkali on the tissues, leaving behind a small, soft cicatrix, which is not re- tractile. '' Now, the knowledge of the foregoing facts is of paramount importance, and they are all the more essential, inasmuch as they happen to be the great factors with which we should be ac- quainted for the intelligent application of the method under consideration. '''' Method of Application. — The first thing the operator will Electricity and Electrical Apparatus. o/ have to consider is, the pathological condition of the particular stricture he has to deal with. Next, to devise a plan for his future action, select the method he intends to employ, and the treatment be means to follow ; what he wishes and what he can accom- plish in a single seance, and what he reasonably can effect. He must know WHEN to operate, and the time that should elapse before the operation is repeated. The patient should not be subjected to pain. " Of course no stereotyped rule can be laid down which should be followed by all alike. Each case depends on its own inherent peculiarities, and must be treated accordingly. The successful issue of each case depends entirely on the operator's choice of method, and he should employ that one which offers the best chances of success, and which he deems the most effective. '•'•First. — Electrolytic action, by mild currents, from batteries united for tension, produces gradual chemical absorption, as be- fore described. The current is gradually increased or decreased. " Another method is a mixed operation. The passage is made by the action of a powerful electrolytic current, which may de- nude the surface of the urethra ; the walls are kept apart to prevent adhesion. This indication is fulfilled by the introduc- tion of the catheter immediately after the operation, and retain- ing it in sitti. " My predilections are in favor of the first method, and I use it because it is more desirable. If circumstances permit, I operate with it in preference to all others, because it is safe, and never has been followed by accident or ill effect. In fact it is the procedure here advocated, practiced and illustrated by cases. It is the method which treats the stricture through mild currents, by a '•galvanic chemical absorption.^ " The mixed operation I only pi'acticed when obliged to do so ; that means, when the first method cannot be used with good effect, then the current must be increased. Only a very few aggravated cases will need this procedure. The after treatment must be conducted carefully, as the retention of the catheter in the urethra may cause irritation, cvstitis and in'ethral fever. But even if it occasions, under very unfavorable circumstances, some inconvenience, it is preferable to the otherwise unavoidable perineal section, which, according to statistics, is dangerous. This method is particularly indicated, if the stricture is impas- sable and tough. The strong current may denude the walls of the ui'ethra, and the plastic lymph thrown out will cause adhe- sions. To avoid such adhesions, the catheter is retained. The new entirely flexible rubber catheter is a great improvement for this purpose, as it is less irritating and self-retaining, thereby avoiding the dangers which might otherwise follow. 15S Electricity and Electrical Apparatus. '■^ Examhiation of the Sirictuye. — Stricture is a pathological condition of the urethra, which by alteration of tissue has nar- rowed its calibre. " The object of surgical interference is the restoration of the urethra to its normal physiological and anatomical condition, which includes power, healthy action, and, above all, its form and natural calibre. This being accomplished, the cure is com- pleted. The method which will accomplish this gratifying result with the least pain or inconvenience to the patient, with' least interference with his daily avocations, is certainly the best. "For all practical purposes, we may divide strictures in three classes: " I. Spasmodic strictures; 2. Inflammatory strictures; 3. Organic strictures. " Spasmodic strictures may occur as a consequence of irrita- tion, venereal excesses, masturbation, excess of acid in the urine, pyelitis, diabetes mellitus, arthritis, cystitis, nervous debility, etc. I have already observed that spasmodic stricture is amen- able to cure by the faradic current. This current is of much value if employed to confirm the diagnosis ; but spasmodic con- traction of the vu^ethra, usually called stricture, is not real stric- ture, and has no bearing on, or' relation to, the electrolytic treatment, and is here referred to merely as a comparison. " The last two kinds of stricture are amenable to treatment by electrolysis. Both are generally the consequences of neglected acute urethritis, or the result of traumatic lesion. I have no in- tention to describe in this paper the different forms of strictures ; I confine myself to the delineation of the last two. In the in- flammatory stricture the calibre of the urethra is narrowed by the product of inflammation thrown out by exudation internal to the mucous lining. The case may be complicated by the pres- ence of more or less granulations ; whereas in organic stricture the calibre is lost by the pressure upon the altered parts, and heteroplasia of the deeper tissues. The knowledge of this path- ological condition is a fact of much value for the intelligent, and successful application of electrolysis. If this is understood, it necessarily follows that the organic stricture needs a stronger, and the inflammatory a milder current of galvanism in order to effect chemical absorption. Certain facts should be inquired into concerning the history of the case, such as the general con- dition of the patient, see whether inhei'ited diathesis can be discovered, a peculiar dyscrasia, or if any complication be pres- ent at the seat, or anywhere adjacent to it. For example, if the stricture be complicated with cicatrices; if there be syphilis, or tertiary symptoms. If either of these complications be present, the case is not a favorable one for electrolysis. The patient, Electricity and Electrical Apparatus. 159 under these circumstances, needs first constitutional treatment. " Meas7ireinent. — In order to ascertain with certaint}' the exact locaiity, length, size, etc., of the stricture, I generally introduce into the urethra a sound as large as the meatus will admit; by this manoeuvre we ascertain at the beginning of our manipula- tion the normal calibre of the urethra. The sound is then gent- ly pushed forward, until we reach the stricture ; that being accom- plished, we carefully note in inches, by actual measurement, the distance the first stricture is met with from the meatus. Next we ascertain how large a sound the stricture will allow to pass ; at the same time an attempt is made to ascertain the length of the stricture. Having discovered the available sound, the explo- ration is continued until the whole of the stricture has been ex- plored. If any more strictures are discovered during the inves- tigation, they are measured in the same manner as the first ; a note of their topography is made and carefully recorded, because in all future operations the perfect knowledge of the localities of the impediments is of extreme importance for their proper treatment. "After a careful and minute examination is made, and the state, size, etc., of the urethra duly noted, a plan of action and future treatment in accordance with the previous principles enun- ciated is decided on, and immediately carried out. ^'■The Modtis Operandi. — First. — The susceptibility of the patient to the galvanic current is to be ascertained, and is accom- plished in the following manner: The two sponge electrodes are grasped in the palm of the hand; the metallic slide is carefully and slowly moved onwards, cell by cell ; the strength of the cur- rent is thus entirely under the control of the operator, and should be augmented until the patient feels a pricking sensation. , The toleration with which the patient endures the current without in- convenience indicates the tension suitable for the operation, and may be varied according to circumstances; still, it should always be in accordance with the well-known laws and influences which govern electricit}'. "The position which the patient should assume during the operation is a matter of slight importance ; his own convenience should be consulted ; he may either stand or sit, or may lie on his back with his knees drawn upward. In my practice the patient generally stands in front of me. Anaesthetics are not used, because I deem them unnecessary. On the contrar}-, I want the patient conscious, so that I may have the advantage of his statement as to the sensations experienced, during the pro- gress of the operation, which, if rightl}- performed, occasions no pain. " One of the bougies with metal bulb, as already stated, is now i6o Electricity and Electrical Apparatus. taken up ; the size to be selected will depend on the method de- termined upon. '/If the stricture is not too firm or fibrous, I generally com- mence with a bougie which is three or four numbers larger than I judge the stricture to be, and on the well based supposition that the current will, through its peculiar action, absorb the strict- ure to such an extent, that the dilatation it produces will be equal to the difference of three or four sizes. " Having ascertained by actual measurement the locality of the stricture or strictures (if there be more than one), I push a small India-rubber ring over the bougie for each of them. This little manoeuvre has many advantages ; not the least important is, that I am made aware as soon as the India-rubber ring arrives at the meatus, that the extremity of the bulb must be in contact with the stricture. "Having the plan of the urethra through actual measurement before me, I operate with additional certainty, and beyond a per- adventure, as to the part which is acted upon. " The operator of some experience in this kind of manipula- tion is always made perfectly aware by digital touch where the sound is, at any time during the operation. The bougie, well lubricated, is now connected to the cord electrode of the nega- tive pole, and then introduced into the urethra down to the first stricture ; a sponge electrode is attached to the positive pole of the battery; the current is completed by placing the sponge either over the superpubic region, the thigh, or inner aspect of the patient's hand. I prefer the latter, because it is more pleas- ing to the patient, without weakening the effect of the negative pole. The current should now be very slowly and gi'adually in- creased, one cell at a time, or still more divided by resistances, until the patient feels there is a certain strength in the current. The galvanic current should never be so strong as to cause either pain or a burning sensation; because, in that event, the current in its action would approach the galvano-caustic, instead of the electrolytic, which is not contemplated. Generally the power from eight cells is adequate, and will fulfill all the indications, and be found sufficient to overcome and penetrate the stricture. It will be found that an application of three to five minutes will be enough to make an impression ; less time may answer for the bougie to advance and slip through the impediment. " During the whole of the operation, the bougie must be held loosely and gently in its place against the obstruction ; all pres- sure or force, however slight, must be avoided. The bougie will take care of itself, doing its own work by the electrolytic power its action involves ; whereas, pressure would not only defeat the object and purpose of its application, but expose the patient to Electricity and Electrical Apparatus. i6i serious danger from hemorrhage, or even rupture of the urethra. " The operation being completed, care should be taken to re- duce the battery to o, by gradually moving the slide back to the starting point, cell by cell, and only one at a time. When the slide is returned to the point from which it started, the current should be interrupted. " It will be observed that on withdrawing the bougie electrode, there is found surrounding its metal bulb a frothy, yellowish mass, which bears a strong resemblance to coagulated albumen. This product is part of the stricture, which has been decomposed by the electrolytic action of the battery. There are failures on record, but in my opinion this want of success is mainly due to a. too prolonged or to a too frequent application of the current, and to the causes previously enunciated. The applications, to war- rant a successful issue in any given case, should be repeated at intervals of nt least two weeks, and in some instances a longer period should elapse before I would repeat the operation. How- ever, if all things are favorable, and circumstances give me abso- lute control of the case, I would prefer a period of four weeks to intervene between the operations. This treatment must be con- tinued until the urethra has recovered, and resumed its-normal calibre, whatever this may be. As a rule, every patient may be well satisfied if his lu-ethra admits a No. i3 English sound, and has no reason to complain that a stricture is troubling him. But if a large man has a normal vu'ethra, the calibre of which corres- ponds to a sound No. 15 or more, our treatment with electrolysis must be contmued until the size of such urethra is sufficiently restored to correspond with the normal calibre. At times I have found a normal urethra of the size of No. 11, the meatus even a little smaller, admitting the No. 11 sound only after careful stretching; and it was clearly proven that such urethi-a never had been larger. In all such cases I am well satisfied with a restora- tion to size No. II, and would not think of enlarging such a ure- thra any further. " The question may be raised here, whether our treatment is ever followed by urethral fever, cystitis, or any other complica- tion. To this I answer, that during the three years in which I practiced the^>5/ method, I never had any untoward symptom. But any complication may arise if either the patient or the opera- tor give cause. Urethral fever is caused by a rough handling of instruments, or an over-exertion of the patient after the opera- tion. Avoid the causes, and you will have no consequences. For this reason only I recommend the first method ; but the mixed operation must be employed in certain cases, in order to avoid more dangerous means, which is the more justifiable, since Dr. Bumstead, in his excellent work, admits that ' either of the i62 Electricity and Electrical Apparatus. modes of treatment (of stricture) now described, may be fol- lowed by rigors and other unpleasant symptoms, which are known as urethral fever.' To illustrate this, I will now narrate an interesting case, in which circumstances forced me to practice the mixed method in order to avoid the more dangerous perineal section." " Case 2 131. — Tra^imatic Impassable Stricture of Nine Tears'' Standing Treated Successfully by the Mixed Method of Electrolysis. — Mr. S. M. S.,of Hartford, was sent tome by Dr. Storrs, of Hartford, on July 22, 1S73, with the following history of a traumatic stricture : Mr. S. was in the mounted service during the war. In 1863 contracted an abscess in the perineum, which resulted in a urethral fistula. In 1S64, Dr. Blackman, in Cincinnati, closed the fistula. The operation was a cutting one, and the wound was left open to heal by granulations. Soon a stricture of the urethra followed, M'hich was treated by the introduction of sounds at intei-vals. The stricture grew gradu- ally worse, imtil no instrument would pass it. For the last six weeks the urine only dribbles away by drops, and not the small- est sound or even catgut will pass the stricture. The kidneys are disturbed, occasionally congested. The urine is pretty con- stantly albuminous, which is occasioned by the difficulty of pass- ing water. For years he never had entirely emptied his bladder, as a residue was left, causing cystitis. The ureters were often filled with urine, producing disturbance of the kidneys. On ex- amination, I found that a large steel sound No. 12 entered the meatus easily, and passed down to the seat of the stricture, which was six inches from the seat of the meatus. Whalebone bougies, catgut and other instruments of the smallest size were tried, but none passed the stricture. Next an examination was made with the endoscope. The large tube enters, with a little difficulty, a distance of six inches, where it encounters the strict- ure. On inspection, we see that the stricture is well formed, and a plastic exudation, like a duck's web-foot, presents a gray- ish white appearance, with elevations standing out like granula- tions. On the light side the remnant of the opening can be seen, very narrow, irregular, congested, irritated, and bleeding on slight touch. Next electrolysis was used with Drescher's galvanic battery. A bougie No. 6, the end of which had a metal bulb, was introduced to the seat of the stricture, and at- tached to the battery as the negative pole ; the circuit was com- pleted by the sponge electrode in the hand of the patient. The current was kept up for eight minutes, but the bougie would not enter the stricture. Then a bougie No. 3 was substituted, and passed into the stricture slowly, and worked its way until it was seven inches in the urethra. Here it could be felt distinctly that Electricity axd Electrical Apparatus. 163 the bougie was at the end of the stricture, and it was then pushed e1\sily into the bhadder to its whole length— nine inches. Hence the stricture was one inch long, from six to seven niches deep. After this operation he felt somewhat relieved. u Aug. 13. — Battery of twelve cells for twenty minutes, with metal bougie No. 6, entered the stricture three-eighths of an inch, but would go no further, nor pass the whole stricture. Hem- orrhage prevented further operation. " Aug. 13. Has had a good night's rest. Urine passes with difficulty, and burns a little. No instrument will pass the strict- ure. Chloroform was given, and electrolysis used. A steel sound No. 7 as negative pole was introduced, and full twenty cells used for twenty minutes. At last the sound passed the stricture and into the bladder. Chloroform was then discontinu- ed, and a bougie No. 15, with a metal end, and the other part insulated, introduced as the negative pole. The patient was conscious, and saw how the bougie No. 15 passed through the stricture into the bladder. The bougie was slowly withdrawn under a galvanic current of fourteen cells. The patient felt no bad effects afterwards, no pain. One hour afterwards he passed water. He left for home in a few hours. " Sept. 9. — After last operation he has improved, and passed a steady stream of water,, equal to about No. 3 or 4. But within the last few days he has grown worse, and the urine only dribbles away with difficulty and pain. Endoscope (large tube) shows an immense inflammation and irritation at the stricture, and many small granulations have sprung up ; therefore it is thought not advisable to interfere operatively at this time, as no good result possibly could be expected under the circumstances. In order to allay irritation and gain space, urethral suppositories were ordered. " Sept. 15. — Feels better ; says in five years he has not felt so well. He passes water better, and is free from any irritation or pain. "Sept. 17. — His constant hard labor in business, and the travels on the railroad, have excited the parts to such a degree that he has a relapse, and cannot void urine, which only dribbles away in di;ops. No instrument will pass the stricture, not the smallest. My friend. Dr. W. H. JSIaxvvell, of this city, saw him in consultation, and coincides that an operation for his re- lief is unavoidable, but is not advisable here in a hotel, where our patient is without care, away from his friends. Consequent- ly he went home, and on September 25th the operation was per- formed in Hartford, in the presence and with the kind assist- ance of Drs. Storrs, Fuller, Elsworth and Russel, all eminent practitioners of Hartford. Under chloroform anoth er effort was 164 Electricity and Electrical Apparatus. made to overcome the stricture, which was still imjDassable to all instruments. Then the electrolysis was used, but my usual bou- gies were not stiff enough, and becoming too flexible, might have made a false passage. Now the only alternative was a different form of electrolysis, with strong currents, to overcome the stricture, or perineal section. But as this latter plan could be pursued if the other failed, therefore electrolysis was decided upon. A steel sound No. 7 was introduced to the seat of the stricture, and the free end connected with the negative pole of the galvanic battery. The circuit was completed by a sponge electrode as a positive pole, and held firmly on his thigh. The electrolysis was kept up with twenty cells for nearly half an hour, during which time the sound made slow but steady progress. The ad- vance was directed with one finger in the rectum, and only guid- ed by the anatomical relation. At lastthe sound could be moved within the bladder. In consultation, the plan of the after treat- ment was decided upon, of which the important point was to keep the urethra open, and thereby to prevent adhesion. The patient was then left under the care of Dr. Storrs, to wdiose judicious treatment I am indebted for the final result. Dr. Storrs' notes are as follows: "Wednesday night restless; first micturition only blood; second time, before daylight, a full stream. Ordered morphine, gr. ss. ; dose every two hours. " Sept. 26. — Morphine only two doses ; pulse 120; sensibili- ty of skin and thirst ; urine in full stream. '•Oct. I. — Urine with more difficulty; smaller stream and straining; pulse 80 ; catheter No. 3 passed, then a No. 5 was left for the night; suffering pain, and frequent vomiting. " Oct. 2. — Catheter removed ; patientfell asleep ; when attempt- ing to urinate, the flow ceased suddenly ; after pain and strain- ing, a calculus was voided ; then the urine flowed in a large stream, and in an easy way, such as had not been known for years. "Oct. 5. — Catheter No. 5, easy. "Oct. 21. — Catheter No. 11, easy; considered well. "Dec. 12. — Sound No. 12 introduced by himself. " I firmly believe that the calculus voided by the urethra was encysted in the bhaddernear the sphincter, and that the electrolyt- ic action loosened it from its encasement. The sudden stoppage of water on Oct. 2 was caused by the calculus dropping into the urethra. The patient has been kept under observation, and has remained well. Only to confirm the success, he passes, in long intervals of many months, a sound No. 12 into his bladder, and reports well. " The first method, as described 1)efore, I practice now almost Electricity and Electrical Apparatus. 165 exclusively, and consider it the only safe one. I have about thirty cases on record, of which the follov^^ing', in brief, I will mention, as details would cause too much repetition: "Case 2045. — T-mo Strictures^ Coinplication of Syphilis. — W. H. B., an actor of this city, came under my treatment in March, 1S71. Found on examination two strictures at one and at five and a half inches. Had syphilis, which aggravated the strictures, and undoubtedly this complication caused the strict- ures to impart a feeling of cartilage, which brings them almost under the calcareous species. The patient received constitu- tional treatment, and a few seances of electrolysis cured the strictures. He has been heard from recently, and has remained well. " Case 2093. — T-vo Strictzires. C/iaJzcroid. Failure of Dilatation. Successes xvitk Electrolysis. — R. A., a hotel keep- er, came under my treatment in JNIarch, 1873. Had been treat- ed in the country for stricture by dilatation, with no success. Found a chancroid in the urethra, which was treated first. The two strictures were found situated at one and a quarter and four and a half inches from meatus, respectively. " Mar. 23. Electrolvsis was used with a bougie No. 10^ with a metal bulb as negative ; positive electrode in the palm of the hand. Ten cells of the galvanic battery were used for nine minutes, and the bougie passed slowly through the strictures into the bladder. "April 14. The operation was repeated with a bougie No. I3. The patient has been heard from only recently, and has not had a relapse. "Case 209S. — O^ie Stricture^ Spermatorrhcpa, ImpotencCi Melazicholia. — ^larch, 1S73: R. T., merchant, in Philadelphia, came to my office in an advanced stage of hvpochondriasis, com- plaining of general malaise, spermatorrhoea, impotence, small stream of water, pain in the urethra, etc. A steel sound No. I3 entered the urethra easily, but was arrested at seven inches. Sounds of smaller size were all arrested likewise at the same point. There is no doubt that a stricture exists, and at last a sound No. 7 passed it with difficulty. The trouble must exist either at the junction of the membranous and prostatic portions, or in the latter. Galvanism was used with \.Qn cells. Bougie No. 10, with metallic end as negative into the urethra; met the same obstruction at seven inches. The positive pole was a nickel bulb, antl grasped firmly with the closed hand. After five minutes of the electrolytic current, tlie bougie passed the strict- ure slowly, and slipped into the bladder. The withdrawal of the bougie was followed by a thick gleety discharge. It seemd that this matter had accumulated behind the stricture, irritates i66 Electricity and Electrical Apparatus. the prostatic portion and the ducts, and thereby was accessory to creating a spermatorrhoea. On passing water, shreds came along of a thick, white mass, which were the product of electrol- ysis. The operation had not caused pain, and the patient trav- eled home without any unpleasant feeling. "April i6. On examination with a sound No. lo, found the stricture at the exact place. The sound passed the stricture after persistent and patient efforts. " Then the galvanism was used as before, with a bougie No. 12 as negative, and with the same result. " May 9. In Philadelphia, a sound No. 12 could be easily passed into the bladder, which proves that the stricture is cured. The patient has been kept under observation for two years, and was seen only two weeks ago; he is perfectly well ; has been married since, and is the father of a healthy child. — [Impotence cured. — Pitzer. ] Case 2129. — Gonorrhoea and Stricture. — Julv, 1S72 : M. M. , merchant, has a gonorrhoea for four months, which has been aggravated by strong injections, which was followed by phymo- sis and epididymitis. On examination, found a large urethra ; at one and a half inches a stricture which permits the passage of a No. 9 sound; at five inches a soreness is encountered, which was afterwards diagnosticated by means of the endoscope, as granular urethritis. After proper treatment of the complica- tions, the stricture was cured by electrolysis in three seances, as follows: "July 30. Galvanic battery ten cells. The bougie No. 12 absorbed the stricture in five minutes. "Aug. 17. Bougie No. 13 passed the stricture in five minutes, during which the galvanic current was gradually increased to fourteen cells. " Sept. 14. Galvanism with nine cells for eight minutes. Bou- gie No. 15 passed through the whole urethra slowl}'. " Patient was ordered to introduce sometimes a No. 15, with an ointment, in order to overcome and heal the soreness of the urethra. " He has been seen since frequently, and during the twenty months following the electrolytic treatment no relapse has occurred. "This is a typical case, in which circumstances permitted the treatment to be carried out as recommended in a former part of this paper. The urethra of this patient has retained the cali- bre of No. 15. "Case 2155 — Ojie Stricttirc and Glcct. — Nov., 1S72 : Mr. P. had gonorrhoea fifteen years ago; cystitis with hiematuria one year ago, and since a serous discharge, with diminished stream of water. Electricity and Electrical Apparatus. 167 "Found one stricture one inch from meatus, which was cured with electrolysis in two sittings. Patient has left the city, and has not been heard from since. ^^r o "■Cxs^2i62.— Got?orrhceal Stricture.— V>qc.^ 1672: VV . K. B., clerk, had gonorrhoea last spring. The discharge ran for five months. Last week had connection, and found on the tol- lowincy day a discharge ; it has now run slightly for one week ; stream of water is small ; straining troublesome ; bougie a boule enters into a pouch at two and a half inches; sound No. 11 en- counters a stricture at five and a half inches ; therefore, it seems that the discharge emerges behind the stricture and is caused by it. Conclusion is, the cure of the stricture will remove the dis- charoe. Two galvanic applications were made at intervals of four weeks, after which a bougie No. 13 passed the whole ure- thra easily. The patient was dismissed as cured on Jan. 21, 1873. He has remained under observation and is perfectly well. TT T3 O " Case 2iG\.— Simple Stricture.— Dec. 30, 1672 : hi. 13. b., from Connecticut; defective history; has one stricture at two and a half inches, which was restored to a normal state m one seance ; on a subsequent visit was found well. "Case 3165.— 77«ree Strictures.—Dec. 30,1872: S. J., saloonkeeper, was brought to my office by Dr. Good. " The patient has had strictures for a long time, which resist all dilatation ; are tough, and cause painful micturition, with a small stream. "Whalebone bougie c\ boule finds three distinct strictures at two, four, and five and a half inches, of a parchment feel. _ _ " Galvanism was applied; the sponge electrode as positive pole was pressed in the iliac region, and a bougie with metaUic bulb pushed into the urethra as the negative pole. In six min- utes, with the current of fourteen cells, all strictures were over- come. Immediately after the operation, he passed water with- out pain or difficulty. The stream was full, and larger than he has had for many years. The patient has not been heard from Since "Case zi^g.— Stricture of Three Tears' Standi?zg. — '^^n., 1873- T G., from Missouri, has a bad stricture at five and a half inches, of three years' standing, caused by a prolonged gonorrhoea. j 1 i .1 "The treatment was tedious, and was retarded by the pa- tient's imprudence. At last the galvanism absorbed the strict- ure, so that a sound No. 15 could be introdviced easily into the urethra. The patient went home after three months' treatment, and has since reported well. r^ o ts Case 2i<^2.— Three Strictures.— A\^x\\ 16, 1873: G. i?. i3., i68 Electric rrv and Electrical Apparatus. from Oneida Co., was sent to me by Dr. Good. Bougie a boule discovered three distinct strictures at two and three-quarter inches, at three and three-quarter inches, and at six and a half inches respectively. In withdrawing the small bougie No. 4, it remained engaged in the second stricture, and was decidedly fibrous. Strong fibrous bands held the extremity of the bougie firmly, and to disengage it, it was almost necessary to rupture that stricture to a certain extent. "The electrolvtic action was applied as in the other cases, and the bougie No. 8 connected with the negative pole passed slovvly through all the strictures in five minutes. The patient reappeared two days afterwards, and reports marked improve- ment. He says he must return home, and therefore wishes an- other galvanic application. It is against all rules to repeat such an operation after so brief an interval ; but necessity knows no rules. The patient had to go home, and felt so much better after the first operation that he desired a repetition, and prom- ised to return as soon as necessary. Therefore an exception from the rule wns made, and the galvanism applied again with an excellent result. The bougie No. 11 passed slowly through all the strictures in four and a half minutes. The patient passed a full stream of water, and felt marked relief. Before his de- parture home on the next day, he came again to state that he is well, feeling no soreness or fatigue. I heard from him in the fall, and he reported well. "Case 2204. — Stricture and Gleet. — June, 1S73: J. R., saloon-keeper, is near his wedding; has a gonorrhoea, which, under the treatment of a druggist, grew worse ; has also an ab- scess in the glans, near the frenum ; has fever and pain in con- sequence of the inflamed urethra. After subduing the inflam- mation by internal means, the discharge continues. On examina- tion with a bougie cl boule., a stricture was found at four inches. There was a contraction, a hard, fibrous resistance. Galvanism applied ; positive in hand, bougie No. 11 in urethra as negative, soon passed the stricture. Then an injection of water brought by its return a large semi-solid white mass, looking like dead skin thrown off. This was the product of the galvanic action, the real stricture absorbed. It had an alkaline reaction, fibrous in appearance, and looked like the core of a carbuncle. There is no doubt that a former gonorrhoea had caused the stricture, behind which a pouch had formed, which acted as a receptacle, and created a discharge, by which means the stricture grew worse. Now it is natural that no remedies adapted to gonor- rhoea or gleet could have stopped the discharge ; but the treat- ment of the stricture cured the gonorrhoea. The patient felt no pain from the operation, and was easier immediately. Two Electricity axd Electrical Apparatus. 169 days afterwards a sound No. I3 passed into the bladder, and no discharfe followed. He married, received afterwards a little treatment, and all went on well. He has been under constant observation, and has remained in good health. "Case 222^. — Three Stricticres. — Sept., 1S73 : Mr. E. S., New Haven, about twenty years since had a gonorrhoea ; was treated only with medicines ; had no injections and finally re- covered. Twelve years ago had renal difficulties ; passed acid formations from the kidneys, but never passed calculi. Two years ago the stream of water grew smaller by degrees, and sometimes he could not void urine at all. Was treated for stricture, but was not relieved. On examination, the bougie a boule encounters three strictures : " Firsts at three and one-eighth inches, which is overcome by rotating, and directing the points to the anterior wall of the ure- thra. The bougie is not caught on the return, but slips easily back. " Second, at five and a half inches, from which point the calibre of the urethra remains narrowed until the " jy^/rc^ stricture, at six and a quarter inches, which is only overcome by bending into the curve, and slowly pushing and pressing forward. This last is the worst stricture. "Oct. 3. — ^ Galvanic battery used. A No. 13 bougie, with metal bulb as negative pole, passed through all the strictures in four minutes. The bougie, during the action of electrolysis, was firmly grasped by the strictures, and even by the prostate, and advanced slowly and by degrees into the bladder, so that the full measure of the bougie introduced was ten inches. The bat- tery used was very weak, and therefore twenty cells were in operation. The positive sponge electrode was held in the palm of the hand. The electrolysis was kept up seven minutes in all. " Oct. 21. — Galvanic application repeated as before ; nine cells for ten minutes. The bougie No. 15 as negative had scarcely any difficulty, and entered soon through all the strictures. "Oct. 31. — Slight galvanization. Bougie No. 15 entered easily, without detention or pain. The patient passes a large stream of water now. For other ailments he is still under treat- ment, but the urethra has had no relapse. Other cases have been treated recently, and the record would not be so valuable, but I believe the clinical facts here recorded are sufficient basis for the theory elicited in the first part of this paper. And in conclusion, I can only repeat that I only recom- mend the first method as a perfectly safe one ; and the success of the electrolysis depends mainly on the chemical decomposi- tion or absorption by mild currents, very gradually increased, and repeated at sufficiently long intervals. "New York, Feb., 1S74. Robert Newman, M. D." 170 Electricity and Electrical Apparatus. "Since my last report was written, August, 1S82, almost daily new cases have been presented, and treated with the same uniform success as related in the former paper. Scarcely any simple cases came, and most of them were the worst and most aggravated strictures which can come under observation, and many patients were accompanied by their family physicians, who acknowledged that they could not pass such strictures with any instrument, no matter how small. In all case the strictures were passed by the electric bougie. This means that the absorbent power of the electrolysis enabled that size of the instrument to pass, which could not have been done without the aid of the electrolysis. To illustrate this power and the method, some se- lected cases will be related here : "Case i. — Six Strictio'es of Twenty-five Years' Standing , Im- passahle hy Instniment!^, Cured by Electrolysis. " October, 1SS3, Dr. D., set. 57 years, a regular physician, practicing in Long Island, suffered witti stricture of the urethra for over twenty-five years, and has been treated off and on, in the usual manner, with only temporary relief. He noticed the stricture first in 1S57, which gradually became worse. Since 1S77 he has been under the care of one of the most eminent surgeons, lately deceased, who during these years never could pass an instrument through all the strictures into the bladder. " 18S2, October 17th. — Patient came under iny treatment, complaining of having scarcely a stream of water at all, not be- ing able to use a force sufficient to propel the water. The stream is very small, almost diminished to a dribble. Penis is cold and flabby. Meatus is large, admitting a sound No. 26, French. A small whalebone bozigie d boitle detects the whole urethra in an indurated state, scarcely free from strictures any- where. The whole canal is a mass of strictures, with little in- termissions, and the small bulb is arrested everywhere. The bougie passed with ditficulty three distinct strictures, and was firmly grasped and arrested at the fourth, at five inches from the meatus. No instrument would pass this fourth stricture. " I. Electrolysis. — The patient was kept standing, resting himself with one hand on the back of a chair, the other hand holding the electrode from the positive pole of the battery, and pressing the wet sponge cover against the thigh. A stiff elec- trode bougie, insulated, except the metal end, egg shaped, No. II, French, is introduced into the urethra, the other end of the bougie is connected with the wire, which in turn is connected with and used as the negative pole of the battery, and completes the circuit. As soon as the bougie is arrested by the first strict- ure, the current of the electricity is slowly increased cell by cell, till the susceptibility of the patient tells that the current is Electricity and Electrical Apparatus. i^i strong enough, without causing pain. During this seance ten cells were used for twenty minutes. There was slow progress, but the electricity worked its way through all the stiictures, and at last entered the bladder. The current was kept up while the bougie was being withdrawn, and was held loosely in each stricture till it could be moved easily, and it was distinctly felt that the contraction was absorbed. The bougie was neither pushed nor pulled, only guided by two fingers of the hand. The work was thereby done entirely by the galvanism, without causing any pain nor a particle of hemorrhage. The patient was much pleased with the result, and passed water immediately in a good full stream. From this operation the seat of the strict- ures was ascertained to be as follows : "First stricture, at if inches from the meatus; second, at 2^; third, at 4^ ; fourth, at 5 ; fifth, at 5|-; sixth, at 7. '■'■ November 8th. — Since the last operation, a-bout three weeks ago, patient has attended to his practice, and has felt better than for many years. "II. Electrolysis was used in the same manner as before, with an electrode bougie. No. 14, French, which passed through all the strictures in ten minutes, while a current of ten cells was working. '■'■ November LStli. III. Electrolysis with a conical sound Xo. 17, as the negative pole, which after passing was replaced by a No. 17, French egg-shaped bulb. In withdrawing, the latter worked up and absorbed each stricture in turn, so that the instru- ment could be moved about freely without any restriction ; ten cells were used for thireen minutes. To use two electrodes in succession during one seance is against the rules, but was indi- cated in this case as an exception. ^^ December 22nd., 1SS3. IV. EJeotrolysis. — Bougie No. 20, French, with ten cells for ten minutes. Strictures were tight, but offer less resistance, and bougie soon passed through all of them. There is much improvenient. ^^ i8S^, Jamtary 3th. — Electrolysis. — Bougie No. 3i passed easily ; nine cells for twelve minutes. '■'• January 19th. VI. Electrolysi'S. — Bougie No. 23 for twelve minutes, with a current of eight cells, passed, but had to work each stricture separately. '■'■ February 13th. VII. Electrolysis. — Bougie No. 26, French, with seven cells for eleven minutes, passed more easily than ever before. In four minutes had worked through all strictures, and passed into the bladder. Not the slightest pain was occasioned. The patient is in excellent health, has regained a natural stream of water with good force, and says he feels better now than he ever did during the last twenty-five years. Is well in every respect. 172 Electricity and Electrical Apparatus. " Case II. — Four Strictures Fifteen Years Old, ^oith Inconti- nence of Urine. " October 17th, 1882. — Mr. B., from Jersey, was brought to my office by Dr. Field. The patient has suffered for fifteen years without being cured by the usual methods. He is now run down, very weak, has lost flesh, is never free from pain, is con- stantly straining, and can neither pass water nor retain it. The urine dribbles away constantly from overflow, and thereby exco- riates the tender skin, notwithstanding that the patient wears a urinal. The patient passes sleepless nights, and is in constant agony. At present no instrument will pass. On examination, I found that no instrument would pass the strictures. The e-s.- i^Xovin^ bojtgie d bottle encountered a mass of hard strictures, which were passed only by manipulation, and with difficulty, and was soon aiTcsted. Then a small filiform guide entered everywhere into lacunse, which bled on ever so careful an exami- nation, and at five inches from the meatus no instrument would pass any further. The family physician present said he knew that no instrument would pass any further than five inches. If he had been able to pass it, he would not have brought the pa- tient to me. Electrolysis was then tried. The patient was placed on the operating table in a half recumbent position. The positive sponge electrode was held on the abdomen ; the nega- tive pole, in the form of a No. 14 French bougie, was inserted into the urethra. The electric current was gradually increased to eleven cells, and during seven minutes the bougie made steady progress, advancing slowly, and working its way into the bladder, to the great relief of everybody present. There were four distinct strictures, at three and a half, five, six and a half, and eight inches respectively from the meatus. " October 27th. — Filiform bougie was tried in vain, it hung in lacunae everywhere, and fearing to cause too much irritation it was abandoned. A whalebone bougie No. 8 passed easily into the bladder. "Electrolysis was used, with a bougie No. 14, French, which, with a power of seven cells, worked slowly through all the strictures. The third stricture was very tight. Present, Drs. Field, Payne and Brush. " The electrolytic applications were continued at intervals of ten days. In four seances up to November zSth, the patient has so much improved that he has gained fifteen pounds of flesh, which gives him normal weight; the water passes freely; the bladder is entirely inider control, and the urinal discarded. He is well, attends to his business, and enjoys life. " Case III. — Four Strictures of Ihoenty Years' Standing Cured by Four Seances of Electrolysis. "" November 14th, 1SS2. — Telor T., get. 62 years, residing in Electricity and Electrical Apparatus. 173 New York City, came to me with a complete occlusion of the urethra, and consequent retention of urine. Has suffered twenty years with strictures, a consequence of urethritis. No treatment has cured him. The strictures became worse, so that recently he is in constant pain, having hacl retention and incontinence at the same time, the water constantly dribbling away, and in- capacitating him for any work. The smallest instrument would not pass the stricture, but an electrode bougie. No. 14, French, worked its way slowly, with the power of twelve cells for seven- teen minutes, through all the strictures and into the bladder. Present, Drs. Meier and Basset. '■'■December 20th. — After three electrolytic applications, the patient says that his stream is large, and he is better in every way than for the last twenty years. Soon after a bougie No. 23, French, passed easily. Case IV. — Stricture of Ten Years — Rupture (Partial) of Urethra. ^ 18S3, February 20th. — Dr. Munson, of Bridgeport, had the kindness to bring this interesting case to my office, with the fol- lowing history: Mr. A., aet. 36 years, suffered from a stricture of over ten years standing, a consequence of urethritis, which off and on closes up. He is an inventor, and made himself an in- strument for the dilatation of the stricture, consisting of a steel rod, surrounded by a spiral spring, which by turning was in- serted into the stricture like a corkscrew. He felt the stricture closing up entirely, and used his instrument as he had done before. In giving another twist, he ruptured the urethra, which caused severe pain and hemorrhage. Micturition could only be performed imperfectly, merely by an overflow of the bladder, causing a dribbling away. The patient vvas^brought to my office by his family physician, Dr. Munson. From the history of the case it was evident that the treatment most indicated for relief would be perineal section, but as the patient needed immediate relief, I tried the introduction of instruments into the urethra. Whalebone bougies d bonle and guides of different sizes would not enter further than five inches, the seat of the stricture and rupture. Each guide entered and stuck in some of the pouches, but none entered or passed the stricture. Therefore the filiforms were abandoned for fear of creating more irritation and hemor- rhage, and direct electrolysis tried. An electric bougie No. I3, French, as negative pole, was carefully introduced and manipu- lated in tne u"°thra, while the positive sponge electrode, held above the pubes, closed the circuit of a galvanic battery of which seven cells were used. The bulb of the electrode glided by manipulation over the partial rupture of the urethra and en- gaged itself in the stricture, where it advanced slowly, absorbing 174 Electricity and Electrical Apparatus. and finally passing. The patient was nervous, but held still, felt each movement as the bougie advanced, without any pain, nor was a drop or a show of blood drawn. Immediately after this operation, the patient passed a steady, good stream of water, such as he had not seen for years. " The electrolysis was used for ten minutes. Rectal supposi- tories of belladonna were ordered. ^' March Gth. — Since the operation the patient has felt com- fortable, and the stream of water has increased in size. Elec- trolysis, with a bougie No. 14, French, was worked for twenty minutes with eleven cells, and passed the stricture slowly, ab- sorbing considerably the indurated masses. On April loth, Dr. Munson reported the patient much improved, and doing well. "Aggravated cases, like the foregoing, and others with differ- ent complications, I see often, almost daily, so that I could tabulate hundreds of them. The operation never causes pain, nor detention from ordinary business, which often surprises the patient. A physician residing in Connecticut wrote me on his return home : "I was much surprised to find that there was less irritation after the use of electricity than after the introduction of the simple sound. The annoyance caused by the electricity was simply zero." " Since my article was written last summer, I have received many reports from eminent practitioners that they have either adopted my method, or have practiced it independently with equal success. Among others, Dr. D. A. Farrand, of Detroit, Mich., writes, Oct. 6th, 1S83, that after reading my article, he has operated with electolysis on about eighteen strictures with very gratifj-ing results. Great pleasure was given me in a letter from Dr. Hutchinson, of Providence, dated September 2Sth, 1SS2, in which he says he has operated in 21 cases in the last six months with unvarying success. " By the unique good results, the method of electrolysis in the treatment of strictures is fully tried and established ; every day brings new converts and new friends. " I will conclude this article with some rules, as a safe guide to practitioners who wish to adopt the treatment of electrolysis in stricture of the urethra, which will also serve as answers to numerous questions received from correspondents. " For the positive pole of the battery a carbon electrode is used, covered with sponge, moistened with warm water, and held firmly against the cutaneous surface of the patient's hand, thigh or abdomen. " For the absorption of the stricture the negative pole is al- ways used. "Electrode bougies are firm sounds insulated, with a hard- Electricity axd Electrical Apparatus. /D baked mass of rubber ; the point is a metal bulb, egg-shaped, which is the acting part in contact with the stricture. These electrode bougies are made by Geo. Tieman & Co., as also by H. H. Stammers, and other instrument makers.* " The curve of the bougie is short; large curves are mistakes. " The plates must be mimersed in the battery flui-d before the electrodes are placed on the patient, and raised again after the electrodes have been removed. " All operations must begin and end while the battery is at zero, increasing and decreasing the power of the current slowly and gradually ; avoiding any shock to the patient, or any inter- ruption of the current. "Before operating, the susceptibility of the patient to the electric current should be ascertained. "The problem is to absorb the stricture, not to cauterize. "At first it is best to operate only by the first method of ab- sorption, ' iveak currents at long i?itervals.' "The exact number of cells to be used can not be given, it must be regulated according to the work to be done. As a general rule" six to twelve cells may be used. " The seances should be held at intervals, not too frequent in succession. " The best position for the patient to assume during the opera- tion is that which is most comfortable for him and the operator. " I prefer the erect posture, but the recumbent, or others, may be used. "Anesthetics I like to avoid; I want the patient conscious, so that he can tell how he feels. "Force should never be used; the bougie must be guided in the most gentle way ; the electricity alone must be allowed to do the work. " During one seance two electrodes in succession should never be used. "All strictures are amenable to the treatment by electrolysis. "Pain should never be inflicted by the use of electrolysis; therefore it should not be applied when the urethra is in an acute or even subacute inflammatory condition. In order to have suc- cess with strictures it is necessary to be a skilful surgeon, who understands the anatomy, and is master in handling the instru- ments. For our purpose the operator must also oe an expert in electricity besides a surgeon. Some of our young men consider themselves surgeons after buying a new set of instruments in a rosewood case. If they do an operation bunglingly they condemn a good method. And some old men *Aloe & Hernstein, of St. Louis, keep them. 176 Electricity and Electrical Apparatus. never wish to adopt any innovation, because they have not learned it at college. But old men must die off, and progress can not be hemmed in. "New York, May, 1883. Robert Newman, M. D." We regfard this method of treating: stricture of the urethra of great value, and since the appearance of the first edition of our work on electricity we have verified the truth of Dr. Newman's methods, and regard his papers as a valuable addition to electro- therapeutics, or electro-surgery, as we may please to call it. G. W. Overall, M. D., in a clinical report to the Mississtp'pi Valley Medical Monthly, gives us a very good example of this treatment. It is Prof. Newman's method, and reads as follows: " Gextlemex: — I have before you C. L., white, aged forty- four, Canadian by birth, tailor by occupation. His history is briefly as follows : In 1863 he had gonorrhoea ; in 1870 the first symptoms of stricture were manifested; in '74 he was operated upon by gradual dilatation, which treatment lasted six months. He then began to have incontinence of urine and suffer consid- erable pain on micturition. In about five months thereafter he again found that he could not pass his urine without considera- ble difficulty. This condition continued until 187S, when he was operated on by urethrotomy and dilatation. The caliber was kept patulous for about two years, when it again closed, and he has been suffering with his urine percolating, drop at a time, ever since. When admitted to the hospital a few days ago, he was having paroxysms of intermittent fever, in addition to his stricture. " I find, on examination, that the meatus is very much con- tracted, and as the stricture will not admit a No. i sound (Am. scale), I will take a very small olive, equal in size to about a No. 6 sound ; I will screw this on to the end of my stiff urethral electrode, which is insulated with vulcanized rubber. I much prefer this to the flexible. I use the constant or galvanic cur- rent, attaching the urethral electrode to the cathode, while I at- tach the sponge electrode to the anode, which the patient holds in his hand. " I now pass the electrode into the urethra, before the current is made, and continue it down till it comes in contact with the stricture. I make the current with four cells in the circuit. He does not feel this in the urethra, so I will increase the num- ber, one cell at a time, until I now have nine cells, and he feels a slight pricking sensation . It is important to note the time the current passes. I increase the number of cells to twelve. He Electricity and Electrical Apparatus. 177 still suffers no pain. I keep the electrode pressed firmly, but not using any force, against the stricture. The current has been passing eight minutes, and I can feel the electrode entering the stricture. It is now seventeen minutes since the operation was begun, and it haspassed into the stricture about an inch, but not entirely through. Although he has no pain, the current has passed as long as is practicable, so I withdraw it, having pre- viously broken the circuit. I do not pass it longer, as it might be followed by hemorrhage and slight inflammation. I intro- duce a No. II sound. It passes as far as the electrode did, but no further. We will now allow him to pass his urine, and see if he can pass it any better. It only passes in drops, as before the operation, but he says it drops faster than it did previously. He has no hemorrhage nor pain. The operation is not complete, so I will have to finish it in about six or seven days. "April 19th. Dr. Watson (the resident hospital physician), as well as the patient himself, tells me that on the morning of the 13th, the day after the operation, he passed a very good stream, and has continued to do so since.* I now introduce a No. 13 sound, and find that it does not pass further than the electrode did at the previous operation. I pass the urethral electrode with an olive on the end, equal to a No. 11 sound, and make the current with six cells, then increase to nine, when he begins to feel the pricking sensation. The electrode passes into the bladder; I break the current, withdraw the instrument, in- troduce a No. 13 sound, and find that it passes into the blad- der without meeting with any resistance. I will allow Dr. Watson to enlarge the meatus, when a much larger sound can be introduced. "One peculiarity of this operation is that the caliber of the urethra, where the stricture was before the operation, is gener- ally larger than any other portion of the canal. The patient has been working in the hospital ever since the operation, and says he can pass as large a stream as he eveT could, and without any trouble. I now consider him entirely cured. You very naturally ask, how does the current act towards effecting a curcf* I have shown you, in my experiments at a previous lecture, the electrolytic effects of the galvanic current in passing through different salts in solution. I took, as you remember, the chlo- rides of pot. and sod., etc., and by passing the current through them they were decomposed into their chemical elements — the electro-negative elements, as chlorine, oxygen, the acids, etc., * The resident physiciau informs rae that on the 15th ult. my patient had a chill, but as this was tliree days after the operation, an I as he had been having them before, it could not have had any connection with the operation. lyS Electricity and Electrical Apparatus. going to the anode, and the electro-positive elements, such as nitrogen, hydrogen, and the alkalies, passing to the cathode. Then I took the white of an egg, which contains the various electrolytes in solution, and by passing the current through it I had the same results. It was also evident to the observer that the clianges'that took place at the two poles were very cliff erent. Around the anode there was a firm coagulum, the result of the combinations of the various electro-negative elements, as the acids, etc., both with the metallic electrode and the albumen of the egg,, while at the cathode the electro-positive elements were escaping in the form of gases, etc. Now the h^'pertrophied tis- sue of a stricture contains these various electrolytes, which are decomposed by the current in the same way, and the elements are either eliminated as gases, and pass out through the urethra (which I frequently feel in passing a strong current), or are ab- sorbed by the blood. You can readily understand now why the urethral electrode is always attached to the cathode, because, should you reverse tne current, you W'ould not only not benefit your patient, but do incalculable damage by causing new deposits in the urethra, and a worse stricture than 30a had at first. The advantages of this operation over others are that it is almost painless, that it is seldom or never ( when cautiouslv handled ) followed with any inflammation or after-trouble, and that, in my opinion, the cure is permanent." From these reports any ordinary intelligent person can learn the principles and theory and practice of 'electrolysis in stricture. In the treatment of impotence, when it depends upon urethral stricture, this is the treatment for a radical cure. If healthy sex- ual function does not return upon the cure of the stricture, then the method described in a former chapter should be adopted. CHOREA. On page 54, under the head of central galvanization, chorea is mentioned as one of the diseases amenable to this treatment, and with certain precautions and modifications we are prepared to commend it highly. Powerful batteries are not required for successful treatment of this kind. Indeed, we are apt to use electricitv too strong in these cases, as well as in many others, and then evil instead of good results are always realized. We use galvanism only in chorea. So far as our experience Electricity and Electrical Apparatus. 179 goes, the faradic and static forms of electricity are not so effect- ive here. We use large sponge electrodes, and very mild cur- rents — from two to eight cells, according the age and impres- sibility of our patients. Children from five to seven years of age rarely bear v^'ithout complaint more than two to four cells ; and older patients — nine, twelve and sixteen — will not require more than four, six or occasionally eight cells of an ordinary Stohrer, Mcintosh, or Daniell. While there is greater quantity in the Daniell, the action is not so quick, and the current milder, and patients can bear more cells from this battery than from others. But the fourteen-cell bichromate battery, double-size elements, as made by Aloe & Hernstein, answers a fine purpose. In making the application, the sponge electrodes should be well wetted with water, and the hair on the head of the patient should be moistened also. Salt water is preferred for these purposes by some, but we can get all the effect w'e want in using plain water, and it is more convenient. Now, if the chorea is con- fined to one side of the body only, the positive pole of the battery is placed on the side of the head, above the ear, opposite to the affected side of the body, and the negative electrode placed in the hand of the affected side. This is all done while the batter\- is at zero. After the electrodes are properly fixed, we take into the circuit one or two cells at a time, till two, four or eight cells are included, as may be required, carefully observing the be- havior of the patient, that vre may avoid the results of too strong currents, or too long continuance, as per cautions given on page 53. It is a good practice to test the impressibility of these pa- tients as described on page 52. From three to sis minutes is long enough for any application of this kind, and they should be made daily. If both sides of a patient are involved, then we should apply the treatment to both sides alternately — a minute or two on one side, and then a minute or two on the other side. In changin"- from one side to the other, we should disconnect the battery, or turn it to zero before we remove or change the sponges. This is done to prevent a shock in breaking the current by suddenly lifting the sponges. Under this treatment alone nearly all chorea patients begin to i8o Electricity and Electrical Apparatus. improve at once, and if the treatment is continued, in harmony with other appropriate therapeutic measures, such as tlie judi- cious use of arsenic, cimicifuga, chloral, etc., we need not fear of success. While we might cure with medicines alone, our observation w^arrants us in stating positively that with the addi- tional use of electricity this disease is materially shortened, and the cure made comparatively easy. A WORD TO BEGINNERS. All physicians, before commencing the use of electricity, should remember that this agent will not cure everything. In fact, there are many cases in which it is not available, and instead of being useful it may do much harm. Again, in all cases where its proper application might prove ben- eficial, it should be used by a skilled hand, or administered b^ one who is quite well acquainted with the instruments employed, and the effects of the currents generated by them. The practice of putting electricity and electrical instruments into the hands of the people, to be used hap-hazard, as domestic remedies, shouL^ be discouraged, even prohibited. Just as well put any other potent remedy in their hands, and tell them to go ahead, for no measure employed by the medical profession requires more skill and experience in its successful employment than electricity. The common use of electricity by the people, all over this coun- try, mostly by means of very cheap and inefficient instruments, ':an only result in disaster to nearly every patient who suffers such quackery to be imposed upon him. And, in many cases, where the good results looked for are not realized, electricity is held responsible, when, in fact, the measure itself is not to blame. The use of electricity should be confined to the medical profession, and its members should thoroughly understand it, and always use the very best instruments to be had. When this comes to be the condition of things, then electricity will be fully appreciated, appropriated when it may do great good, and avoided when it can only do harm. It is to be hoped that every intelligent physician in the country will discourage the foolish oractice of advising yami/tes to buy batteries, and use them upon Electricity axd Electrical Apparatus. iSi the different members of the household who ma}- happen to complaiu of pains and aches here and there. Such a practice is exceedingly reprehensible. To succeed in the use of electricity, it is not only imperatively necessary that the operator understands the instruments used, but that he has a good knowledge of the disease he undertakes to treat; and then he must give the matter his personal attention. And it should also be remembered that time is required in bringing about favorable changes with electricity. It is true that much good may result from a few applications of electricity, but we more frequently find th^vt great changes and permanent good result from the long contiraied and patient use of this measure. Patience is positively requu-ed ;u the use of this agent; and un- less operators have sufficient faith, and the patient confidence to continue treatment for any reasonable length of time, it is hardly worth while to commence. These are the essential requisites in the use of electricity, and if properly observed, there is enough in this volume to guide any intelligent physician in the success- ful application of this great therapeutic measure. DR. PITZER'S ONE-HUNDRED-CELL Thislsthe working part of Dr. Pitzer's onp-hiindred-cell Galvanic Hattery. The «;Tan(1 tHerhani!=in -n-asiuaile toordtT, liy Jpronie KidcJor ManufactiirinE:Co., of New York cltv. It is fixrd iu a suitable cabinet, and lias every convenience requiriMl. Tlie arrangement is such tliat by properly moving the arms on tlieconiiiound circle switch. A, any desired number ofcells, addinu four ata time, may be taken into the circuit. Or any number of c»lls iu any part of the circuit may be used at pleasure. (At W the wires are seen coming from the Battery in the cellar.) GALVANIC BATTERY INDEX. PAGE. A Word to Beginners 180 Acne "3 Aloe & Hernstein's Galvanic Bat- tery 10, 11 Aloe & Hernsteiu's Improved Elec- tro-Magnetic Machine 22 Amaurosis 73 Amenorrhea 73 An Impostor Exposed 85 Asphj'xia — How to Relieve 91 Atliinson's Topler Electric Machine 123 Bartholow's Method for Produc- ing the Static Induced Current.. 109 Bartlett's Galvanic Battery 11, 12 Battery Elements 7 Battery Fluid for Zinc and Carbon Elements 7 Battery Fluid for Smee Elements.. 19 Cases in Illustration of Asphyxia Patients 92 to 96 Central Galvanization 52 Chloroform Anaesthesia — How to Manage 91 Cliorea 54, 178 Commutators 10 Conduction and Induction 7 Conductors and Conducting Cords 10 Dana, C. L., M.D , on Impotency.. 142 Dangers of Strong Currents 53 Death — Testing for Life or Death in doubtful cases 87, 88, 89, 90, 91 Drowning — How Treated with Electricity 91 Dr. Hathaway's Elfectro-Magnetic Chair 2G, 49 Dr. Pitzer's One-IIundred-Cell Gal- vanic Battery 182 Dr. Romaine J. Curtiss on the Value and Us 3 of Static Elec- tricity 110 to 115 Dr. W.J. Morton's Clinical Expe- rience with Static Electricity 115 Electricity — what is it? 3 Electricity, Different Forms of 5 Electrodes 10 Electro-Therapeutics 32 Electricity as a Stimulant, Tonic and Sedative 32 Electricity in Diagnosis 34, 35, 37 Electrolysis 55 Electro-Diaguosis 81 Electrodes for Static Machines Il- lustrated 132 to 135 Eye Electrode, or Electro-Magnet. 136 Eyes — the Effects of Electricity upon 83 Facial Paralysis 31 Facial Paralysis, Complicated..36 to 38 Facial Paralysis 78 Faradic Machines 18 Faradic or Induced Current 18 Faradic or Induced Current Ex- plained 21, 22 Faradization, Local and General.... 33 Forms of Static Electricity 105 Frauklinic or Static Electricity 6 Gaiffe's Pocket Electro-Medical Apparatus 25 Galvanism G Galvanic Battery Cells 7 Galvano-Caustic Electrodes and "Instruments 17 Galvanometers and Galvano- scopes 2S, 29 Galvanism to Relieve Paiu 42 Galvanic and Faradic Current both Necessary 41 Galvanism and Faradism Com- pared 46 Galvano-Cautery and Galvano- Cautery Batteries 9G to 99 General Effects of Electricity 4 Gross, Prof. S.W., M.D., Urethral Stricture and Sexual Weakness.. 151 Hairs Removed by Electrolysis 59 Heart Disease 45 Hammond, Prof. Wm. A., on Im- potency -- 143 How to Administer Electricity Properly 41 How to Succeed with Electricity.... 181 1 86 Index. Hutclimson, Wm. F., M.D., on Im- potency 141 Hysteria 54 Hysteria and Spasm 116 Impotency 139, 151 Induration 75 Insulators 10 Insulation lOG, 131 Kidder's Improved Cells for Tip Batteries 20 Kidder's Pliysician's Office Elec- tro-Medical Apparatus 21 Kidder's Physician's Visiting Ma- chine 25 Kidder's Pocket Induction Appa- ratus 2G Lead Poisoning 71 Liver Disease 44 Loadstone 5 Local Atrophy 76 Locomotor Ataxia 120 Lumbago 74 Malingerers — How to Detect them 84 Magnetism 5 Mcintosh's Galvanic and Faradic Batteries 12, 13, 14, 15, 16 Mothers' Marks 76 Nervous Headache 43 Neuralgia— the Proper Current to Use 40 Neuralgia of the Head 43 Neuralgia, Complicated 113 Newman, Robert, M.D., Urethral Stricture and Electrolysis 153 Obscure Diseases 55 Opium and Morphine Narcotism.... 91 Overall, G. W., M.D., Urethral Stricture and Electrolysis 176 Paralysis of Leg 78 Paralysis, Central and Peripheral.. 84 Paralysis, Bell's 119, 120 Peripheral Paralysis, Tests for 34 Piffard's Galvano-Cautery Battery 16 Polarity of Electricity .".. 5 Poles— Positive and Negative 8 Poles 6 Positive and Negative Static Elec- tricity 131 Pressure Paralysis 120 Prof. J. O. Stillson's Cases in Eye Surgery 137, 138 Pulmonary Disease 45 Quantity and Tension or Intensity 8 Queen's Toepler-Holtz Machine .... 100 Rheotonies 30 Rheostats 31 Rheumatism 75 Rheumatism 112 Rheumatism, Muscular 118 Romaine J. Curtiss, M. D., on Static Electricity 104 to 105 Sciatica 42, 44, 111, 112 Sciatica and Cruralgia lit) Sensitive Parts of the Body to Electricity 82 Sexual Weakness 139 Skin Diseases 71 Smee's Elements 19 Sparks 106 to 109 Spinal Curvature 47 Static or Franklinic Electricity 99 Static Induced Current 109 Static Induced Current as a Tonic 114 Static Electricity and Ozone 135 Stohrer's Galvanic Battery G Tasting Electricity 83 The Wrong Current 77 Toepler-Holtz Machine 100 Trance — How to Distinguish from Death 87 Trouve's Polyscope 98 Tumors Removed by Electrolysis.. 56 Uniting Cells for Tension or Q lantity 9 Urethral Stricture 151 Very Strong Currents Injurious .... 39 Which Pole to Use 49 W. J. Morton, M. D., on Static Electricity 101 to 104 Zinc and Carbon Elements 19 d,